Emmanuel E. Effa

University of Calabar | unical · Department of Internal Medicine

Background Fenoldopam is a short‐acting benzazepine selective dopaminergic A1 (DA1) receptor agonist with increased activity at the D1 receptor compared with dopamine. Activation of the DA1 receptors increases kidney blood flow because of dilatation of the afferent and efferent arterioles. Previous reviews have been published on the efficacy and s...

Among all nephropathies, diabetic kidney disease (DKD) is the most common cause of kidney impairment advancement to end-stage renal disease (ESRD). Although DKD has no cure, the disease is commonly managed by strict control of blood glucose and blood pressure, and in most of these cases, kidney function often deteriorates, resulting in dialysis, ki...

Problem Many national child health guidelines in Malawi, Nigeria and South Africa are outdated and score poorly on rigorous methods and stakeholder participation. Approach In line with the World Health Organization’s (WHO) emphasis on local guideline contextualization, the Global Evidence-Local Adaptation (GELA) project supported multistakeholder...

Background Poverty-related diseases (PRD) remain amongst the leading causes of death in children under-5 years in sub-Saharan Africa (SSA). Clinical practice guidelines (CPGs) based on the best available evidence are key to strengthening health systems and helping to enhance equitable health access for children under five. However, the CPG developm...

There is a need to constantly assess the awareness, treatment, and control of hypertension in Nigeria. This study determined the frequency of undiagnosed hypertension across the six geopolitical zones of Nigeria. We conducted an opportunistic screening of adults aged at least 18 years in the month of May 2021. Participants were recruited by trained...

Background The Global Evidence, Local Adaptation (GELA) project aims to maximise the impact of research on poverty-related diseases by increasing researchers’ and decision-makers’ capacity to use global research to develop locally relevant guidelines for newborn and child health in Malawi, Nigeria and South Africa. To facilitate ongoing collaborati...

Background Sub-Saharan Africa is the region with the highest under-five mortality rate globally. Child healthcare decisions should be based on rigorously developed evidence-informed guidelines. The Global Evidence, Local Adaptation (GELA) project is enhancing capacity to use global research to develop locally relevant guidelines for newborn and chi...

Background Well‐conducted systematic reviews contribute to informing clinical practice and public health guidelines. Between 2008 and 2018 Cochrane authors in sub‐Saharan Africa were publishing progressively fewer Cochrane Reviews, compared to non‐Cochrane reviews. The objective of this study was to determine what motivated trained Cochrane authors...

Background Sepsis is a leading cause of morbidity and mortality especially in low- and middle-income countries such as Nigeria. Training of health workers using digital platforms may improve knowledge and lead to better patient outcomes. Objectives To assess the effectiveness of a digital health educational module on sepsis in improving the knowle...

Background Low and middle-income countries remain disproportionately affected by high rates of child mortality. Clinical practice guidelines are essential clinical tools supporting implementation of effective, safe, and cost-effective healthcare. High-quality evidence-based guidelines play a key role in improving clinical management to impact child...

The global increase in the frequency of infectious-disease epidemics has rekindled interest in the role of disruption of the human–animal–environment interface by human activities in propagating disease outbreaks. It is estimated that zoonotic diseases account for >75% of emerging infectious diseases. Human modifications to the environment via agri...

Patients admitted to hospital for cerebrovascular accident are at a high risk of developing acute kidney injury (AKI) because of comorbid conditions, and other potential risk factors, such as exposure to nephrotoxic medications, dehydration or utilization of hypertonic crystalloid solutions. This study, therefore aims to determine the risk factors...

Patients admitted to hospital for cerebrovascular accident are at a high risk of developing acute kidney injury (AKI) because of comorbid conditions, and other potential risk factors, such as exposure to nephrotoxic medications, dehydration or utilization of hypertonic crystalloid solutions. This study, therefore aims to determine the risk factors...

Background Immunisation plays a major role in reducing childhood morbidity and mortality. Getting children immunised against potentially fatal and debilitating vaccine‐preventable diseases remains a challenge despite the availability of efficacious vaccines, particularly in low‐ and middle‐income countries. With the introduction of new vaccines, th...

