Open Access Review Article

Migrant Health: Healthy Migrant Effect and the Need to Prioritize Migrant Health

Quraish Sserwanja, Joseph Kawuki

Asian Journal of Medicine and Health, Page 11-16
DOI: 10.9734/ajmah/2020/v18i630209

Globally, the number of international migrants is about 258 million with over 60% of these living in Asia and Europe and the rest of the 40% living in Northern America, Africa, Latin America and the Caribbean and Oceania. We aimed to describe the healthy migrant effect, the public health challenges faced by migrants and approaches that host countries can adopt to improve migrant health. We used literature searched from key databases such as Google Scholar, PubMed, among others, to collect relevant and recent information about migrant health. Several studies have shown recent migrants to be healthier than native-born populations. Several studies have concluded that with a longer stay in a host country, the health of migrants tends to deteriorate which could be as a result of low living and working conditions and adoption of risky health behaviour. Communicable diseases, non-communicable diseases (NCDs), mental and social problems, contribute significantly to the morbidity burden of new migrants in host countries.  Migrants in host countries are less likely to access or fully benefit from the healthcare system as they face various challenges such as language barrier, denial of access basing on the lack of documentation, and negative healthcare provider attitudes. This mini-review identifies that in order to ensure the health of migrants, host countries have to effectively coordinate and collaborate with other countries and sectors. Furthermore, it highlights a need to promote migrant-sensitive health policies aimed at improving the health of migrants, promoting equitable access to health protection and care for migrants and advocating migrants’ health rights.

Open Access Original Research Article

A Qualitative Exploration of Access and Utilization of Focused Antenatal Care among Pastoral Community in North Eastern Kenya

Ismail Ahmed, Isaac Mwanzo, Okello Agina

Asian Journal of Medicine and Health, Page 1-10
DOI: 10.9734/ajmah/2020/v18i630208

Background: Ministry of Health Kenya has adopted new guidelines for FANC services emphasizing on four antenatal care visits, birth planning and emergency preparedness. In North eastern Kenya predominately occupied by Somali pastoralist Communities only 37% of women of reproductive age receive ANC service at least 4 times during pregnancy, which is considerably lower than the national rate of 58%. There is limited utilization of healthcare services among nomadic pastoralist compared to general population, this is due to several constraints stemming from their migratory way of life, poor social services and spatial disparities. Limited studies have adopted qualitative approaches to explore access and utilization FANC among pastoralist communities. The study explored access and utilization of FANC service among pastoralist community of North Eastern Kenya.

Methodology: The study is an exploratory qualitative study, using a purposive sampling       method forty eight women who give birth two years prior to the study were selected, sixteen male partners and three ANC providers. Data was collected using FGDs and KIIs and analyzed thematically.

Results: There is low utilization of FANC among pastoralist communities, the proportion of respondents who had utilized was 83.3% but only few 39.6% had utilized the required four visits (FANC). There is delayed initiation of uptake of FANC services where majority respondents 55.0% had attended ANC in their second trimester while only 17.5% had utilized in their first trimester as recommended. Barrier that hampered FANC uptake are: long distance to health centre, transport cost, low level of FANC knowledge, TBAs practice, low income and harmful cultural practices. Major facilitators identified are free FANC charges, good attitude of a care giver and fear of pregnancy complication. Access challenges range from inadequate infrastructure, lack of skilled health attendants and logistical constraints to harmful cultural practices.

Conclusion: There is need to reduce travelling time to the health facility by conducting regular outreach services targeting nomads with no near facility, improve culturally sensitive FANC to increase accessibility, involving all health stakeholders and community representatives to increase cultural acceptability and also help priorities policies that increases FANC service uptake.

Open Access Original Research Article

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2): What Can Africa Learn from Ongoing Research in Epidemiology, Clinical Manifestations, Chemotherapy and Prevention?

