TB Spike In Horn Of Africa Linked To Non-Prescription Drugs

 The Somali healthcare system has been one of the institutions severely affected by collapse of the state.

Before 1991, the Health Ministry coordinators ran hospitals and clinics in regions around the country. 

Those hospitals, despite being under-resourced and understaffed, delivered basic health services and ran health awareness campaigns on vaccination against “six deadly diseases”.

Mogadishu had several public hospitals such as Digfeer and Martini in addition to privately owned clinics at which government-employed doctors practiced in the afternoon to supplement their incomes. 

Tuberculosis patients in regions preferred to travel to Mogadishu where the Somalia-Finland Tuberculosis Project was based. The decision to base key health projects in the capital city was a feature of health inequalities in Somalia.

A different healthcare challenge emerged after 1990 though:  predominantly private healthcare systems characterized by poor quality control and unregulated pharmacies.

A sample of antibiotics Puntland Post reporters managed to buy at several pharmacies in Garowe

The sale of antibiotics without prescription throughout Somalia demonstrates the enormity of the problem.

Pharmacies in Puntland sell medicines imported from different countries.

In Somalia, there is no authority tasked with ensuring that pharmacies employ qualified pharmacists bound by a professional code of ethics.

Many pharmacies in Puntland sell antibiotics to customers with or without a prescription from a doctor.

Puntland Post reporters have managed to buy different types of antibiotics from several pharmacies in Garowe.

No pharmacist asked our reporters to produce a prescription from a doctor or tried to ask why the antibiotics were needed in the first place. Many pharmacies sell antibiotics the way they sell over-the-counter medicines such as paracetamol, aspirin, and ibuprofen.

A paper published in 2009, in the American Journal of Respiratory and Critical Care Medicine delineated how “common antibiotic may be undercutting its utility as a first-line defense against drug-resistant tuberculosis (TB)”.

A silent epidemic

In Puntland, Medicins Sans Frontiers supports a tuberculosis hospital where drug-resistant tuberculosis patients undergo a treatment regimen.

In a 2013, paper published in Emerging Infectious Diseases researchers discussed the spread of drug-resistant tuberculosis in Somalia. 

750 out of 9,760 pulmonary TB cases notified in Somalia in 2011 were multidrug-resistant tuberculosis “and therefore required treatment with second-line drugs…”

The documented levels of MDR TB [in Somalia] are among the highest reported in Africa and the Middle East…” the researchers concluded. “Puntland Ministry of Health is aware of the availability of antibiotics sold without prescription. The research conducted in 2011 on which the paper is based shows comparatively marked prevalence of multidrug-resistant tuberculosis in Somalia, but no preventive measures have so far been taken” says a senior Puntland Health Ministry official who spoke to Puntland Post on condition of anonymity.

Without the Puntland State Government taking decisive steps to crack down on the sale of antibiotics without a prescription from a practicing doctor, there is a risk that patients with drug-resistant tuberculosis could overwhelm the rudimentary healthcare system of Puntland State at a time the second wave of COVID-19 is costing lives in Somalia.

It is not solely a matter for Puntland State. It is matter for all Federal Member States and the Federal Government of Somalia to agree a health strategy to tackle the silent epidemic of  drug-resistant tuberculosis added the Puntland Health Ministry official.

This article first appeared in the © Puntland Post, 2021, and is republished with permission.

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MEAL DPro Course: Monitoring Evaluation Accountability & Learning for Development Professionals!

  Pyramid Learning delivers the MEAL DPro Online Course to individuals – via a 4-week on-line course – and via organization-wide cohorts.

Just one month to learn MEAL DPro and be ready for the MEAL DPro certification!

Course Instructor:

Leslie Sherriff is an Adjunct Professor at the American University, MEAL, and International Development Professional with 20 years of experience. Her career includes work with the National Endowment for Democracy, Catholic Relief Services, Humentum, American University, and others.  

Over the past decade, Leslie has focused on MEAL field capacity-building via on-line learning. She designed courses and taught for American University’s online MSc in Measurement and Evaluation and is part of the team that developed the Guide to the MEAL DPro and its supporting learning materials.

Leslie has double Masters degrees in Public and International Affairs from the University of Pittsburgh (USA), and Evaluation and Social Research from London Metropolitan University (UK), and a BA in International Relations from the University of Southern California (USA).

Institutional Background

Pyramid Learning provides engaging and scalable learning for humanitarian relief and development practitioners. They work with individuals and organizations – delivering online and face-to-face courses, designing custom courses, such as PMD Pro, MEAL DPro, FMD Pro, Program DPro developing credentials, and facilitating learning events. 

