The Ptolemy project: a scalable model for delivering health information in Africa

Challenges and possible solutions for accessing scholarly literature among medical and nursing professionals and students in low-and-middle income countries: A systematic review

BACKGROUND

Access to high quality research literature is essential for educating nursing and healthcare students to promote evidence-based practice. Within Low- and Middle-Income countries (LMICs) access is limited due to financial and structural constraints within countries and institutions. Reduced access to research literature limits the achievement of the Sustainable Development Goals through its impact on the education of healthcare staff and on the development of contextually appropriate evidence for practice.

OBJECTIVE

To identify the challenges and possible solutions for accessing scholarly literature among medical and nursing professionals and students in low-and-middle income countries.

DESIGN

Systematic review.

DATA SOURCES

Searches were conducted in MEDLINE, CINAHL PLUS, ERIC, ASSIA, EMBASE, and Google Scholar.

REVIEW METHODS

Five bibliography databases were searched using relevant search terms, from January 2002 to July 2022. Additional searches were carried out in Google Scholar. Titles, abstracts, and full texts were independently screened by at least two authors, based on predefined eligibility criteria. Pertinent data were extracted from included studies, and critical appraisal was undertaken. Data were analysed and presented in a narrative approach.

RESULTS

Five papers met the inclusion criteria and were included. Three aspects of challenges at different levels emerged: infrastructure and institutional level factors, individual factors, and lack of contextually appropriate evidence. Three solutions were identified: capacity development opportunities, improving Internet access, and increasing awareness of free resources.

CONCLUSION

This review provides an overview of common barriers medical and nursing professionals and students encounter whilst accessing scholarly literature in LMICs and identifies some possible solutions to address them. The findings can be used to guide institutions, as well as national and international decision makers to elicit policy which can promote the uptake of research in LMICs. Further research should focus on how these solutions could be harnessed to address the problems identified in this review.

International Neurosurgery: The Role for Collaboration

The global death toll from lack of access to basic surgical care is three times as much as for tuberculosis, HIV and malaria combined. Patients dying of curable neurosurgical conditions solely because of inadequacy or absence of neurosurgical infrastructure is an issue deserving immediate attention and action. Global neurosurgery is an important step forward in this regard, under which different models of collaboration between HICs and LMICs aim to increase both the number of neurosurgeons as well the quality of neurosurgical care available in these countries through arranging surgical camps, providing neurosurgical training and education, and restructuring the health system in these countries in order to create an environment conducive to the provision of the highest form of neurosurgical care. Despite the many challenges faced by LMICs in furthering neurosurgery programs such as poor resource allocation, brain drain, turbulent socioeconomic conditions, limited training facilities, and population explosion, data now being reported from LMICs the world over, exemplifies the immense positive impact that collaborations have had over the last few decades in improving neurosurgical capacity and infrastructure. So far, conventional methods of collaboration (i.e. neurosurgical missions to LMICs and training of neurosurgeons in HICs) have been effective in progressively bringing about the desired change in LMICs. However, these methods have been limited by a finite funding, pushing the global neurosurgical community to look for alternatives such as online curricula, task shifting and sharing, and long distance mentor-mentee relationships. In this review, we aim to provide an update on the current state of neurosurgical collaborations and identify the barriers in the way of collaborations and what alternative models of collaboration might be used to overcome them..

Capacity-building partnerships for surgical post-graduate training in low- and middle-income countries: a scoping review of the literature with exploratory thematic synthesis

