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Elanjeran R, Ramkumar A, Mahmood LS. Digitalisation of the simulation landscape - Novel solutions for simulation in low-resource settings. Indian J Anaesth 2024; 68:71-77. [PMID: 38406337 PMCID: PMC10893818 DOI: 10.4103/ija.ija_1246_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 02/27/2024] Open
Abstract
Simulation-based training is an acceptable method in medical sciences. The available simulators and the conduct of simulation require both simulators and infrastructural requirements. This narrative review highlights the potential of digital tools for team-based simulation exercises in low-resource settings. This review presents a comprehensive list of affordable digital tools for scenario planning, scenario design, and assessment. It covers various applications and platforms, providing detailed insights into their features, types, and accessibility. Different low-cost digital tools are available, from generative artificial intelligence for scenario planning to online repositories of simulation cases, browser-based assessment designers, and simulation games. These digital tools can make simulation accessible, transforming it into an immersive learning experience to enhance understanding and skill acquisition.
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Affiliation(s)
- Rajkumar Elanjeran
- Simulation and Skills Advancement for Education and Research (SAFE) Centre, Aarupadai Veedu Medical College and Hospital, Vinayaka Mission Research Foundation (DU), Puducherry, India
| | - Anitha Ramkumar
- Department of Emergency Medicine and Adjunct Faculty of Skills Lab, Aarupadai Veedu Medical College and Hospital, Vinayaka Mission Research Foundation (DU), Puducherry, India
| | - Lulu Sherif Mahmood
- Department of Anesthesiology, Father Muller Medical College, Mangalore, Karnataka, India
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Rakers M, van de Vijver S, Bossio P, Moens N, Rauws M, Orera M, Shen H, Hallensleben C, Brakema E, Guldemond N, Chavannes NH, Villalobos-Quesada M. SERIES: eHealth in primary care. Part 6: Global perspectives: Learning from eHealth for low-resource primary care settings and across high-, middle- and low-income countries. Eur J Gen Pract 2023; 29:2241987. [PMID: 37615720 PMCID: PMC10453992 DOI: 10.1080/13814788.2023.2241987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 07/13/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND eHealth offers opportunities to improve health and healthcare systems and overcome primary care challenges in low-resource settings (LRS). LRS has been typically associated with low- and middle-income countries (LMIC), but they can be found in high-income countries (HIC) when human, physical or financial resources are constrained. Adopting a concept of LRS that applies to LMIC and HIC can facilitate knowledge interchange between eHealth initiatives while improving healthcare provision for socioeconomically disadvantaged groups across the globe. OBJECTIVES To outline the contributions and challenges of eHealth in low-resource primary care settings. STRATEGY We adopt a socio-ecological understanding of LRS, making LRS relevant to LMIC and HIC. To assess the potential of eHealth in primary care settings, we discuss four case studies according to the WHO 'building blocks for strengthening healthcare systems'. RESULTS AND DISCUSSION The case studies illustrate eHealth's potential to improve the provision of healthcare by i) improving the delivery of healthcare (using AI-generated chats); ii) supporting the workforce (using telemedicine platforms); iii) strengthening the healthcare information system (through patient-centred healthcare information systems), and iv) improving system-related elements of healthcare (through a mobile health financing platform). Nevertheless, we found that development and implementation are hindered by user-related, technical, financial, regulatory and evaluation challenges. We formulated six recommendations to help anticipate or overcome these challenges: 1) evaluate eHealth's appropriateness, 2) know the end users, 3) establish evaluation methods, 4) prioritise the human component, 5) profit from collaborations, ensure sustainable financing and local ownership, 6) and contextualise and evaluate the implementation strategies.
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Affiliation(s)
- Margot Rakers
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- National eHealth Living Lab (NELL), Leiden, the Netherlands
| | | | - Paz Bossio
- Universidad Nacional de Jujuy, San Salvador de Jujuy, Argentina
| | - Nic Moens
- Africa eHealth Foundation, Veenendaal, the Netherlands
| | | | | | - Hongxia Shen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- School of Nursing Guangzhou, Guangzhou Medical University, Guangdong, China
| | - Cynthia Hallensleben
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- National eHealth Living Lab (NELL), Leiden, the Netherlands
| | - Evelyn Brakema
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- National eHealth Living Lab (NELL), Leiden, the Netherlands
| | | | - Niels H. Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- National eHealth Living Lab (NELL), Leiden, the Netherlands
| | - María Villalobos-Quesada
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- National eHealth Living Lab (NELL), Leiden, the Netherlands
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Osseiran A, Makki F, Haidar A, Saleh N, Yammine J, Birungi J, Chaya R, Kanaan W, Hamadeh R. Using behavioral insights to increase the demand for childhood vaccination in low resource settings: Evidence from a randomized controlled trial in Lebanon. SAGE Open Med 2023; 11:20503121231199857. [PMID: 37808510 PMCID: PMC10559695 DOI: 10.1177/20503121231199857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 08/22/2023] [Indexed: 10/10/2023] Open
Abstract
Objective Lebanon has historically maintained high immunization coverage rates for most routine vaccines. However, an increase in poverty rates coupled with an influx of over a million refugees posed significant challenges to the national immunization program. In response, an accelerated immunization activities (AIA) program, encompassing community-based outreach and referral activities, was launched to increase the demand for childhood vaccination through the public healthcare system. Despite this effort, uptake among refugee and host community households remained low, resulting in pockets of low immunization coverage rates. This study investigates the barriers that prevent households in low coverage areas from vaccinating their children, and evaluates a behavior change intervention designed to overcome the identified social, perceptual, and cognitive barriers. Methods Households with un- or under-vaccinated children were recruited from seven cadastres with low immunization coverage rates. A mixed methods approach, including stakeholder interviews and field observations, was employed to identify the main barriers to vaccination. Thereafter, a cluster randomized trial was conducted to evaluate the impact of a visual planning aid comprising five behavior change techniques (nudges) on vaccine uptake. Results A total of 12,332 un- or under-vaccinated children from 6160 households (3045 (49.4%) control households; 3115 (50.6%) treated households) were reached during the trial. The observed vaccination rates were 13.5% and 20.2% for control and treated households, respectively. This represents a 6.7 percentage points increase in the likelihood of a treated household to vaccinate at least one child, compared to the control group. At least 390 additional children benefited from life-saving vaccines due to the behavioral intervention. Conclusions This study highlights the importance of integrating behavioral insights into vaccination campaigns and programs, especially in low resource settings, to ensure that more children can benefit from life-saving vaccines.
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Affiliation(s)
| | - Fadi Makki
- The Behavioral Science Lab, Boston Consulting Group, Boston, MA, USA
| | | | | | | | | | - Rima Chaya
- Ministry of Public Health, Beirut, Lebanon
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Jafri L, Ahmed S, Majid H, Ghani F, Pillay T, Khan AH, Siddiqui I, Shakeel S, Ahmed S, Azeem S, Khan A. A framework for implementing best laboratory practices for non-integrated point of care tests in low resource settings. EJIFCC 2023; 34:110-122. [PMID: 37455843 PMCID: PMC10349313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The method we respond to pandemics is still inadequate for dealing with the point of care testing (POCT) requirements of the next large epidemic. The proposed framework highlights the importance of having defined policies and procedures in place for non-integrated POCT to protect patient safety. In the absence of a pathology laboratory, this paradigm may help in the supply of diagnostic services to low-resource centers. A review of the literature was used to construct this POCT framework for non-integrated and/or unconnected devices. It also sought professional advice from the Chemical Pathology faculty, quality assurance laboratory experts and international POCT experts from the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). Our concept presents a comprehensive integrated and networked approach to POCT with direct and indirect clinical laboratory supervision, particularly for outpatient and inpatient care in low-resource health care settings.
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Affiliation(s)
- Lena Jafri
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
- Corresponding member for Pakistan-IFCC Committee on Point of Care Testing
| | - Sibtain Ahmed
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Hafsa Majid
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Farooq Ghani
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Tahir Pillay
- Department of Chemical Pathology, University of Pretoria, Pretoria, South Africa
- Chair, IFCC Communications and Publications Division
| | - Aysha Habib Khan
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Imran Siddiqui
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Shahid Shakeel
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Shuja Ahmed
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Saba Azeem
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Adil Khan
- Point-of-Care Testing & Clinical Chemistry, Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- Chair, IFCC Committee on Point of Care Testing
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Thomas PT, Warrier MG, Arun S, Bhuvaneshwari B, Vengalil S, Nashi S, Preethish-Kumar V, Polavarapu K, Rajaram P, Nalini A. An individualised psychosocial intervention program for persons with MND/ALS and their families in low resource settings. Chronic Illn 2023; 19:458-471. [PMID: 35469482 DOI: 10.1177/17423953221097076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To develop individualised psychosocial intervention program for people with MND and their families in India. METHODS People with MND and healthcare staff were constructively involved in co-designing the intervention program in four phases adapted from the MRC framework: 1. A detailed need assessment phase where 30 participants shared their perceptions of psychosocial needs 2. Developing the intervention module (synthesis of narrative review, identified needs); 3. Feasibility testing of the intervention program among seven participants; 4. Feedback from participants on the feasibility (acceptance, practicality adaptation). The study adopted an exploratory research design. RESULTS Intervention program of nine sessions, addressing psychosocial challenges through the different stages of progression of the illness and ways to handle the challenges, specific to the low resource settings, was developed and was found to be feasible. People with MND and families who participated in the feasibility study shared the perceived benefit through feedback interviews. CONCLUSION MND has changing needs and challenges. Intervention programme was found to be feasible to be implemented among larger group to establish efficacy.
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Affiliation(s)
- Priya Treesa Thomas
- Department of Psychiatric Social Work, 29148National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Manjusha G Warrier
- Department of Psychology, 119667CHRIST (Deemed to be University), Bangalore
| | - S Arun
- Department of Counselling Psychology, Montfort College, Bangalore
| | - B Bhuvaneshwari
- Department of Psychiatry, 236748St John's Medical college and hospital, Bangalore, India
| | - Seena Vengalil
- Department of Neurology, 29148National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Saraswati Nashi
- Department of Neurology, 29148National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Veeramani Preethish-Kumar
- Department of Neurology, 29148National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Kiran Polavarapu
- Department of Neurology, 29148National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Prakashi Rajaram
- Department of Psychiatric Social Work, 29148National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Atchayaram Nalini
- Department of Neurology, 29148National Institute of Mental Health and Neuro Sciences, Bangalore, India
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Teka H, Gidey H, Gebrehiwot TG, Yemane A, Abraha HE, Ebrahim MM, Abate E, Hasan A, Gebremeskel M, Berhe E, Ahmed S, Zelelow YB. Perinatal outcome of oligohydramnios in academic hospitals in a low resource setting. Afr J Reprod Health 2023; 27:54-64. [PMID: 37584908 DOI: 10.29063/ajrh2023/v27i4.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Oligohydramnios has been a topical issue in obstetrics. The prevalence of oligohydramnios ranges from 1 to 5%. Conflicting data exists concerning its effects on adverse perinatal outcome. This study aims to assess perinatal outcomes of oligohydramnios at the Mekelle Public Hospitals from April 1, 2018 - March 31, 2019. This was a cross-sectional study and a total population purposive sampling method was employed to collect data prospectively. During the study period, there were a total of 10,451 deliveries in both hospitals. Oligohydramnios complicated 332 pregnancies (3.2%, 95%CI: 2.9%, 3.5%) across all gestations and 273 pregnancies (2.6%, 95% CI: 2.3%, 2.9%) at term. The composite adverse perinatal outcome rate was 29.7% (95% CI, 24.5, 35.4). Primigravidity and presenting at post-term gestation were associated with adverse perinatal outcome. Nearly 70% of mothers gave birth via Cesarean delivery. Oligohydramnios was found to be associated with a significant increase in adverse newborn and maternal outcomes in the study setting. Although a significant proportion of mothers underwent Cesarean delivery for a perceived increased complications associated with vaginal delivery in this population of patients, Cesarean delivery was found to not improve perinatal outcome. Primigravids and postdated pregnancies must receive increased surveillance to detect oligohydramnios early and to institute appropriate and timely interventions. Indications for Cesarean delivery in patients complicated by oligohydramnios must be carefully examined to balance the benefit on the perinatal outcome on the one hand and to avoid unnecessary major surgery with potential fatal maternal complications on the other.