Its mission is to make quality learning appropriate, accessible, and actionable. To help those doing good, do even better.

All their products and services are designed to be accessible, appropriate, and actionable. They prioritize practical skills and tools while providing easy-to-deploy learning systems that can be used to upskill a single team or scaled to support a whole organization.

Course Schedule & Timeline

Starting & ending date: April 5 – May 2, 2021

The course is approximately 5-8 hours per week over 4 weeks – there are many learning styles and some people prefer to take longer. 

This course gives you the skills you need to conduct monitoring, evaluation, accountability, and learning (MEAL) activities through the entire project cycle, helping you successfully deliver your project on scope, on time, and on budget.

Format

This MEAL DPro Online Course is designed for the active professionals who want to learn MEAL via a process that is virtual, social, and mobile-ready, participants will get their access data, the usernames, and the password for the learning system prior to the class starting after the payment received through the local agent.

As you go through the course, you will interact with facilitators and other learners from across the globe, exploring ideas and participating in conversations about the different skills and tools of project management.  

Learning activities include completing course readings, watching instructional videos, competing for complete e-learning modules, and submitting examples of work.

Everything about the course design is flexible!  The learning platform is accessible when you want – day or night.  

As you go through the course, modules will unlock – as long as you are doing the work! The platform allows you to go back and review what others are saying. If you need to take a break, you can catch up. The course is also mobile-ready, so you continue to learn when you are on-the-go.

For best results, we recommend that you develop a learning plan that allocates approximately 5-8 hours each week for study.  In order to progress through the course, you will need to complete the learning activities. You will also be expected to join in course discussions, contributing to discussions and responding to your classmates' comments!

 The more you do, the more you learn and the faster you progress through the course. We hope that this creates an interesting learning and sharing experience.

Curriculum

The course approaches MEAL as a puzzle made up of four pieces. Each piece—monitoring, evaluation, accountability, and learning—has its unique place and purpose, but the MEAL system is only effective when the pieces are aligned, connected, and working together.

MEAL DPro Course Schedule and Learning Objectives

Week 1:    Introducing MEAL

• Define the components and purpose of MEAL
• Explain the benefits of a strong MEAL system
• Describe the relationship between MEAL and project management
• Identify the five phases of MEAL
• Describe the ethical standards and principles relevant to MEAL

Week 2:   Logic Models

• Describe how project logic models contribute to establishing a strong foundation for MEAL
• Compare and contrast the components, structure, and purpose of the Theory of Change, Results Framework, and the Logical Framework
• Explain the purpose of identifying assumptions in project logic models
• Interpret the vertical and horizontal logic of the Logical Framework
• Understand the characteristics of a SMART indicator
• Identify the most common measurement methods and when they are used

Week 3    MEAL Planning Tools

• Identify and describe the purpose, process, and content of key MEAL planning tools, including
  • Performance Monitoring Plans
  • Indicator Performance Tracking Table
  • Evaluation Summary Table
  • Evaluation Terms of Reference
  • Feedback Response Mechanisms
• Discuss the various types of evaluation and the data required for each

Week 4    Collecting and analyzing MEAL data

• Explain the 5 elements of data quality
• Describe the components of a basic data collection tool, including questionnaires, surveys, interviews, and focus groups
• Explain the basic principles of sampling
• Describe key steps in preparing to implement data collection tools
• Identify generally accepted protocols and standards for responsible data management
• Describe the purpose and processes of quantitative data analysis
• Describe the purpose and processes of qualitative data analysis.

Course Fee (updated)

Individual participants would pay $125 for the course including local coaching (virtual or face-to-face based on the situation), an honorarium of the facilitator/s, and the marketing development.

NB: There is still a chance to book the course for $100 only, but there will be no extra help or coaching. You will simply be purchasing the generic, open course.

Certificate of Completion/Attendance

Everyone who completes the course will receive a certificate of attendance. Everyone who passes the MEAL DPro exam will also receive the MEAL DPro certification.

We have designed the MEAL DPro Online Course so that participants who wish to pursue certification will be able to successfully pass the certification exam in the first attempt assuming that:

• they participate actively in the course
• they extensively study the Guide to the MEAL DPro
• they complete the preparatory activities found on the MEAL DPro certification website (see below.)

MEAL DPro Certification Exam

MEAL D Pro is a globally recognized certification for development professionals who understand the key concepts, purposes, components, and ethical principles relevant to MEAL. This course prepares learners to take the MEAL D Pro Certification Exam.