Silas Lendzele Sevidzem, Aubin Armel Koumba, Christophe Roland Zinga- Koumba, Nonvignon Marius Kedote, Gaël Darren Maganga, Essé Elvire Agossou, Safiatou Niaré- Doumbo, Bitsha-Kitime Dieudoné Kabkia, Luc Salako Djogbenou, Genevieve Lydie Acapovi- Yao, Idrissa Sarr, Julien Zahouli Bi Zahouli, Chimène Nze- Nkoghé, Rodrigue Mintsa- Nguema, Athanase Badolo, Emmanuel Kamba Mebourou, Jacques François Mavoungou, Fatou Bintou Sarr

Asian Journal of Medicine and Health, Page 17-27
DOI: 10.9734/ajmah/2020/v18i630213

The world is experiencing an outbreak due to the new and mysterious SARS-CoV-2. Information regarding its source and transmission dynamics in different environments as well as medications for its prevention and cure is weak. This review seeks to document on the epidemiology, clinical signs, control, prevention, and present some perspectives for SARS-CoV-2 research in Africa. There are geographical differences in morbidity and mortality rates of this disease all over the world. The scientific community strongly reject claims regarding the fact that the virus has been genetically manipulated, but supports the theory that it has a natural origin from animal host as any other emerging viral disease. Although animals are thought to be the original source of global spill over, person-to-person transmission is well comprehended. Transmission could be enhanced by symptomatic and asymptomatic individuals with high contaminations reported in dense urban environments. Scientific evidences from the Center for Disease Control (CDC) and other publications reported that contaminated surfaces and air could possibly be the underlying mechanism through which SARS-CoV-2 spreads. Cohort studies reveal that children as well as adults could be vulnerable to the disease, but others attribute it to health care workers, some risky habits (drinking and smoking) and comorbid individuals due to their immune suppressed status. There is no drug of choice for SARS-CoV-2, but clinical studies including several antiviral drugs are underway. Similarly, vaccine studies and clinical trial studies are ongoing. Because there is no medication, preventive measures such as Personal Protective Equipments (PPEs), ventilators, sanitation, social distancing, and quarantine are the gears globally used to curb the spread of this virus. The African continent does not have high morbidity and mortality compared to other continents that are highly affected. The following lessons could be learned by Africans from ongoing research: that the SARS-CoV-2 originated from an animal host, individuals could be infected irrespective of their age, sex, race, and origin, there is a broad spectrum of clinical signs and confirmatory diagnosis is required, there is no approved drug of choice, vaccine trials are ongoing and community-based prevention is required, the recommendations put in place by the Government and the WHO to curb the spread of this virus should be strictly followed. From the above lessons, a research project to study the ecological epidemiology of SARS-CoV-2 in tropical African settings by including the following aspects: socio-cultural, economic, and political characteristics as well as the evaluation of measures taken by the different countries to combat the disease is required.

Open Access Original Research Article

Occurrence of Medical Cases and Utilisation among Enrollees of Private Health Insurance Programme in Kaduna, Nigeria

Oni, Oluwatobi Dapo, Zakari, Mustapha Mohammed, Okemmiri, Innocentia Chidinma

Asian Journal of Medicine and Health, Page 30-37
DOI: 10.9734/ajmah/2020/v18i630215

Aims: This study examines the occurrence of various medical cases presented by enrollees that have subscribed to access healthcare from a network of healthcare providers (HCPs) managed by a Health Maintenance Organisation (HMO) under its Private Health Insurance Programme (PHIP).

Study Design:  A descriptive cross-sectional design was employed.

Methodology: Secondary data from collected or submitted medical encounters in form of bills of registered enrollees (principals and their dependants) who have visited and received treatment from their chosen healthcare providers in Kaduna State between the month of January and December 2019 were purposively compiled and analysed. Cases were classified using the National Health Insurance Scheme (NHIS) Operational Guideline. Frequency tables, charts, percentages and Chi-Square analysis were used with the aid of Statistical Package for Social Sciences (SPSS) 22 at P=.05 level of significance.

Results: A total of 11,156 medical cases were recorded after attrition, 9,525 (85.38%) primary cases and 1,632 (14.62%) secondary cases. Malaria (41.23%) and Respiratory Tract Infection (11.98%) led the primary case table while Hypertension (3.83%) Urology related cases (2.49%) and Diabetes (0.79%) were among the leading secondary cases. Female enrollees had slightly more cases and therefore higher tendencies to seek medical treatment than their male counterpart even though there was no significant relation between gender and type of case.