Importance Overuse of surgical procedures is increasing around the world and harms both individuals and health care systems by using resources that could otherwise be allocated to addressing the underuse of effective health care interventions. In low- and middle-income countries (LMICs), there is some limited country-specific evidence showing that...

Background Malaria remains a major public health concern in The Gambia. The study assessed the trend of malaria admissions and outcome of adult patients admitted after the start of the COVID-19 pandemic in a tertiary hospital in The Gambia. Methods This was a retrospective hospital-based study and data was collected from the 18th October 2020 to 2...

There is a paradigm shift towards adopting a multidisciplinary team (MDT) model in the care of cancer patients, with increasing evidence to support its effectiveness. Cancers are biologically distinct, patients present in diverse ways and require, different therapeutic approaches in their management. Patient symptoms and treatment side-effects as w...

Background Human resources for health (HRH) shortages are a major limitation to equitable access to healthcare. African countries have the most severe shortage of HRH in the world despite rising communicable and non-communicable disease (NCD) burden. Task shifting provides an opportunity to fill the gaps in HRH shortage in Africa. The aim of this...

Background Community screening for chronic kidney disease has often been based on single measurements of markers of kidney damage worldwide. The evaluation of kidney dysfunction and related risk factors may be facilitated by the deployment of telehealth services such as short message service. Methodology Cross-sectional study for screening partici...

Introduction: The burden of chronic kidney disease (CKD) is rising in sub-Saharan Africa. Access to kidney replacement therapy (KRT) remains limited and modelling suggests a significant hidden burden of kidney failure managed without KRT. Kidney failure is contributing to serious health-related suffering (SHS) at a global level. Despite this, acces...

Background Low and middle-income countries remain disproportionately affected by high rates of childhood mortality, often caused by preventable conditions. Clinical practice guidelines (CPGs) are essential policy tools in supporting implementation of effective, safe, and cost-effective healthcare. High-quality evidence-based CPGs play a key role in...

Objective: To identify and summarize the evidence about the extent of overuse of medications in low- and middle-income countries, its drivers, consequences and potential solutions. Methods: We conducted a scoping review by searching the databases PubMed®, Embase®, APA PsycINFO® and Global Index Medicus using a combination of MeSH terms and free...

Background Malaria is a major public health concern in The Gambia. There is limited data on the clinical manifestation and outcome of severe malaria in adult patients in The Gambia. The study therefore assessed the clinical manifestations and outcome of severe malaria in adult patients admitted at the Edward Francis Small Teaching Hospital. Method...

Probiotic-based multi-component preparations refer to a mixture of bioactive agents, containing probiotics or postbiotics as main functional ingredients, and prebiotics, protectants, stabilizers, encapsulating agents, and other compounds as additional constituents.

Objective To pilot the use of a scalable innovative mobile health (mHealth) non-communicable diseases (NCDs) training application for nurses at the primary care level. Design Mixed methods pilot of mHealth training on NCD care for nurses at primary healthcare (PHC) facilities. We provide a descriptive analysis of mHealth training test scores, with...

Probiotics and related preparations, including synbiotics and postbiotics, are living and non-living microbial-based multi-components, which are now among the most popular bioactive agents. Such interests mainly arise from the wide range and numerous beneficial effects of their use for various hosts. The current minireview article attempts to provi...

Delivery of kidney care in Africa is significantly constrained by various factors. In this review, we used International Society of Nephrology–Global Kidney Health Atlas (ISN–GKHA) data for Africa to address sub-regional differences in care delivery in the continent with focus on infrastructure, workforce, and the economic aspects of kidney care. F...

Introduction Sepsis is a leading cause of morbidity and mortality worldwide. In low- to middle-income countries (LMICs) such as Nigeria, the disproportionately high mortality rate is linked to lack of awareness, poor recognition, and late implementation of sepsis care bundles among health workers. Training of health workers using digital platforms...

