Abstract BackgroundGraft survival post-kidney transplant may be influenced by APOL1 risk variant status of both donors and recipients. There are several conflicting reports on screening, eligibility and inclusion of APOL1 risk variant testing in the Kidney Donor Risk Index. We aimed to produce a protocol for synthesizing evidence from available data on Apoprotein L1 risk variants and kidney transplantation.METHODS:We developed a search strategy using MeSH, text words and entry terms. Nine databases will be searched: PubMed, Embase, CINAHL, AJOL, Google Scholar, Web of Science, Cochrane Library, Research gate and Scopus. Only observational studies retrievable in the English Language will be included. The primary measurable outcome is the recipient’s post-transplant graft survival time from APOL1 high-risk variant donors. The secondary outcomes are the proportion of APOL1 high-risk variants in End-Stage Kidney Disease requiring a kidney transplant, the proportion in graft recipients and kidney donors; the effect of APOL1 high-risk variant on donor's kidney function post-kidney donation, recipient kidney allograft survival in APOL1 low and high-risk recipients. Deduplication, screening, and selection of identified studies will be done using Covidence software while CMA software version 3 will be used for meta-analysis. All studies will be assessed for methodological, clinical, and statistical heterogeneity. Publication bias will be visually assessed using the funnel plot. Results will be presented in forest plots with pooled survival time, standard error, and variance. Subgroup analysis will be performed using moderators such as socio-demographics: race, age, gender, and socio-economic status; hypertension, HIV status, forms of rejection, and other environmental factors.Discussion: The effect size for the primary outcome is a standardized mean difference in survival time for APOL1 high-risk variants in kidney transplants. The changes in kidney functions of donors and recipients pre and post-transplantation would be examined. The suitability of donors who have APOL1 high-risk variants will be explored in relation to graft survival time, donors' kidney function, and moderating effects of socio-demographic and environmental determinants.Trial Registration Number: This protocol is registered in PROSPERO, with registration number CRD42021230358

Background: Rehabilitation aims to restore and optimize the functioning of impaired systems. It is an integral part of universal health coverage and access to it is a human right for people with disabilities. It is important to identify the key challenges to rehabilitation services in Sub-Saharan Africa (SSA) from a user, health system and service provider perspective Objective: To identify the key challenges to rehabilitation services in Sub-Saharan Africa (SSA) from a user, health system and service provider perspective Methods: This scoping review was conducted in accordance with the five steps framework proposed by Arksey and O'Malley and a comprehensive electronic search was run to identify published articles on rehabilitation services in Sub-Saharan Africa. Of all 131 articles retrieved in the searches, 83 articles were assessed for eligibility and 15 papers met the inclusion criteria were considered Results: The results showed that people with disabilities in Sub-Saharan Africa face multifactorial challenges to access rehabilitation services. Poor access to rehabilitation services is associated with less attention given to rehabilitation by governments which led to less funding, cultural and social beliefs, less and poorly equipped rehabilitation centers, failure of the health systems, lack of trainings to professionals, logistical and financial constraints.This review also revealed that digital rehabilitation reduced costs and improved access to services in hard-to-reach geographical areas. However, it faced connectivity issues, inaccessibility to technology and lack of technical knowledge, lack of privacy and ethical challenges Conclusions: This review concludes that people with disabilities face multifactorial challenges to access rehabilitation services in SSA. It is therefore critical to address these challenges to optimize patients’ health outcomes and offer better rehabilitation services.

Abstract Background: S. aureus is a skin and mucosal bacterial commensal of both humans and animals which has evolved as an important pathogen implicated to cause various infections. High levels of antibiotic use have resulted into multi-drug resistance MRSA, especially among HA-MRSA, CA-and LA - MRSA. Awareness on coexistence and diversity of MRSA clones among humans and household Livestock particularly cattle and swine in our region is limited. We used spa typing method to determine spa diversity, distribution and coexistence in outpatients, household contacts and respective livestock (cattle and swine) in Kabale region, south western Uganda. Methods: This was a cross sectional study by design consisting of outpatients, household contacts and livestock. Outpatients (n =100) colonized with MRSA were traced back to their respective homesteads where household members, domestic cattle, and, swine were tested for S. aureus and subsequently MRSA colonization. High-resolution DNA melting analysis was used to determine spa types among MRSA isolates. Overlap of MRSA isolates among humans and livestock was based on the presence of similar spa types.Results: A total of 3371 S.aureus isolates were collected from outpatients (n =376), household contacts (n = 1531), Cattle (n = 1159) and Swine (n = 305), among which 482 had mecA gene where 27% (100/376) and 8% (123/1531) were outpatients and household contacts respectively while 11% (132/1159) and 42% (127/305) were cattle and swine respectively. Twenty different spa types were identified; t034, t4677, t108, t1451, t9377, t1081, t040, t701, t041, t002, t044, t037,t121, t127, t922, t032, t019, t018, t012 and t030, among which t034 (109/482), t4677 (53/482), t9377 (63/482) and t1081 (53/482) were most prevalent and distributed among human and livestock. All the MRSA isolates were multidrug resistant to antibiotics tested. Conclusion: In Kabale region, there is high diversity of spa types among MRSA. Presence of similar spa types was found circulating among humans and their respective livestock which demonstrates a possible bidirectional transmission. Presence of MDR - MRSA highlights the need for effective prevention and control of MRSA among livestock and in the community using One Health approach.

