A model for point of care testing for non-communicable disease diagnosis in resource-limited countries

Abstract Non-communicable disease diagnosis frequently relies on biochemical measurements but laboratory infrastructure in low-income settings is often insufficient and distances to clinics may be vast. We present a model for point of care (POC) epidemiology as used in our study of chronic disease in the Haiti Health Study, in rural and urban Haiti. Point of care testing (POCT) of creatinine, cholesterol, and hemoglobin A1c as well as physical measurements of weight, height, and waist circumference allowed for diagnosis of diabetes, chronic kidney disease, dyslipidemias, and obesity. Methods and troubleshooting techniques for the data collection of this study are presented. We discuss our method of community-health worker (CHW) training, community engagement, study design, and field data collection. We also discuss the machines used and our quality control across CHWs and across geographical regions. Pitfalls tended to include equipment malfunction, transportation issues, and cultural differences. May this paper provide information for those attempting to perform similar diagnostic and screening studies using POCT in resource poor settings.

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Risk factors and non-communicable disease diagnosis in China

China Economic Review ◽

10.1016/j.chieco.2018.03.008 ◽

2018 ◽

Vol 50 ◽

pp. 72-84

Author(s):

Tianxin Pan ◽

Michael Palmer

Keyword(s):

Risk Factors ◽

Communicable Disease ◽

Disease Diagnosis ◽

Non Communicable Disease

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Newborn Screening for Sickle Cell Disease Using Point-of-Care Testing in Low-Income Setting

PEDIATRICS ◽

10.1542/peds.2018-4105 ◽

2019 ◽

Vol 144 (4) ◽

pp. e20184105 ◽

Cited By ~ 3

Author(s):

Ofelia A. Alvarez ◽

Tally Hustace ◽

Mimose Voltaire ◽

Alejandro Mantero ◽

Ulrick Liberus ◽

...

Keyword(s):

Sickle Cell Disease ◽

Newborn Screening ◽

Sickle Cell ◽

Low Income ◽

Point Of Care ◽

Cell Disease ◽

Point Of Care Testing ◽

Low Income Setting

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Current Trends of Nanobiosensors for Point-of-Care Diagnostics

Journal of Analytical Methods in Chemistry ◽

10.1155/2019/2179718 ◽

2019 ◽

Vol 2019 ◽

pp. 1-16 ◽

Cited By ~ 8

Author(s):

Naumih M. Noah ◽

Peter M. Ndangili

Keyword(s):

Health Care ◽

Care Management ◽

Early Stage ◽

Point Of Care ◽

Health Care Management ◽

Disease Onset ◽

Disease Diagnosis ◽

Point Of Care Testing ◽

Quality Health Care ◽

Current Trends

In order to provide better-quality health care, it is very important that high standards of health care management are achieved by making timely decisions based on rapid diagnostics, smart data analysis, and informatics analysis. Point-of-care testing ensures fast detection of analytes near to the patients facilitating a better disease diagnosis, monitoring, and management. It also enables quick medical decisions since the diseases can be diagnosed at an early stage which leads to improved health outcomes for the patients enabling them to start early treatment. In the recent past, various potential point-of-care devices have been developed and they are paving the way to next-generation point-of-care testing. Biosensors are very critical components of point-of-care devices since they are directly responsible for the bioanalytical performance of an essay. As such, they have been explored for their prospective point-of-care applications necessary for personalized health care management since they usually estimate the levels of biological markers or any chemical reaction by producing signals mainly associated with the concentration of an analyte and hence can detect disease causing markers such as body fluids. Their high selectivity and sensitivity have allowed for early diagnosis and management of targeted diseases; hence, facilitating timely therapy decisions and combination with nanotechnology can improve assessment of the disease onset and its progression and help to plan for treatment of many diseases. In this review, we explore how nanotechnology has been utilized in the development of nanosensors and the current trends of these nanosensors for point-of-care diagnosis of various diseases.