Background The burden of hepatitis B and hepatitis C virus (HBV, HCV) infection is exceptionally high in sub-Saharan Africa (SSA). Many countries in the SSA region are classified as hyperendemic for HBV by the World Health Organization (WHO), with West Africa being most affected. Data from the WHO suggest that Africans infected with hepatitis virus...

Sickle cell disorder (SCD) is a multisystem disease with heterogeneous phenotypes. Although all patients have the mutated hemoglobin (Hb) in the SS phenotype, the severity and frequency of complications are variable. When exposed to low oxygen tension, the Hb molecule becomes dense and forms tactoids, which lead to the peculiar sickled shapes of th...

Background Decisions on whether to screen for chronic kidney disease (CKD) or not remains contentious in nephrology. This study provides a global overview of early CKD identification efforts. Methods Guidelines for scoping reviews were followed and studies were identified by searching Medline, Embase, Cochrane Library, CINAHL, ISI Web of Science a...

The increasing global human population is projected to reach 9.7 billion people by 2050. This population growth is currently linked to the trends of world-wide urbanization, growth of megacities and shifting dietary patterns. While humankind faces the daunting challenge of feeding and providing healthy lives for its teeming populations, urban agric...

Feasibility of personalized medical care for patients with sickle cell anaemia using a lab-on-chip microfluidic platform to mimic and unravel components of vaso-occlusive crisis. Abstract: Sickle cell disorder (SCD) is a multisystem disease with heterogeneous phenotypes. Although all patients have the mutated haemoglobin (Hb) in the SS phenotype, t...

The increasing global human population is projected to reach 9.7 billion people by 2050. This population growth is currently linked to the trends of worldwide urbanization, growth of megacities, and shifting dietary patterns. While humankind faces the daunting challenge of feeding and providing healthy lives for its teeming populations, urban agric...

Background: The Bacille Calmette-Guérin (BCG) vaccine, given as a single dose, offers variable protection against Tuberculosis (TB). It is plausible that repeat doses could improve the effectiveness of the BCG vaccine in settings where the population remain at risk of the disease. Objective: To assess the effectiveness of BCG revaccination as a bo...

Introduction Cochrane Africa ( https://africa.cochrane.org/ ) aims to increase Cochrane reviews addressing high priority questions in sub-Saharan Africa (SSA). Researchers residing in SSA, despite often drawing on Cochrane methods, training or resources, conduct and publish systematic reviews outside of Cochrane. Our objective was to investigate th...

Background: Health worker training is an essential component of epidemic control; rapid delivery of such training is possible in low-middle income countries with digital platforms. Methods: Based on prior experience with the Ebola outbreak, we developed and deployed a bespoke InStrat COVID-19 tutorial app, to deliver accurate and regularly updated...

Abstract Background: As part of the Global Action Plan against antimicrobial resistance (AMR), countries are required to generate local evidence to inform context-specifc implementation of national action plans against AMR (NAPAR). We aimed to evaluate the knowledge, attitude, and practice (KAP) regarding antibiotic prescriptions (APR) and AMR a...

Urbanization, armed confict, and deforestation in African countries have increased the risk of zoonotic infections, which requires a One Health approach focused on the environment, animal health and human health. This approach facilitates the assessment of risks from the human-animal-environment interface. Only by fully implementing One Health appr...

Background: As part of the Global Action Plan against antimicrobial resistance (AMR), countries are required to generate local evidence to inform context-specific implementation of national action plans against AMR (NAPAR). We aimed to evaluate the knowledge, attitude, and practice (KAP) regarding antibiotic prescriptions (APR) and AMR among physi...

Background: Globally, one of the major problems facing health systems is an acute deficit of health workforce. To ensure equitable distribution and deployment of health workers, up-to-date and timely information on the health workforce is vital. Health workforce registries (HWRs) have the potential to generate data for evidence-based human resourc...

Background: Many low- and middle-income countries (LMICs) are facing a crisis of human resources for health (HRH) attributed to poor governance and leadership that characterizes the health sector in this setting. It is unclear which specific strategies are effective in ameliorating the crisis. Methods: Selected electronic databases were searched...

