Africa has seen an upsurge in diagnostic imaging utilization, with benefits of efficient and accurate diagnosis, but these could easily be offset by undesirable effects attributed to unjustified, unoptimized imaging and poor quality examinations. This paper aims to present Africa’s position regarding quality and safety in imaging, give reasons for the rising interest in quality and safety, define quality and safety from an African context, list drivers for quality and safety in Africa, discuss the impact of COVID-19 on quality and safety, and review Africa’s progress using the Bonn Call for Action framework while proposing a way forward for imaging quality and safety in Africa. In spite of a healthcare setting characterized by meagre financial, human and technology resources, a rapidly widening disease-burden spectrum, growing proportion of non-communicable diseases and resurgence of tropical and global infections, Africa has over the last ten years made significant strides in quality and safety for imaging. These include raising radiation-safety awareness, interest and application of evidence-based radiation safety recommendations and guidance tools, establishing facility and national diagnostic reference levels (DRLs) and strengthening end-user education and training. Major challenges are: limited human resource, low prioritization of imaging in relation to other health services, low level of integration of imaging into the entire health service delivery, insufficient awareness for radiation safety awareness, a radiation safety culture which is emerging, insufficient facilities and opportunities for education and training. Solutions to these challenges should target the entire hierarchy of health service delivery from prioritization, policy, planning, processes to procedures.

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Background Clinical imaging guidelines (CIGs) have been demonstrated to reduce inappropriate diagnostic imaging. There is insufficient evidence for CIG effectiveness to reduce inappropriate imaging in Africa. We assessed the effectiveness of CIGs training and implementation to reduce inappropriate diagnostic imaging at Mengo Hospital, Uganda. Methods A clinical audit of head CT examinations was conducted at Mengo Hospital. A baseline review of 262 requisitions was done to determine the level of appropriateness for imaging requisitions. We also determined the baseline knowledge level on radiation protection (RP) and CIG use among 15 referrers. We trained these referrers on RP, awareness and use of CIGs and uploaded the iGUIDE onto their smart phones and computer work stations for use. This was followed by a post-intervention assessment where we reviewed 154 requisitions to determine the level of appropriateness. We also assessed the post-intervention knowledge level on radiation protection (RP) and CIG use among the referring clinicians. Results We found 53% and 47% levels of inappropriate head CT requisitions for pre- and post-intervention, respectively. At pre-intervention, we found a 73% level of knowledge on radiation protection and CIGs use while we found a 93% at post-intervention assessment among referrers. Conclusions Implementation and training referring clinicians on CIGs are effective in reducing inappropriateness of head CT requisitions.

Background: Vesico-uterine fistula refers to abnormal communication between the urinary bladder and the uterine cavity. It’s among the obstetric fistulas which occur as part of the complications of medico-surgical procedures such as post-caesarian sections, and post-irradiation as in cancer treatment among others. About two million women worldwide have genital fistula with an annual incidence of 50,000 to 100,000 cases. In sub-Saharan Africa. an estimated 33,000 new fistula cases occur each year.  Case presentation:  This case study was of a 34-year-old female who came into the hospital complaining of long-standing abdominal pains associated with constant vaginal watery discharge, menstrual irregularities, painful sexual intercourse, and on-and-off urinary incontinence. All these started after a caesarian section was done one year ago. Her past Obstetric history revealed that she had ever had two vaginal deliveries and 1 caesarian section a year ago.  Results: On ultrasonography, it was revealed that there was a defect in the continuity of the anterior wall of the uterus making a connection between the endometrial cavity and the urinary bladder. This was in line with the definition of a vesicouterine fistula. Conclusion:  The report concluded that vesicouterine fistula is one of the genital urinary fistulae that can occur following a caesarian section and with increasing trends directly proportional to an increase in the incidence of caesarian sections. Recommended: That every mother who has had a caesarian section should do a post-natal ultrasound at least within the first 6 months following the operation. This will help to identify potential genito-urinary fistulas earlier enough which can improve their overall management.