Telemedicine during COVID-19 in India—a new policy and its challenges

AbstractDuring the COVID-19 pandemic, a countrywide lockdown of nearly twelve weeks in India reduced access to regular healthcare services. As a policy response, the Ministry of Health & Family Welfare which exercises jurisdiction over telemedicine in India, rapidly issued India’s first guidelines for use of telemedicine. The authors argue that: guidelines must be expanded to address ethical concerns about the use of privacy, patient data and its storage; limited access to the internet and weaknesses in the telecom infrastructure challenge widespread adoption of telemedicine; only by simultaneously improving both will use of telemedicine become equitable; Indian medical education curricula should include telemedicine and India should rapidly extend training to practitioner. They determine that for low- and middle-income countries (LMIC), including India, positive externalities of investing in telemedicine are ample, thus use of this option can render healthcare more accessible and equitable in future.

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Video Relay Interpreting and Overcoming Barriers in Health Care for Deaf Users: A Scoping Review (Preprint)

10.2196/preprints.32439 ◽

2021 ◽

Author(s):

Minerva Rivas Velarde ◽

Caroline Jagoe ◽

Jess Cuculick

Keyword(s):

Health Care ◽

Sign Language ◽

Scoping Review ◽

Secondary Analysis ◽

Healthcare Services ◽

Eligibility Criteria ◽

Middle Income ◽

Middle Income Countries ◽

Healthcare Settings ◽

Study Selection

UNSTRUCTURED Abstract Objectives To identify existing evidence regarding the use of Video Remote Interpretation (VRI) in healthcare settings. To assess if VRI technology can enable deaf-users to overcome interpretation barriers and improve communication outcomes between them and health care personnel. Design Scoping review. Data sources Seven medical research databases (Medline, Web of Science, Embase, Google Scholar) from 2006 and bibliographies and citations of relevant papers. Searches included articles in English, Spanish and French. Eligibility criteria for study selection Original articles about the use of VRI for Deaf or Hard of Hearing sign language users (DHH) for, or within, healthcare. Results From the original 176 articles identified, 120 were eliminated after reading the article title and abstract, and 41 articles were excluded after they were fully read. Fifteen articles were selected for inclusion. Four were literature reviews; four were surveys, three qualitative studies; and one mixed-methods study that combined qualitative and quantitative data, one brief communication, one quality improvement report and one secondary analysis. This scoping review identified a knowledge gap regarding the quality of interpretation and training of sign language interpretation for healthcare. It also shows that this area is under researched and evidence is scant. All evidence was from high-income countries which is particularly problematic given that the majority of DHH persons live in low- and middle-income countries. Conclusions Furthering our understanding on the use of VRI technology is pertinent and relevant. Available literature shows that VRI may enable deaf-users to overcome interpretation barriers and can potentially improve communication outcomes between them and health personnel within healthcare services. For VRI to be acceptable, sign language users require a VRI system supported by devices with large screen and a reliable internet connection, as well as qualified interpreters trained on medical interpretation.

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E-Government for Health Facilities in Africa

Advances in Electronic Government, Digital Divide, and Regional Development - Emerging Issues and Prospects in African E-Government ◽

10.4018/978-1-4666-6296-4.ch002 ◽

2015 ◽

pp. 21-27

Author(s):

Paul Macharia ◽

Davies Kimanga ◽

Onesimus Kamau

Keyword(s):

Information And Communication Technologies ◽

Clinical Care ◽

Health Financing ◽

Cost Effective ◽

Healthcare Services ◽

Bring Your Own Device ◽

Workplace Flexibility ◽

Middle Income ◽

Middle Income Countries ◽

Information And Communication

Low and Middle Income Countries (LMICs) face healthcare worker shortages, skill mix imbalances, and maldistributions; there is concern in their quality and productivity. Africa's infrastructural developments also are way behind the rest of the world, and this gap is widening. Scalable, cost-effective, and long-term strategies in healthcare services are greatly needed. This chapter explores how Information and Communication Technologies (ICTs) could play an important role in improving healthcare. Components of e-health, an emerging field in medicine, clinical care, and public health are discussed. The role of m-health is explored, identifying the benefits of integrating mobile phone technologies in healthcare. To meet the health financing deficiencies, the chapter also explores how Bring-Your-Own-Device (BYOD) could drive healthcare professionals' productivity through increased workplace flexibility.

