By Professor Mark Thursz, Professor of Hepatology within the Department of Surgery and Cancer, Imperial College London
Five viruses, hepatitis A – E, specifically infect the liver and cause acute hepatitis or chronic hepatitis.
Over 350 million people worldwide are chronically infected and are therefore at risk of cirrhosis, liver failure and liver cancer. Hepatitis B and Hepatitis C virus are together responsible for over a million deaths per year. The majority of infections and deaths related to these viruses occur in low and middle income countries. In 2010 the United Nations World Health Assembly passed a resolution which recognised the burden of disease imposed by these viruses and initiated a public health response to viral hepatitis which included the inception of World Hepatitis Day.
Chronic viral hepatitis infections rarely cause any symptoms or signs of the disease and therefore patients do not seek help until the final stages of disease when treatment is usually futile. However, if the infections are picked up early then they can be treated (Hepatitis B) or cured (Hepatitis C) in the majority of cases. It is therefore vital that people with viral hepatitis infection are diagnosed in good time which requires active case-finding or screening. Our work in West Africa demonstrated that screening for infection in the community is feasible, acceptable to the public and cost effective. (more…)
By Stella Nikolaou, Clinical Research Fellow, The Royal Marsden Hospital and Imperial College London and Shahnawaz Rasheed, Consultant Surgeon, The Royal Marsden Hospital and Senior Lecturer, Imperial College London.
Worldwide, there are more than 5 million people who die from violence and injury1. Uncontrolled bleeding causes more than 40% of trauma-related deaths1. More than 530 000 women die each year during pregnancy, childbirth or post partum and 99% of these women are in low and middle-income countries with severe bleeding being the commonest cause of death1. Safe and affordable surgery, therefore relies on access to a sufficient volume of blood which can be safely transfused2. Unfortunately this is not the case in most of the world2.
Blood donation rates are lowest in nations, which are afflicted with high rates of malnutrition, chronic anaemia and transfusion-transmissible infections (TTIs) which further decrease the blood donor pool2.
The Lancet Commission of Global surgery recommends blood donation of at least 15 units per 1000 people per year3. However according to the WHO data in 2015, the median blood donation in low income countries (LICs) is 3.9 units/1000 people/year and 11.7 units/1000 people/year in Middle Income Countries (MICs) which is a tenth of what high income countries are estimated to have (36.8 units/1000 people/year)4.
These figures are likely to be overestimated as they include blood that is unsafe to use due to TTIs (e.g. AIDS, malaria and syphilis)2. (more…)
By guest bloggers Sophie Uyoga and Charles Kamau, Research Scientists in Kilifi, Kenya
Africa has the highest risk of road traffic accident globally.
Most blood prescribed for transfusion in the developing world is mainly in emergency care. According to the WHO 2015 Report on Road Safety, the African Region has the highest risk of road traffic accident, one of the greatest contributors of emergencies needing blood transfusions. However, hospitals in this region are constantly facing blood stock outs, greatly contributes to the poor outcome all forms of medical emergencies as well as among admissions with severe anaemia. A clinical trial in East Africa by Kiguli et al., demonstrated how timely access reduces the risk of mortality among children with severe anaemia with a high proportion of those not transfused dying within 2.5 hours post admission. This therefore highlights the need to have screened donor blood readily available in the system. (more…)
5 May 2017 marked the International Day of the Midwife. Recognising the important role that midwives play to families and mothers, the day was first established in 1992. Midwives endure rigorous training to ensure that they can provide quality care for those in need. The level of skills amongst midwives however, can vary across the world.
March 2017 saw the arrival of Dr Beverly Donaldson, her midwifery colleagues Maggie Welch and Judith Robbins and paediatrician Dr Anna Battersby from Imperial College London/Imperial NHS Trust to facilitate the third midwifery training programme at the MRC Fajara The Gambia. The aim of the training was to support local midwives in their clinical practice by teaching them the necessary skills to manage basic obstetric emergencies in order to save the lives of mothers and babies in their care. Together, they give their account of the event.
“It was a busy few days following our arrival; preparing all the equipment and teaching materials over the weekend in readiness for the start of the intensive two day training programme on the Monday morning.
Midwives attended practical emergency skills training in the management of Eclampsia, Postpartum Haemorrhage and blood loss estimation.
The first day began with lectures in maternal and neonatal mortality and the management of high risk pregnancy in The Gambia. The afternoon was dedicated to practical emergency skills training in the management of Eclampsia, Postpartum Haemorrhage and blood loss estimation – the major causes of maternal mortality. Running concurrently to the skills stations was a question and answer session in the library which gave participants the opportunity to openly discuss concerns related to maternal and neonatal care.
The second day focused on helping babies breathe
The second day focused on neonatal wellbeing and ‘Helping Babies Breathe’- an evidence-based educational program to teach neonatal resuscitation techniques in resource-limited countries- an initiative of the American Academy of Pediatrics (AAP) in collaboration with the World Health Organization (WHO). Anna and the team had previously adapted these materials to meet the needs of the Gambian staff and shortened it to make it more accessible to more midwives. We found this to be a simple and effective teaching method which was well received by the lovely midwives in the picture.
Following the formal training sessions, we then visited three participating maternity facilities to evaluate the effectiveness of the training by meeting with the lead midwife from each establishment and then assessing their ability to lead the teaching in their own unit. Consequently, we met with very enthusiastic midwives who were very happy to share the knowledge and skills they had been taught.
It quickly became evident that the midwives were very good at leading the teaching but they lacked the necessary equipment to continue training at their respective units. After discussion with our training faculty it was decided that we would donate the training mannequins with a view to replacing them before we facilitate the next programme.
Overall the training was very successful, was well evaluated and received very positive feedback from the midwives who attended”.
The training was organised and facilitated by Dr Beverly Donaldson with Dr Anna Battersby and the Centre of International Child Health (CICH) at Imperial, led by Prof Beate Kampmann, who also regularly works at the MRC Unit. Prof Kampmann stated: “I am very pleased that the CICH can support this training effort, as it is an excellent example of our vision to involve a multi-disciplinary group of health care professionals and advocates in our work to improve maternal and child health. Midwives worldwide play such an important role in achieving this goal and I thank the imperial team for their efforts and dedication.”