In recent years, international surgical programmes have moved away from vertical service delivery and towards collaborative, capacity-building partnerships. The aim of this review was to provide a map of the current literature on international surgical training partnerships together with an exploration of factors influencing their implementation. Three bibliographic databases were searched for peer-reviewed reports of surgical training partnerships between organizations in high- and low or middle-income countries to July 2018. Reports were sorted in an iterative fashion into groups of similar programmes, and data were extracted to record the intervention strategies, context, financing, reported results and themes around implementation. Eighty-six reports were grouped into five types of programme: full residency training, bi-institutional twinning partnerships, diagonal/sub-specialist programmes, focused interventions or courses and programmes using remote support. Few articles were written from the perspective of the low-middle income partner. Full residency programmes and some diagonal/sub-specialist programmes report numbers trained while twinning partnerships and focused interventions tend to focus on process, partners' reactions to the programme and learning metrics. Two thematic networks emerged from the thematic synthesis. The first made explicit the mechanisms by which partnerships are expected to contribute to improved access to surgical care and a second identified the importance of in-country leadership in determining programme results. Training partnerships are assumed to improve access to surgical care by a number of routes. A candidate programme theory is proposed together with some more focused theories that could inform future research. Supporting the development of the surgical leadership in low- and middle-income countries is key.

Communication Networking: ICTs and health information in Africa

This paper examines the uses of information and communication technologies (ICTs) in the African health sector. In particular, it shows the benefits that ICTs can bring to African health care systems in the areas of medical information, clinical data exchange, treatment, health education campaigns and international collaboration between African medical experts and their colleagues abroad. Despite the potential benefits and uses of ICTs, the paper warns that ICTs should not be naively celebrated as the panacea of African health care. It suggests that ICTs should be a means, not an end, for development in Africa. In this context, the paper illustrates how ICTs can be adapted for human development, social capabilities and literacy within African society.

The role of tablets in accessing information throughout undergraduate medical education in Botswana

BACKGROUND

Mobile learning (mLearning) uses wireless networks and mobile devices to expand physician trainees' and healthcare providers' access to and exchange of medical information. Opportunities to increase implementation and expand use of mobile devices to support health care information access and delivery in Africa are vast, but the rapid growth of mLearning has caused project implementation to outpace objective measurement of impact. This study makes a contribution to the existing body of literature regarding mLearning implementation in Africa through its focus on the use of smart devices (tablets) in undergraduate medical education and medical students' perceptions of the effects on their learning environment.

MATERIALS AND METHODS

The population of this prospective mixed-methods study consisted of 82 undergraduate medical students (45 third year and 37 fourth year) at the University of Botswana Faculty of Medicine. They received tablets in the earliest phase of the mLearning project implementation (between November 2012 and January 2013), when they were in the third and fourth year of their medical training. Usage of the tablets was assessed both quantitatively and qualitatively, through both application usage tracking and focus groups.

RESULTS

Based on application usage data and coding and analysis of focus group discussions, undergraduate medical students indicated that tablets were useful in their medical education, allowing them continual access to information and opportunities for communication. Participants noted that the primary barrier to use of tablets was the lack of mobile cellular Internet beyond the Wi-Fi zones at the training sites. Moreover, participants offered suggestions for improvements to the implementation process.

CONCLUSIONS

Even in resource-limited settings where Internet access can be unreliable and intermittent, the adoption of tablets can have benefits to medical education by providing consistent access to extensive and current medical information resources. This study highlights the value of clinical resources with offline functionality, with or without consistent access to the Internet. There is also the potential for optimizing the use of tablets through improved training and technical support.

Open access of evidence-based publications: the case of the orthopedic and musculoskeletal literature

The open access model, where researchers can publish their work and make it freely available to the whole medical community, is gaining ground over the traditional type of publication. However, fees are to be paid by either the authors or their institutions. The purpose of this paper is to assess the proportion and type of open access evidence-based articles in the form of systematic reviews and meta-analyses in the field of musculoskeletal disorders and orthopedic surgery. PubMed database was searched and the results showed a maximal number of hits for low back pain and total hip arthroplasty. We demonstrated that despite a 10-fold increase in the number of evidence-based publications in the past 10 years, the rate of free systematic reviews in the general biomedical literature did not change for the last two decades. In addition, the average percentage of free open access systematic reviews and meta-analyses for the commonest painful musculoskeletal conditions and orthopedic procedures was 20% and 18%, respectively. Those results were significantly lower than those of the systematic reviews and meta-analyses in the remaining biomedical research. Such findings could indicate a divergence between the efforts engaged at promoting evidence-based principles and those at disseminating evidence-based findings in the field of musculoskeletal disease and trauma. The high processing fee is thought to be a major limitation when considering open access model for publication.