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Affiliation(s)
- Hale Teka
- Department of Obstetrics and Gynecology, Mekelle University, College of Health Sciences, Ethiopia
| | - Hagos Gidey
- Department of Obstetrics and Gynecology, Mekelle University, College of Health Sciences, Ethiopia
| | - Tesfay G Gebrehiwot
- Department of Obstetrics and Gynecology, Mekelle University, College of Health Sciences, Ethiopia
| | - Awol Yemane
- Department of Obstetrics and Gynecology, Mekelle University, College of Health Sciences, Ethiopia
| | - Hiluf Ebuy Abraha
- Department of Obstetrics and Gynecology, Mekelle University, College of Health Sciences, Ethiopia
| | - Mohamedawel M Ebrahim
- Department of Obstetrics and Gynecology, Mekelle University, College of Health Sciences, Ethiopia
| | - Ermias Abate
- Department of Obstetrics and Gynecology, Mekelle University, College of Health Sciences, Ethiopia
| | - Abida Hasan
- Department of Obstetrics and Gynecology, Mekelle University, College of Health Sciences, Ethiopia
| | - Mebrihit Gebremeskel
- Department of Radiology, Mekelle University, College of Health Sciences, Ethiopia
| | - Ephrem Berhe
- Department of Internal Medicine, Mekelle University, College of Health Sciences, Ethiopia
| | - Sumeya Ahmed
- Department of Obstetrics and Gynecology, Mekelle University, College of Health Sciences, Ethiopia
| | - Yibrah B Zelelow
- Department of Obstetrics and Gynecology, Mekelle University, College of Health Sciences, Ethiopia
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Hamshari S, Shahid H, Saudi L, Nazzal Z, Zink T. Virtual class room as a learning format in a family medicine residency program: Lessons learned in Palestine. Med Teach 2022; 44:1032-1036. [PMID: 35452584 DOI: 10.1080/0142159x.2022.2058387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Due to geopolitical and socioeconomic challenges, the Family Medicine (FM) speciality in Palestine is in early stages of development. Volunteer British General Practitioner (BGP) trainers worked with FM faculty to develop an online tutorial program (OTP) and a novel evaluation framework E-QUaL (Evaluation-Quality, Utilization and Learning) to enhance residents' patient-centered communication and clinical skills. MATERIALS AND METHODS Three OTP cycles were facilitated and evaluated at An Najah National University (ANNU) in Palestine between 2017-2020. Qualitative data were collected during focus groups and online chats and analysed. RESULTS AND CONCLUSIONS The development and joint facilitation of the OTP developed faculty skills and enhanced clinically oriented education. The collaborative (BGPs and ANNU faculty) approach and the use of the EQUaL framework helped to identify and address strengths and opportunities as well as the challenges and threats of the educational content and the virtual learning format with each iteration. The COVID pandemic provided a new and inexpensive platform which improved training quality. Issues such as the volunteer nature of BGPs, internet instability, and differing cultural approaches and expectations between physicians and patients were addressed in a continuous quality improvement approach and continues today. This may be a useful model in other low resourced settings.
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Affiliation(s)
- Suha Hamshari
- Department of Family and Community Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Hina Shahid
- Foundation for Family Medicine in Palestine, London, UK
| | - Lubna Saudi
- Department of Family and Community Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Zaher Nazzal
- Department of Family and Community Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Therese Zink
- Department of Family Medicine/Alpert School of Medicine + Behavioural and Social Sciences/School of Public Health, Brown University, Providence, Rhode Island, USA
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Effah K, Attivor EK, Atuguba BH, Adaletey DD, Ofori DA, Diame P, Tekpor E, Wormenor CM, Gedzah I, Agyiri D, Amuah JE, Akakpo PK, Gmanyami JM, Adjuik M, Amu H, Kweku M. Application of the hub and spokes model in improving access to cervical cancer screening in Ghana. Ghana Med J 2022; 56:134-140. [PMID: 37448999 PMCID: PMC10336637 DOI: 10.4314/gmj.v56i3.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE To examine the contribution of lower-level health facilities in increasing access to cervical cancer screening in the North Tongu District. DESIGN A descriptive cross-sectional study design was used. The Cervical Cancer Prevention and Training Centre (CCPTC) of the Catholic Hospital, Battor, served as the hub, and six health facilities (3 health centres and 3 CHPS compounds) served as the spokes. From April 2018 to September 2019, the well-resourced CCPTC trained 6 nurses at selected Community-based Health Planning and Services (CHPS) / Health Centres (HCs) (spokes) to provide cervical cancer screening services. The nurses, after training, started screening with VIA and HPV DNA testing. PARTICIPANTS A total of 3,451women were screened by the trained nurses. This comprised 1,935 (56.1%) from the hub and 1,516 (43.9%) from the spokes. MAIN OUTCOME MEASURE The detection of screen positives. RESULTS The screen positives were 19.4% (375/1935) at the hub and 4.9% (74/1516) at the spokes. CONCLUSION We have demonstrated that a hub and spokes model for cervical cancer screening is possible in limited resource settings. Designating and resourcing a 'hub' that supports a network of 'spokes' could increase women's access to cervical cancer screening. This approach could create awareness about cervical cancer screening services and how they can be accessed. FUNDING None declared.
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Affiliation(s)
| | - Evans K Attivor
- North Tongu District Health Directorate, Ghana Health Service, Adidome, Ghana
| | | | | | - Delali A Ofori
- North Tongu District Health Directorate, Ghana Health Service, Adidome, Ghana
| | | | | | | | | | | | | | - Patrick K Akakpo
- Department of Pathology, School of Medical Sciences, University of Cape Coast, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Jonathan M Gmanyami
- Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Martin Adjuik
- Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Hubert Amu
- Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Margaret Kweku
- Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
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Boro E, Stoll B. Barriers to COVID-19 Health Products in Low-and Middle-Income Countries During the COVID-19 Pandemic: A Rapid Systematic Review and Evidence Synthesis. Front Public Health 2022; 10:928065. [PMID: 35937225 PMCID: PMC9354133 DOI: 10.3389/fpubh.2022.928065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/13/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic has intensified the urgency in addressing pressing global health access challenges and has also laid bare the pervasive structural and systemic inequities that make certain segments of society more vulnerable to the tragic consequences of the disease. This rapid systematic review analyses the barriers to COVID-19 health products in low-and middle-income countries (LMICs). It does so from the canon of global health equity and access to medicines by proposing an access to health products in low-and middle-income countries framework and typology adapted to underscore the complex interactive and multiplicative nature and effects of barriers to health products and their root cause as they coexist across different levels of society in LMICs. Methods Modified versions of the Joanna Briggs Institute (JBI) reviewers' manual for evidence synthesis of systematic reviews and the PRISMA-ScR framework were used to guide the search strategy, identification, and screening of biomedical, social science, and gray literature published in English between 1 January 2020 and 30 April 2021. Results The initial search resulted in 5,956 articles, with 72 articles included in this review after screening protocol and inclusion criteria were applied. Thirty one percent of the articles focused on Africa. The review revealed that barriers to COVID-19 health products were commonly caused by market forces (64%), the unavailability (53%), inaccessibility (42%), and unaffordability (35%), of the products, incongruent donors' agenda and funding (33%) and unreliable health and supply systems (28%). They commonly existed at the international and regional (79%), health sectoral (46%), and national cross-sectoral [public policy] (19%) levels. The historical heritage of colonialism in LMICs was a commonly attributed root cause of the barriers to COVID-19 health products in developing countries. Conclusion This review has outlined and elaborated on the various barriers to health products that must be comprehensively addressed to mount a successful global, regional, national and subnational response to present and future epidemics and pandemics in LMICs.
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Affiliation(s)
- Ezekiel Boro
- Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland
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Tegenaw GS, Amenu D, Ketema G, Verbeke F, Cornelis J, Jansen B. A Hybrid Approach for Designing Dynamic and Data-Driven Clinical Pathways Point of Care Instruments in Low Resource Settings. Stud Health Technol Inform 2022; 290:316-320. [PMID: 35673026 DOI: 10.3233/shti220087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Though a clinical pathway is one of the tools used to guide evidence-based healthcare, promoting the practice of evidence-based decisions on healthcare services is incredibly challenging in low resource settings (LRS). This paper proposed a novel approach for designing an automated and dynamic generation of clinical pathways (CPs) in LRS through a hybrid (knowledge-based and data-driven based) algorithm that works with limited clinical input and can be updated whenever new information is available. Our proposed approach dynamically maps and validate the knowledge-based clinical pathways with the local context and historical evidence to deliver a multi-criteria decision analysis (concordance table) for adjusting or readjusting the order of knowledge-based CPs decision priority. Our finding shows that the developed approach successfully delivered probabilistic-based CPs and found a promising result with Jimma Health Center "pregnancy, childbearing, and family planning" dataset.
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Affiliation(s)
- Geletaw Sahle Tegenaw
- Department of Electronics and Informatics ETRO, Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050 Brussel, Belgium.,Faculty of Computing, JiT, Jimma University, Ethiopia
| | - Demisew Amenu
- Department of Obstetrics and Gynecology. College of Health Science, Jimma University, Ethiopia
| | - Girum Ketema
- Faculty of Computing, JiT, Jimma University, Ethiopia
| | - Frank Verbeke
- Department of Electronics and Informatics ETRO, Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050 Brussel, Belgium
| | - Jan Cornelis
- Department of Electronics and Informatics ETRO, Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050 Brussel, Belgium
| | - Bart Jansen
- Department of Electronics and Informatics ETRO, Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050 Brussel, Belgium.,iMEC, Kapeldreef 75, 3001 Leuven, Belgium
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Ilozumba O, Kabukye J, de Keizer N, Cornet R, Broerse JEW. Cancer as a death sentence: developing an initial program theory for an IVR intervention. Health Promot Int 2022; 37:6652934. [PMID: 35913900 PMCID: PMC9342624 DOI: 10.1093/heapro/daac070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
To address current trends in poor health-seeking behaviour and late cancer diagnosis in many low- and middle-income countries, like Uganda, it is important to explore innovative awareness building interventions. One possible intervention is a common digital format, an interactive voice response (IVR) system, which is suitable for individuals with low technological and reading literacy. It is increasingly acknowledged that developing digital interventions requires co-creation with relevant stakeholders and explication of program developers’ assumptions, to make them effective, sustainable, and scalable. To this end, we sought to develop an initial program theory for a co-created IVR system for cancer awareness in Uganda. Utilising principles of the realist approach, a qualitative exploratory study was conducted through seven focus group discussions (FGDs) with people living with cancer (PLWC), health workers, and policy makers. Thematic analysis of the transcripts resulted in the emergence of four major themes. Through all themes the most consistent finding was that myths, misconceptions, and misinformation about cancer were related to every aspect of the cancer journey and influenced the experiences and lives of PLWC and their caregivers. Participants were positive about the potential of an IVR system but also had reservations about the design and reach of the system. The resulting initial program theory proposes that a context-specific IVR system has the potential to improve awareness on cancer, provided attention is given to aspects such as language, message framing, and accuracy.