Background Traditional medicine is commonly used in low- and middle-income countries (LMICs). Little is known about the use of traditional medicine among women undergoing cesarean section (c- section) and the association to surgical site infections (SSIs) in LMICs. In this study, we describe peripartum use of traditional medicines and the risk of SSIs among women delivering via c-section in rural Rwanda. Methods This prospective cohort study enrolled women who underwent c-section at Kirehe District Hospital in rural Rwanda between September 2019 and February 2020. We collected self-reported data regarding traditional medicine use before and during pregnancy and after discharge up to postoperative day (POD) 11. On POD 11 (+/- 3 days), the women returned to the hospital for a study follow-up visit. We used Fisher’s exact test to assess the relationship between sociodemographic characteristics and traditional medicine use, and logistic regression to determine the association between traditional medicine use and SSI development while controlling for confounders. Results Of the 841 women enrolled in this study, 45 (5.4%) reported using traditional medicine to get pregnant. Nearly 39% used traditional medicine during pregnancy; the majority (96.9%) for a pregnancy-related reason. Only four women (0.5%) reported traditional medicine use between c- section and the POD 11 study visit. Of the 775 women who responded at all time-points, 341 2 (44.0%) reported using traditional medicine at some point during pregnancy or c-section recovery. No demographic characteristics were significantly associated with traditional medicine use (p>0.05), except for smoking (p=0.048) and alcohol consumption (p=0.010). Both traditional medicine use during pregnancy (p=0.04, aOR=2.0, 95% CI: 1.05, 3.85) and at any time point (p=0.04, aOR=2.0, 95% CI: 1.04, 3.83) were associated with development of SSI. Conclusions Traditional medicine use among c-section patients was high in the peripartum period, particularly during pregnancy, and was significantly associated with SSI. Knowing patterns of traditional medicine use during the peripartum period can help providers collaborate with traditional healers and give appropriate, culturally-sensitive pregnancy and postoperative care and counseling to patients.

Abstract Background The implementation of simulation-based learning for surgical training in sub-Saharan Africa can help prepare trainees to address surgical burden. The current status of simulation for surgical skills training in undergraduate medical education in Africa South of the Sahara needs to be better defined. In this scoping review we aimed to identify gaps in the application of simulation to undergraduate surgical education in sub-Saharan Africa. Methods We conducted a scoping literature search using PubMed, Embase, and African Index Medicus in August 2021. Studies reporting data on the use of simulation-based learning for undergraduate or internship surgical training in SSA specific to surgical clerkships, programs or procedures were included in the analysis. There were no language or date restrictions. Results We identified 119 studies and included 19 in the final analysis. Most simulation-based learning for undergraduate surgical training in sub-Saharan Africa began recently (2017–2021), and were reported from Eastern Africa (78%). Half were planned as recurring, sustained simulation programs, and only 25% of programs applied simulation to early undergraduate training. Up to 44% of primary care and 32% of first-level hospital essential surgical procedures, as defined by the Disease Control Priority Program (DCP3), are reported as taught by simulation. Only 15% of programs taught non-technical skills and 14% had engineering collaborations. Conclusions We found a lack of published simulation-based learning for undergraduate medical education in sub-Saharan Africa for 65% of World Health Organization/World Bank Disease Control Priorities 3-defined essential operations. There is need to expand the range and depth of content, and participant spread. Interdisciplinary, trans-sectoral collaboration will enrich simulation program quality, and assist with expansion to other African regions.