Current Management of Acute Ischemic Stroke in Africa: A Review of the Literature

Exploring the lived experiences of family caregivers of patients with stroke in Africa: a scoping review of qualitative evidence

OBJECTIVE

The burden of stroke is immense in African countries, with post-stroke care usually becoming the responsibility of family. This review sought to determine the current breadth and depth of qualitative evidence regarding the lived experiences of family caregivers of patients with stroke in Africa.

METHODS

Informed by Joanna Briggs Institute (JBI) methodology for scoping reviews, six databases were searched. Included articles were appraised for quality using the JBI checklist. A priori themes developed using the study objectives were used to synthesize study findings.

RESULTS

The review included 22 articles, which outlined key patterns in stroke outcomes with most articles focused on rehabilitation and the experiences, outcomes, burdens, and coping mechanisms of caregiving. The intersectionality of socio-economic status, socio-political structures, and religious or traditional beliefs, attitudes, and practices characterized etiology beliefs, treatment trajectories of stroke, and caregiving role assignment. Whereas burdens were driven by limited resources, adopted coping strategies involved spiritual or religious beliefs, optimism, resilience, and social support networks.

CONCLUSIONS

Family caregivers' values must be acknowledged, supported, and integrated into the traditional healthcare system to provide comprehensive stroke care. Caregivers' health and well-being should be given more attention given their necessary contribution to stroke survivorship in Africa.

Addressing hydrocephalus in Africa: Challenges and way forward

Hydrocephalus occurs when the cerebrospinal fluid (CSF) accumulates in the cerebral ventricles. This is due to either obstruction in the CSF flow, decreasing its absorption by the arachnoid villus to the Dural venous sinuses, or increasing production of the CSF. The most disproportionately and severely affected by the disease consequences are African children. This is because of the high incidence of postinfectious hydrocephalus and spinal dysraphism compared with other world children. The health care system in Africa has access to 488 neurosurgeons which represents less than 1% of the global neurosurgeons, thus pediatric hydrocephalus is considered an emerging public health problem in Africa because of the difficulty of the patient's access to proper care. Numerous studies conducted in Africa have revealed a significant imbalance in the distribution of neurosurgical resources across the continent. Specifically, South Africa and North Africa collectively account for 86% of the total practicing neurosurgeons, indicating a pronounced concentration of these specialized medical professionals in these regions. Having an abundance of case studies regarding hydrocephalus is vital to increase our awareness and understanding. Hydrocephalus should gain more priority by current policymakers as an important health concern. This may be achieved by proper resource allocation to ensure better quality means of diagnosis, intervention, and rehabilitation.

Epidemiology and etiology of brain cancer in Africa: A systematic review

BACKGROUND

Cancer is a significant threat to public health and a leading cause of morbidity across the globe. Of all cancers, brain cancer can be particularly catastrophic as treatment often fails to achieve the desired degree of effectiveness and diagnosis remains associated with a high mortality rate. Africa, as a continent with resource-limited countries, needs to allocate the necessary proper healthcare infrastructure to significantly reduce cancer rates and improve patient survival. In addition, the relative paucity of data within this field in Africa makes effective management a challenge.

OBJECTIVE

This review is aimed at elucidating the currently available evidence base with regard to the epidemiology and etiology of brain cancer within resource-limited African countries. This review hopes to bring to the attention of the wider clinical community the growing burden of brain cancer within Africa and to encourage future research into this field of research.

METHODS

The available literature for this Systematic Review was searched on two bibliographic databases, PubMed and Scopus, using an individually verified, prespecified approach. In addition, the Global Cancer Observatory and Global Burden of Disease databases were also utilized. Studies reporting on the epidemiology, etiology, and impact of brain cancer in Africa were suitable for inclusion. The level of evidence of the included studies was considered as per the Centre for Evidence-Based Medicine recommendations.

RESULTS

Out of the four databases searched, 3848 articles were initially screened rigorously, filtered into 54 articles, and finally assessed qualitatively and quantitatively. We have demonstrated a poor survival rate and lack of proper funds/resources necessary to report, identify, and treat cases, as well as the dearth of comprehensive research on the subject of brain cancer that has become a challenging healthcare concern in many African developing nations. Also, because of the gradual improvement in healthcare facilities and the increasing population within many countries in Africa, the number of patients with central nervous system and intracranial tumors is rising specifically in the elder population. In addition, the population in West Africa is at a higher risk of HIV-related malignancies due to the high prevalence of HIV in West Africa. The burden of brain cancer in Africa is increasing in comparison with the developed parts of the world in which it is decreasing. Moreover, the mismanagement of cancers in Africa leads to higher morbidity and mortality and decreased quality of life.

CONCLUSION

This study addresses the burden of brain cancer as a major public health crisis in Africa. Improved treatment modalities and access to screening are required to better address the burden of this disease. Therefore, there is a clear need for more substantial and comprehensive research on etiology, epidemiology, and treatment of brain cancer within Africa to understand its epidemiological distribution and provide a means for managing and reducing the associated morbidity and mortality.