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Affiliation(s)
- Onaedo Ilozumba
- Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Johnblack Kabukye
- Uganda Cancer Institute, Kampala, Uganda.,Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam UMC-Location AMC, Amsterdam, The Netherlands
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12
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Connery AK, Lamb MM, Colbert AM, Bauer D, Olson D, Paniagua-Avila A, Calvimontes M, Bolaños GA, Sahly HME, Muñoz FM, Asturias EJ. A prospective cohort study of head circumference and its association with neurodevelopmental outcomes in infants and young children in rural Guatemala. J Dev Orig Health Dis 2022;:1-8. [PMID: 35450541 DOI: 10.1017/S204017442200023X] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Microcephaly, an anthropometric marker of reduced brain volume and predictor of developmental disability, is rare in high-income countries. Recent reports show the prevalence of microcephaly to be much higher in lower resource settings. We calculated the prevalence of microcephaly in infants and young children (n = 642; age range = 0.1-35.9 months), examined trends in occipitofrontal circumference (OFC) growth in the year after birth and evaluated the relationship between OFC and performance on the Mullen Scales of Early Learning (MSEL) in rural Guatemala. Multivariable regression analyses adjusted for age were performed: (1) a model comparing concurrent MSEL performance and OFC at all visits per child, (2) concurrent OFC and MSEL performance by age group, and (3) OFC at enrollment and MSEL at final visit by age group. Prevalence of microcephaly ranged from 10.1% to 25.0%. OFC z-score decreased for most infants throughout the first year after birth. A significant positive association between continuous OFC measurement and MSEL score suggested that children with smaller OFC may do worse on ND tests conducted both concurrently and ∼1 year later. Results were variable when analyzed by OFC cutoff scores and stratified by 6-month age groups. OFC should be considered for inclusion in developmental screening assessments at the individual and population level, especially when performance-based testing is not feasible.
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13
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Kalra A, Subramaniam N, Longkumer O, Siju M, Jose LS, Srivastava R, Lin S, Handu S, Murugesan S, Lloyd M, Madriz S, Jenny A, Thorn K, Calkins K, Breeze-Harris H, Cohen SR, Ghosh R, Walker D. Super Divya, an Interactive Digital Storytelling Instructional Comic Series to Sustain Facilitation Skills of Labor and Delivery Nurse Mentors in Bihar, India-A Pilot Study. Int J Environ Res Public Health 2022; 19:ijerph19052675. [PMID: 35270366 PMCID: PMC8910046 DOI: 10.3390/ijerph19052675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 11/16/2022]
Abstract
To improve the quality of intrapartum care in public health facilities of Bihar, India, a statewide quality improvement program was implemented. Nurses participated in simulation sessions to improve their clinical, teamwork, and communication skills. Nurse mentors, tasked with facilitating these sessions, received training in best practices. To support the mentors in the on-going facilitation of these trainings, we developed a digital, interactive, comic series starring “Super Divya”, a simulation facilitation superhero. The objective of these modules was to reinforce key concepts of simulation facilitation in a less formal and more engaging way than traditional didactic lessons. This virtual platform offers the flexibility to watch modules frequently and at preferred times. This pilot study involved 205 simulation educators who were sent one module at a time. Shortly before sending the first module, nurses completed a baseline knowledge survey, followed by brief surveys after each module to assess change in knowledge. Significant improvements in knowledge were observed across individual scores from baseline to post-survey. A majority found Super Divya modules to be acceptable and feasible to use as a learning tool. However, a few abstract concepts in the modules were not well-understood, suggesting that more needs to be done to communicate their core meaning of these concepts.
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Affiliation(s)
- Anika Kalra
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA 94158, USA; (A.K.); (S.L.); (S.M.); (A.J.); (D.W.)
| | | | - Ojungsangla Longkumer
- PRONTO India Foundation, Patna 800025, Bihar, India; (O.L.); (M.S.); (L.S.J.); (R.S.); (S.H.)
| | - Manju Siju
- PRONTO India Foundation, Patna 800025, Bihar, India; (O.L.); (M.S.); (L.S.J.); (R.S.); (S.H.)
| | - Liya Susan Jose
- PRONTO India Foundation, Patna 800025, Bihar, India; (O.L.); (M.S.); (L.S.J.); (R.S.); (S.H.)
| | - Rohit Srivastava
- PRONTO India Foundation, Patna 800025, Bihar, India; (O.L.); (M.S.); (L.S.J.); (R.S.); (S.H.)
| | - Sunny Lin
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA 94158, USA; (A.K.); (S.L.); (S.M.); (A.J.); (D.W.)
| | - Seema Handu
- PRONTO India Foundation, Patna 800025, Bihar, India; (O.L.); (M.S.); (L.S.J.); (R.S.); (S.H.)
| | | | - Mikelle Lloyd
- Department of OB/GYN, The University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA; (M.L.); (S.R.C.)
| | - Solange Madriz
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA 94158, USA; (A.K.); (S.L.); (S.M.); (A.J.); (D.W.)
| | - Alisa Jenny
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA 94158, USA; (A.K.); (S.L.); (S.M.); (A.J.); (D.W.)
| | - Kevin Thorn
- NuggetHead Studioz, LLC, 1862 Gracie Road, Hernando, MS 38632, USA;
| | - Kimberly Calkins
- PRONTO International, 5419 Greenwood Ave N, Seattle, WA 98103, USA; (K.C.); (H.B.-H.)
| | - Heidi Breeze-Harris
- PRONTO International, 5419 Greenwood Ave N, Seattle, WA 98103, USA; (K.C.); (H.B.-H.)
| | - Susanna R. Cohen
- Department of OB/GYN, The University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA; (M.L.); (S.R.C.)
| | - Rakesh Ghosh
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA 94158, USA; (A.K.); (S.L.); (S.M.); (A.J.); (D.W.)
- Correspondence:
| | - Dilys Walker
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, San Francisco, CA 94158, USA; (A.K.); (S.L.); (S.M.); (A.J.); (D.W.)
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14
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Bhandari D, Ozaki A, Ghimire B, Sigdel S, Shrestha R, Shrestha S, Higuchi A, Uprety A, Tsubokura M, Tanimoto T, Singh YP. Oncology clinical practice guidelines usage among physicians in Nepal. J Eval Clin Pract 2022; 28:142-150. [PMID: 34184374 DOI: 10.1111/jep.13594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Oncology clinical practice guidelines (OCPGs) are systematically developed evidence-based recommendations aimed to guide practitioners in decision making during the diagnosis, management, and treatment of cancer patients under specific circumstances, thereby optimizing clinical outcomes. However, little is known about the implementation of those guidelines in low and middle-income countries including Nepal. This research aimed to identify the type of OCPGs used by Nepalese physicians working in oncology departments and to explore barriers and facilitators affecting their use. METHODS Using the total population sampling technique, we conducted an online cross-sectional survey from June 2020 to January 2021 among physicians working in the oncology departments of Nepal. Descriptive analyses were conducted to summarize the research findings. RESULTS Out of 171 physicians approached for the study, 102 (59.6%) responded to the questionnaire. The sizable proportions of the participants were a senior group of physicians with 27.5% being consultants, 14.7% senior consultants, and 16.7% professors. The most commonly used guideline was the National Comprehensive Cancer Network guideline of the United States (75.5%) followed by the American Society of Clinical Oncology guideline (44.7%). While only 22.6% of physicians reported using OCPGs every time, more than half (56.9%) highlighted that OCPGs are not feasible to implement in Nepal. Insufficient facilities/equipment, physicians' unwillingness to change their usual practice, inability to discuss research with knowledgeable colleagues, and lack of time were commonly cited barriers. CONCLUSION Findings of our study highlighted that the OCPGs developed in high-income countries may not be feasible for low resource settings like Nepal. Comprehensive local OCPGs should be developed considering the available resources, feasibility, and financial constraints of patients. Furthermore, a constant sharing and learning environment should be created to enhance the knowledge of practicing physicians and to promote the proper implementation of evidence-based findings.
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Affiliation(s)
| | - Akihiko Ozaki
- Medical Governance Research Institute, Tokyo, Japan.,Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan
| | - Bikal Ghimire
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Shailendra Sigdel
- Department of Cardiothoracic and Vascular Anesthesiology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - Ranish Shrestha
- Infection Control Unit, Nepal Cancer Hospital and Research Center, Lalitpur, Nepal
| | - Sunil Shrestha
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Nepal
| | - Asaka Higuchi
- Medical Governance Research Institute, Tokyo, Japan.,Department of Radiation Health Management, Fukushima Medical University, Fukushima, Japan
| | - Anup Uprety
- Department of Anesthesiology, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University, Fukushima, Japan.,Research Center for Community Health, Minamisoma Municipal General Hospital, Fukushima, Japan
| | | | - Yogendra Prasad Singh
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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15
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Xue Z, Angara S, Levitz D, Antani S. Analysis of digital noise and reduction methods on classifiers used in automated visual evaluation in cervical cancer screening. Proc SPIE Int Soc Opt Eng 2022; 11950:1195008. [PMID: 35529321 PMCID: PMC9074910 DOI: 10.1117/12.2610235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The burden of cervical cancer disproportionately falls on low- and middle-income countries (LMICs). Automated visual evaluation (AVE) is a technology being considered as an adjunct tool for the management of HPV-positive women. AVE involves analysis of a white light illuminated cervical image using machine learning classifiers. It is of importance to analyze various impacts of different kinds of image degradations on AVE. In this paper, we report our work regarding the impact of one type of image degradation, Gaussian noise, and one of its remedies we have been exploring. The images, originated from the Natural History Study (NHS) and ASCUS-LSIL Triage Study (ALTS), were modified by the addition of white Gaussian noise at different levels. The AVE pipeline used in the experiments consists of two deep learning components: a cervix locator which uses RetinaNet (an object detection network), and a binary pathology classifier that uses the ResNeSt network. Our findings indicate that Gaussian noise, which frequently appears in low light conditions, is a key factor in degrading the AVE's performance. A blind image denoising technique which uses Variational Denoising Network (VDNet) was tested on a set of 345 digitized cervigram images (115 positives) and evaluated both visually and quantitatively. AVE performances on both the synthetically generated noisy images and the corresponding denoised images were examined and compared. In addition, the denoising technique was evaluated on several real noisy cervix images captured by a camera-based imaging device used for AVE that have no histology confirmation. The comparison between the AVE performances on images with and without denoising shows that denoising can be effective at mitigating classification performance degradation.
