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San Francesco al Campo, Italy

Quaglio G.,Foresight | Goerens C.,Parliament | Putoto G.,Doctors with Africa CUAMM | Rubig P.,Parliament | And 5 more authors.
The Lancet Infectious Diseases | Year: 2016

The Ebola virus epidemic has topped media and political agendas for months; several countries in west Africa have faced the worst Ebola epidemic in history. At the beginning of the disease outbreak, European Union (EU) policies were notably absent regarding how to respond to the crisis. Although the epidemic is now receding from public view, this crisis has undoubtedly changed the European public perception of Ebola virus disease, which is no longer regarded as a bizarre entity confined in some unknown corner in Africa. Policy makers and researchers in Europe now have an opportunity to consider the lessons learned. In this Personal View, we discuss the EU's response to the Ebola crisis in west Africa. Unfortunately, although ample resources and opportunities for humanitarian and medical action existed, the EU did not use them to promote a rapid and well coordinated response to the Ebola crisis. Lessons learned from this crisis should be used to improve the role of the EU in similar situations in the future, ensuring that European aid can be effectively deployed to set up an improved emergency response system, and supporting the establishment of sustainable health-care services in west Africa. © 2016 Elsevier Ltd. Source

Wilunda C.,Doctors with Africa CUAMM | Massawe S.,Muhimbili University of Health and Allied Sciences | Jackson C.,University of Queensland | Jackson C.,London School of Hygiene and Tropical Medicine
Tropical Medicine and International Health | Year: 2013

Objective: To identify determinants of moderate-to-severe anaemia among women of reproductive age in Tanzania. Methods: We included participants from the 2010 Tanzania Demographic and Health Survey, which collected data on socio-demographic and maternal health and determined haemoglobin levels from blood samples. We performed logistic regression to calculate adjusted odds ratios for associations between socio-demographic, contextual, reproductive and lifestyle factors, and moderate-to-severe anaemia and investigated interactions between certain risk factors. Results: Of 9477 women, 20.1% were anaemic. Pregnancy was significantly associated with anaemia (adjusted OR 1.75, 95% CI 1.43-2.15), but the effect varied significantly by urban/rural residence, wealth and education. The effect of pregnancy was stronger in women without education and those who were in lower wealth groups, with significant interactions observed for each of these factors. Education was associated with a lower anaemia risk, particularly in the poorest group (OR 0.58, 95% CI 0.43-0.80), and in pregnant women. The risk of anaemia fell with rising iron supplementation coverage. Lack of toilet facilities increased anaemia risk (OR 1.26, 95% CI 1.00-1.60), whereas using hormonal contraception reduced it. There was no association with age, urban/rural residence, wealth or type of cooking fuel in adjusted analysis. Conclusion: Pregnant women in Tanzania are particularly at risk of moderate-to-severe anaemia, with the effect modified by urban/rural residence, education and wealth. Prevention interventions should target women with lower education or without proper sanitation facilities, and women who are pregnant, particularly if they are uneducated or in lower wealth groups. © 2013 John Wiley & Sons Ltd. Source

Segagni Lusignani L.,Medical University of Vienna | Quaglio G.,Doctors with Africa CUAMM | Quaglio G.,Research and Planning | Atzori A.,Doctors with Africa CUAMM | And 5 more authors.
BMC Infectious Diseases | Year: 2013

