Low- and middle-income countries bear the majority of neurosurgical disease burden and patients face significant barriers to seeking, reaching, and receiving care. We aimed to understand barriers to ...seeking care among adult Africans by evaluating the public perception, knowledge of availability, and readiness to use neurosurgical care services.
An e-survey was distributed among African adults who are not in the health sector or pursuing a health-related degree. Chi-square test and ANOVA were used for bivariate analysis and the alpha value was set at 0.05. Odds ratios and their 95% confidence intervals were calculated.
Six hundred and sixty-two adults from 16 African countries aged 25.4 (95% CI: 25.0, 25.9) responded. The majority lived in urban settings (90.6%) and were English-speaking (76.4%) men (54.8%). Most respondents (76.3%) could define neurosurgery adequately. The most popular neurosurgical diseases were traumatic brain injury (76.3%), congenital brain and spine diseases (67.7%), and stroke (60.4%). Unwillingness to use or recommend in-country neurosurgical services was associated with rural dwelling (β = -0.69, SE = 0.31, P = 0.03), lack of awareness about the availability of neurosurgeons in-country (β = 1.02, SE = 0.20, P<0.001), and believing neurosurgery is expensive (β = -1.49, SE = 0.36, P<0.001).
Knowledge levels about neurosurgery are satisfactory; however, healthcare-seeking is negatively impacted by multiple factors.
Surgery has been largely neglected within global public health despite growing evidence that the overall burden of disease requiring surgical intervention is rapidly growing and affordable access to ...surgical care can avert many deaths and disabilities. This study assessed the factors influencing delayed access to essential surgical care in Uganda.
A descriptive multi-center cross-sectional survey was carried out in 3 hospitals designated for major surgeries in Uganda from December 2019 to December 2021 across 3 regions of the country i.e. Eastern – Mbale Regional Referral Hospital, Northern – St Mary's Hospital Lacor and Central region – Mulago National Referral Hospital in a prospective manner. Patients admitted to the above-mentioned hospitals and required surgical intervention were included. Data was analyzed using STATA 16 (StataCorp LLC, College Station, Texas, USA). Bivariate analysis using, the chi-square test or Fischers’ exact test and multivariable logistic regression models to adjust for confounders were done. A p<0.05 was considered statistically significant.
A total of 635 patients participated in the study of which the majority were males (n=399, 63%) from the Northern region (n=347, 54.7 %.). Most patients (n=406, 63.9%) and (n=402, 63.3%) sought surgical help immediately and were operated on time respectively however only 23.3% (n=148) were able to reach the hospital for care on time. Caretakers’ hesitancy on the surgical procedure contributed to all surgical delays in seeking care (aOR: 2.41 95% CI: 1.07 – 5.43; p=0.035), hospital inaccessibility (aOR: 5.35 95% CI: 1.82 – 5.75; p=0.002), and delayed surgical procedure performance (aOR: 6.37 95% CI: 2.64 – 5.34; p<0.001) among other factors in each category.
All three factors contribute to surgical delay but most significantly access to hospital. Several socioeconomic factors like education, long distances, and poverty interplay in a complex web to hamper access to essential surgical care.
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A well-conducted prenatal visit remains of paramount importance because it allows the preservation of mother and child health by reducing the rates of morbidity and mortality for them. However, the ...quality of prenatal visits remains a serious problem in our environment, and a new approach is urgently needed to improve the quality of prenatal visits in our environment.
Bladder diverticulum is a congenital malformation characterized by the outpouching of the bladder following an obstruction of urine flux. We present a case of 82-year-old Congolese male patient ...presented at our facility with a poor urinary stream and lower abdominal pain. A distended abdomen was found on physical examination while the external genitalia were normal. All blood laboratory values were found to be within normal ranges. The patient’s urine analysis revealed an uncountable number of white blood cells. Ultrasonography revealed multiple diverticula in the right posterolateral and posterior wall. An ultrasound of the abdomen revealed numerous bladder diverticula in the bladder’s left posterolateral and posterior aspects, mild right-sided hydronephrosis, and severe left hydronephrosis with a thinned-out cortex. Both ureters were normal. A computed tomographic (CT) scan of the abdomen confirmed the diagnosis. The patient underwent an open laparotomy which allowed complete ablation of the diverticula followed by bladder wall repair. A one-week course of antibiotics was prescribed, and the patient was discharged fully recovered with no immediate complications. Although bladder diverticula are a congenital malformation, the presence of multiple diverticula suggests that the condition is acquired. In elderly patients, open laparotomy combined with intravenous antibiotics yields positive results.