Use of mobile learning by resident physicians in Botswana

With the growth of mobile health in recent years, learning through the use of mobile devices (mobile learning [mLearning]) has gained recognition as a potential method for increasing healthcare providers' access to medical information and resources in resource-limited settings. In partnership with the University of Botswana School of Medicine (SOM), we have been exploring the role of smartphone-based mLearning with resident (physicians in specialty training) education. The SOM, which admitted its first class of medical students and residents in 2009, is committed to providing high-level on-site educational resources for resident physicians, even when practicing in remote locations. Seven residents were trained to use an Android-based myTouch 3G smartphone equipped with data-enabled subscriber identity module (SIM) cards and built-in camera. Phones contained locally loaded point-of-care and drug information applications, a telemedicine application that allows for the submission of cases to local mentors, and e-mail/Web access. Surveys were administered at 4 weeks and 8 weeks following distribution of phones. We found that smartphones loaded with point-of-care tools are effectively utilized by resident physicians in resource-limited settings, both for accessing point-of-care medical information at the bedside and engaging in self-directed learning at home.

Use of a pilot drug information centre

INTRODUCTION

Provision of access to drug information by prescribers and other health care professionals is important in pharmacotherapy. At the time of this study there was very scanty literature in this area from Africa.

OBJECTIVE

To assess use of a pilot drug information centre (DIC) which was set up in a department of Pharmacology and Therapeutics in a university teaching hospital in Uganda.

METHODS

This was a situational analysis with a prospective study design. The pilot DIC was established and its use over an eleven-month period was assessed. The received queries were evaluated for source of the query, reason for the query and type of query.

RESULTS

During the 11 months 297 queries were received, 72.3% of which were from public hospitals. Most were from prescribing doctors (54.2%). Majority were on drug-drug interaction (41.2%), followed by therapy (23.2%). Out of 197 specific drug requests, 65.5% were on antiretroviral.

CONCLUSION

We found that healthcare professionals were enthusiastically using the drug information centre. It is, therefore, necessary and feasible to establish a DIC in Uganda that will enable these professionals to readily access drug information.

Low-income countries' orthopaedic information needs: challenges and opportunities

BACKGROUND

The Internet should, in theory, facilitate access to peer-reviewed scientific articles for orthopaedic surgeons in low-income countries (LIC). However, there are major barriers to access, and most full-text journal articles are available only on a subscription basis, which many in LIC cannot afford. Various models exist to remove such barriers. We set out to examine the potential, and reality, of journal article access for surgeons in LIC by studying readership patterns and journal access through a number of Internet-based initiatives, including an open access journal ("PLoS Medicine"), and programs from the University of Toronto (The Ptolemy Project) and World Health Organization (WHO) (Health InterNetwork Access to Research Initiative [HINARI]).

QUESTIONS/PURPOSES

Do Internet-based initiatives that focus on peer-reviewed journal articles deliver clinically relevant information to those who need it? More specifically: (1) Can the WHO's program meet the information needs of practicing surgeons in Africa? (2) Are healthcare workers across the globe aware of, and using, open access journals in a manner that reflects global burden of disease (GBD)?

METHODS

We compared actual Ptolemy use to HINARI holdings. We also compared "PLoS Medicine" readership patterns among low-, middle-, and high-income regions.

RESULTS

Many of the electronic resources used through Ptolemy are not available through HINARI. In contrast to higher-income regions, "PLoS Medicine" readership in Africa is proportional to both the density of healthcare workers and the GBD there.

CONCLUSIONS

Free or low-cost Internet-based initiatives can improve access to the medical literature in LIC. Open access journals are a key component to providing clinically relevant literature to the regions and healthcare workers who need it most.

Mobile learning for HIV/AIDS healthcare worker training in resource-limited settings

Background

We present an innovative approach to healthcare worker (HCW) training using mobile phones as a personal learning environment.