Measles outbreak in Zimbabwe: An urgent rising concern

Introduction

Measles, one of the most common infections in the world, accounts for more than over 100.000 deaths every year. Measles outbreaks are still ravaging the African continent, and the 2010 Measles outbreak in Zimbabwe is one to be noted, where more than 7754 infections and 517 deaths were reported, ultimately leading to the UN initiation of the vaccination program. COVID-19 could have been delaying the vaccination process in Africa. This article aims to shed the light on the current Measles outbreak in Zimbabwe and how global health organizations are taking measures to fight off this outbreak.

Methodology

Data was collected from online databases PubMed, Science Direct, and the Lancet, as well as news and conferences and press releases on the current measles outbreak. All articles and news related to the measles outbreak in Zimbabwe were taken into consideration.

Results

A measles outbreak was reported earlier in August of 2022, with more than 2000 confirmed cases out of which 157 were reported dead. Since the outbreak this year, cases of measles in Zimbabwe have been rapidly growing. The government in Zimbabwe started a massive vaccination campaign for children in and near the areas where the outbreak is present. Traditional and faith leaders are involved in the campaigns to encourage the public to volunteer to be vaccinated.

Conclusion

Efforts to control the measles outbreak in Zimbabwe are being mitigated by the government as well as the WHO and other global health organizations. With many people refusing the vaccination, this outbreak might not see an end, and more cases, as well as deaths, will increase by the end of the year.

Yellow fever outbreak in Kenya: A review

Yellow fever (YF) is a viral acute hemorrhagic illness caused by infected mosquitoes of the flavivirus family. The first yellow fever outbreak in Kenya was in 1992. Similar outbreaks were recorded in the western part of the country in 1993, 1995, and 2011, particularly in the Rift Valley province of Kenya. In early 2022, the viral acute illness resurfaced and hit Kenya. On January 12, 2022, the first case was discovered, with over 14 patients suffering from fever, jaundice, and joint and muscle pains. On March 4, 2022, a yellow fever outbreak re-emerged in Kenya, affecting 11 wards in Isiolo County. The fatality rate recorded was 11.3% (six deaths), with Chari accounting for 39.6% of the total 21 cases, Cherab 14 (26.4%), and 5 Garba Tulla (9.4%).

This has the potential to further endanger the nation's economic growth while also negatively impacting people's daily lives in a part of the world that is already dealing with the catastrophic impacts of the coronavirus pandemic. However, there is no curative therapy for yellow fever. The only options for curbing its spread are through vaccination and preventive measures.

Hence, Kenya's government must take responsibility for requiring vaccination of its citizens, implement an active national disease surveillance protocol, and set up anti-yellow fever campaigns in the country.

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Yellow fever (YF) is a viral acute hemorrhagic illness caused by infected mosquitoes of the flavivirus family.

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The first yellow fever outbreak in Kenya was in 1992. Similar outbreaks were recorded in the western part of the country in 1993, 1995, and 2011, particularly in the Rift Valley province of Kenya.

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In 2022, a yellow fever outbreak re-emerged in Kenya.

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The only options for curbing its spread are through vaccination and preventive measures.

Poliovirus returns to the UK after nearly 40 years: current efforts and future recommendations

On 22 June 2022, the UK Health Security Agency declared a 'rare national incidence' after finding poliovirus in sewage in London for the first time in nearly 40 years. Although no cases of the disease or accompanying paralysis have been documented, the general public's risk is considered minimal. However, public health experts recommend that families are up to date on their polio vaccines to decrease the chance of harm. This article discusses the epidemiology of poliovirus by examining the aetiology of the disease and current mitigation policies implemented to prevent the spread of type 2 vaccine-deceived poliovirus in the UK. Finally, by examining the clinical features of polio, which range from mild gastroenteritis episodes, respiratory sickness, malaise and severe paralysis type, this article offers an advice on particular therapies and tactics to avoid poliovirus outbreaks and other future outbreaks.

The impact of COVID-19 on patients with neurological disorders and their access to healthcare in Africa: A review of the literature

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic has hampered the progress of neurological healthcare services for patients across Africa. Before the pandemic, access to these services was already limited due to elevated treatment costs among uninsured individuals, shortage of medicines, equipment, and qualified personnel, immense distance between residing areas and neurological facilities, and a limited understanding of neurological diseases and their presentation by both the health workers and the African population.

METHODOLOGY

The databases PubMed, Google Scholar, Science Direct, and the National Library of Medicine were searched for literature. All articles on neurological disorders in Africa were considered.

AIM

This review article explores the challenges of providing the best services for patients suffering from neurological disorders in Africa amid the COVID-19 pandemic and provides evidence-based recommendations.

RESULTS

As Africa's governments made more resources available to support patients affected by COVID-19, neurological care received less priority and the capacity and competency to treat patients with neurological disorders thus suffered substantially. Both short-term and long-term strategies are needed to improve the quality of neurological services after the pandemic in the region.

CONCLUSION

To strengthen Africa's neurological services capability during and after the COVID-19 pandemic, African governments must ensure appropriate healthcare resource allocation, perform neurology management training, and increase health security measures in medication supply. Long-term strategies include incorporating responsible finance and resource procurement and advancement of tele-neurology. International collaboration is essential to promote the sustainable improvement of neurological services in Africa.