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Affiliation(s)
- Zhiyun Xue
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894
| | - Sandeep Angara
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894
| | - David Levitz
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894
- DL Analytics, North Hollywood, CA 91602
| | - Sameer Antani
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894
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16
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Jordan KC, Di Gennaro JL, von Saint André-von Arnim A, Stewart BT. Global trends in pediatric burn injuries and care capacity from the World Health Organization Global Burn Registry. Front Pediatr 2022; 10:954995. [PMID: 35928690 PMCID: PMC9343701 DOI: 10.3389/fped.2022.954995] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/27/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Burn injuries are a major cause of death and disability globally. The World Health Organization (WHO) launched the Global Burn Registry (GBR) to improve understanding of burn injuries worldwide, identify prevention targets, and benchmark acute care. We aimed to describe the epidemiology, risk factors, and outcomes of children with burns to demonstrate the GBR's utility and inform needs for pediatric burn prevention and treatment. METHODS We performed descriptive analyses of children age ≤ 18 years in the WHO GBR. We also described facility-level capacity. Data were extracted in September of 2021. RESULTS There were 8,640 pediatric and adult entries from 20 countries. Of these, 3,649 (42%) were children (0-18 years old) from predominantly middle-income countries. The mean age was 5.3 years and 60% were boys. Children aged 1-5 years comprised 62% (n = 2,279) of the cohort and mainly presented with scald burns (80%), followed by flame burns (14%). Children >5 years (n = 1,219) more frequently sustained flame burns (52%) followed by scald burns (29%). More than half of pediatric patients (52%) sustained a major burn (≥15% total body surface area) and 48% received surgery for wound closure during the index hospitalization. Older children had more severe injuries and required more surgery. Despite the frequency of severe injuries, critical care capacity was reported as "limited" for 23% of pediatric patients. CONCLUSIONS Children represent a large proportion of people with burn injuries globally and often sustain major injuries that require critical and surgical intervention. However, critical care capacity is limited at contributing centers and should be a priority for healthcare system development to avert preventable death and disability. This analysis demonstrates that the GBR has the potential to highlight key epidemiological characteristics and hospital capacity for pediatric burn patients. To improve global burn care, addressing barriers to GBR participation in low- and low-middle-income countries would allow for greater representation from a diversity of countries, regions, and burn care facilities.
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Affiliation(s)
- Kelly C Jordan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Jane L Di Gennaro
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Amélie von Saint André-von Arnim
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Barclay T Stewart
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, Seattle, WA, United States
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17
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Dsouza JP, Van den Broucke S, Pattanshetty S, Dhoore W. Cervical cancer screening status and implementation challenges: Report from selected states of India. Int J Health Plann Manage 2021; 37:824-838. [PMID: 34716616 DOI: 10.1002/hpm.3353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/31/2020] [Revised: 07/28/2021] [Accepted: 10/04/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cervical cancer contributes to 6%-29% of the cancers in India. Although the Government of India in 2010 integrated cancer screening within the National Programme for the prevention of Non-communicable Diseases, only 22% of women aged 15-45 years had undergone examination of the cervix by 2016. This prompts the question regarding the organisation of the program's implementation and service delivery and regarding challenges that may explain poor screening uptake. METHODS Semi-structured interviews were held with program managers and implementers in seven districts of three selected States of India. The data analysis looked at program content, the organisation of screening delivery, and the challenges to the implementation of the program, considering six theoretically derived dimensions of public health capacity: leadership and governance, organisational structure, financial resources, workforce, partnerships, and knowledge development. RESULTS Participants perceive the existing capacities across the six domains as insufficient to implement the CCS program nationwide. A context specific implementation, a better coordination between the program and district health facilities, timely remuneration, better maintenance of data and a strong monitoring system are possible solutions to remove health system related barriers. CONCLUSION The study provides evidence on the practical challenges and provides recommendations for strengthening the capacities of the health system.
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Affiliation(s)
- Jyoshma Preema Dsouza
- Psychological Sciences Research Institute (IPSY), School of Public Health, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute (IPSY), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Sanjay Pattanshetty
- School of Public Health, Manipal Academy of Higher Education, Manipal University, Manipal, India
| | - William Dhoore
- School of Public Health, Université Catholique de Louvain, Woluwe, Brussels, Belgium
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18
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Kutoane M, Brysiewicz P, Scott T. Interventions for managing professional isolation among health professionals in low resource environments: A scoping review. Health Sci Rep 2021; 4:e361. [PMID: 34532595 PMCID: PMC8435295 DOI: 10.1002/hsr2.361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/09/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Professional isolation is viewed as a sense of isolation from ones professional peers and this has contributed to compromised quality of health service delivery as well as quality of life for health professionals in low resource environments. Professional isolation is a multidimensional concept which may be either geographic, social, and/or ideological. However, professional isolation in low resource environments remains poorly defined with a limited body of research focusing on health professionals. AIM To map and examine available literature on interventions for managing professional isolation among health professionals in low resource environments. METHODS We conducted a scoping review of the published and grey literature to examine the extent, range and nature of existing research studies relevant to professional isolation in health professionals. RESULTS Of the 10 articles retrieved, 70% were conducted in high income countries where the context may be different if applied to other low-income settings such as in Africa. Only 20% of the studies focused specifically on nurses or the nursing profession and only 10% were conducted on the African continent. CONCLUSION There is insufficient research on the definition and origins of professional isolation among health professionals including the interventions that can be employed. Rural, remote and/or isolated settings significantly predispose health professionals to professional isolation but remain poorly defined. Additional research is recommended to explore and determine the interventions for managing professional isolation among health professionals in low resource environments.
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Affiliation(s)
- Mahlomola Kutoane
- School of Nursing & Public Health, College of Health SciencesUniversity of KwaZulu‐NatalDurbanSouth Africa
- School of Nursing & Public Health, College of Health SciencesUniversity of KwaZulu‐Natal, Howard CollegeDurbanSouth Africa
| | - Petra Brysiewicz
- School of Nursing & Public Health, College of Health SciencesUniversity of KwaZulu‐NatalDurbanSouth Africa
- School of Nursing & Public Health, College of Health SciencesUniversity of KwaZulu‐Natal, Howard CollegeDurbanSouth Africa
| | - Tricia Scott
- Healthcare Research and Education ConsultantLondonHertfordshireUK
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19
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Okpechi IG, Bello AK, Luyckx VA, Wearne N, Swanepoel CR, Jha V. Building optimal and sustainable kidney care in low resource settings: The role of healthcare systems. Nephrology (Carlton) 2021; 26:948-960. [PMID: 34288246 DOI: 10.1111/nep.13935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/21/2021] [Accepted: 07/01/2021] [Indexed: 01/04/2023]
Abstract
Healthcare systems in low-income and lower-middle income countries (LLMICs) face significant challenges in the provision of health services, for example, kidney care to the population. Although this is linked to several high-level factors such as poor infrastructure, socio-demographic and political factors, healthcare funding has often been cited as the major reason for the wide gap in availability, accessibility and quality of care between LLMICs and rich countries. With the steady rising incidence and prevalence of kidney diseases globally, as well as cost of care, LLMICs are likely to suffer more consequences of these increases than rich countries and may be unable to meet targets of universal health coverage (UHC) for kidney diseases. As health systems in LLMICs continue to adapt in finding ways to provide access to affordable kidney care, various empirical and evidence-based strategies can be applied to assist them. This review uses a framework for healthcare strengthening developed by the World Health Organization (WHO) to assess various challenges that health systems in LLMICs confront in providing optimal kidney care to their population. We also suggest ways to overcome these barriers and strengthen health systems to improve kidney care in LLMICs.
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Affiliation(s)
- Ikechi G Okpechi
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada.,Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Aminu K Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Valerie A Luyckx
- Institute for Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland.,Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicola Wearne
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Charles R Swanepoel
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India.,School of Public Health, Imperial College, London, United Kingdom.,Manipal Academy of Higher Education, Manipal, India
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20
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Fekadu G, Bekele F, Tolossa T, Fetensa G, Turi E, Getachew M, Abdisa E, Assefa L, Afeta M, Demisew W, Dugassa D, Diriba DC, Labata BG. Impact of COVID-19 pandemic on chronic diseases care follow-up and current perspectives in low resource settings: a narrative review. Int J Physiol Pathophysiol Pharmacol 2021; 13:86-93. [PMID: 34336132 PMCID: PMC8310882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
Coronavirus is a respiratory disease that spreads globally. The severity and mortality risk of the disease is significant in the elderly, peoples having co-morbidities, and immunosuppressive patients. The outbreak of the pandemic created significant barriers to diagnosis, treatment and follow-up of chronic diseases. Delivering regular and routine comprehensive care for chronic patients was disrupted due to closures of healthcare facilities, lack of public transportation or reductions in services. The purpose of this narrative review was to update how patients with chronic care were affected during the pandemic, healthcare utilization services and available opportunities for better chronic disease management during the pandemic in resources limited settings. Moreover, this review may call to the attention of concerned bodies to make decisions and take measures in the spirit of improving the burden of chronic diseases by forwarding necessary recommendations for possible change and to scale up current intervention programs.
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Affiliation(s)
- Ginenus Fekadu
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong KongShatin, New Territory, Hong Kong
- School of Pharmacy, Institute of Health Sciences, Wollega UniversityNekemte, Ethiopia
| | - Firomsa Bekele
- Department of Pharmacy, College of Health Sciences, Mettu UniversityMettu, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institute of Health, Wollega UniversityNekemte, Ethiopia
| | - Getahun Fetensa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega UniversityNekemte, Ethiopia
| | - Ebisa Turi
- Department of Public Health, Institute of Health, Wollega UniversityNekemte, Ethiopia
| | - Motuma Getachew
- Department of Public Health, Institute of Health, Wollega UniversityNekemte, Ethiopia
| | - Eba Abdisa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega UniversityNekemte, Ethiopia
| | - Lemessa Assefa
- Department of Public Health, Institute of Health, Wollega UniversityNekemte, Ethiopia
| | - Melkamu Afeta
- Department of Psychology, College of Education and Behavioral Studies, Kotobe Metropolitan UniversityAddis Ababa, Ethiopia
| | - Waktole Demisew
- Department of Psychology, College of Behavioral Science, Wollega UniversityNekemte, Ethiopia
| | - Dinka Dugassa
- School of Pharmacy, Institute of Health Sciences, Wollega UniversityNekemte, Ethiopia
| | - Dereje Chala Diriba
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega UniversityNekemte, Ethiopia
| | - Busha Gamachu Labata
- School of Pharmacy, Institute of Health Sciences, Wollega UniversityNekemte, Ethiopia
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21
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Fadelu T, Rebbeck TR. The rising burden of cancer in low- and middle-Human Development Index countries. Cancer 2021; 127:2864-2866. [PMID: 34086352 DOI: 10.1002/cncr.33586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/27/2021] [Accepted: 03/09/2021] [Indexed: 01/22/2023]
Affiliation(s)
| | - Timothy R Rebbeck
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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22
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Byanjankar P, Poudyal A, Kohrt BA, Maharjan SM, Hagaman A, van Heerden A. Utilizing passive sensing data to provide personalized psychological care in low-resource settings. Gates Open Res 2021; 4:118. [PMID: 33709058 PMCID: PMC7940775 DOI: 10.12688/gatesopenres.13117.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 12/19/2022] Open
Abstract
Background: With the growing ubiquity of smartphones and wearable devices, there is an increased potential of collecting passive sensing data in mobile health. Passive data such as physical activity, Global Positioning System (GPS), interpersonal proximity, and audio recordings can provide valuable insight into the lives of individuals. In mental health, these insights can illuminate behavioral patterns, creating exciting opportunities for mental health service providers and their clients to support pattern recognition and problem identification outside of formal sessions. In the Sensing Technologies for Maternal Depression Treatment in Low Resource Settings (StandStrong) project, our aim was to build an mHealth application to facilitate the delivery of psychological treatments by lay counselors caring for adolescent mothers with depression in Nepal. Methods: This paper describes the development of the StandStrong platform comprising the StandStrong Counselor application, and a cloud-based processing system, which can incorporate any tool that generates passive sensing data. We developed the StandStrong Counselor application that visualized passively collected GPS, proximity, and activity data. In the app, GPS data displays as heat maps, proximity data as charts showing the mother and child together or apart, and mothers' activities as activity charts. Lay counselors can use the StandStrong application during counseling sessions to discuss mothers' behavioral patterns and clinical progress over the course of a five-week counseling intervention. Achievement Awards based on collected data can also be automatically generated and sent to mothers. Additionally, messages can be sent from counselors to mother's personal phones through the StandStrong platform. Discussion: The StandStrong platform has the potential to improve the quality and effectiveness of psychological services delivered by non-specialists in diverse global settings.