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SMS-based family planning communication and its association with modern contraception and maternal healthcare use in selected low-middle-income countries

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-01228-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Yingying Hu ◽

Rui Huang ◽

Bishwajit Ghose ◽

Shangfeng Tang

Keyword(s):

Family Planning ◽

Antenatal Care ◽

Healthcare Services ◽

Facility Delivery ◽

Maternal Healthcare ◽

Middle Income ◽

Modern Contraception ◽

Middle Income Countries ◽

Delivery Services ◽

Meta Analyses

Abstract Background The objectives of this study were to 1) measure the percentage of women who received SMS-based family planning communication, and 2) its association with modern contraception and maternal healthcare services among mothers. In recent years, there has been a growing interest surrounding mobile phone-based health communication and service delivery methods especially in the areas of family planning and reproductive health. However, little is known regarding the role of SMS-based family planning communication on the utilisation of modern contraception and maternal healthcare services in low-resource settings. Methods Cross-sectional data on 94,675 mothers (15–49 years) were collected from the latest Demographic and Health Surveys in 14 low-and-middle-income countries. The outcome variables were self-reported use of modern contraception and basic maternal healthcare services (timely and adequate use of antenatal care, and of facility delivery services). Data were analysed using multivariate regression and random effect meta-analyses. Results The coverage of SMS-based family planning communication for the pooled sample was 5.4% (95%CI = 3.71, 7.21), and was slightly higher in Africa (6.04, 95%CI = 3.38, 8.70) compared with Asia (5.23, 95%CI = 1.60, 8.86). Among the countries from sub-Saharan Africa, Malawi (11.92, 95%CI = 11.17, 12.70) had the highest percent of receiving SMS while Senegal (1.24, 95%CI = 1.00, 1.53) had the lowest. In the multivariate analysis, SMS communication shown significant association with the use of facility delivery only (2.22 (95%CI = 1.95, 2.83). The strength of the association was highest for Senegal (OR = 4.70, 95%CI = 1.14, 7.33) and lowest for Burundi (OR = 1.5; 95%CI = 1.01, 2.74). Meta analyses revealed moderate heterogeneity both in the prevalence and the association between SMS communication and the utilisation of facility delivery. Conclusion Although positively associated with using facility delivery services, receiving SMS on family planning does not appear to affect modern contraceptive use and other components of maternal healthcare services such as timely and adequate utilisation of antenatal care.

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The internet penetration rate is on par with other upper middle-income countries

OECD Economic Surveys: China 2019 - OECD Economic Surveys: China ◽

10.1787/3df7da02-en ◽

2019 ◽

Keyword(s):

Penetration Rate ◽

The Internet ◽

Middle Income ◽

Middle Income Countries ◽

Internet Penetration

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Essential healthcare services provided to conflict-affected internallydisplaced populations in low and middle-income countries: A systematicreview

Health Promotion Perspectives ◽

10.15171/hpp.2020.06 ◽

2020 ◽

Vol 10 (1) ◽

pp. 24-37

Author(s):

Winifred Ekezie ◽

Enemona Emmanuel Adaji ◽

Rachael L Murray

Keyword(s):

Disease Surveillance ◽

Health Resources ◽

Healthcare Services ◽

Outcome Data ◽

Sub Saharan Africa ◽

Middle Income ◽

Internally Displaced ◽

Middle Income Countries ◽

Food And Nutrition ◽

Low And Middle Income

Background: Conflict and violent crises have resulted in over 40 million of internally displaced persons (IDPs). Most affected regions lack access to basic health resources and generally rely on humanitarian support. The objective of this review was to appraise primary health service interventions among conflict-induced internally displaced populations in low and middle income countries between 2000 and 2019. Methods: A systematic review of literature in the following databases: Embase, MEDLINE, PsyArticles, PsycINFO, Scopus, Web of Science, LILAC and CAB Articles, was performed to identify interventions implemented in conflict IDP settings. Results: Initial searches yielded 4578 papers and 30 studies met the inclusion criteria. Descriptivesynthesis analysis was used, and the final selections were assessed using a customized CriticalAppraisal Skills Programme (CASP) checklist. Included papers were from Sub-Saharan Africa, South Asia and the Middle East regions. Most studies were on prevention interventions, especially water treatment and maternal health. Treatment interventions mostly focused on onmalaria and mental health. Only one food and nutrition study with outcome data was identified, indicating limitations in IDP health-related intervention publications. Reported interventions were conducted between one week to five years, and the study qualities were moderate. The most effective interventions were integrated programmes and common challenges were weakstudy methodology and data reporting. Conclusion: Regardless of the intervention types and durations, the services offered were beneficial to the IDPs. More intervention evidence are, however required as shown in gaps around food and nutrition, health education and disease surveillance.

