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Rylance S, Bateman ED, Boulet L, Cohen M, El Sony A, Halpin DMG, Khoo EM, Marks GB, Masekela R, Mikkelsen B, Mortimer KJ, Chakaya Muhwa J, Nunes da Cunha I, Šajnić A, Salvi S, Slama S, Winders T, Yorgancioglu A, Zar HJ. Key messages and partnerships to raise awareness and improve outcomes for people with asthma and COPD in low- and middle-income countries. Int J Tuberc Lung Dis 2022; 26:1106-1108. [PMID: 36447314 DOI: 10.5588/ijtld.22.0544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- S Rylance
- Noncommunicable Diseases Department, World Health Organization, Geneva, Switzerland
| | - E D Bateman
- Global Initiative for Asthma (GINA), Fontana, WI, USA, University of Cape Town Lung Institute, Cape Town, South Africa
| | - L Boulet
- Global Initiative for Asthma (GINA), Fontana, WI, USA, Laval University, Quebec City, QC, Canada
| | - M Cohen
- Forum of International Respiratory Societies, Lausanne, Switzerland, Asociacion Latinoamericana de Torax, Montevideo, Uruguay, Hospital Centro Medico, Guatemala City, Guatemala
| | - A El Sony
- International Union Against Tuberculosis and Lung Disease, Paris, France, Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan
| | - D M G Halpin
- Global Initiative for Obstructive Lung Disease (GOLD), Fontana, WI, USA, University of Exeter Medical School, Exeter, UK
| | - E M Khoo
- International Primary Care Respiratory Group (IPCRG), Edinburgh, UK, Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - G B Marks
- International Union Against Tuberculosis and Lung Disease, Paris, France, University of New South Wales, Sydney, NSW, Australia
| | - R Masekela
- International Union Against Tuberculosis and Lung Disease, Paris, France, Global Asthma Network (GAN), Auckland, New Zealand, Pan African Thoracic Society, Congella, South Africa, Department of Paediatrics and Child Health, University of KwaZulu Natal, Durban, South Africa
| | - B Mikkelsen
- Noncommunicable Diseases Department, World Health Organization, Geneva, Switzerland
| | - K J Mortimer
- Global Initiative for Asthma (GINA), Fontana, WI, USA, International Union Against Tuberculosis and Lung Disease, Paris, France, Global Initiative for Obstructive Lung Disease (GOLD), Fontana, WI, USA, Global Asthma Network (GAN), Auckland, New Zealand, Aintree University Hospital, Liverpool, UK
| | - J Chakaya Muhwa
- International Union Against Tuberculosis and Lung Disease, Paris, France, Kenyatta University, Nairobi, Kenya
| | | | - A Šajnić
- International Coalition of Respiratory Nurses, University Hospital Centre Zagreb, Croatia
| | - S Salvi
- Global Initiative for Obstructive Lung Disease (GOLD), Fontana, WI, USA, Pulmocare Research and Education Foundation, Pune, India
| | - S Slama
- Noncommunicable Diseases Department, World Health Organization, Geneva, Switzerland
| | - T Winders
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - A Yorgancioglu
- Global Initiative for Asthma (GINA), Fontana, WI, USA, Celal Bayar University, Manisa, Turkey
| | - H J Zar
- Forum of International Respiratory Societies, Lausanne, Switzerland, Pan African Thoracic Society, Congella, South Africa, SA Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Stolbrink M, Chinouya MJ, Jayasooriya S, Nightingale R, Evans-Hill L, Allan K, Allen H, Balen J, Beacon T, Bissell K, Chakaya J, Chiang CY, Cohen M, Devereux G, El Sony A, Halpin DMG, Hurst JR, Kiprop C, Lawson A, Macé C, Makhanu A, Makokha P, Masekela R, Meme H, Khoo EM, Nantanda R, Pasternak S, Perrin C, Reddel H, Rylance S, Schweikert P, Were C, Williams S, Winders T, Yorgancioglu A, Marks GB, Mortimer K. Improving access to affordable quality-assured inhaled medicines in low- and middle-income countries. Int J Tuberc Lung Dis 2022; 26:1023-1032. [PMID: 36281039 PMCID: PMC9621306 DOI: 10.5588/ijtld.22.0270] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: Access to affordable inhaled medicines for chronic respiratory diseases (CRDs) is severely limited in low- and middle-income countries (LMICs), causing avoidable morbidity and mortality. The International Union Against Tuberculosis and Lung Disease convened a stakeholder meeting on this topic in February 2022.METHODS: Focused group discussions were informed by literature and presentations summarising experiences of obtaining inhaled medicines in LMICs. The virtual meeting was moderated using a topic guide around barriers and solutions to improve access. The thematic framework approach was used for analysis.RESULTS: A total of 58 key stakeholders, including patients, healthcare practitioners, members of national and international organisations, industry and WHO representatives attended the meeting. There were 20 pre-meeting material submissions. The main barriers identified were 1) low awareness of CRDs; 2) limited data on CRD burden and treatments in LMICs; 3) ineffective procurement and distribution networks; and 4) poor communication of the needs of people with CRDs. Solutions discussed were 1) generation of data to inform policy and practice; 2) capacity building; 3) improved procurement mechanisms; 4) strengthened advocacy practices; and 5) a World Health Assembly Resolution.CONCLUSION: There are opportunities to achieve improved access to affordable, quality-assured inhaled medicines in LMICs through coordinated, multi-stakeholder, collaborative efforts.