Twenty physicians used individual Smartphones (Nokia N95 and iPhone), each equipped with a portable solar charger. Doctors worked in urban and peri-urban HIV/AIDS clinics in Peru, where almost 70% of the nation's HIV patients in need are on treatment. A set of 3D learning scenarios simulating interactive clinical cases was developed and adapted to the Smartphones for a continuing medical education program lasting 3 months. A mobile educational platform supporting learning events tracked participant learning progress. A discussion forum accessible via mobile connected participants to a group of HIV specialists available for back-up of the medical information. Learning outcomes were verified through mobile quizzes using multiple choice questions at the end of each module.

Methods

In December 2009, a mid-term evaluation was conducted, targeting both technical feasibility and user satisfaction. It also highlighted user perception of the program and the technical challenges encountered using mobile devices for lifelong learning.

Results

With a response rate of 90% (18/20 questionnaires returned), the overall satisfaction of using mobile tools was generally greater for the iPhone. Access to Skype and Facebook, screen/keyboard size, and image quality were cited as more troublesome for the Nokia N95 compared to the iPhone.

Conclusions

Training, supervision and clinical mentoring of health workers are the cornerstone of the scaling up process of HIV/AIDS care in resource-limited settings (RLSs). Educational modules on mobile phones can give flexibility to HCWs for accessing learning content anywhere. However lack of softwares interoperability and the high investment cost for the Smartphones' purchase could represent a limitation to the wide spread use of such kind mLearning programs in RLSs.

Crossing the digital divide: the contribution of information technology to the professional performance of malaria researchers in Africa

BACKGROUND

The US National Library of Medicine supports the Multilateral Initiative on Malaria (MIM) through the design, implementation, and operation of the Multilateral Initiative on Malaria Communications Network (MIMCom.) MIMCom makes possible enhanced access to the Internet and to medical literature.

OBJECTIVES

The main objectives of the present study were to examine the use of MIMCom supported information technology (IT) by scientists, students, and administrative personnel to facilitate communication, retrieve information, obtain documents, write proposals, and prepare papers for publication; and to determine the contribution of this intervention to their professional performance.

METHODS

The authors analyzed the contribution of enhanced Internet connectivity and access to electronic information resources to the performance of malaria research staff and their institutes through a cross-sectional questionnaire survey of 181 respondents at 14 health research centers in Africa. Separate reviews of bandwidth usage, requests for document delivery, and publications in peer reviewed journals support the data of the survey.

RESULTS

The MIMCom network makes a positive contribution to the performance of malaria researchers and support staff at the sites reviewed by improving e-mail exchange, access to published literature, and research proposal development and submission. Implications of these findings are discussed.

CONCLUSION

By providing full access to the Internet and the resources of the WorldWide Web, MIMCom has been shown to be invaluable to malaria researchers and their institutes in Africa. This access has increased visibility of scientists in their respective institutions and provided opportunities for stronger engagement with the international scientific community.

Global access to literature on trauma

The trauma pandemic disproportionately kills and maims citizens of low-income countries although the immediate cause of the trauma is often an industrial export of a high income country, such as a motor vehicle. Addressing the trauma pandemic in low-income countries requires access to relevant research information regarding prevention and treatment of injuries. Such information is also generally produced in high income countries. We explored various means of making scientific information available to low-income country surgeons using the internet. If orthopaedic surgeons want to maximize their global impact, they should focus on writing about trauma questions relevant to their colleagues in low-income countries and ensuring these same colleagues have access to the literature.

Building surgical research capacity in Africa: the Ptolemy Project

The authors describe the Ptolemy Project, a recently developed model of electronic access to medical literature for surgeons in developing countries.

Health practitioners' and health planners' information needs and seeking behavior for decision making in Uganda

BACKGROUND

Access to reliable information is the most cost-effective and achievable strategy for sustainable improvement in health care. While several studies have described practitioners' information seeking behavior in developed countries, literature from developing countries is lacking. The aims of the study were: (i) to determine the most influential type of information for health workers' and planners' decision making; (ii) to establish the practitioners' evaluation of the availability and quality of this important information; and (iii) to establish the most commonly used/accessible sources of the information relevant for decision making in Uganda.