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Medical injection and access to sterile injection equipment in low- and middle-income countries: a meta-analysis of Demographic and Health Surveys (2010–2017)

International Health ◽

10.1093/inthealth/ihz113 ◽

2019 ◽

Vol 12 (5) ◽

pp. 388-394

Author(s):

Emmanuel O Adewuyi ◽

Asa Auta

Keyword(s):

Health Surveys ◽

Meta Analysis ◽

Healthcare Services ◽

Demographic And Health Surveys ◽

Injection Equipment ◽

Middle Income ◽

Middle Income Countries ◽

Unsafe Injection ◽

Injection Practices ◽

Low And Middle Income

Abstract Background Unsafe injection practices contribute to increased risks of blood-borne infections, including human immunodeficiency virus, hepatitis B and hepatitis C viruses. The aim of this study was to estimate the prevalence of medical injections as well as assess the level of access to sterile injection equipment by demographic factors in low- and middle-income countries (LMICs). Methods We carried out a meta-analysis of nationally representative Demographic and Health Surveys (DHSs) conducted between 2010 and 2017 in 39 LMICs. Random effects meta-analysis was used in estimating pooled and disaggregated prevalence. All analyses were conducted using Stata version 14 and Microsoft Excel 2016. Results The pooled 12-month prevalence estimate of medical injection was 32.4% (95% confidence interval 29.3–35.6). Pakistan, Rwanda and Myanmar had the highest prevalence of medical injection: 59.1%, 56.4% and 53.0%, respectively. Regionally, the prevalence of medical injection ranged from 13.5% in west Asia to 42.7% in south and southeast Asia. The pooled prevalence of access to sterile injection equipment was 96.5%, with Pakistan, Comoros and Afghanistan having comparatively less prevalence: 86.0%, 90.3% and 90.9%, respectively. Conclusions Overuse of medical injection and potentially unsafe injection practices remain a considerable challenge in LMICs. To stem the tides of these challenges, national governments of LMICs need to initiate appropriate interventions, including education of stakeholders, and equity in access to quality healthcare services.

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SMS-based family planning communication and its association with modern contraception and maternal healthcare use in selected low-middle-income countries (Preprint)

10.2196/preprints.12780 ◽

2018 ◽

Author(s):

Bishwajit Ghose ◽

Ruoxi Wang ◽

Tang Shangfeng ◽

Sanni Yaya

Keyword(s):

Family Planning ◽

Antenatal Care ◽

Healthcare Services ◽

Facility Delivery ◽

Maternal Healthcare ◽

Middle Income ◽

Modern Contraception ◽

Middle Income Countries ◽

Delivery Services ◽

Meta Analyses

BACKGROUND In recent years, there has been a growing interest surrounding mobile phone-based health communication and service delivery methods especially in the areas of family planning (FP) and reproductive health. However, little is known regarding the role of SMS-based FP communication on the utilisation of modern contraception and maternal healthcare services in low-resource settings. OBJECTIVE The objectives of this study were to 1) measure the coverage of SMS-based family planning (FP) communication, and 2) its association with modern contraception and maternal healthcare services (MHS) among mothers. METHODS Cross-sectional data on 94,675 mothers (15-49 years) were collected from the latest Demographic and Health Surveys on 14 low-and-middle-income countries. The outcome variables were self-reported use of modern contraception and basic MHS (timely and adequate use of antenatal care, and of facility delivery services). Data were analysed using multivariate regression and random effect meta-analyses. RESULTS The coverage of SMS-based FP communication for the pooled sample was 5.4% (95%CI=3.71, 7.21), and was slightly higher in Africa (6.04, 95%CI=3.38, 8.70) compared with Asia (5.23, 95%CI=1.60, 8.86). Among the countries from sub-Saharan Africa, Malawi (11.92, 95%CI=11.17, 12.70) had the highest percent of receiving SMS while Senegal (1.24, 95%CI=1.00, 1.53) had the lowest. In the multivariate analysis, SMS communication shown significant association with the use of facility delivery only (2.22 (95%CI=1.95, 2.83). The strength of the association was highest for Senegal (OR=4.70, 95%CI=1.14, 7.33) and lowest for Burundi (OR=1.5; 95%CI=1.01, 2.74). Meta analyses revealed moderate heterogeneity both in the prevalence and the association between SMS communication and the utilisation of facility delivery. CONCLUSIONS Although positively associated with using facility delivery services, receiving SMS on FP does not appear to affect modern contraceptive use and other components of MHS such as timely and adequate utilisation of antenatal care.