Background: Tuberculosis (TB) is still a great challenge to public health in sub-Saharan Africa. Most transmissions occur between the onset of coughing and initiation of treatment. Delay in diagnosis is significant to disease prognosis, thus early diagnosis and prompt effective therapy represent the key elements in controlling the disease. The objective of this study was to investigate the factors influencing the patient delay and the health system delay in TB diagnosis in Angola.Methods: On a cross-sectional study, 385 TB patients who visited 21 DOTS clinics in Luanda were included consecutively. The time from the onset of symptoms to the first consultation of health providers (patients' delay) and the time from the first consultation to the date of diagnosis (health system's delay) were analysed. Bivariate and logistics regression were applied to analyse the risk factors of delays.Results: The median total time elapsed from the onset of symptoms to diagnosis was 45 days (interquartile range [IQR]: 21-97 days). The median patient delay was 30 days (IQR: 14-60 days), and the median health care system delay was 7 days (IQR: 5-15 days). Primary education (AOR = 1.75; CI [95%] 1.06-2.88; p <0.029) and the health centre of the first contact differing from the DOTS centre (AOR = 1.66; CI [95%] 1.01-2.75; p <0.046) were independent risk factors for patient delay >4 weeks. Living in a suburban area (AOR = 2,32; CI [95%] 1.21-4.46; p = 0.011), having a waiting time in the centre >1 hour (AOR = 4.37; CI [95%] 1.72-11.14; p = 0.002) and the health centre of the first contact differening from the DOTS centre (AOR = 5.68; CI [95%] 2.72-11,83; p < 0,00001) were factors influencing the system delay.Conclusions: The results indicate that the delay is principally due to the time elapsed between the onset of symptoms and the first consultation. More efforts should be placed in ensuring the availability of essential resources and skills in all healthcare facilities other than the DOTS centres, especially those located in suburban areas. © 2013 Segagni Lusignani et al.; licensee BioMed Central Ltd. Source

Groppi L.,Doctors with Africa CUAMM | Somigliana E.,Fondazione caGranda | Pisani V.,Doctors with Africa CUAMM | Ika M.,Yirol County Hospital | And 7 more authors.
International Journal of Gynecology and Obstetrics | Year: 2015

Objective To assess provision of emergency obstetric care (EmOC) in Greater Yirol, South Sudan, after implementation of a hospital-centered intervention with an ambulance referral system.Methods In a descriptive study, data were prospectively recorded for all women referred to Yirol County Hospital for delivery in 2012. An ambulance referral system had been implemented in October 2011. Access to the hospital and ambulance use were free of charge.Results The number of deliveries at Yirol County Hospital increased in 2012 to 1089, corresponding to 13.3% of the 8213 deliveries expected to have occurred in the catchment area. Cesareans were performed for 53 (4.9%) deliveries, corresponding to 0.6% of the expected number of deliveries in the catchment area. Among 950 women who delivered a newborn weighing at least 2500 g at the hospital, 6 (0.6%) intrapartum or very early neonatal deaths occurred. Of 1232 women expected to have major obstetric complications in 2012 in the catchment area, 472 (38.3%) received EmOC at the hospital. Of 115 expected absolute obstetric indications, 114 (99.1%) were treated in the hospital.Conclusion A hospital-centered approach with an ambulance referral system effectively improves the availability of EmOC in underprivileged remote settings. © 2014 International Federation of Gynecology and Obstetrics. Source

Wilunda C.,Doctors with Africa CUAMM | Putoto G.,Doctors with Africa CUAMM | Manenti F.,Doctors with Africa CUAMM | Castiglioni M.,University of Padua | And 7 more authors.
International Journal for Equity in Health | Year: 2013

Introduction. Improving equity in access to services for the treatment of complications that arise during pregnancy and childbirth, namely Emergency Obstetric Care (EmOC), is fundamental if maternal and neonatal mortality are to be reduced. Consequently, there is a growing need to monitor equity in access to EmOC. The objective of this study was to develop a simple questionnaire to measure equity in utilization of EmOC at Wolisso Hospital, Ethiopia and compare the wealth status of EmOC users with women in the general population. Methods. Women in the Ethiopia 2005 Demographic and Health Survey (DHS) constituted our reference population. We cross-tabulated DHS wealth variables against wealth quintiles. Five variables that differentiated well across quintiles were selected to create a questionnaire that was administered to women at discharge from the maternity from January to August 2010. This was used to identify inequities in utilization of EmOC by comparison with the reference population. Results: 760 women were surveyed. An a posteriori comparison of these 2010 data to the 2011 DHS dataset, indicated that women using EmOC were wealthier and more likely to be urban dwellers. On a scale from 0 (poorest) to 15 (wealthiest), 31% of women in the 2011 DHS sample scored less than 1 compared with 0.7% in the study population. 70% of women accessing EmOC belonged to the richest quintile with only 4% belonging to the poorest two quintiles. Transportation costs seem to play an important role. Conclusions: We found inequity in utilization of EmOC in favour of the wealthiest. Assessing and monitoring equitable utilization of maternity services is feasible using this simple tool. © 2013 Wilunda et al.; licensee BioMed Central Ltd. Source

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