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   Table of Contents - Current issue
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September-December 2020
Volume 13 | Issue 3
Page Nos. 175-265

Online since Monday, October 5, 2020

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EDITORIAL  

Chest computed tomography in relation to reverse-transcription polymerase chain reaction in diagnosis of coronavirus disease 2019 Highly accessed article p. 175
Rajendra B Nerli, Shridhar C Ghagane
DOI:10.4103/kleuhsj.kleuhsj_276_20  
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REVIEW ARTICLE Top

Biochemical features of blood vessel extracellular calcium-sensing receptor and their physiological mechanism of action in the regulation of vascular tone and blood pressure p. 178
Leta Melaku, Lemma Amsalu
DOI:10.4103/kleuhsj.kleuhsj_94_20  
The extracellular calcium-sensing receptor (CaR) is a G protein coupled receptor superfamily that has ability to sense very small changes in extracellular Ca2+ with primary physiological function of maintenance of constant blood Ca2+ levels. In addition to being expressed in tissues involved in [Ca2+]o homeostasis, it is also expressed in tissues not involved in mineral homeostasis, suggestive of additional physiological functions such as control vasomotor tone and blood pressure. However, the exact cellular mechanisms involved in these responses remain unclear. Stimulation of CaRs on perivascular nerves is proposed to evoke synthesis and release of nitric oxide (NO) from pre-synaptic terminals, which activate large conductance Ca2+-activated K+ channels in adjacent VSMCs that induce membrane hyperpolarisation and subsequent vasorelaxation. Plus, activation of CaRs on endothelial cells is reported to generate NO or vasoactive lipids or induce activation of intermediate conductance Ca2+-activated K+ channels to induce vasorelaxations. In contrast, CaR-induced activation of Gq and MAPK kinase-mediated pathways in VSMCs are linked to vasoconstriction and cell proliferation respectively. Taken together, these findings indicate that stimulation of vascular CaRs is reported to induce both constrictions and relaxations. In the endothelium intact artery, CaR mediated vasorelaxations are the dominant physiological phenomenon.
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ORIGINAL ARTICLES Top

Perspective of medical students on online teaching-learning process during COVID-19 pandemic Highly accessed article p. 197
Pradnya Shree Dhotre, Abdul Kayyum Shaikh, Shree Vinayak Dhotre
DOI:10.4103/kleuhsj.kleuhsj_235_20  
Context: In India, responses to the COVID-19 pandemic in medical education resulted in closures of medical colleges and adoption of online teaching-learning methods, which is challenging for both faculty and students. Aim and Objectives: The aim of this study is to know the perspectives of medical students on online teaching-learning method and to evaluate the efficacy of online teaching-learning process. Subjects and Methods: One hundred students of the first MBBS course were included in the study. The present study was conducted in a form of online survey using Google forms. Results: A total of 97 students participated willingly in the study, among the participants 56% were satisfied, 32% remained neutral, and 12% were dissatisfied regarding class curriculum. Student's feedback on knowledge gained through online methods was that, 59% students felt to be useful; however, 41% felt to be not enough. When finally, the student's responses on the comparison of online teaching learning method versus traditional teaching-learning methods were obtained, it was observed that majority 75% felt that traditional teaching-learning methods are better; whereas 17% felt online classes may be better and 8% felt online methods are excellent. Conclusion: Online teaching is beneficial, but students prefer traditional teaching-learning method over it. However, in view of the current situation, students by and large have accepted the online teaching-learning method with a greater goal of gaining knowledge.