Mobile health (mhealth) tools delivered through wireless technology are emerging as effective strategies for delivering quality training, ensuring rapid clinical decision making, and monitoring implementation of simple and effective interventions in under-resourced settings. We share our early experience of developing and deploying the InStrat COVI...

Across Africa, there is some evidence of COVID-19 private sector activities to tackle COVID-19 which include the development of rapid diagnostic kits, deployment of e-health platforms for bespoke health workforce training, disease surveillance, reporting, auto-screening and advisories. Inequities in living and access to care by disadvantaged popula...

The practice of Nephrology in Nigeria dates back to the 1960s when the country gained independence from the UK. The University College Hospital (UCH) in Ibadan, as a college of the University of London, had the first recognised Nephrology unit. Several other units have been established over the years countrywide in federal, state and private instit...

Background As part of the Global Action Plan against antimicrobial resistance (AMR), countries are required to generate local evidence to inform context-specific implementation of national action plans against AMR (NAPAR). We aimed to evaluate the knowledge, attitude, and practice (KAP) regarding antibiotic prescriptions (APR) and AMR among physici...

Background and Objectives The World Health Organization estimates that 2 million health-care workers (HCWs) are at risk of occupational exposure to hepatitis B virus (HBV), with the majority (90%) of such infections arising in sub-Saharan Africa. This study aimed to determine HBV knowledge and vaccination uptake among HCWs. Materials and Method Th...

Context: Access to chronic hemodialysis for patients with end-stage kidney disease has improved over the years. However, it is unclear if this has resulted in lower cost and improved dialysis vintage. Aim: We aimed to assess the demographics, cost implication, and sustainability of maintenance hemodialysis in our cohort of end-stage kidney disea...

The coronavirus disease 2019 (COVID-19) is now a pandemic with devastating social and economic consequences. The extent of the spread of COVID-19 within populations is uncertain since diagnostic tests have not been carried out on all eligible persons and doing such diagnostic tests on everyone is much less feasible in developing countries such as N...

Rationale & Objective Recent studies in the human immunodeficiency virus (HIV)-infected population have suggested that there are genetic predispositions to the development of chronic kidney disease (CKD) in this context. We investigated the association of genetic polymorphisms of the genes encoding apolipoprotein L1 (APOL1), transforming growth fac...

Objectives The International Society of Nephrology (ISN) has called for zero deaths by 2025. This survey aimed to determine the preparedness of Southern African Development Community (SADC) countries and Nigeria to heed this call.SettingA questionnaire was emailed to facilities, where renal replacement therapy is available; to determine type of ser...

Priority setting to identify topical and context relevant questions for systematic reviews involves an explicit, iterative and inclusive process. In resource-constrained settings of low-income and middle-income countries, priority setting for health related research activities ensures efficient use of resources. In this paper, we critically reflect...

Background: In 2011 the World Health Organization (WHO) recommended parenteral artesunate in preference to quinine as first-line treatment for people with severe malaria. Prior to this recommendation many countries, particularly in Africa, had begun to use artemether, an alternative artemisinin derivative. This Cochrane Review evaluates intramuscu...

Introduction: Haemodialysis (HD) which is a form of renal replacement therapy commonly prescribed for patients with chronic kidney disease (CKD). However, it is not without deleterious haemodynamic responses which may occur either during or immediately after the termination of the procedure. These may include hypotension or hypertension. Methods:...

Background: The burden of the people living with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS) is largely borne by communities in Sub-Saharan Africa. The rate of kidney disease is increasing amongst HIV patients and occurs more often in patients with advanced stage of the disease with lower CD4 count...

Background: The Cochrane Africa Network (CAN) aims to conduct relevant reviews informing healthcare decisions in sub-Saharan Africa. In 2017 the Network’s Hubs engaged evidence users to conduct priority setting. From the topics identified, we scoped the literature identifying gaps for new review topics. Objectives: To describe CAN Hubs' methods f...

Background: To a large extent, Africa - especially sub-Saharan African countries - bears most of the global burden of both communicable and non-communicable diseases. Therefore, it is important to set priorities for systematic reviews of interventions for identified priority conditions, so that scarce and limited resources can be allocated where th...