The certification was created by the PHAP Credentialing Program. You can find more information about the certification at the following website:  https://phap.org/cp-meal  (or click the image below)

Online Course: The course fee does not include the cost of the exam, and it is not administered at the end of the course. You can arrange to take the exam online at any time after the course, with costs starting from $80. More information can be found here. 

MEAL DPro in-house or face-to-face training

We would be very happy to run this course in-house, 5-7 days contact sessions in Somalia/Somaliland, and also to discuss your organization’s learning needs.

Any organization purchasing an in-house virtual course will also receive an extra day of consulting to help you plan the next steps and implementation.

For more Information

In case you may need additional details about the course, please contact us at info@pyramidlearning.org or info@DrMohamedDualeh.com or call Dr. Mohamed Y. Dualeh at this number +252 63 4417945.

Official website: https://www.pyramidlearning.org 

Thank you

Study: Covid-19 patients should delay surgery by up to seven weeks

 A new global study has recommended that patients with Covid-19 should delay surgery by up to seven weeks to lower the risk of postoperative mortality.

The joint statement by the College of Surgeons, Academy of Medicine Malaysia, and the University of Birmingham said the study’s findings revealed patients who undergo surgery six weeks after their initial Covid-19 diagnosis are two-and-a-half times more likely to die post-op.

“Surgery should be delayed for seven weeks after a patient tests positive for Covid-19, as operations taking place up to six weeks after diagnosis are associated with increased risk of death, according to a new global study.

“Researchers discovered that patients are more than two-and-a-half times more likely to die after their operations if the procedure takes place in the six weeks following a positive diagnosis for SARS-CoV- 2,” the statement read.

SARS-CoV-2 is a “severe acute respiratory syndrome coronavirus 2” that causes Covid-19 and is responsible for the current global pandemic.

However, the findings that were published in the medical journal Anaesthesia offered little by way of optimal duration of the surgery delay for patients with ongoing symptoms of Covid-19.

The study mentioned that hospitals that participated in the study included all patients undergoing surgical procedures in October 2020 and excluded those who were infected with the virus post-surgery.

It also said the statistical model based on a 30-day time frame of postoperative death showed the mortality rate between patients without the virus and those who went for surgery seven to eight weeks after being diagnosed with Covid-19 stands at 1.5 percent.

Meanwhile, the study found that patients with Covid-19 symptoms who underwent surgery within six weeks of their diagnosis increased their risk of postoperative mortality from 3.6 per cent to 4 per cent.

Adjusted 30-day mortality in patients who did not have SARS-CoV-2 infection was 1.5 per cent. This was increased in patients operated at zero-two weeks (4 per cent), three to four weeks (4 per cent), and at five to six weeks (3.6 per cent), but not at seven to eight weeks (1.5 per cent) after SARS-CoV-2 diagnosis, the study added.

It said that the study’s findings were consistent across all age groups, severity of patients’ condition, urgency of surgery and grade of surgery, among other factors.

The study concluded that following a delay of seven weeks or more, patients with ongoing Covid-19 symptoms (6 percent) also had a higher mortality rate than patients whose symptoms had been resolved (2.4 percent) or who had been asymptomatic (1.3 percent).

National study for Malaysia, College of Surgeons, Academy of Medicine of Malaysia president, Dr. April Camilla Roslani, said that in light of the findings, it is important to provide clarity on the timing of surgery and the impact of mass vaccination.

It is, however, important to contextualize the application of these findings. Life-saving surgery should not be delayed, and the impact of mass vaccination will need to be evaluated in due course, she said.

The study involved more than 25,000 surgeons working together to be part of the CovidSurg Collaborative to collect data from 140,727 patients in 1,674 hospitals across 116 countries including Australia, Brazil, China, India, the United Arab Emirates, the United Kingdom, the United States, and Malaysia — creating one of the world’s largest and broadest studies on surgery in Covid times.

The University of Birmingham is ranked among the world’s top 100 institutions. It boasts researchers, teachers, and more than 6,500 international students from over 150 countries.

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Bay Regional Hospital: 85 years of serving Healthcare to South West State Residents

 Baidoa – Quiet and calm are rare at the Bay Regional Hospital in the city of Baidoa. 

On any given day, the usual hustle and bustle associated with a major hospital feature throughout its grounds, as could be expected for the main referral hospital in Somalia’s South West State. 

Inside, with nurses assisting, doctors are doing their rounds of the wards, checking in on the progress of patients. 

I came from Wajid district; it took me three days to get here. I have been in this hospital for eight days taking drugs prescribed by the doctors. Finally, this morning Dr. Aden cut off the toe on my leg that was giving me so much trouble, says Ibrahim Ali Isak, a 70-year-old patient recovering from treatment for a long-suffering ailment. The Wajid district is some 95 kilometres north-west of Baidoa. 