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Use of mask at public places among health care professionals following COVID-19 postquarantine period in Southern Haryana, India p. 202
Abhishek Singh, Ram Kumar Panika, Vikas Gupta, Pawan Kumar Goel
DOI:10.4103/kleuhsj.kleuhsj_245_20  
Introduction: The instances of social stigma and violence against health care worker was already prevalent but during COVID-19, such instances have reached its peak. So, this global health crisis of COVID-19 pandemic offers a unique opportunity to investigate the level of perceptions and practices regarding use of mask or personnel protective equipment (PPE) in public places amongst health care professionals following COVID-19 postquarantine period. Materials and Methods: The study included 100 health care personnel working in COVID-19 outpatient and wards as participants who have completed their quarantine period after being sent on quarantine at home/hostels or state-run facilities during the 3rd week of June 2020. After obtaining informed consent from participants, a structured questionnaire was used to collect the data. All the tests were performed at significance level of 5%. Results: More than two third of the participants (69.0%) were using mask/PPE at all in public places. Around two third of participants were willing to wear mask/PPE in public places like local markets/street (64.0%); bus/train/flight (74.0%); institution/college (61.0%) and malls/shopping complex (73.0%). Only 58.0% of study participants were having overall good perception score for wearing mask/PPE. Conclusions: The present study made an attempt to find out the perceptions and practices of health care personnel regarding mask/PPE use while they are in public place and it was observed that perception and practices were not satisfactory in this regard. The need of hour is psychological support for health care workers to overcome such stigma fear and the findings might help local administration to enhance that support.
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Barefoot nurse project: A micro-entrepreneurship health model for universal access to the screening of diseases, ensuring self-sustainability in India p. 208
TN Sathyanarayana, Biswamitra Sahu, Achala Gopalkrishna Pai, PV Vivekananda, Avishek Hazra
DOI:10.4103/kleuhsj.kleuhsj_109_20  
Context: There is still a substantial service gap in India, especially in preventive screening and referral of noncommunicable diseases. There is a growing evidence supporting the role of community health workers (CHWs) in screening diseases and their effectiveness in averting noncommunicable diseases. Aim: The aim of this article is to describe a model of CHW-barefoot nurse (BFN) (concept, design, recruitment, training, services, products, and evaluation) and share some initial findings. Setting and Design: This study was implemented in seven locations (Doddaballapura, Nelamangala, Magadi, Bidar, Aland, Hadagali, and Aurad) of Karnataka. Materials and Methods: The model of BFN, design, intervention development, and implementation is carefully documented and elaborated in this article. Statistical Analysis Used: The preliminary findings of the intervention were analyzed using descriptive statistics. Results: The concept of BFN model is a preventive health delivery model where local women from the community get trained with skillsets required for screening several diseases and provide health promotion products at the doorstep of the community. BFNs are young (25–45), from community, completed basic education (10–12 years), digitally literate, and speak local language. Self-sustainability is embedded in the model as it ensures that the BFN earns livelihood from their services by charging a nominal fee with no investment, just using a kit donated by philanthropic organizations. The screened beneficiaries of BFN suggest relatively higher prevalence of hypertension (22.2%) than diabetes (14%). The female beneficiaries and those in the younger age group are relatively more hypertensive. Conclusion: There is high acceptability of the BFNs reflected from the screened number reflecting the willingness of the community to pay a nominal fee for the BFN services. This study has generated evidence supporting self-sustainable model of funding CHW which is crucial in improving access and strengthening the health system in India.
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Herpes zoster oticus among pediatric patients: Our experiences at a tertiary care teaching hospital p. 215
Santosh Kumar Swain, Jasashree Choudhury, Satyabrata Acharya
DOI:10.4103/kleuhsj.kleuhsj_100_20  
Introduction: Herpes zoster oticus (HZO) occurs due to the reactivation of the varicella zoster virus (VZV) in the geniculate ganglion of the facial nerve. It is characterized by erythematous vesicular eruptions on the pinna and external auditory canal with severe otalgia. When it is associated with ipsilateral facial nerve paralysis, a diagnosis of Ramsay Hunt syndrome (RHS) can be made. It is rare in the pediatric age group but with low immunity, so prone for increased risk of disseminated infections, neurological complications, and recurrence of infections. Objective: The aim of this study was to evaluate the clinical profile and management of the HZO among pediatric patients at a tertiary care teaching hospital. Materials and Methods: In this prospective study, 24 pediatric patients of HZO were reviewed those presented during the period of December 2015–January 2020. All pediatric patients underwent thorough clinical examinations before getting the diagnosis. All the participants also underwent thorough neuro-otological and otolaryngological examinations. Results: Out of 24 pediatric patients, 15 were boys and 9 were girls. All were in the pediatric age group with age ranging from 5 years to 16 years. After the diagnosis of HZO/RHS, all were treated with acyclovir for 10 days along with tapering dose of deflazacort, labyrinthine sedatives, and eye care in case of facial palsy. All the pediatric patients were recovered by our treatment protocol except 3 cases those are still in follow-up with facial weakness. Conclusions: Adequate awareness for the HZO in pediatric patients is required, and the management of RHS patients is paramount among pediatrician or pediatric otorhinolaryngologists.