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Affiliation(s)
- Prabin Byanjankar
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, 44600, Nepal
| | - Anubhuti Poudyal
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, Washington, DC, 20036, USA
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, Washington, DC, 20036, USA
| | - Sujen Man Maharjan
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, 44600, Nepal
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
| | - Alastair van Heerden
- Centre for Community Based Research, Human and Social Capabilities, Human Sciences Research Council, Pietermaritzburg, South Africa
- Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Connery AK, Lamb MM, Colbert AM, Bauer D, Hernández S, Arroyave P, Martínez MA, Barrios EE, El Sahly HM, Paniagua-Avila A, Calvimontes M, Bolaños GA, Olson D, Asturias EJ, Munoz FM. Parent Report of Health Related Quality of Life in Young Children in Rural Guatemala: Implementation, Reliability, and Validity of the PedsQL in Stunting and Wasting. Glob Pediatr Health 2021; 8:2333794X21991028. [PMID: 33614851 PMCID: PMC7868501 DOI: 10.1177/2333794x21991028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/07/2021] [Indexed: 11/16/2022] Open
Abstract
In this study, we review the implementation, reliability, and validity of the Pediatric Quality of Life Inventory (PedsQL), a measure of health-related quality of life, in young children in rural Guatemala. Mothers of 842 children (age range = 1-60 months) completed the PedsQL Generic Core Scales 4.0 serially for 1 year. Low (Pearson’s r = 0.28, P < .0001) to moderate (Pearson’s r = 0.65, P < .0001) consistency in responding over time was shown. The PedsQL did not discriminate reliably between healthy children and those with stunting or wasting. PedsQL scores were not lower during the time of an acute illness. While we found low to moderate evidence for the reliability of the PedsQL in healthy children, it did not discriminate between healthy children and those with stunting, wasting or other acute illness.
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Affiliation(s)
- Amy K Connery
- Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | - Molly M Lamb
- Colorado School of Public Health, Aurora, CO, USA
| | - Alison M Colbert
- Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Sara Hernández
- Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | - Paola Arroyave
- Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | | | | | - Hana M El Sahly
- Department of Molecular Virology and Microbiology, Baylor College of Medicine
| | | | - Mirella Calvimontes
- Fundación para la Salud Integral de los Guatemaltecos, Retalhuleu, Guatemala
| | | | - Daniel Olson
- Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA.,Colorado School of Public Health, Aurora, CO, USA
| | - Edwin J Asturias
- Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA.,Colorado School of Public Health, Aurora, CO, USA
| | - Flor M Munoz
- Department of Molecular Virology and Microbiology, Baylor College of Medicine.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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24
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Atif N, Rahman A, Huma ZE, Hamdani SU. Preparing for parenthood: developing a life-skills and socioemotional health program for young married couples in rural Pakistan. Glob Health Action 2021; 14:1982485. [PMID: 34605368 PMCID: PMC8491718 DOI: 10.1080/16549716.2021.1982485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Socioemotional life-skills to negotiate important life-transitions such as marriage and parenthood are critical for the wellbeing of young couples and their offspring, but programs addressing this issue are lacking in Low and Middle-Income Countries (LMICs). Objective This study describes the development of a ‘life-skills’ program for young married women, their husbands and families, living in rural settings in Pakistan. Methods Our methods included: a) a targeted review of relevant literature on life-skills and mental health in young people, b) a qualitative study and, c) intervention development workshops with experts and stakeholders. The review showed that common life-skills employed as part of psychosocial interventions in LMICs were communication skills, problem-solving, assessing relations, stress management, emotional regulation, identifying/eliciting affect, and self-awareness. Results The qualitative study indicated that areas of particular need included interpersonal communication skills with significant others, coping with the pressures of parenthood, and mental well-being. Existing helpful practices included social support by family members and elders. Lack of empowerment in young married women and poor engagement of husbands were identified as a barrier to accessing a potential intervention. Our proposed intervention called ‘Preparing for Parenthood’ consisted of 10 core sessions and 10 follow-up sessions designed to be delivered by lay health workers. It synergistically combined evidence-based socioemotional life-skills (awareness, communication skills, assertiveness, decision-making skills, goal-setting, critical thinking, problem-solving, and coping with stress), with cognitive behavioural strategies (gently challenging existing thoughts and attitudes, behaviour activation and problem solving). The intervention focuses on engagement of the entire family, including husbands. Conclusions The intervention can supplement existing sexual and reproductive health programs by providing skills to prospective parents to effectively negotiate stressful life-transitions and life-events. We envisage the intervention would improve mental as well as sexual and reproductive health of young couples and plan to test this in future randomised trials.
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Affiliation(s)
- Najia Atif
- Child and Adolescent Mental Health, Human Development Research Foundation, Rawalpindi, Pakistan
| | - Atif Rahman
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Zill-E- Huma
- Child and Adolescent Mental Health, Human Development Research Foundation, Rawalpindi, Pakistan.,Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Syed Usman Hamdani
- Child and Adolescent Mental Health, Human Development Research Foundation, Rawalpindi, Pakistan.,Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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25
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Byanjankar P, Poudyal A, Kohrt BA, Maharjan SM, Hagaman A, van Heerden A. Utilizing passive sensing data to provide personalized psychological care in low-resource settings. Gates Open Res 2020; 4:118. [PMID: 33709058 PMCID: PMC7940775 DOI: 10.12688/gatesopenres.13117.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 10/18/2023] Open
Abstract
Background: With the growing ubiquity of smartphones and wearable devices, there is an increased potential of collecting passive sensing data in mobile health. Passive data such as physical activity, Global Positioning System (GPS), interpersonal proximity, and audio recordings can provide valuable insight into the lives of individuals. In mental health, these insights can illuminate behavioral patterns, creating exciting opportunities for mental health service providers and their clients to support pattern recognition and problem identification outside of formal sessions. In the Sensing Technologies for Maternal Depression Treatment in Low Resource Settings (StandStrong) project, our aim was to build an mHealth application to facilitate the delivery of psychological treatments by lay counselors caring for adolescent mothers with depression in Nepal. Methods: This paper describes the development of the StandStrong platform comprising the StandStrong Counselor application, and a cloud-based processing system, which can incorporate any tool that generates passive sensing data. We developed the StandStrong Counselor application that visualized passively collected GPS, proximity, and activity data. In the app, GPS data displays as heat maps, proximity data as charts showing the mother and child together or apart, and mothers' activities as activity charts. Lay counselors can use the StandStrong application during counseling sessions to discuss mothers' behavioral patterns and clinical progress over the course of a five-week counseling intervention. Awards based on collected data also can be automatically generated and sent to mothers. Additionally, messages can be sent from counselors to mother's personal phones through the StandStrong platform. Discussion: The StandStrong platform has the potential to improve the quality and effectiveness of psychological services delivered by non-specialists in diverse global settings.
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Affiliation(s)
- Prabin Byanjankar
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, 44600, Nepal
| | - Anubhuti Poudyal
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, Washington, DC, 20036, USA
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, Washington, DC, 20036, USA
| | - Sujen Man Maharjan
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, 44600, Nepal
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
| | - Alastair van Heerden
- Centre for Community Based Research, Human and Social Capabilities, Human Sciences Research Council, Pietermaritzburg, South Africa
- Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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26
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Prabhakaran D, Perel P, Roy A, Singh K, Raspail L, Faria-Neto JR, Gidding SS, Ojji D, Hakim F, Newby LK, Stępińska J, Lam CSP, Jobe M, Kraus S, Chuquiure-Valenzuela E, Piñeiro D, Khaw KT, Bahiru E, Banerjee A, Narula J, Pinto FJ, Wood DA, Sliwa K. Management of Cardiovascular Disease Patients With Confirmed or Suspected COVID-19 in Limited Resource Settings. Glob Heart 2020; 15:44. [PMID: 32923338 DOI: 10.5334/gh.823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In this paper, we provide recommendations on the management of cardiovascular disease (CVD) among patients with confirmed or suspected coronavirus disease (COVID-19) to facilitate the decision making of healthcare professionals in low resource settings. The emergence of novel coronavirus disease, also known as Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), has presented an unprecedented global challenge for the healthcare community. The ability of SARS-CoV-2 to get transmitted during the asymptomatic phase and its high infectivity have led to the rapid transmission of COVID-19 beyond geographic regions, leading to a pandemic. There is concern that COVID-19 is cardiotropic, and it interacts with the cardiovascular system on multiple levels. Individuals with established CVD are more susceptible to severe COVID-19. Through a consensus approach involving an international group this WHF statement summarizes the links between cardiovascular disease and COVID-19 and present some practical recommendations for the management of hypertension and diabetes, acute coronary syndrome, heart failure, rheumatic heart disease, Chagas disease, and myocardial injury for patients with COVID-19 in low-resource settings. This document is not a clinical guideline and it is not intended to replace national clinical guidelines or recommendations. Given the rapidly growing burden posed by COVID-19 illness and the associated severe prognostic implication of CVD involvement, further research is required to understand the potential mechanisms linking COVID-19 and CVD, clinical presentation, and outcomes of various cardiovascular manifestations in COVID-19 patients.
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27
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Zafereo M, Yu J, Onakoya PA, Aswani J, Baidoo K, Bogale M, Cairncross L, Cordes S, Daniel A, Diom E, Maurice ME, Mohammed GM, Biadgelign MG, Koné FI, Itiere A, Koch W, Konney A, Kundiona I, Macharia C, Mashamba V, Moore MG, Mugabo RM, Noah P, Omutsani M, Orloff LA, Otiti J, Randolph GW, Sebelik M, Todsen T, Twier K, Fagan JJ. African Head and Neck Society Clinical Practice guidelines for thyroid nodules and cancer in developing countries and limited resource settings. Head Neck 2020; 42:1746-1756. [PMID: 32144948 DOI: 10.1002/hed.26094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/07/2019] [Revised: 10/11/2019] [Accepted: 01/15/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND International thyroid nodule and cancer management guidelines generally fail to take into account potential limitations in diagnostic and treatment resources. METHODS Thyroid cancer specialists from the African Head and Neck Society and American Head & Neck Society Endocrine Section developed guidelines for diagnosis and management of thyroid nodules and cancer in low resource settings. Recommendations were based on literature review and expert opinion, with level of evidence defined. RESULTS Using the ADAPTE process, diagnostic and treatment algorithms were adapted from the National Comprehensive Cancer Network (NCCN). Low resource settings were simulated by systematically removing elements such as availability of laboratory testing, hormone replacement, imaging, and cytopathology from NCCN guidelines. CONCLUSIONS Successful management of thyroid nodules and cancer in low resource settings requires adaptation of treatment methodologies. These guidelines define specific scenarios where either more or less aggressive intervention for thyroid pathology may be advisable based on limited available resources.
