Leaving no one behind in armed conflict-affected settings of Africa: is universal health coverage a possibility or mirage?

The world is off track six years to the 2030 deadline for attaining the sustainable development goals and universal health coverage. This is particularly evident in Africa's armed conflict-affected and humanitarian settings, where pervasively weak health systems, extreme poverty and inequitable access to the social dimensions and other determinants of health continue to pose significant challenges to universal health coverage. In this article, we review the key issues and main barriers to universal health coverage in such settings.

The Chronic Cholera Situation in Africa: Why Are African Countries Unable to Tame the Well-Known Lion?

Seven years to the Global Taskforce on Cholera Control's target of reducing cholera cases and deaths by 90% by 2030, Africa continues to experience a high incidence of the disease. In the last 20 years, more than 2.6 million cases and 60 000 deaths of the disease have been recorded, mostly in sub-Saharan Africa.

Transformation of World Health Organization's management practice and workforce to fit the priorities of African countries.

Introduction: The WHO Regional Office for Africa developed an evidence-based tool, called the Dalberg tool to guide the functional review and restructuring of the workforce and management of the country offices to better fit the health priorities of Member States.

Methods: The Dalberg tool was used in conjunction with a series of consultations and dialogues to review twenty-two countries have undergone the functional review. Results: the "core functions" in WHO country offices (WCOs) were identified.

What should the African health workforce know about disasters? Proposed competencies for strengthening public health disaster risk management education in Africa.

Background: As part of efforts to implement the human resources capacity building component of the African Regional Strategy on Disaster Risk Management (DRM) for the health sector, the African Regional Office of the World Health Organization, in collaboration with selected African public health training institutions, followed a multistage process to develop core competencies and curricula for training the African health workforce in public health DRM. In this article, we describe the methods used to develop the competencies, present the identified competencies and training curricula, and propose recommendations for their integration into the public health education curricula of African member states.

Methods: We conducted a pilot research using mixed methods approaches to develop and test the applicability and feasibility of a public health disaster risk management curriculum for training the African health workforce.

Estimating the met need for emergency obstetric care (EmOC) services in three payams of Torit County, South Sudan: a facility-based, retrospective cross-sectional study.

Objective: To determine the met need for emergency obstetric care (EmOC) services in three Payams of Torit County, South Sudan in 2015 and to determine the frequency of each major obstetric complication.

Design: This was a retrospective cross-sectional study.

Setting: Four primary healthcare centres (PHCCs) and one state hospital in three payams (administrative areas that form a county) in Torit County, South Sudan.

Using the Stop Transmission of Polio (STOP) Program to Develop a South Sudan Expanded Program on Immunization Workforce.

In 2009, the international Stop Transmission of Polio (STOP) program began supporting the Global Polio Eradication Initiative in the Republic of South Sudan to address shortages of human resources and strengthen acute flaccid paralysis surveillance. Workforce capacity support is provided to the South Sudan Expanded Program on Immunization by STOP volunteers, implementing partners, and non-governmental organizations. In 2013, the Polio Technical Advisory Group recommended that South Sudan transition key technical support from external partners to national staff as part of the Polio Eradication and Endgame Strategic Plan, 2013-2018.

Sero-prevalence for Hepatitis B virus among pregnant women attending antenatal clinic in Juba Teaching Hospital, Republic of South Sudan.

Introduction: Hepatitis B virus infection is a major public health problem worldwide and in Africa. This would be the first ever documented study on epidemiology of Hepatitis B infections in the newly formed Republic of South Sudan. This study was designed to estimate the sero-prevalence of Hepatitis B virus infection amongst pregnant women attending antenatal services in Juba.

Dengue fever outbreaks in Eritrea, 2005-2015: A case for strengthening surveillance, control and reporting.

Background: The geographic distribution and burden of dengue is increasing globally. This study aims to evaluate dengue outbreaks and to substantiate the need for strengthened surveillance, reporting and control in Eritrea.

Methods: Data from two cross-sectional dengue epidemic investigations in 2005 and 2010 were analyzed.

Strengthening health disaster risk management in Africa: multi-sectoral and people-centred approaches are required in the post-Hyogo Framework of Action era.

Background: In November 2012, the 62nd session of the Regional Committee for Africa adopted a comprehensive 10-year regional strategy for health disaster risk management (DRM). This was intended to operationalize the World Health Organization's core commitments to health DRM and the Hyogo Framework for Action 2005-2015 in the health sectors of the 47 African member states. This study reported the formative evaluation of the strategy, including evaluation of the progress in achieving nine targets (expected to be achieved incrementally by 2014, 2017, and 2022).

Artesunate/Amodiaquine-Induced Acute Extrapyramidal Reactions in Children and Younger Adults: Case Series Assessment.

Introduction: Several studies conducted in African countries reported the artesunate and amodiaquine (AS/AQ) tablet as a safe and well-tolerated anti-malarial drug in children and younger adults. The aim of this case series assessment was to assess the causal relationship between the AS/AQ tablet and extrapyramidal reactions in children and younger adults and to investigate the factor(s) predisposing to the adverse drug reactions.