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How physically active are women in the third trimester of pregnancy? A cross-sectional study of physical activity in pregnancy and its outcomes among women delivering at a rural maternity hospital in South India p. 221
Madonne Rufina Dishani, Avita Rose Johnson, Merlyn Joseph, Manisha James, Preeti Lakra, Naveen Ramesh
DOI:10.4103/kleuhsj.kleuhsj_147_20  
Background: Physical activity influences perinatal outcomes. Moderate-intensity aerobic activity of 150 min/week during pregnancy is recommended. Objective: This study aimed at assessing the physical activity levels during pregnancy and determining the factors associated with physical activity among rural women. Methods: This was a cross-sectional study conducted in a rural maternity hospital, in a village in Ramanagara district located in the south of Karnataka among pregnant women >29 weeks of gestation and newly delivered mothers availing obstetric services at the hospital. A structured questionnaire with sociodemographic characteristics, pregnancy details, and neonate details was used. International Physical Activity Questionnaire Short Form was used for measuring physical activity. Physical activity was classified as low, moderate, and high intensity by calculating metabolic equivalent minutes per week based on the Compendium of Physical Activities. Results: Among the 158 study participants, 113 were antenatal women and 45 had just delivered. The mean age of the study participants was 23.31 ± 3.14 years and the mean weight gain per week was 0.35 ± 0.11 kg. About 96% of the subjects had high-intensity physical activity while 4% had moderate-intensity physical activity. Women from nuclear families and older mothers had significantly high physical activity. Women with high-intensity physical activity were significantly more likely to deliver a low birth weight baby in the early neonatal period. Conclusion: Being a rural area, majority of the pregnant mothers had high-intensity level of physical activity, which was significantly associated with lower birth weight among neonates. It is recommended to avoid high-intensity physical activity during pregnancy and focus advice on moderate physical activity for pregnant women.
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Otologic cause of giddiness in a tertiary hospital: Our experience p. 226
Soumick Ranjan Sahoo, Mandira Sarma
DOI:10.4103/kleuhsj.kleuhsj_160_20  
Context: Giddiness affects a large percentage of population at any time. It also forms a large part of patient group attended by neurologists, cardiologists, and also commonly referred to otolaryngology clinics. Among otologic causes, those commonly regarded are benign paroxysmal positional vertigo (BPPV), Ménière's disease, Labyrinthitis, and Vestibular neuronitis. Aim: The aim is to study the proportion of patients of vertigo referred to ear, nose, and throat (ENT) Outpatient Department (OPD), having otologic cause of vertigo and to study common causes of otologic cause of vertigo. Settings and Design: Prospective observational study. Subjects and Methods: A data was recorded for 125 subjects above the age of 15 years, complaining for vertigo, presenting to ENT OPD of a tertiary care center from January 2019 to January 2020. A thorough detailed history was taken from all patients. Otology and oto-neurological examination was thoroughly done. Computed tomography scan/magnetic resonance imaging kept reserved only for those patients in whom there is a suspicion of cerebellopontine angle tumor or stroke. Based on these batteries of tests a diagnosis of otologic cause of vertigo was made. All the findings were recorded into a Data sheet. Results: The result it was found that 28.8% of the patients (total 36) who complained of vertigo had an otologic cause for it. From the tests conducted, BPPV occurred as the most common cause (23.2%). Others were vestibular neuronitis (3.2%) and labyrinthine causes (1.6%) Meniere's disease (0.8%). The maximum affected age group was from 41 to 60 years and frequency of females was reported to be higher than males. Conclusion: The result of this study draws our attention to the causes of vertigo that are from otologic disease. This information can also be used for awareness amongst physicians and the general practitioners around this hospital for referring vertigo cases to ENT OPD.