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A mixed-method study of quality, availability and timeliness of non-communicable disease (NCD) related data and its link to NCD prevention: Perceptions of health care workers in Ethiopia

Health Information Management Journal ◽

10.1177/1833358318786313 ◽

2018 ◽

Vol 48 (3) ◽

pp. 135-143

Author(s):

Melkamu Dugassa Kassa ◽

Jeanne Martin Grace

Keyword(s):

Developing Countries ◽

Data Collection ◽

Healthcare System ◽

Mixed Method ◽

Communicable Disease ◽

Phase 1 ◽

Mixed Method Research ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Non Communicable Disease

Background: Three-quarters of non-communicable disease (NCD) mortality occurs in low- and middle-income countries. However, in most developing countries, quality and reliable data on morbidity, mortality and risk factors for NCD to predict its burden and prevalence are less well understood and availability of these data is limited. To better inform policymakers and improve healthcare systems in developing countries, it is also important that these factors be understood within the context of the particular country in question. Objective: The aim of this study is to further inform practitioners in Ethiopia about the availability and status of NCD information within the Ethiopian healthcare system. Method: A mixed method research design was used with data collected from 13 public referral hospitals in Ethiopia. In phase 1 quantitative data were collected from 312 health professionals (99 physicians; 213 nurses) using a cross-sectional survey. In phase 2, qualitative data were collected using: interviews ( n = 13 physician hospital managers); and one focus group ( n = 6 national health bureau officers). Results: Results highlighted the lack of NCD morbidity, mortality and risk factor data, periodic evaluation of NCD data and standardised protocols for NCD data collection in hospitals. The study also identified similar discrepancies in the availability of NCD data and standardised protocols for NCD data collection among the regions of Ethiopia. Conclusion: This study highlighted important deficiencies in NCD data and standardised protocols for data collection in the Ethiopian healthcare system. These deficiencies were also observed among regions of Ethiopia, indicating the need to strengthen both the healthcare system and health information systems to improve evidence-based decision-making. Implications: Identifying the status of NCD data in the Ethiopian healthcare system could assist policymakers, healthcare organisations, healthcare providers and health beneficiaries to reform and strengthen the existing healthcare system.

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The Case for Point-of-Care Testing in Infectious-Disease Diagnosis

Clinical Microbiology Newsletter ◽

10.1016/j.clinmicnews.2007.11.001 ◽

2007 ◽

Vol 29 (23) ◽

pp. 177-179 ◽

Cited By ~ 6

Author(s):

Ernest A. Trevino ◽

Alice S. Weissfeld

Keyword(s):

Infectious Disease ◽

Point Of Care ◽

Disease Diagnosis ◽

Point Of Care Testing

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Delivering a primary-level non-communicable disease programme for Syrian refugees and the host population in Jordan: a descriptive costing study

Health Policy and Planning ◽

10.1093/heapol/czaa050 ◽

2020 ◽

Vol 35 (8) ◽

pp. 931-940

Author(s):

Éimhín Ansbro ◽

Sylvia Garry ◽

Veena Karir ◽

Amulya Reddy ◽

Kiran Jobanputra ◽

...

Keyword(s):

Low Income ◽

Care Delivery ◽

Communicable Disease ◽

Host Population ◽

Syrian Refugees ◽

Task Sharing ◽

Primary Level ◽

Costing Study ◽

The Impact ◽

Non Communicable Disease

Abstract The Syrian conflict has caused enormous displacement of a population with a high non-communicable disease (NCD) burden into surrounding countries, overwhelming health systems’ NCD care capacity. Médecins sans Frontières (MSF) developed a primary-level NCD programme, serving Syrian refugees and the host population in Irbid, Jordan, to assist the response. Cost data, which are currently lacking, may support programme adaptation and system scale up of such NCD services. This descriptive costing study from the provider perspective explored financial costs of the MSF NCD programme. We estimated annual total, per patient and per consultation costs for 2015–17 using a combined ingredients-based and step-down allocation approach. Data were collected via programme budgets, facility records, direct observation and informal interviews. Scenario analyses explored the impact of varying procurement processes, consultation frequency and task sharing. Total annual programme cost ranged from 4 to 6 million International Dollars (INT$), increasing annually from INT$4 206 481 (2015) to INT$6 739 438 (2017), with costs driven mainly by human resources and drugs. Per patient per year cost increased 23% from INT$1424 (2015) to 1751 (2016), and by 9% to 1904 (2017), while cost per consultation increased from INT$209 to 253 (2015–17). Annual cost increases reflected growing patient load and increasing service complexity throughout 2015–17. A scenario importing all medications cut total costs by 31%, while negotiating importation of high-cost items offered 13% savings. Leveraging pooled procurement for local purchasing could save 20%. Staff costs were more sensitive to reducing clinical review frequency than to task sharing review to nurses. Over 1000 extra patients could be enrolled without additional staffing cost if care delivery was restructured. Total costs significantly exceeded costs reported for NCD care in low-income humanitarian contexts. Efficiencies gained by revising procurement and/or restructuring consultation models could confer cost savings or facilitate cohort expansion. Cost effectiveness studies of adapted models are recommended.