Conclusion: The study concludes that the awareness and utilization of healthcare services are gradually growing among enrollees under the Private Health Insurance Programme (PHIP). In ensuring that there is an improvement in the health sector of Nigeria and achieving universal health coverage, focus should be on the primary healthcare services with high consideration for research, proper data management and periodic sharing of trends, observations and outcome of researches with the growing health community.

Open Access Original Research Article

Assessment of Anxiety in Healthcare Providers Working in ICU during COVID-19 Pandemics

Hakan Dal, Esra Sultan Karabulut Keklik, Baris Kaki

Asian Journal of Medicine and Health, Page 46-53
DOI: 10.9734/ajmah/2020/v18i630222

Objective: After onset of coronavirus disease (COVID-19), the risk for exposure or having the disease is increased among healthcare providers involved in the treatment of the disease. There are reports of healthcare providers died due to COVID-19 disease who became ill during work. This resulted in psychological distress in healthcare providers. In this study, we aimed to investigate anxiety in healthcare providers working at intensive care units, considered as an area at highest risk, and to confirm social psychological factors among healthcare providers working in hospitals.

Materials and Methods: The study included 106 healthcare providers working in intensive care unit who accepted participation to the survey. The healthcare providers responded to survey were stratified into 2 groups as those working in pandemic intensive care unit (pandemic group; n=55) and those working in remaining intensive care units (others; n=51). The relationship between sociodemographic characteristics and levels of anxiety and depression was evaluated using State-Trait Anxiety Inventory.

Results: In our study, it was found that STAI anxiety scores were higher in healthcare providers working in pandemic intensive care unit during COVID-19 outbreak (p<0.05). In the pandemic group, anxiety scores were significantly higher in male healthcare providers when compared to female healthcare providers (p>0.05). However, it was seen that healthcare providers with work experience of 1-10 years had higher mean anxiety level in STAI-II scale. It was also seen that anxiety score was significantly higher in those with work experience of 1-10 years when compared to those work experience of 11-20 years or ≥21 years (p<0.05). Work setting, male gender, experience of intensive care and concerns about outbreak were identified as factors associated to anxiety.

Conclusion: Our study showed that STAI anxiety scores were higher in healthcare providers working in pandemic ICU during COVID-19 outbreak. The COVID-19 period has led psychological problems in healthcare providers working in ICU. It is important to provide psychological support and information, and to monitor psychological status in healthcare providers.

Open Access Case Study

Exceptional Fertility and Poor Fetal Outcome in a Female with 17-Year Hemodialysis: A Case Study and Mini-review

Abir Farouk Megahed, Al Zahraa Ahmed Gamal Ammar, Ehab Hussein Hashish, Nagy Sayed- Ahmed

Asian Journal of Medicine and Health, Page 38-45
DOI: 10.9734/ajmah/2020/v18i630216

Background: Chronic kidney disease can affect different aspects of female patient’s life including menstrual pattern, marital status and sexuality, fertility, pregnancy outcome, and recommended methods of contraception especially when initiated on HD.

In Egypt, it has been noticed that it is infrequent for a hemodialysis (HD) female to start her marriage after initiation of HD; this may be attributed to a negative self-image experienced by the patient and perceived by the community. Moreover, it is also less common for an HD patient to marry another HD partner and it is odd for them to conceive during HD.

Aim: To describe the possibility of starting family and plan for successful pregnancy during the course of HD therapy in patients with ESRD.

Patient Scenario: Our case is a 36 years old Egyptian female who started HD in 1999 and continued on HD for 17 years. She married four times and conceived five times from three husbands. She got live birth only once from her second HD husband, but unfortunately, the baby died within a few days. The patient used Implanon - with its possible side effects- as a method of contraception during her last four years of life. After hectic 17 years under HD and unfortunate marital and fertility events, she decided to withdraw from her dialysis program, chose to live in isolation, and passed away within five days as a consequence of cerebral hemorrhage.

Results and Conclusions: Fertility and successful pregnancies are believed to be possible in HD couples if they receive proper care.

Open Access Letter to the Editor