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Affiliation(s)
- M Stolbrink
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Stellenbosch University, Tygerberg, South Africa
| | - M J Chinouya
- Education Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S Jayasooriya
- Academic Unit of Primary Care, University of Sheffield, Sheffield, UK
| | - R Nightingale
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, IcFEM Dreamland Mission Hospital, Kimilili, Kenya
| | | | - K Allan
- Healthcare Consultant, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, The Gambia
| | - H Allen
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, The Gambia
| | - J Balen
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - T Beacon
- Medical Aid International, Bedford, UK
| | - K Bissell
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - J Chakaya
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Department of Medicine, Therapeutics and Dermatology, Kenyatta University, Nairobi, Kenya
| | - C-Y Chiang
- International Union Against Tuberculosis and Lung Disease, Paris, France, Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - M Cohen
- Asociación Latinoamericana del Tórax, Forum of International Respiratory Societies, Guatemala
| | - G Devereux
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A El Sony
- The Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum Sudan
| | - D M G Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - J R Hurst
- UCL Respiratory, University College London, London, UK
| | - C Kiprop
- IcFEM Dreamland Mission Hospital, Kimilili, Kenya
| | | | - C Macé
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A Makhanu
- IcFEM Dreamland Mission Hospital, Kimilili, Kenya
| | - P Makokha
- IcFEM Dreamland Mission Hospital, Kimilili, Kenya
| | - R Masekela
- Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - H Meme
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - E M Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, International Primary Care Respiratory Group, Larbert, Scotland, UK
| | - R Nantanda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - C Perrin
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - H Reddel
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia, Global Initiative for Asthma (GINA), Fontana, WI, USA
| | - S Rylance
- Noncommunicable Diseases Department, World Health Organization, Geneva, Switzerland
| | | | - C Were
- GlaxoSmithKline, Brentford, UK
| | - S Williams
- International Primary Care Respiratory Group, Larbert, Scotland, UK
| | - T Winders
- Global Allergy & Airways Patient Platform, Vienna, Austria
| | - A Yorgancioglu
- Department of Pulmonology, Celal Bayar University Medical Faculty, Manisa, Turkey, Global Alliance Against Chronic Respiratory Diseases, Geneva, Switzerland
| | - G B Marks
- International Union Against Tuberculosis and Lung Disease, Paris, France, University of New South Wales, Sydney, NSW, Australia
| | - K Mortimer
- International Union Against Tuberculosis and Lung Disease, Paris, France, University of Cambridge, Cambridge, UK
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Cramer G, Winders T, Solano L, Kleinschmit DH. Evaluation of agreement among digital dermatitis scoring methods in the milking parlor, pen, and hoof trimming chute. J Dairy Sci 2017; 101:2406-2414. [PMID: 29290450 DOI: 10.3168/jds.2017-13755] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/05/2017] [Indexed: 11/19/2022]
Abstract
Digital dermatitis (DD) is the most common infectious foot lesion affecting welfare and productivity of dairy cattle. The key to DD control programs is routine and frequent identification of DD lesions. The objective was to evaluate accuracy of detecting and scoring DD lesions in 3 milking parlor designs and in 3 alternative settings compared with scoring in the hoof trimming chute as reference. A total of 552 cows and 1,104 hind feet from 17 freestall farms were scored by 1 observer in the milking parlor and in 1 other setting: pen, headlocks, or management rail. After being scored in the milking parlor and at least 1 other setting, cows were examined in the hoof trimming chute, considered the gold standard. In every setting, all hind feet were inspected visually using a flashlight and without prior washing of feet. Agreement of the scoring settings was assessed using the 5 M-stage scoring system and a dichotomous absence (M0 or M0/M1) or presence (M1 to M4.1 or M2 to M4.1) system. At trimming chute inspection, 44% of feet had a DD lesion, with estimates of 11, 5, 2, 10, and 16% for M1, M2, M3, M4, and M4.1 lesions, respectively. Apparent DD foot-level prevalence at the milking parlor, pen, management rail, and headlocks was 28, 22, 16, and 22%, respectively. M-stages were less discernible in the pen, management rail, and headlocks (apparent prevalence of M1, M2, M3, and M4.1 was ≤1%) compared with the trimming chute and milking parlor. Agreement beyond chance between any scoring setting and trimming chute scoring ranged from 0.48 to 0.70 for the dichotomous scoring system (absence = M0/M1 vs. presence = M2 to M4.1). Diagnostic test performance varied greatly among DD scoring settings but, in general, it had low sensitivity (<70%) and high specificity (>93%) for detecting any DD lesion. Agreement and test characteristics were not affected by the type of milking parlor. Although the milking parlor and headlocks were the most reliable settings in which to detect DD, none of the settings were reliable enough to replace inspection of feet in the trimming chute. However, scoring the presence or absence of DD in the milking parlor, pen, management rail, and headlocks could be used to estimate within-herd DD prevalence, to improve DD surveillance through routine monitoring, and to evaluate effects of interventions at the farm level.
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Affiliation(s)
- G Cramer
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul 55108.
| | - T Winders
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln 68583
| | - L Solano
- Farm Animal Care Associates, Calgary, Alberta, Canada T2L 0T6
| | - D H Kleinschmit
- Zinpro Corporation, 10400 Viking Dr., Eden Prairie, MN 55344
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