Fournier's gangrene, a rapidly progressive necrotizing fasciitis of the perineum and external genitalia that leads to extensive soft tissue necrosis, remains a medical‐surgical emergency. The authors ...present a case of coverage of a scrotal loss of substance with testicular exposure by a medial fasciocutaneous flap of the unilateral thigh after debridement and initial medical treatment of Fournier's gangrene in a 50‐year‐old quadriplegic patient. The clinical examination at 8 months showed an aesthetic and functional result. The trophic‐cutaneous thigh flap that the authors propose for frail, elderly, and neurological subjects with low functional requirements allows coverage of the scrotal region with relatively thick skin, color, and texture close to those of the scrotum. It also offers technical simplicity, moderate scarring, and functional remnants at the price of less morbidity.
Fournier's gangrene remains the most challenging form of necrotizing fasciitis due to its location and poor prognosis. The medial fasciocutaneous flap offers an easy to perform and low‐cost alternative solution for scrotum reconstruction in elder and quadriplegic patients.
Bladder exstrophy is a rare and complex malformation. Often associated with diverse deformations, an accurate diagnosis is a must for adequate management. In the African setting, especially in a ...remote area, delivery rarely occurs within a healthcare structure, thus reducing the chance of an early diagnosis. Due to a low density of specialists, people in rural areas refer to traditional healers for healthcare problems, the thing that delays the time to diagnosis. We report, according to the CARE guidelines (https://www.equator‐network.org/reporting‐guidelines/care/), a case of an 18‐year‐old male patient who was transferred to us for better management of a reddish hypogastric mass leaking urine. Initially considered as a congenital wound, his parents applied traditional products to heal it. Following the poor outcomes, the parents will consult several general physicians; unfortunately, no one gave a clear diagnosis. The clinical examination on admission revealed a good general condition and noted the presence of a reddish, ovoid structure of about 9 centimeters of the minor axis and 11 centimeters of the major axis in the hypogastric region allowing urine to flow in its upper part. The external genitalia examination revealed a retracted and short penis with urine exit at its base through the reddish structure. The patient was transferred outside the country for better management due to a lack of dedicated equipment. Although vesical exstrophy is a rare disease, an early diagnosis allows adequate management and good outcome. Thus, a well‐performed neonatal examination is required to avoid later diagnosis and complications.
Bladder exstrophy remains one of the most challenging conditions managed by pediatric urologists. It requires early reconstructive management in the neonatal period to expect good results. Late management can lead to fatal complications.
Visual localization enables autonomous vehicles to navigate in their surroundings and augmented reality applications to link virtual to real worlds. Practical visual localization approaches need to ...be robust to a wide variety of viewing condition, including day-night changes, as well as weather and seasonal variations, while providing highly accurate 6 degree-of-freedom (6DOF) camera pose estimates. In this paper, we introduce the first benchmark datasets specifically designed for analyzing the impact of such factors on visual localization. Using carefully created ground truth poses for query images taken under a wide variety of conditions, we evaluate the impact of various factors on 6DOF camera pose estimation accuracy through extensive experiments with state-of-the-art localization approaches. Based on our results, we draw conclusions about the difficulty of different conditions, showing that long-term localization is far from solved, and propose promising avenues for future work, including sequence-based localization approaches and the need for better local features. Our benchmark is available at visuallocalization.net.