METHODS

Self-administered questionnaires were sent to 610 health workers, planners, and administrators at the national, district and health facility levels in four districts in Uganda. Respondents were reminded three times, after which non-response was registered. Data were entered, cleaned and analysed using SPSS version 12.0. Logistic regression analysis was used to test for differences in responses.

RESULTS

The response rate was 67.7% (413). The respondents indicated that personal experience (79%), discussion with colleagues (76%) and national policy and treatment guidelines (75%) were most influential when making decisions in health care and planning. They reported that most of the epidemiological information was available and of relatively good quality but there was lack of information about distribution of benefit, segregated demographic data, and social values. The most often used sources of information included; discussions with colleagues (89%), doctors' statements (85%) and text books (77%). The least frequently used sources were the internet and the library. This varied with respondents' designation and region of origin.

CONCLUSIONS

Health planners and practitioners lack some of the information relevant for decision making. They tend to rely on the national policy and treatment guidelines, discussion with colleagues, and personal experience. Most frequently used sources of information are similar to previous studies. The variation in the frequency of use of the different sources of research information necessitates research to understand the barriers and careful planning of health information delivery to ensure equitable access.

Message in a bottle: sinking in a sea of safe motherhood concepts

The experiences of implementing maternal health programmes over the last two decades have resulted in the development of many approaches and concepts to address the problems of maternal death and disability in developing countries. These safe motherhood "messages" are generally conveyed from international organisations to implementers of programmes working in developing countries. The messages are sometimes unclear, ambiguous and open to misinterpretation. Case studies are used to describe varying interpretations of messages on essential and emergency obstetric care, skilled attendance at delivery and measurement of progress. Limited technological access to information, rapidly changing ideology, overly complicated terminology, inadequate evidence, poor international and inter-agency consensus are key reasons contributing to confusion in implementation. Policy-implementation gaps can be bridged with better needs-based evidence, improved consistency and means of delivery of global messages, building capacity, strengthening partnerships and more inclusive participation in the global arena.

Relevance of Electronic Health Information to Doctors in the Developing World: Results of the Ptolemy Project’s Internet-based Health Information Study (IBHIS)

The aim of this study was to determine the current usage, relevance, and preferences for electronic health information (EHI) in the participant surgeons' clinical, research, and teaching activities. The Internet-Based Health Information Survey (IBHIS) was conducted from August to December 2003. Thirty-seven doctors (primarily practicing in East Africa) participated, all of whom had been using the Ptolemy resources for at least 6 months. Survey questions concerned time spent reading medical literature, preferred information sources, preferred type of publication, relevance, preference for western versus local medical literature, and academic productivity. Among the 75 eligible participants, 37 (48%) responded. From these responses it was found that African surgeons with access to EHI read more than articles than they did before they had such access, and they find that the information obtained is highly relevant to their clinical, teaching, and research activities. They prefer electronic journals to textbooks and are more inclined to change their practice based on information found in western journals than local journals. Ptolemy resources helped the respondents who reported academic work write a total of 33 papers for presentation or publication. Overall, access to EHI enables doctors in Africa to read more, is relevant, and contributes directly to academic productivity; thus Western medical literature is useful in the developing world, and EHI delivery should continue to expand.

Como acessar a literatura biomédica e cruzar o "divisor de águas digital" em Pneumologia

Em países pobres e subdesenvolvidos, incluindo o Brasil, os pneumologistas têm enormes dificuldades em prover assistência médica de bom nível, em manterem-se em dia e em fazer pesquisa. Um de seus principais problemas é o acesso à literatura médica e científica, com os custos altíssimos e crescentes das assinaturas das revistas biomédicas. A expressão "divisor de águas digital" ("digital divide" em inglês) refere-se ao abismo entre aqueles que podem usar efetivamente as novas tecnologias de informação, como a Internet e aqueles que não tem acesso, tanto dentro dos países como entre os mesmos. Neste trabalho, chamamos a atenção para algumas soluções para esta situação de pobreza em informação, que estão disponíveis na Internet, a baixo ou quase nenhum custo. Em especial o projeto SciELO Brasil, o portal Periódicos CAPES, o PubMed e o projeto HINARI da OMS são detalhados e explicados.