Methods: The causal relationship of all the cases was first assessed individually using the Naranjo Probability Scale and then subjected to a case series assessment using Austin Bradford-Hill criteria.

Underestimation of prevalence of raised blood sugar from history compared to biochemical estimation: support for the WHO rule of halves in a population based survey in Eritrea of 2009.

To ascertain the prevalence of diabetes mellitus from history and biochemical estimation so as to attest the WHO Rule of halves in a lean population. A population based national survey on diabetes mellitus was carried out in 2009. History and fingerpicks blood analysis were examined according to recommended procedures of the WHO STEPwise approach and the WHO recommended automated machine to compare the two modalities of estimating diabetes prevalence.

Consolidating strategic planning and operational frameworks for integrated vector management in Eritrea.

Background: Contemporary malaria vector control relies on the use of insecticide-based, indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs). However, malaria-endemic countries, including Eritrea, have struggled to effectively deploy these tools due technical and operational challenges, including the selection of insecticide resistance in malaria vectors. This manuscript outlines the processes undertaken in consolidating strategic planning and operational frameworks for vector control to expedite malaria elimination in Eritrea.

Gains attained in malaria control coverage within settings earmarked for pre-elimination: malaria indicator and prevalence surveys 2012, Eritrea.

Background: Eritrea, like most countries in sub-Saharan Africa, has expended much effort towards malaria control with the view of transitioning from reduction of the disease burden to elimination. This paper reports on the level of achievement as highlighted by the follow-on, malaria-endemic area representative, survey that aimed to provide data and to assess progress on malaria indicators and parasite prevalence at household level across the country.

Methods: In 2012, data were collected using a two-stage stratified cluster random sample of 1887 households in 96 clusters (villages in rural areas and census enumeration areas in urban centers) during a malaria indicator and prevalence survey in Eritrea.

Lessons learnt from coordinating emergency health response during humanitarian crises: a case study of implementation of the health cluster in northern Uganda.

Background: Between the late 1980s and 2000s, Northern Uganda experienced over twenty years of armed conflict between the Government of Uganda and Lord's Resistance Army. The resulting humanitarian crisis led to displacement of a large percentage of the population and disruption of the health care system of the area. To better coordinate the emergency health response to the crisis, the humanitarian cluster approach was rolled out in Uganda in October 2005.

Profile of patients with diabetes in Eritrea: results of first phase registry analyses.

A cross-sectional descriptive study was done on patients recently entered into the National Diabetes Registry in Eritrea where the prevalence was estimated to be 2.2% based on patient information in 2004. Of the 627 patients with diabetes, two thirds were type 2.

Cost analysis of an integrated disease surveillance and response system: case of Burkina Faso, Eritrea, and Mali.

Background: Communicable diseases are the leading causes of illness, deaths, and disability in sub-Saharan Africa. To address these threats, countries within the World Health Organization (WHO) African region adopted a regional strategy called Integrated Disease Surveillance and Response (IDSR). This strategy calls for streamlining resources, tools, and approaches to better detect and respond to the region's priority communicable disease.

Prevalence of non-communicable disease risk factors in Eritrea.

Objective: To establish the baseline prevalence rates for non-communicable disease risk factors in Eritrea.

Study Design: A cross-sectional survey was conducted among all the ethnic groups in Eritrea with the WHO STEPwise approach. Hypertension was defined as blood pressure > or = 140/90 mm Hg or a person on medication for hypertension, while diabetes based on medical history of the disease.

Emerging non-communicable disease epidemic in Africa: preventive measures from the WHO Regional Office for Africa.

The World Health Organization Regional Office for Africa (WHO AFRO) commissioned a study to compile and analyze published reports on non-communicable diseases (NCDs) in Africa to build evidence on the burden of NCDs in the region. Anecdotally, little information or literature was available on this subject. The objective of the study was to establish the status of NCDs in Africa by using published sources of information.

Prevalence of tobacco use in Eritrea: results from a noncommunicable disease risk factor survey.

The prevalence of noncommunicable diseases in Eritrea is increasing. Tobacco use is a recognized risk factor for most of these diseases, especially cardiovascular disease. No data have been published on tobacco use in Eritrea.

Roll back malaria--an African success story in Eritrea.

Background: High morbidity and mortality from malaria in Africa prompted the Abuja Declaration by African Heads of State in 2000. The goal set in the declaration for 2010 was to reduce malaria mortality by 50%. Countries were therefore expected to ensure that 60% of people suffering from malaria had access to treatment, that 60% of those at risk received intermittent prophylaxis, and that 60% of people in high-risk groups were using insecticide-treated nets (ITNs) by 2005.

A steep decline of malaria morbidity and mortality trends in Eritrea between 2000 and 2004: the effect of combination of control methods.

Background: Malaria is a huge public health problem in Africa that is responsible for more than one million deaths annually. In line with the Roll Back Malaria initiative and the Abuja Declaration, Eritrea and other African countries have intensified their fight against malaria. This study examines the impact of Eritrea's Roll Back Malaria Programme: 2000-2004 and the effects and possible interactions between the public health interventions in use.