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Effect of tamoxifen-loaded transdermal patch on physical and biochemical parameters in DMBA-induced breast cancer p. 230
Anjana Adhyapak, BG Desai
DOI:10.4103/kleuhsj.kleuhsj_38_20  
Background: The current study assessed the effect of tamoxifen-loaded transdermal patch in Dimethylbenz(a)anthracene (DMBA)-induced breast cancer. Materials and Methods: Different formulations composed of various concentrations of tamoxifen citrate, poly (SA: RA), glucose, mannitol were formulated and were evaluated in DMBAinduced breast cancer in female albino Wistar rats. Multiple parameters such as body weight, hemoglobin content, red blood cell, white blood cell, SGPT, and SGOT were evaluated. Results: Treatment with formulations showed a decrease in body weight contrast to disease. Equally, a considerable increase in hemoglobin was observed in the formulation treated group over disease grouping. Likewise, there decrease in SGPT and SGOT in formulation compared to disease. Conclusion: The present study revealed a transdermal patch loaded with tamoxifen showed promising antitumor activity.
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Evaluation of sleep-disordered breathing by level 1 polysomnography in a tertiary care hospital p. 235
Anusha Chittapur Madhusoodan, Gajanan S Gaude, Bhagyashri Santosh Patil, Jyothi Hattiholi
DOI:10.4103/kleuhsj.kleuhsj_14_20  
Background: Sleep Disordered Breathing has become one of the primary causes of mortality in especially obese individuals owing to the modern lifestyle Material and methods: 60 patients coming to outpatient clinic of a tertiary care hospital with Epworth sleepiness scale between 8 to 24 representing increasing levels Results: There were 60 (34 males and 26 females) subjects with mean age 56.45±12.51years and BMI 28.7±3.1. 16, 9, 22 subjects had mild, moderate Conclusions: OSA predominantly affects middle aged men who are overweight with many having high neck circumference. Severe OSA patients had longer.
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Comparison of octenidine wound gel versus povidone-iodine dressing in healing of chronic diabetic foot ulcers: A randomized controlled trial for period of 1 year p. 240
Sreenivasa Reddy Guddety, Basavaraj M Kajagar
DOI:10.4103/kleuhsj.kleuhsj_25_20  
Context: Octenidine is an antiseptic known for the past 20 years. Very few clinical studies have been done in evaluating the advantages of octenidine. Specific characters of no anti microbial resistance, good host tissue tolerability and very few clinical studies made us to conduct this study. Aims: To compare octenidine wound gel dressing versus povidone-iodine (PVI) dressing in healing of chronic diabetic foot ulcers (DFUs) in terms of mean percentage reduction in the ulcer area. Settings and Design: A randomized controlled study was conducted at a tertiary care hospital in North Karnataka between January 2018 and December 2018. Subjects and Methods: Eighty cases of chronic DFU were selected and randomized (sequentially numbered, opaque-sealed envelopes technique) into two groups – Group A: octenidine dressing done and Group B: PVI dressing done for 14 days. The wound healing was calculated as the mean percentage reduction in the ulcer area. The wound healing was then compared between two groups. Statistical Analysis Used: Student's unpaired t-test and Chi-square test were used for analysis. Results: Ulcer healing was early in Group A compared to Group B; the mean percentage reduction in the ulcer area was 25.51 ± 9.26 and 14.48 ± 6.54 sq.cm in Group A and Group B, respectively (P < 0.001). Conclusions: Octenidine wound gel has shown good progress of ulcer healing in terms of ulcer area reduction compared to PVI dressing.