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Affiliation(s)
- Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Justin Yu
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Paul A Onakoya
- Department of Otorhinolaryngology, University of Ibadan, Ibadan, Nigeria
| | - Joyce Aswani
- Department of Surgery, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Kenneth Baidoo
- Department of Otolaryngology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Mesele Bogale
- Department of Surgery, Adama Hospital Medical College, Adama, Ethiopia
| | - Lydia Cairncross
- Department of Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | | | - Adekunle Daniel
- Department of Otorhinolaryngology, University of Ibadan, Ibadan, Nigeria
| | - Evelyne Diom
- Department of Otolaryngology, Assane Seck University, Ziguinchor, Senegal
| | - Mpessa E Maurice
- Department of Otolaryngology, University Hospital of Yopougon, Abidjan, Ivory Coast
| | - Garba M Mohammed
- Department of Otolaryngology, Kaduna State University, Kaduna, Nigeria
| | | | - Fatogoma I Koné
- Department of Head and Neck Surgery, Gabriel Touré University Hospital, Bamako, Mali
| | - Arnaud Itiere
- Department of Otorhinolaryngology, General Hospital of Brazzaville, Brazzaville, Congo
| | - Wayne Koch
- Department of ORL/Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Anna Konney
- Department of Otolaryngology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Innocent Kundiona
- Department of Otolaryngology, Parirenyatwa Group of Hospitals, Harare, Zimbabwe
| | - Chege Macharia
- Department of General Surgery, AIC Kijabe Hospital, Kenya
| | - Victor Mashamba
- Department of Otorhinolaryngology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Michael G Moore
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana
| | - Rajab M Mugabo
- Department of Otolaryngology, King Faisal Hospital, Kigali, Rwanda
| | - Patrick Noah
- Department of Surgery, University of Malawi, Zomba, Malawi
| | - Mary Omutsani
- Department of Otolaryngology-Head and Neck Surgery, Kenyatta National Hospital, Nairobi, Kenya
| | - Lisa A Orloff
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Jeffrey Otiti
- Department of Otolaryngology, Uganda Cancer Institute, Kampala, Uganda
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Merry Sebelik
- Department of Otolaryngology, Head and Neck Surgery, Emory School of Medicine, Atlanta, Georgia
| | - Tobias Todsen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Copenhagen, Copenhagen, Denmark
| | - Khaled Twier
- Department of Otohinolaryngology, University of Cape Town, Cape Town, South Africa
| | - Johannes J Fagan
- Department of Otohinolaryngology, University of Cape Town, Cape Town, South Africa
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28
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Abstract
PURPOSE Wheelchair outcomes measures are useful to support evidence-based practice in wheelchair provision, especially in low- and middle-income countries (LMIC). The Wheelchair Interface Questionnaire (WIQ) was developed to provide a professional perspective on the quality of the interface between a wheelchair and its user. Studies conducted during the development of the WIQ indicated it has face validity and content validity. The objective of this field study was to conduct a subsequent investigation of the inter-rater reliability of the WIQ at a school for children with disabilities in Kenya. MATERIALS AND METHODS Eight practitioners with wheelchair experience from disparate cultural backgrounds participated in the study. They evaluated eight wheelchairs and the interface with their users. The interclass correlation coefficient (ICC) of the mean rating for the eight-item dataset was computed using SPSS. RESULTS The ICC was found to be 0.911, indicating that the WIQ possesses inter-rater reliability. Common comment topics indicated that the qualitative data yielded by the WIQ is meaningful. Informal timing indicated that the WIQ is a brief measure. CONCLUSION The WIQ is a reliable tool that can meet the need for a professional assessment of the wheelchair-user interface. The reliability of this questionnaire is important because the tool can be used to evaluate the interface between a wheelchair user and their wheelchair, strengthening evidence-based practice in wheelchair provision.Implications for RehabilitationBased on the score of a specific wheelchair interface, a rehabilitation professional could recommend more assessment, seating modification, or wheelchair replacement in order to maximize rehabilitation benefit for a clientThe WIQ could provide evidence-based information to support the need for wheelchair repair or replacement to funders.In large-scale studies involving many of the same wheelchair type in the same setting, the WIQ could be used to identify problems with the interface between that wheelchair type and its intended user population so that manufacturers can make responsive design changes.The WIQ could be used in a clinical setting over time to identify the most common wheelchair interface issues for that setting.
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Affiliation(s)
| | - Vicki Sheafer
- School of Psychology and Counseling, LeTourneau University, Longview, TX, USA
| | | | - Natasha Layton
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
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29
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Nagraj S, Hinton L, Praveen D, Kennedy S, Norton R, Hirst J. Women's and healthcare providers' perceptions of long-term complications associated with hypertension and diabetes in pregnancy: a qualitative study. BJOG 2019; 126 Suppl 4:34-42. [PMID: 31257668 PMCID: PMC6771686 DOI: 10.1111/1471-0528.15847] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 12/27/2022]
Abstract
Objectives A diagnosis of hypertensive disorders during pregnancy (HDPs) or gestational diabetes mellitus (GDM) is highly predictive of women at increased risk of developing chronic hypertension, Type 2 diabetes, and cardiovascular disease. This study investigates perceptions of women and healthcare providers in rural India regarding these long‐term risks. Design Qualitative study using modified grounded theory. Setting Two states in rural India: Haryana and Andhra Pradesh. Population Pregnant and postpartum women, community health workers (CHWs), primary care physicians, obstetricians, laboratory technicians, and healthcare officials. Methods In‐depth interviews and focus group discussions explored: (1) priorities for high‐risk pregnant women; (2) detection and management of HDPs and GDM; (3) postpartum management, and (4) knowledge of long‐term sequelae of high‐risk conditions. A thematic analysis was undertaken. Results Seven focus group discussions and 11 in‐depth interviews (n = 71 participants) were performed. The key priority area for high‐risk pregnant women was anaemia. Blood pressure measurement was routinely embedded in antenatal care; however, postpartum follow up and knowledge of the long‐term complications were limited. GDM was not considered a common problem, although significant variations and challenges to GDM screening were identified. Knowledge of the long‐term sequelae of GDM with regard to an increased risk of Type 2 diabetes and cardiovascular disease among doctors was minimal. Conclusions There is a need for improved education, standardisation of testing and postpartum follow up of HDPs and GDM in rural Indian settings. Funding SN is supported by an MRC Clinical Research Training Fellowship (MR/R017182/1). The George Institute for Global Health Global Women's Health programme provided financial support for the research assistant and fieldwork costs in India. Tweetable abstract Improved education and postpartum care of women with hypertension and diabetes in pregnancy in rural India are needed to prevent long‐term risks. Improved education and postpartum care of women with hypertension and diabetes in pregnancy in rural India are needed to prevent long‐term risks.
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Affiliation(s)
- S Nagraj
- The George Institute for Global Health, University of Oxford, Oxford, UK.,Nuffield Department of Women's & Reproductive Health, Level 3 Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - L Hinton
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - D Praveen
- The George Institute for Global Health, Hyderabad, India
| | - S Kennedy
- Nuffield Department of Women's & Reproductive Health, Level 3 Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - R Norton
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - J Hirst
- The George Institute for Global Health, University of Oxford, Oxford, UK.,Nuffield Department of Women's & Reproductive Health, Level 3 Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
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30
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Abstract
Anorectal malformation is one of the most common structural congenital malformations treated by pediatric surgeons globally. The outcome of care is largely dependent on the spectrum, clinical features, associated malformations, expertise of the surgeons, and available perioperative facilities. Africa has a large burden of unmet surgical needs in children, and as in other low resource settings, local pediatric surgeons are faced with different and challenging clinical scenarios, hence, adopt various measures to enable children with surgically correctable congenital malformations to survive. There are increasing collaborations between local surgeons and experts in other continents, which often involves surgeons traveling to Africa on missions or well-structured partnerships. It is highly beneficial for the physician who is interested in global-surgery to understand the terrain in low resource settings and prepare for possible changes in management plan. This review highlights the epidemiology, clinical presentation, treatment, and outcome of care of children with anorectal malformations in Africa and provides options adopted by pediatric surgeons working with limited resources.
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Affiliation(s)
- Taiwo A Lawal
- Division of Pediatric Surgery, Department of Surgery, University of Ibadan and University College Hospital, Ibadan, Nigeria
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31
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Sahu J, Mishra N. Role of intravenous tranexamic acid in reducing blood loss during caesarean section: Study at tribal-dominated area hospital in Chhattisgarh, India. J Obstet Gynaecol Res 2019; 45:841-848. [PMID: 30663200 DOI: 10.1111/jog.13915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/17/2018] [Accepted: 12/08/2018] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the effect of low dose (1 g) of intravenous tranexamic acid (TXA) before caesarean delivery upon the mean blood loss during and after surgery as well side effects of the drug and to compare these effects with those who did not receive this medication in a referral hospital situated at the tribal terrain of Chhattisgarh. METHODS Total 100 women fulfilling inclusion criteria and shifted for caesarean section were studied. Fifty women comprising the study group were given one gram TXA (10 mL) intravenously over 10-20 min before skin incision whereas the other 50 women did not receive the drug (control group). Active Management of the Third Stage of Labor was done in all using 10 units of oxytocin intramuscularly within one minute of delivery of baby. The blood loss was quantified by the combination of gravimetric and direct measurement. RESULTS The mean blood loss (intra as well as postoperative) was 436.5 ± 118.07 mL in the study group in comparison to 616.5 ± 153.34 mL in the control group (P ≤ 0.05), only two (4%) women had a blood loss >500 mL during surgery versus nine (18%) (P ≤ 0.05), none versus three (6%) had PPH and postoperative mean change in the hemoglobin was 0.494 ± 0.12 g % versus 0.594 ± 0.16 g % (P ≤ 0.05) in the study and control groups, respectively. No adverse effects were reported in women or neonates. CONCLUSION TXA is a cheap, easily available antifibrinolytic drug that significantly reduces the intra and postoperative blood loss in caesarean section and is very useful for low resource settings.
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Affiliation(s)
- Jaiprakash Sahu
- Department of Obstetrics & Gynaecology, Govt Medical College, Ambikapur, India
| | - Nalini Mishra
- Department of Obstetrics & Gynaecology, Govt Medical College, Ambikapur, India
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32
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Boateng L, Quarpong W, Ohemeng A, Asante M, Steiner‐Asiedu M. Effect of complementary foods fortified with Moringa oleifera leaf powder on hemoglobin concentration and growth of infants in the Eastern Region of Ghana. Food Sci Nutr 2019; 7:302-311. [PMID: 30680185 PMCID: PMC6341130 DOI: 10.1002/fsn3.890] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 10/29/2018] [Accepted: 11/03/2018] [Indexed: 11/11/2022] Open
Abstract
Complementary foods that are deficient in both macronutrients and micronutrients coupled with a high burden of infections during the complementary feeding period are major underlying causes of child malnutrition in developing countries. Among the recent efforts to combat malnutrition by improving the quality of complementary foods in the developing world is the use of Moringa oleifera leaf powder (MLP) as a food fortificant. We conducted a randomized controlled trial to test the effect of feeding MLP-fortified complementary food on hemoglobin concentration and growth of infants and young children after 4 months of feeding. Infants aged 8-12 months were randomly assigned to receive one of three study foods; Weanimix a cereal-legume blend formulated with Moringa (MCL-35g), MLP sprinkled on infants' usual complementary foods (MS-5g) and the control food Weanimix without Moringa (CF-35g). Blood samples for hemoglobin determination as well as dietary intake and anthropometric data were collected at baseline and endline for 237 infants who completed the study. Data analysis was performed with SPSS (version 20) and comparisons were done by analysis of covariance (ANCOVA). There were no significant differences in hemoglobin concentration or growth indicators at endline between the three study groups. Findings of this study indicated that feeding infants a 5 g daily dose of MLP, either as part of a cereal-legume blend or as a supplement which was sprinkled on infants' usual complementary foods for 4 months, did not significantly improve infants' hemoglobin concentration or growth indicators.
