TP8.2.23 Surgical education in low resource settings

Abstract Aims To help build medical capacity in low resource settings. Methods I researched and worked with two organisations, Médecins Sans Frontières (MSF) and Mercy Ships. I worked with Mercy Ships in collaboration with ASGBI Results MSF is a humanitarian organisation. Although MSF works in low resource settings, it is not developmental and therefore education was not part of its brief. I completed 2x 2 month missions with MSF, in Central African Republic and Chad. Mercy Ships is a developmental organisation. I worked with Mercy Ships, in four countries, to help deliver a total of 10 skills courses and 5 Training the Trainers courses which had been set up in collaboration with ASGBI. The first time was with a UK surgical trainee under this scheme. French was the working language in each setting. Conclusions There is a real and pressing need for basic surgical education in most low resource settings. Teaching with Mercy Ships is a good vehicle for teaching essential surgical skills locally and training local trainers to continue the process. It is also a good opportunity for providing a supervised introduction to working in a low resource setting for those trainees who wish to become involved in humanitarian work.

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Context

Global Anaesthesia ◽

10.1093/med/9780198809821.003.0001 ◽

2020 ◽

pp. 1-20

Author(s):

Tom Bashford ◽

Julian Gore-Booth ◽

Jo James ◽

Stephen Pickering ◽

Becky Paris ◽

...

Keyword(s):

Local Context ◽

Technical Aspects ◽

Low Resource Settings ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting ◽

Clinical Background ◽

Developmental Principles ◽

The Way

The chapter provides the reader with information on the non-clinical background to working as an anaesthetist in a low-resource setting. It concentrates on important concepts that should inform the way you practise and teach, rather than technical aspects of anaesthesia. Although technical aspects of delivering anaesthesia are usually uppermost in the minds of anaesthetists new to working in low-resource settings, it is often the case that adapting successfully to the local context proves the more challenging aspect. Topics covered include humanitarian and developmental principles, teaching anaesthesia, looking after your own health, being a good visitor, and how to adapt your practice.

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Unravelling ‘low-resource settings’: a systematic scoping review with qualitative content analysis

BMJ Global Health ◽

10.1136/bmjgh-2021-005190 ◽

2021 ◽

Vol 6 (6) ◽

pp. e005190

Author(s):

Chanel van Zyl ◽

Marelise Badenhorst ◽

Susan Hanekom ◽

Martin Heine

Keyword(s):

Content Analysis ◽

Scoping Review ◽

Qualitative Content Analysis ◽

Middle Income ◽

Low Resource Settings ◽

Low Resource ◽

Middle Income Countries ◽

Resource Setting ◽

Low Resource Setting ◽

Low Middle Income Countries

IntroductionThe effects of healthcare-related inequalities are most evident in low-resource settings. Such settings are often not explicitly defined, and umbrella terms which are easier to operationalise, such as ‘low-to-middle-income countries’ or ‘developing countries’, are often used. Without a deeper understanding of context, such proxies are pregnant with assumptions, insinuate homogeneity that is unsupported and hamper knowledge translation between settings.MethodsA systematic scoping review was undertaken to start unravelling the term ‘low-resource setting’. PubMed, Africa-Wide, Web of Science and Scopus were searched (24 June 2019), dating back ≤5 years, using terms related to ‘low-resource setting’ and ‘rehabilitation’. Rehabilitation was chosen as a methodological vehicle due to its holistic nature (eg, multidisciplinary, relevance across burden of disease, and throughout continuum of care) and expertise within the research team. Qualitative content analysis through an inductive approach was used.ResultsA total of 410 codes were derived from 48 unique articles within the field of rehabilitation, grouped into 63 content categories, and identified nine major themes relating to the term ‘low-resource setting’. Themes that emerged relate to (1) financial pressure, (2) suboptimal healthcare service delivery, (3) underdeveloped infrastructure, (4) paucity of knowledge, (5) research challenges and considerations, (6) restricted social resources, (7) geographical and environmental factors, (8) human resource limitations and (9) the influence of beliefs and practices.ConclusionThe emerging themes may assist with (1) the groundwork needed to unravel ‘low-resource settings’ in health-related research, (2) moving away from assumptive umbrella terms like ‘low-to-middle-income countries’ or ‘low/middle-income countries’ and (3) promoting effective knowledge transfer between settings.

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Outcomes of Treatment With CHOP and EPOCH in Patients With HIV Associated NHL in a Low Resource Setting

10.21203/rs.3.rs-23153/v3 ◽

2020 ◽

Author(s):

Clement Dove Okello ◽

Abrahams Omoding ◽

Henry Ddungu ◽

Yusuf Mulumba ◽

Jackson Orem

Keyword(s):

Retrospective Study ◽

Adverse Events ◽

Overall Response Rate ◽

Survival Rates ◽

Curative Intent ◽

Low Resource Settings ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting ◽