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Anaemia among adolescents: A community-based study using cluster sampling in villages under Sarjapur Primary Health Centre, Bangalore urban district Highly accessed article p. 244
Avita Rose Johnson, Cency Baburajan, T Sulekha
DOI:10.4103/kleuhsj.kleuhsj_253_20  
Background: India has the largest adolescent population in the world, the majority of whom reside in rural areas. Anemia is one of the top five causes of morbidity among adolescents. Objective: To assess the prevalence of anemia and its associated factors among adolescents aged 10–19 years residing in a rural area. Methods: Community-based, cross-sectional study in 25 villages and one town under Sarjapur Primary Health Centre (PHC), Bangalore Urban District. Two-staged cluster sampling was done. The interview schedule for sociodemographic details, diet, and physical activity was administered. Nutritional status was estimated by body mass index-for-age. Hemoglobin (Hb) was estimated using photometric analyzer. Chi-square test was done for the association between anemia (Hb <12 g/dl) and independent co-variates. Results: Of 210 adolescents, 48.1% had anemia, most were mild anemia. No significant association found between anemia and sociodemographic factors such as age, gender, and socioeconomic status or nutrition status, diet, and physical activity. None of the anemic adolescents were investigated or treated for anemia before. None of the subjects were aware of adolescent-friendly health services at the PHC. Conclusion: Nearly half of adolescents in this rural area were anemic. In addition to on-going Weekly Iron and Folic Acid Supplementation for the prevention of anemia and bi-annual deworming, there is a need for routine screening and treatment of anemia in schools, and follow-up of school drop-outs at household level by auxiliary nurse midwife (ANM). Community-level workers like Accredited Social Health Activist, ANM, and Anganwadi worker must create awareness regarding available adolescent services, treat anemia with iron and folic acid tablets and focus on counseling adolescents to promote healthy eating habits and iron-rich foods.
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CASE REPORT Top

High creatine kinase-muscle brain levels greatly exceeding total creatine kinase levels in a 2-month-old infant p. 250
Vatsala Khurana, Elvia Jamatia, Reena Rani, Binita Goswami
DOI:10.4103/kleuhsj.kleuhsj_31_20  
The measurement of creatine kinase muscle brain (CK-MB) by the method of immunoinhibition has various drawbacks, which are posing as a hindrance in its role as a sensitive diagnostic indicator. A 2-month-old infant presented with symptoms of difficulty in breathing and cough. A chest X-ray done showed an incidental finding of a cardiac anomaly, and ultrasonography cranium showed a well-defined cystic lesion seen in the frontal horn of the bilateral lateral ventricle and signs of a resolving hemorrhage. The CK-MB level (761U/L) was greatly exceeding the CK levels (427U/L). This raise in CK-MB may be due to the presence of CK-BB or macro-CK in the plasma. Electrophoresis of the CK enzyme is, therefore, the best way to resolve the shortcomings of immunoinhibition. Macro-CK and CK-BB should hence also be kept in mind when the physician makes a diagnosis on the basis of such a laboratory report.
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SHORT COMMUNICATIONS Top

Envisaging capacity building among faculty members to ensure successful implementation of integrated teaching in medical colleges p. 254
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/kleuhsj.kleuhsj_44_20  
Integrated teaching in the field of medical education has been looked upon as the key approach to deliver complex information to the medical students in a relatively easier manner. In order to address the existing lacunae in the traditional curriculum with regard to integrated teaching, specific provisions in terms of various levels, topics and nature of integration, has been clearly specified in the recently implemented competency-based curriculum for undergraduate students. The successful implementation of the integrated teaching program across all the phases will essentially require support from all the concerned stakeholders, especially the management, administration, curriculum committee, medical education unit, alignment & integration teams, and faculty members. Considering that implementation of integrated teaching needs to be done within the available human resources, it becomes quite obvious that we have to focus towards capacity building. In conclusion, the process of implementation of integrated teaching in any of the medical colleges across India is a challenging task. However, the overall process can be simplified and made effective through active faculty involvement and support from the administration.