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Affiliation(s)
- Laurene Boateng
- Department of Nutrition and Food ScienceUniversity of GhanaLegonGhana
| | | | - Agartha Ohemeng
- Department of Nutrition and Food ScienceUniversity of GhanaLegonGhana
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Laflamme L, Chipps J, Fangerau H, Juth N, Légaré F, Sawe HR, Wallis L. Targeting ethical considerations tied to image-based mobile health diagnostic support specific to clinicians in low-resource settings: the Brocher proposition. Glob Health Action 2019; 12:1666695. [PMID: 31532350 PMCID: PMC6758631 DOI: 10.1080/16549716.2019.1666695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 09/09/2019] [Indexed: 01/12/2023] Open
Abstract
Background: mHealth applications assist workflow, help move towards equitable access to care, and facilitate care delivery. They have great potential to impact care in low-resource countries, but have significant ethical concerns pertaining to patient autonomy, safety, and justice. Objective: To achieve consensus among stakeholders on how to address concerns pertaining to autonomy, safety, and justice among mHealth developers and users in low-resource settings, in particular for the application of image-based consultation for diagnostic support. Methods: A consensus approach was taken during a three-day workshop using a purposive sample of global mHealth stakeholders (n = 27) professionally and geographically spread. Throughout a series of introductory talks, group brainstorming, plenary reviews, and synthesis by the moderators, lists of actions were generated that address the concerns engendered by mHealth applications on autonomy, justice and safety, taking into account the development, implementation, and scale-up phases of an mHealth application lifecycle. Results: Several types of actions were recommended; key ones among them included building in risk mitigation measures from the development stage, establishing inclusive consultation processes, using open sources platform whenever possible, training all clinical users, and bearing in mind that the gold standard of care is face-to-face consultation with the patient. Recommendations of patient, community and health system participation and of governance were identified as cutting across the mHealth lifecycle. Conclusion: Priorities agreed-upon at the meeting echo those put forward concerning other domains and locations of application of mHealth. Those more forcefully articulated are the need to adopt and maintain participatory processes as well as promoting self-governance. They are expected to cut across the mHealth lifecycle and are prerequisites to the safeguard of autonomy, safety and justice.
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Affiliation(s)
- L. Laflamme
- Department of Public Health Sciences, Global Health, Karolinska Institutet, Widerströmska Huset, Stockholm, Sweden
- Institute for Social and Health Sciences, University of South Africa, Johannesburg, South Africa
| | - J. Chipps
- School of Nursing, University of the Western Cape, Belville, South Africa
| | - H. Fangerau
- Department of the History, Philosophy and Ethics of Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - N. Juth
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Widerströmska Huset, Stockholm, Sweden
| | - F. Légaré
- Centre de recherche sur les soins et services de première ligne de l’Université Laval, CIUSSS de la Capitale-Nationale, Quebec City, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - H. R. Sawe
- Emergency Medicine Department, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - L. Wallis
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Bellville, South Africa
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Hariprasad R, Mehrotra R. Pocket colposcope: could it improve attendance and increase access to cervical cancer screening programmes? Expert Rev Anticancer Ther 2018; 18:603-605. [PMID: 29768062 DOI: 10.1080/14737140.2018.1477592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Roopa Hariprasad
- a Division of Preventive Oncology , National Institute of Cancer Prevention and Research , Noida , India
| | - Ravi Mehrotra
- a Division of Preventive Oncology , National Institute of Cancer Prevention and Research , Noida , India
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Slusher TM, Kiragu AW, Day LT, Bjorklund AR, Shirk A, Johannsen C, Hagen SA. Pediatric Critical Care in Resource-Limited Settings-Overview and Lessons Learned. Front Pediatr 2018; 6:49. [PMID: 29616202 PMCID: PMC5864848 DOI: 10.3389/fped.2018.00049] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/20/2018] [Indexed: 01/09/2023] Open
Abstract
Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs) remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most LMICs lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units (PICU) and high dependency areas. PICU can improve the quality of pediatric care in general and, if properly organized, can effectively treat the severe complications of high burden diseases, such as diarrhea, severe malaria, and respiratory distress using low-cost interventions. Setting up a PICU in a LMIC setting requires planning, specific resources, and most importantly investment in the nursing and permanent medical staff. A thoughtful approach to developing pediatric critical care services in LMICs starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built on in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease pediatric morbidity and mortality in the context of public health goals as we reach toward the sustainable development goals.
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Affiliation(s)
- Tina M Slusher
- Department of Pediatrics, University of Minnesota and Hennepin County Medical Center, Minneapolis, MN, United States
| | - Andrew W Kiragu
- Department of Pediatrics, University of Minnesota and Hennepin County Medical Center, Minneapolis, MN, United States
| | - Louise T Day
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ashley R Bjorklund
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Arianna Shirk
- Department of Pediatrics AIC Kijabe Hospital, Kijabe, Kenya
| | - Colleen Johannsen
- Cardiac Intensive Care Unit of Regions Medical Center, St. Paul, MN, United States
| | - Scott A Hagen
- Department of Pediatrics, University of Wisconsin, Madison, WI, United States
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Beane A, Athapattu PL, Dondorp AM, Haniffa R. Commentary: Challenges and Priorities for Pediatric Critical Care Clinician-Researchers in Low- and Middle-Income Countries. Front Pediatr 2018. [PMID: 29536985 PMCID: PMC5835091 DOI: 10.3389/fped.2018.00038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Abigail Beane
- Network for Improving Critical Care Systems and Training (NICST), Colombo, Sri Lanka
| | | | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training (NICST), Colombo, Sri Lanka
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Ngugi P, Were MC, Babic A. Facilitators and Barriers of Electronic Medical Records Systems Implementation in Low Resource Settings: A Holistic View. Stud Health Technol Inform 2018; 251:187-190. [PMID: 29968634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Electronic Medical Records (EMR) systems show promise for facilitating health care improvement in quality patient care, patient safety and cost reduction. Nevertheless, their adoption requires careful planning and execution for successful implementation and optimal benefits. The main objective of this review was to identify, analyse and categorize facilitators and barriers to the implementation of EMRs in resource constrained settings in order to gain insight for successful EMR implementation. A literature review on papers from 2007 to 2017 concerning facilitators and barriers to EMRs implementation was conducted. The study included 18 articles that met selection criteria. Four categories of facilitators and barriers including a total of 28 sub-categories were identified from content analysis. These are technical, human, processes and organizational. EMR implementers should pay attention to these issues and adopt a change management strategy for sustainable EMR use in resource-constrained settings.
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Affiliation(s)
- Philomena Ngugi
- Department of Information Science and Media Studies, University of Bergen, Norway
| | - Martin C Were
- Institute of Biomedical Informatics, Moi University, Kenya
| | - Ankica Babic
- Department of Information Science and Media Studies, University of Bergen, Norway
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Dumont A, Bodin C, Hounkpatin B, Popowski T, Traoré M, Perrin R, Rozenberg P. Uterine balloon tamponade as an adjunct to misoprostol for the treatment of uncontrolled postpartum haemorrhage: a randomised controlled trial in Benin and Mali. BMJ Open 2017; 7:e016590. [PMID: 28864699 PMCID: PMC5589006 DOI: 10.1136/bmjopen-2017-016590] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of low-cost uterine tamponade as an adjunct to misoprostol for the treatment of uncontrolled postpartum haemorrhage (PPH) in low-resource settings. DESIGN Randomised controlled trial. SETTING Seven healthcare facilities in Cotonou, Benin and Bamako, Mali. POPULATION Women delivering vaginally who had clinically diagnosed PPH that was suspected to be due to uterine atony, who were unresponsive to oxytocin and who needed additional uterotonics. METHODS Women were randomly assigned to receive uterine balloon tamponade with a condom-catheter device or no tamponade; both groups were also given intrarectal or sublingual misoprostol. MAIN OUTCOME MEASURE Proportion of women with invasive surgery or who died before hospital discharge. RESULTS The proportion of primary composite outcome did not differ significantly between the tamponade arm (16%; 9/57) and the standard second line treatment arm (7%; 4/59): relative risk 2.33 (95% CI 0.76 to 7.14, p=0.238). A significantly increased proportion of women with tamponade and misoprostol versus misoprostol alone had total blood loss more than 1000 mL: relative risk 1.52 (95% CI 1.15 to 2.00, p=0.01). Case fatality rate was higher in the tamponade group (10%; 6/57) than in the control group (2%; 1/59) (p=0.059). TRIAL REGISTRATION NUMBER ISRCT Registry Number 01202389; Post-results.
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Affiliation(s)
- Alexandre Dumont
- Research Institute for Development, Université Paris Descartes, Paris, France
| | - Cécile Bodin
- Research Institute for Development, Université Paris Descartes, Paris, France
- Community of Practice QUAHOR, Quality of Care in Referral Hospitals, Paris, France
| | - Benjamin Hounkpatin
- Department of Obstetrics and Gynaecology, CHU-MEL, University Hospital for Mother and Child of Lagune, Cotonou, Benin
| | - Thomas Popowski
- Department of Obstetrics and Gynaecology, Poissy Saint Germain Hospital, Poissy, France
| | - Mamadou Traoré
- Department of Obstetrics and Gynaecology, Referral Health Center of the Commune V, Bamako, Mali
| | - René Perrin
- Department of Obstetrics and Gynaecology, CHU-MEL, University Hospital for Mother and Child of Lagune, Cotonou, Benin
| | - Patrick Rozenberg
- Department of Obstetric and Gynecology, Poissy Saint Germain Hospital, Poissy, France
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McLaren ZM, Sharp A, Hessburg JP, Sarvestani AS, Parker E, Akazili J, Johnson TRB, Sienko KH. Cost effectiveness of medical devices to diagnose pre-eclampsia in low-resource settings. Dev Eng 2017; 2:99-106. [PMID: 29276756 PMCID: PMC5737708 DOI: 10.1016/j.deveng.2017.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Maternal mortality remains a major health challenge facing developing countries, with pre-eclampsia accounting for up to 17 percent of maternal deaths. Diagnosis requires skilled health providers and devices that are appropriate for low-resource settings. This study presents the first cost-effectiveness analysis of multiple medical devices used to diagnose pre-eclampsia in low- and middle-income countries (LMICs). METHODS Blood pressure and proteinuria measurement devices, identified from compendia for LMICs, were included. We developed a decision tree framework to assess the cost-effectiveness of each device using parameter values that reflect the general standard of care based on a survey of relevant literature and expert opinion. We examined the sensitivity of our results using one-way and second-order probabilistic multivariate analyses. RESULTS Because the disability-adjusted life years (DALYs) averted for each device were very similar, the results were influenced by the per-use cost ranking. The most cost-effective device combination was a semi-automatic blood pressure measurement device and visually read urine strip test with the lowest combined per-use cost of $0.2004 and an incremental cost effectiveness ratio of $93.6 per DALY gained relative to a baseline with no access to diagnostic devices. When access to treatment is limited, it is more cost-effective to improve access to treatment than to increase testing rates or diagnostic device sensitivity. CONCLUSIONS Our findings were not sensitive to changes in device sensitivity, however they were sensitive to changes in the testing rate and treatment rate. Furthermore, our results suggest that simple devices are more cost-effective than complex devices. The results underscore the desirability of two design features for LMICs: ease of use and accuracy without calibration. Our findings have important implications for policy makers, health economists, health care providers and engineers.