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Determinants of health seeking behavior for chronic non-communicable diseases and related out-of-pocket expenditure: results from a cross-sectional survey in northern Bangladesh

Journal of Health Population and Nutrition ◽

10.1186/s41043-019-0195-z ◽

2019 ◽

Vol 38 (1) ◽

Cited By ~ 2

Author(s):

Fatema Binte Rasul ◽

Olivier Kalmus ◽

Malabika Sarker ◽

Hossain Ishrath Adib ◽

Md Shahadath Hossain ◽

...

Keyword(s):

Low Income ◽

Multinomial Logistic Regression ◽

Communicable Disease ◽

Self Care ◽

Communicable Diseases ◽

Low Income Countries ◽

Health Seeking ◽

Non Communicable Diseases ◽

Professional Care ◽

Non Communicable Disease

Abstract Background In spite of high prevalence rates, little is known about health seeking and related expenditure for chronic non-communicable diseases in low-income countries. We assessed relevant patterns of health seeking and related out-of-pocket expenditure in Bangladesh. Methods We used data from a household survey of 2500 households conducted in 2013 in Rangpur district. We employed multinomial logistic regression to assess factors associated with health seeking choices (no care or self-care, semi-qualified professional care, and qualified professional care). We used descriptive statistics (5% trimmed mean and range, median) to assess related patterns of out-of-pocket expenditure (including only direct costs). Results Eight hundred sixty-six (12.5%) out of 6958 individuals reported at least one chronic non-communicable disease. Of these 866 individuals, 139 (16%) sought no care or self-care, 364 (42%) sought semi-qualified care, and 363 (42%) sought qualified care. Multivariate analysis confirmed that the following factors increased the likelihood of seeking qualified care: a higher education, a major chronic non-communicable disease, a higher socio-economic status, a lower proportion of chronic household patients, and a shorter distance between a household and a sub-district public referral health facility. Seven hundred fifty-four (87 %) individuals reported out-of-pocket expenditure, with drugs absorbing the largest portion (85%) of total expenditure. On average, qualified care seekers encountered the highest out-of-pocket expenditure, followed by those who sought semi-qualified care and no care, or self-care. Conclusion Our study reveals insufficiencies in health provision for chronic conditions, with more than half of all affected people still not seeking qualified care, and the majority still encountering considerable out-of-pocket expenditure. This calls for urgent measures to secure better access to care and financial protection.

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3D Printing of Microfluidics for Point of Care Diagnosis

Volume 4: Bio and Sustainable Manufacturing ◽

10.1115/msec2017-2778 ◽

2017 ◽

Author(s):

John P. Sibbitt ◽

Mei He

Keyword(s):

3D Printing ◽

Low Income ◽

Point Of Care ◽

Low Cost ◽

High Sensitivity ◽

Disease Diagnosis ◽

Low Income Countries ◽

3D Design ◽

Resource Limited ◽

Production Techniques

Microfluidic lab-on-a-chip (MLOC) technology is a promising approach for point-of-care (POC) diagnosis; low reagent consumption, high sensitivity and quick analysis time are the most prominent benefits. However, microfabrication of MLOCs utilizes specialized techniques and infrastructure, making conventional fabrication time consuming and difficult. While relatively inexpensive production techniques exist for POC diagnoses, such as replication of polymer-based (e.g., PDMS) microfluidic POC devices on lithographic molds, this approach has limitations including: further hydrophilic surface modifications of PDMS, inability to change lithographic mold Z dimensions, and slow prototyping. In contrast, stereo-lithographical (SLA) printing can integrate all of the necessary fabrication resources in one instrument, allowing highly versatile microfluidic devices to be made at low cost. In this paper, we report two microfabrication approaches of microfluidics utilizing (SLA) 3D printing technology: I) Direct SLA printing of channels and structures of a monolithic microfluidic POC device; II) Indirect fabrication, utilizing SLA 3D printed molds for PDMS based microfluidic device replication. Additionally, we discuss previous work providing a proof of concept of applications in POC diagnosis, using direct 3D printing fabrication (approach I). The robustness and simplicity of these protocols allow integrating 3D design and microfabrication with smartphone-based disease diagnosis as a stand-alone system, offering strong adaptability for establishing diagnostic capacity in resource-limited areas and low-income countries.

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