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Onlay preputial flap urethroplasty for children with mid- or proximal penile hypospadias with chordee p. 256
RB Nerli, Priyeshkumar Patel, Shridhar C Ghagane, Sushant Deole, Sreeharsha Nutalapati, Murigendra B Hiremath, Neeraj S Dixit
DOI:10.4103/kleuhsj.kleuhsj_35_20  
Introduction: We report our results of preputial flap onlay urethroplasty for the one-stage repair of mid- and proximal penile hypospadias with chordee. Materials and Methods: We retrospectively reviewed the hospital data base for children undergoing onlay flap urethroplasty and hypospadias repair for mid- or proximal penile hypospadias with chordee. Results: During the study period January 2000–December 2017, 21 children underwent onlay preputial flap urethroplasty. The procedure was successful in 15 (71.42%) children with no need to undergo further procedures or operations. There were five urethrocutaneous fistulas and dehiscence of glans in one. Conclusions: An onlay urethroplasty using the preputial flap yields results comparable to those of staged techniques and results in fewer procedures under anesthesia in children.
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Extending an equitable COVID-19 response to the disabled individuals p. 260
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/kleuhsj.kleuhsj_168_20  
The ongoing coronavirus disease-2019 (COVID-19) pandemic has affected everyone, but the impact is relatively higher among people who are vulnerable, such as disabled, refugee, migrants, elderly, and suffering from preexisting illness. The disabled people are more at the risk of acquisition of infection owing to the limited access to the public health messaging and the fact that if they are subjected to physical distancing, they will find it extremely difficult to survive as they depend on their caregivers for their routine activities. In these difficult times, it is of utmost importance that disabled persons should minimize the probability of exposure to COVID-19, and for this to happen, the government, disability service providers, caregivers, and the local community have to play an important role. In conclusion, the COVID-19 pandemic has started to threaten and increase the disparities of care and services for the disabled individuals. It is the need of the hour to ensure that COVID-19-related services are offered to disabled people in a dignified manner without jeopardizing their human rights.
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Scope of organ system-based curriculum in the delivery of medical education: A critique p. 262
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/kleuhsj.kleuhsj_117_20  
The role of basic science subjects in the making of a competent medical graduate and a health care professional is crucial and thus multiple number of approaches have been tried to merge basic science with clinical medicine. The organ-system based medical curriculum is a type of integrated teaching, which has been advocated and adopted across different medical curriculum and has delivered promising results, especially with regard to increasing the depth of medical knowledge and a comprehensive understanding of each of the organ systems. Even though, this form of curriculum has been adopted by different medical schools, we have to acknowledge that for getting the intended outcomes, loads of investment in terms of time and efforts are required for the successful planning, organization and implementation. In conclusion, the adoption of an organ system-based medical curriculum is an effective and a sound approach to curriculum delivery as it addresses the limitations of the traditional curriculum and also strengthen the relevance of basic and clinical medicine in the minds of the medical students.
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Sustaining the delivery of malaria elimination services amidst an ongoing coronavirus disease 2019 outbreak in the African Region p. 264
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/kleuhsj.kleuhsj_111_20  
The Corona Virus Disease-2019 (COVID-19) pandemic has become a global public health priority and it has compelled multiple nations to divert their resources for the containment of the disease at the earliest. With regard to malaria, the African region is the most affected one, accounting for 93% of the reported cases worldwide. However, since the emergence of the COVID-19 outbreak, there is a sense of fear about the disease among the health sector personnel. It won't be wrong to say that COVID-19 outbreak has exposed weaknesses in our preparedness activities, but then we have to identify a balance between the outbreak response activities and the activities which are ongoing in the region for decades for the control of malaria. It is of utmost importance that all the malaria-endemic nations in the African region should continue to sustain malaria-related prevention, diagnostic and treatment services. In conclusion, the activities pertaining to the containment of COVID-19 and malaria are equally important in the African region. The services pertaining to prevention and control of malaria should be continued as it is and the public health authorities should not allow COVID-19 to become a more important priority and thus reallocate the available resources.
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