Outside, families and friends loiter in the hospital’s gardens while waiting to be able to see their loved ones. 

“I came from Usley. My daughter was constantly vomiting and had a high fever. I knew this hospital treats children well, including with the provision of three meals per day. I have been in this ward for the last ten days. Thanks to Allah, my daughter is now doing well,” says Fadumo Hassan Moalim, the mother of two-year-old Amina Osman, recovering in the pediatric ward. The village of Usley is some 70 kilometres north of Baidoa.  

Ibrahim Ali Isak and Amina Osman are just some of the 20,000 people treated at the hospital each year.  

Located in the heart of Baidoa city, in South West State’s Bay region, the Bay Regional Hospital is a public health institution which provides free 24/7 health care service to residents of the state’s three regions as well as the neighbouring region of Gedo in the Federal Member State of Jubaland.  

The hospital is run by the South West State administration, with the support of international aid agencies. It has eight departments which include surgery, maternity care, pediatric health, nutrition, out-patient treatment and a laboratory. There are 18 doctors on staff, out of a total staff number of 285, and it has 400 beds for patients. 

Much progress 

The hospital has come a long way in its 85 years of existence.   

“Bay Regional Hospital was built in 1936. It was part of the infrastructure built by the Italian colonial administration. It has covered a big gap by reducing the need for travelling to Mogadishu for medication and treatment,” says Abdifatah Ibrahim Hashi, who has served as the hospital’s director since 2015. 

Mr. Hashi has an affinity for the hospital, having been born there in 1981. Before his appointment he had worked with local and international humanitarian agencies, including the United Nations Mine Action Service (UNMAS). As a child, he was witness to some of the upheaval the hospital went through. 

Like many other institutions, the hospital was affected by the collapse of Somalia’s central government in 1991 and, between 1992-1999, control of it changed hands several times.  

“When the civil war broke out, Baidoa’s main health centre was seized by warring factions in different times. People began to seek treatment in Mogadishu and other neighbouring capital cities, like Nairobi and Addis Ababa,” says Mr. Hashi.   

The murder in 1997 of a Médecins Sans Frontières (MSF) doctor working there presaged tougher times. All support from the United Nations and international non-governmental organizations was halted.  

Things started to change in 2007.  The Italian non-governmental organization Cooperazione Internazionale (COOPI) stepped in to support the hospital, and was soon followed by other such as the International Committee of the Red Cross (ICRC) and MSF-Holland. 

The renewed support allowed the hospital to rebuild and grow. The current international support from them and other non-governmental organizations includes the provision of medical supplies, staff salaries and new buildings.  

Recently, the hospital premises were expanded with two new buildings, as well as a waste disposal centre that helps reduce environmental pollution. The new additions were officially opened by South West State’s President Abdiaziz Hassan Mohamed ‘Laftagareen’ in December 2020.  

MSF has recently built for us two new spacious obstetric and pediatric departments, along with hospital incinerator that can easily crush hospital’s waste materials, Mr. Hashi says. 

All of these developments have helped the hospital get to where it is today. 

“In 2020, the Bay Regional Hospital received a total of 6,551 people as out-patients, 8,820 people in the emergency care departments and 5,808 people were admitted as in-patients,” says Mr. Hashi. 

Dedicated staff 

In addition to the support of international donors, the hospital administrator pays tribute to the medical staff for the health centre’s success. 

One of them is Dr. Aden Abdikadir Noor, a general surgeon at the hospital since 2012.  

Born in Baidoa in 1985, he attended primary and secondary school in Mogadishu and completed his medical studies at Jilin University in Changchun, China, in 2011.  

“I then came back to Somalia to serve my people,” Dr. Noor says.  

His desire to return and serve his countrymen and countrywomen stems from his experiences during Somalia’s years of conflict.  

In 2006, my colleagues and I used to visit Mogadishu hospitals to donate blood. Hospitals were overwhelmed by patients with multiple injuries and fractures caused by fierce fighting between warring sides – so, what influenced my career choices is pretty clear, Dr. Noor says. 

The surgeon’s days are long and challenging, often involving hours of delicate surgery, but his motivation to continue remains strong.

“My day starts with morning ward rounds to review patients’ condition, followed by the operating theatre to perform planned surgery interventions, then I go to the recovery wards to evaluate patients’ condition. As doctors, we sometimes work longer hours when there are explosions or deadly battles – but I am happy and, indeed, it makes my day whenever I come across recovered patients.”  

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