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E-Government for Health Facilities in Africa

E-Health and Telemedicine ◽

10.4018/978-1-4666-8756-1.ch045 ◽

2016 ◽

pp. 893-899

Author(s):

Paul Macharia ◽

Davies Kimanga ◽

Onesimus Kamau

Keyword(s):

Information And Communication Technologies ◽

Clinical Care ◽

Health Financing ◽

Cost Effective ◽

Healthcare Services ◽

Bring Your Own Device ◽

Workplace Flexibility ◽

Middle Income ◽

Middle Income Countries ◽

Information And Communication

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Perspectives on Disability and Non-Communicable Diseases in Low- and Middle-Income Countries, with a Focus on Stroke and Dementia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16183488 ◽

2019 ◽

Vol 16 (18) ◽

pp. 3488 ◽

Cited By ~ 4

Author(s):

Josephine E. Prynn ◽

Hannah Kuper

Keyword(s):

People With Disabilities ◽

Well Being ◽

Healthcare Services ◽

Communicable Diseases ◽

Health Condition ◽

Middle Income ◽

Non Communicable Diseases ◽

Middle Income Countries ◽

Healthcare Needs ◽

Vulnerability To Poverty

Non-communicable diseases (NCD) and disability are both common, and increasing in magnitude, as a result of population ageing and a shift in disease burden towards chronic conditions. Moreover, disability and NCDs are strongly linked in a two-way association. People living with NCDs may develop impairments, which can cause activity limitations and participation restriction in the absence of supportive personal and environmental factors. In other words, NCDs may lead to disabilities. At the same time, people with disabilities are more vulnerable to NCDs, because of their underlying health condition, and vulnerability to poverty and exclusion from healthcare services. NCD programmes must expand their focus beyond prevention and treatment to incorporate rehabilitation for people living with NCDs, in order to maximize their functioning and well-being. Additionally, access to healthcare needs to be improved for people with disabilities so that they can secure their right to preventive, curative and rehabilitation services. These changes may require new innovations to overcome existing gaps in healthcare capacity, such as an increasing role for mobile technology and task-sharing. This perspective paper discusses these issues, using a particular focus on stroke and dementia in order to clarify these relationships.

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Effect of unintended pregnancy on skilled antenatal care uptake in Bangladesh: analysis of national survey data

Archives of Public Health ◽

10.1186/s13690-020-00468-1 ◽

2020 ◽

Vol 78 (1) ◽

Author(s):

Md Nuruzzaman Khan ◽

Melissa L. Harris ◽

Christopher Oldmeadow ◽

Deborah Loxton

Keyword(s):

Antenatal Care ◽

Unintended Pregnancy ◽

Unwanted Pregnancy ◽

Healthcare Services ◽

Informative Priors ◽

Middle Income ◽

Logistic Regression Models ◽

Middle Income Countries ◽

Mainstream Healthcare ◽

Skilled Anc

Abstract Background Around 48% of all pregnancies in low- and middle-income countries are unintended. Unintended pregnancy may contribute to lower use of antenatal care (ANC); however, current research in the area is largely inconclusive due to the methodological approaches applied. Methods Responses from 4493 women extracted from the 2014 Bangladesh Demographic and Health Survey (BDHS) were used to assess the association between unintended pregnancy and subsequent uptake of at least one and at least four skilled ANC visits. For this, Bayesian multilevel logistic regression models with informative priors (representing a range of values within which the researcher is certain the true effect of the parameters included lies) were used, adjusting for other factors that affect ANC uptake. Informative priors were selected from the BDHS data collected in 2004, 2007, and 2011. Results Around 64% of women in Bangladesh who had at least one pregnancy within 3 years prior to the survey (that ended in a live birth) received ANC at least once, and of these around 32% used ANC at least four times. Mistimed (aOR, 0.73, 95% Cred I, 0.66–0.81) and unwanted (aOR, 0.69, 95% Cred I, 0.64–0.75) pregnancy were associated with reduced odds of attending the recommended minimum of four skilled ANC visits compared with wanted pregnancy. These likelihoods were even lower for at least one skilled ANC visit among women with a mistimed (aOR, 0.59, 95% Cred I, 0.53–0.65) or an unwanted pregnancy (aOR, 0.67, 95% Cred I, 0.61–0.74) than women with a wanted pregnancy. Conclusions In Bangladesh, more than one-quarter of women who report an unintended pregnancy at conception and do not terminate the pregnancy are at high risk of not using ANC. It is important for policies to include women with unintended pregnancy in mainstream healthcare services. This will increase the use of ANC and reduce associated adverse consequences.

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