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Affiliation(s)
- Zoë M McLaren
- Health Management and Policy, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA
| | - Alana Sharp
- Health Management and Policy, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA
| | - John P Hessburg
- Department of Biomedical Engineering, College of Engineering, University of Michigan, 2350 Hayward St., 1109 GG Brown, Ann Arbor, MI 48109-2125USA
| | - Amir Sabet Sarvestani
- Design Science Program, College of Engineering, University of Michigan, 2350 Hayward St., 1109 GG Brown, Ann Arbor, MI 48109-2125, USA
| | - Ethan Parker
- Health Management and Policy, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA
| | - James Akazili
- Navrongo Health Research Centre, Navrongo, Upper East, Ghana
| | - Timothy R B Johnson
- Department of Obstetrics & Gynecology, Medical School, University of Michigan, L4000 Womens SPC 5276, Ann Arbor, MI 48109-5276, USA
| | - Kathleen H Sienko
- Departments of Mechanical and Biomedical Engineering, College of Engineering, University of Michigan, 2350 Hayward St., 3454 GG Brown, Ann Arbor, MI 48109-2125, USA
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Gupta R, Gupta S, Mehrotra R, Sodhani P. Cervical Cancer Screening in Resource-Constrained Countries: Current Status and Future Directions. Asian Pac J Cancer Prev 2017; 18:1461-1467. [PMID: 28669152 PMCID: PMC6373785 DOI: 10.22034/apjcp.2017.18.6.1461] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cervical cancer continues to be a major public health problem affecting large numbers of women in many developing countries. Limitations of various screening modalities and the lack of ready availability of a cost-effective point-of-care screening tool have hindered the efficient implementation of population-based screening programs in these settings. It has not proved possible for many countries to adopt cytology as a screening modality due to inadequate infrastructure and trained manpower. However, recent developments, notably design and testing of a low-cost HPV test kit and initiatives by countries like India in developing and putting into operation a framework for large-scale screening of women, have raised hopes that cervical cancer control may be possible even in resource-constrained locations. With the advent of HPV vaccination, primary prevention of cervical cancer also seems a distinct possibility. However, wide availability and acceptability of vaccination is still an unresolved issue for developing countries. The possible future effects of vaccination on test characteristics of various screening strategies also need to be evaluated. This review gathers information on the current status of cervical cancer screening with a special focus on low resource settings. It revisits the strengths and limitations of the available screening modalities for cervical cancer viz. cytology, visual methods and HPV testing, in the context of their applicability in developing countries. In addition, the role of newer HPV-detection methods, for instance DNA, RNA and protein-based techniques, in triage of screen-positive women is discussed. The contemporary issue of impact of HPV vaccination on cervical cancer screening is also addressed briefly. The main highlight of the review is the reference to ‘operational framework guidelines’ for population-based cervical cancer screening, which have recently been formulated and are in the process of being implemented in India. The guidelines may serve as a model for other similar low-resource settings where implementation of cancer screening is desired.
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Affiliation(s)
- Ruchika Gupta
- Division of Cytopathology, National Institute of Cancer Prevention and Research, Noida, India
| | - Sanjay Gupta
- Division of Cytopathology, National Institute of Cancer Prevention and Research, Noida, India
| | - Ravi Mehrotra
- Division of Cytopathology, National Institute of Cancer Prevention and Research, Noida, India
| | - Pushpa Sodhani
- Division of Cytopathology, National Institute of Cancer Prevention and Research, Noida, India
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Hernandez S, Oliveira JB, Shirazian T. How a Training Program Is Transforming the Role of Traditional Birth Attendants from Cultural Practitioners to Unique Health-care Providers: A Community Case Study in Rural Guatemala. Front Public Health 2017; 5:111. [PMID: 28580354 PMCID: PMC5437202 DOI: 10.3389/fpubh.2017.00111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 05/02/2017] [Indexed: 11/13/2022] Open
Abstract
In low- and middle-income countries (LMICs), where the rates of maternal mortality continue to be inappropriately high, there has been recognition of the importance of training traditional birth attendants (TBAs) to help improve outcomes during pregnancy and childbirth. In Guatemala, there is no national comprehensive training program in place despite the fact that the majority of women rely on TBAs during pregnancy and childbirth. This community case study presents a unique education program led by TBAs for TBAs in rural Guatemala. Discussion of this training program focuses on programming implementation, curriculum development, sustainable methodology, and how an educational partnership with the current national health-care system can increase access to health care for women in LMICs. Recent modifications to this training model are also discussed including how a change in the clinical curriculum is further integrating TBAs into the national health infrastructure. The training program has demonstrated that Guatemalan TBAs are able to improve their basic obstetrical knowledge, are capable of identifying and referring early complications of pregnancy and labor, and can deliver basic prenatal care that would otherwise not be provided. This training model is helping transform the role of the TBA from a sole cultural practitioner to a validated health-care provider within the health-care infrastructure of Guatemala and has the potential to do the same in other LMICs.
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Abstract
Background Ectopic pregnancy contributes to maternal morbidity and mortality, especially in low-resourced countries with limited facilities for early diagnosis and treatment. It is a very challenging condition to diagnose. Patients may collapse and die while undergoing investigation. Aims To assess surgical treatment given to patients presenting at Mpilo Central Hospital, the challenges that are faced and the outcomes; and also to document how women survive this dangerous condition in a setting challenged by low resources. Results All the patients had prompt life-saving surgery within 48 h of admission despite the challenges faced. The survival rate was 100% during the period of the study. Conclusion It is possible to prevent maternal mortality in low-resource countries by maintaining basic clinical and surgical skills.
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Affiliation(s)
- Solwayo Ngwenya
- 1 Consultant Obstetrician & Gynaecologist, Head of Department of Obstetrics & Gynaecology, Clinical Director, Mpilo Central Hospital, Mzilikazi, Zimbabwe.,2 Part-Lecturer, National University of Science & Technology, Medical School, Mzilikazi, Zimbabwe.,3 Founder and Chief Executive Officer, Royal Women's Clinic, Bulawayo, Matabeleland, Zimbabwe
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von Saint André-von Arnim AO, Attebery J, Kortz TB, Kissoon N, Molyneux EM, Musa NL, Nielsen KR, Fink EL. Challenges and Priorities for Pediatric Critical Care Clinician-Researchers in Low- and Middle-Income Countries. Front Pediatr 2017; 5:277. [PMID: 29312909 PMCID: PMC5744187 DOI: 10.3389/fped.2017.00277] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 12/06/2017] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There is need for more data on critical care outcomes and interventions from low- and middle-income countries (LMIC). Global research collaborations could help improve health-care delivery for critically ill children in LMIC where child mortality rates remain high. MATERIALS AND METHODS To inform the role of collaborative research in health-care delivery for critically ill children in LMIC, an anonymous online survey of pediatric critical care (PCC) physicians from LMIC was conducted to assess priorities, major challenges, and potential solutions to PCC research. A convenience sample of 56 clinician-researchers taking care of critically ill children in LMIC was targeted. In addition, the survey was made available on a Latin American PCC website. Descriptive statistics were used for data analysis. RESULTS The majority of the 47 survey respondents worked at urban, public teaching hospitals in LMIC. Respondents stated their primary PCC research motivations were to improve clinical care and establish guidelines to standardize care. Top challenges to conducting research were lack of funding, high clinical workload, and limited research support staff. Respondent-proposed solutions to these challenges included increasing research funding options for LMIC, better access to mentors from high-income countries, research training and networks, and higher quality medical record documentation. CONCLUSION LMIC clinician-researchers must be better empowered and resourced to lead and influence the local and global health research agenda for critically ill children. Increased funding options, access to training and mentorship in research methodology, and improved data collection systems for LMIC PCC researchers were recognized as key needs for success.
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Affiliation(s)
- Amelie O von Saint André-von Arnim
- Department of Pediatrics, Division of Pediatric Critical Care, Seattle Children's Hospital, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jonah Attebery
- Department of Pediatrics, Division of Critical Care, Washington University, St. Louis, MO, United States
| | - Teresa Bleakly Kortz
- Department of Pediatrics, Division of Pediatric Critical Care, University of California, San Francisco, San Francisco, CA, United States.,Institute of Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Niranjan Kissoon
- Department of Pediatrics and Emergency Medicine, University of British Columbia and British Columbia Children's Hospital, Vancouver, Canada
| | | | - Ndidiamaka L Musa
- Department of Pediatrics, Division of Pediatric Critical Care, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Katie R Nielsen
- Department of Pediatrics, Division of Pediatric Critical Care, Seattle Children's Hospital, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Ericka L Fink
- Division of Pediatric Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States
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Acker P, Newberry JA, Hattaway LBF, Socheat P, Raingsey PP, Strehlow MC. Implementing an Innovative Prehospital Care Provider Training Course in Nine Cambodian Provinces. Cureus 2016; 8:e656. [PMID: 27489749 PMCID: PMC4963230 DOI: 10.7759/cureus.656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Despite significant improvements in health outcomes nationally, many Cambodians continue to experience morbidity and mortality due to inadequate access to quality emergency medical services. Over recent decades, the Cambodian healthcare system and civil infrastructure have advanced markedly and now possess many of the components required to establish a well functioning emergency medical system. These components include enhanced access to emergency transportation through large scale road development efforts, widspread availability of emergency communication channels via the spread of cellphone and internet technology, and increased access to health services for poor patients through the implementation of health financing schemes. However, the system still lacks a number of key elements, one of which is trained prehospital care providers. Working in partnership with local providers, our team created an innovative, Cambodia-specific prehospital care provider training course to help fill this gap. Participants received training on prehospital care skills and knowledge most applicable to the Cambodian healthcare system, which was divided into four modules: Basic Prehospital Care Skills and Adult Medical Emergencies, Traumatic Emergencies, Obstetric Emergencies, and Neonatal/Pediatric Emergencies. The course was implemented in nine of Cambodia’s most populous provinces, concurrent with a number of overarching emergency medical service system improvement efforts. Overall, the course was administered to 1,083 Cambodian providers during a 27-month period, with 947 attending the entire course and passing the course completion exam.
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Affiliation(s)
- Peter Acker
- Department of Emergency Medicine, Stanford University School of Medicine
| | | | | | | | - Prak P Raingsey
- Preventive Medicine Department, Cambodian Ministry of Health
| | - Matthew C Strehlow
- Department of Emergency Medicine, Stanford University School of Medicine
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Abstract
Vaginal birth after Caesarean section (VBAC) has long been practised in low resource settings using unconventional methods. This not only poses danger to the woman and her baby, but could also have serious legal and ethical implications. The adoption of this practice has been informed by observational studies with many deficiencies; this is so despite other studies from settings in which the standard of care is much better that show that elective repeat Caesarean section (ERCS) may actually be safer than VBAC. This raises questions about whether we should insist on a dangerous practice when there are safer alternatives. We highlight some of the challenges faced in making this decision, and discuss why the fear of ERCS may not be justified after all in low resource settings. Since a reduction in rates of Caesarean section may not be applicable in these regions, because their rates are already low, the emphasis should instead be on adequate birth spacing and safer primary operative delivery.
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