Visual localization enables autonomous vehicles to navigate in their surroundings and augmented reality applications to link virtual to real worlds. Practical visual localization approaches need to ...be robust to a wide variety of viewing conditions, including day-night changes, as well as weather and seasonal variations, while providing highly accurate six degree-of-freedom (6DOF) camera pose estimates. In this paper, we extend three publicly available datasets containing images captured under a wide variety of viewing conditions, but lacking camera pose information, with ground truth pose information, making evaluation of the impact of various factors on 6DOF camera pose estimation accuracy possible. We also discuss the performance of state-of-the-art localization approaches on these datasets. Additionally, we release around half of the poses for all conditions, and keep the remaining half private as a test set, in the hopes that this will stimulate research on long-term visual localization, learned local image features, and related research areas. Our datasets are available at visuallocalization.net , where we are also hosting a benchmarking server for automatic evaluation of results on the test set. The presented state-of-the-art results are to a large degree based on submissions to our server.
Background: There is an increasing global concern of Antibiotic resistance causing a serious threat to public health with estimated 700,000 deaths per year and it’s estimated to increase to about 10 ...million deaths by 2050(WHO). The aim of this study was to assess the knowledge and attitude towards antibiotic resistance among people residing in Namuwongo, Makindye East Division, Kampala Uganda. Methodology: A qualitative and descriptive cross-sectional study among 178 randomly selected participants through a structured questionnaire. Results: Of the 178 respondents, majority of the respondents were females 125/178 (70.22%).137 (76.97)of residents agreed that missing an antibiotic dose contributes to antibiotic resistance (mean score of 2.62±0.74). 122 (68.54) respondents agreed that consumption of antibiotics without physician's prescription can contribute to antibiotic resistance. (mean score of 2.45±0.85).Majority of respondents agreed to antibiotic resistance is increasing (73.60%, Mean score 2.58±0.75). 135 (75.84) agreed that antibiotic resistance can be accelerated by the overuse of antibiotics.(mean score of 2.61±0.73). But 127 (71.35) also agreed that Antibiotics are effective for the treatment of both bacterial and viral infections (mean score of 2.56±0.75). . 93.82% agreed that the government should create more awareness of antibiotic resistance (Mean score 2.91±0.37). Recommendations Each pharmacy should at-least have a basic laboratory so that patients get tested before any prescription, this will curb the unnecessary and wrong usage of antibiotics for illnesses not caused by bacteria. Drug shops should strongly be advised only to dispense medicines especially antibiotics provided the buyer has a genuine prescription note from a medical doctor,this practise shall thereby reduce self medication that leads to irrational use of antibiotics in treatment of viral infection Conclusion:There was poor knowledge about the usage of antibiotics in treatment of viral infections. There is need for raising more awareness and education on antibiotic resistance, particularly on the proper antibiotics usage.
Background: There is an increasing global concern about Antibiotic resistance causing a serious threat to public health with estimated 700,000 deaths per year and it’s estimated to increase to about ...10 million deaths by 2050. The aim of this study was to assess the knowledge and attitude toward antibiotic resistance among people residing in Namuwongo, Makindye East Division, Kampala Uganda. Methodology: A descriptive cross-sectional study among 178 randomly selected participants through a structured questionnaire. Results: The majority of the respondents were females 125/178 (70.22%).137 (76.97)of residents agreed that missing an antibiotic dose contributes to antibiotic resistance (mean score of 2.62±0.74). 122 (68.54) respondents agreed that the consumption of antibiotics without a physician's prescription can contribute to antibiotic resistance. (mean score of 2.45±0.85). Majority of respondents agreed that antibiotic resistance is increasing (73.60%, Mean score 2.58±0.75). 135 (75.84) agreed that antibiotic resistance can be accelerated by the overuse of antibiotics. (mean score of 2.61±0.73). 127 (71.35) also agreed that Antibiotics are effective for the treatment of both bacterial and viral infections (mean score of 2.56±0.75). 93.82% agreed that the government should create more awareness of antibiotic resistance. Recommendations: Each pharmacy should at least have a basic laboratory so that patients get tested before any prescription, this will curb the unnecessary and wrong usage of antibiotics for illnesses not caused by bacteria. Drug shops should strongly be advised only to dispense medicines, especially antibiotics provided the buyer has a genuine prescription note from a medical doctor, this practice shall thereby reduce self-medication that leads to irrational use of antibiotics in the treatment of viral infection Conclusion: There was poor knowledge about the usage of antibiotics in the treatment of viral infections. There is a need to raise more awareness and education on antibiotic resistance, particularly on proper antibiotic usage.
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