Challenges of addressing neglected tropical diseases amidst the COVID-19 pandemic in Africa: A case of Chagas Disease

Chagas Disease (CD) is an infectious, neglected tropical disease (NTD) that has affected over 1.7 billion people worldwide. Unfortunately, most countries usually put little effort into mitigating the spread of NTDs, having weak public health approaches, diagnostic delays, and ineffective clinical management guidelines and resources. However, the ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by the coronavirus SARS-CoV-2, exacerbates the impact of NTDs. In this review, we examine the subsequent changes that have been imposed on CD prevention and treatment. Articles from Google Scholar and PubMed were extracted which satisfied our inclusion criteria. From our data, we gather that COVID-19 has — from preventive measures to treating patients — greatly affected every stage in the fight against CD. For instance, co-infection of CD and COVID-19 puts patients at higher risk for cardiomyopathy (i.e., atrial fibrillation, chronic heart failure), yet no clinical guidelines were established for co-infected patients. To mitigate the spread of CD during the COVID-19 pandemic, further investigations on the impacts of co-infections and vaccines that can be developed to treat such conditions are warranted.

Is Alzheimer's disease an infectious neurological disease? A review of the literature

INTRODUCTION

Alzheimer's disease (AD) is a leading cause of dementia around the globe. Its pathogenesis is characterized primarily by the extracellular deposition of amyloid β peptides and intracellular neurofibrillary tangles. Despite the significant investments in neurological research, the exact molecular mechanism of AD pathogenesis is still not fully elucidated. Several studies converge on a hypothesis that pathogenic microbes might play a role in AD progression. Although this hypothesis has been considered relatively weak for decades, it has recently received considerable attention due to increasing evidence on the association between microorganisms and AD. There is a lack of experimental and scientific arguments conveying that these microorganisms engender cognitive and neuropathological deficits and modifications specific to AD, challenging the theory that it could be an infectious neurological disease. This review focuses on recent advances in the infection hypothesis and provides an overview of new findings portraying the significance of pathogenic microbes in AD and the challenges confronting the validity of the hypothesis.

METHODOLOGY

Data were collected from medical journals published on PubMed, Ovid MEDLINE, ScienceDirect, and Embase bibliographical databases with a predefined search strategy. All articles considering neurological disorders, especially AD associated with infectious diseases, were included.

RESULTS

This work focused on providing an overview of new findings around the relationship between microorganisms and AD, challenges facing the validity of the theory, and recommendations on how the scientific community can best develop alternative approaches to address the pathophysiology of AD.

CONCLUSION

While many studies reinforce the suspicion of an infectious etiology of AD, it is important to note that it is yet not validated how microorganisms' presence in the brain can develop AD due to the limited available evidence. Certainly, ground-breaking work is mandatory in this field of research, and these reports so far warrant a thorough investigation into how a chronic infection may remain silent while progressing its neuroinflammation. Amid this uncertainty arises the hope that many researchers will take on this challenge and join this endeavor to benefit AD patients worldwide.

Leptospirosis outbreak in Tanzania: An alarming situation

On July 5, 2022, the Tanzanian Ministry of Health (MoH) announced the re-emergence of leptospirosis after reporting 20 confirmed symptomatic cases and 3 mortalities. Leptospirosis is caused by a spirochete bacterium that lives in an animal's renal tubule and spreads to individuals through contact with contaminated animal urine. Unsupervised agricultural practices, urban development, wildlife infiltration, and a lack of sanitation have all been proposed as potential environmental causes of the present outbreak. The MoH is taking the necessary steps to halt the spread of said outbreak with assistance from the World Health Organization (WHO).

This article examines the risk factors, etiology, number of confirmed cases, and subsequent case index to analyse the epidemiology of the current leptospirosis outbreak in Tanzania's southern Linda region. In light of these findings, this research further details recent recommendations made by the WHO, Centers for Disease Control and Prevention, and MoH to mitigate such an alarming situation. These recommendations include early detection and isolation, contact tracing, and chemoprophylaxis using doxycycline. The article concludes by outlining suggestions for individuals and governments, including the launch of public awareness campaigns, immunisation, increased surveillance, rapid detection testing, and the installation of suitable purification systems, to help contain future leptospirosis outbreaks.

Leishmaniasis control in the light of the COVID-19 pandemic in Africa

Leishmaniasis is a parasitic disease, endemic to Africa, Asia, and South America due to inadequate access to medication and underreporting of leishmaniasis cases. Leishmaniasis has two forms: cutaneous and visceral. The fight against leishmaniasis has been greatly affected by the coronavirus disease 2019 (COVID-19) pandemic that impacted resource distribution and access to medication. Continuous effort in vaccine development and affordable therapeutics are necessary to eliminate leishmaniasis in low-income countries. Further research is necessary to determine molecular drug resistance markers in leishmaniasis patients. In this analysis, we focus on the effect of COVID-19 on leishmaniasis in Africa.