One Year

Abstract Background: The optimal chemotherapy regimen for treating HIV associated NHL in low resource settings is unknown. We conducted a retrospective study to describe survival rates, treatment response rates and adverse events in patients with HIV associated NHL treated with CHOP and dose adjusted-EPOCH regimens at the Uganda Cancer Institute. Methods: A retrospective study of patients diagnosed with HIV and lymphoma and treated at the Uganda Cancer Institute from 2016 – 2018 was done. Results: One hundred eight patients treated with CHOP and 12 patients treated with DA-EPOCH were analysed. Patients completing 6 or more cycles of chemotherapy were 51 (47%) in the CHOP group and 8 (67%) in the DA-EPOCH group. One year overall survival (OS) rate in patients treated with CHOP was 54.5% (95% CI, 42.8 – 64.8) and 80.2% (95% CI, 40.3 – 94.8) in those treated with DA-EPOCH. Factors associated with favourable survival were BMI 18.5-24.9 kg/m2, (p=0.03) and completion of 6 or more cycles of chemotherapy, (p<0.001). The overall response rate was 40% in the CHOP group and 59% in the DA-EPOCH group. Severe adverse events occurred in 19 (18%) patients in the CHOP group and 3 (25%) in the DA-EPOCH group; these were neutropenia (CHOP=13, 12%; DA-EPOCH=2, 17%), anaemia (CHOP=12, 12%; DA-EPOCH=1, 8%), thrombocytopenia (CHOP=7, 6%; DA-EPOCH=0), sepsis (CHOP=1), treatment related death (DA-EPOCH=1) and hepatic encephalopathy (CHOP=1). Conclusion: Treatment of HIV associated NHL with curative intent using CHOP and infusional DA-EPOCH is feasible in low resource settings and associated with >50% one year survival.

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Comparison Of Treatment Outcomes Between Epoch And Chop Regimens In Patients With Hiv Associated Nhl In A Low Resource Setting

10.21203/rs.3.rs-23153/v2 ◽

2020 ◽

Author(s):

Clement Dove Okello ◽

Abrahams Omoding ◽

Henry Ddungu ◽

Yusuf Mulumba ◽

Jackson Orem

Keyword(s):

Retrospective Study ◽

Adverse Events ◽

Overall Response Rate ◽

Survival Rates ◽

Curative Intent ◽

Low Resource Settings ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting ◽

One Year

Abstract Background: The optimal chemotherapy regimen for treating HIV associated NHL in low resource settings is unknown. We conducted a retrospective study to describe survival rates, treatment response rates and adverse events in patients with HIV associated NHL treated with EPOCH and CHOP regimens at the Uganda Cancer Institute.Methods: A retrospective study of patients diagnosed with HIV and lymphoma and treated at the Uganda Cancer Institute from 2016 – 2018 was done.Results: One hundred eight patients treated with CHOP and 12 patients treated with EPOCH were analysed. Patients completing 6 or more cycles of chemotherapy were 51 (47%) in the CHOP group and 8 (67%) in the EPOCH group. One year overall survival (OS) rate in patients treated with CHOP was 54.5% (95% CI, 42.8 – 64.8) and 80.2% (95% CI, 40.3 – 94.8) in those treated with EPOCH. The observed survival rates differences were not statistically different between the two groups; hazard ratio, 0.43 (95% CI, 0.10 - 1.78; p=0.24). Factors associated with favourable survival were BMI 18.5-24.9 kg/m2, (p=0.03) and completion of 6 or more cycles of chemotherapy, (p<0.001). The overall response rate was 40% in the CHOP group and 59% in the EPOCH group. Severe adverse events occurred in 19 (18%) patients in the CHOP group and 3 (25%) in the EPOCH group; these were neutropenia (CHOP=13, 12%; EPOCH=2, 17%), anaemia (CHOP=12, 12%; EPOCH=1, 8%), thrombocytopenia (CHOP=7, 6%; EPOCH=0), sepsis (CHOP=1), treatment related death (EPOCH=1) and hepatic encephalopathy (CHOP=1).Conclusion: Treatment of HIV associated NHL with curative intent using CHOP and infusional EPOCH is feasible in low resource settings and associated with >50% one year survival.

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Nursing Care of Low-Risk Newborns in Low Resource Setting: Nurses' Aides May Bridge the Gap at Community Hospitals

European Journal of Clinical Medicine ◽

10.24018/clinicmed.2022.3.1.158 ◽

2022 ◽

Vol 3 (1) ◽

pp. 1-4

Author(s):

Subhashchandra Daga

Keyword(s):

Nursing Staff ◽

Health Workers ◽

Newborn Care ◽

Low Resource Settings ◽

Neonatal Deaths ◽

Low Resource ◽

General Duty ◽

Care Services ◽

Resource Setting ◽

Low Resource Setting

Objective: To study the role of a nurses' aide in the care for newborns weighing between 1500 and 2000 g at birth in a low resource setting. Study Design: Observational. Setting: The General hospital in 1994-95, in a public sector, located in a remote area in India Intervention: A female ward assistant with seven years of schooling trained, on-the-job, to keep babies warm, initiate maternal breastfeeding, and to detect rapid breathing. The nursing staff from the pediatric ward supervised her performance. A separate "warm room" appropriately heated for preterm and sick babies became a makeshift nursery. The nursing staff administered enteral feeding, oxygen, and antibiotics. Services of the resident doctors or general duty medical officers were not available. Results: The survival rate was nearly 100% for babies with birthweights between 1,500 and 2,000 g (none referred out). Conclusions: A nurses' aide may facilitate the delivery of special care for newborns where nursing personnel are grossly inadequate and saving babies weighing between 1,500 and 2,000 g may need minimal inputs. It may be worthwhile to target 1,500 and 2,000 g birthweight categories even when resources are meager. What is already known about this subject? Low resource settings face staff shortages, especially nursing staff. Health workers with midwifery skills can deliver nearly 90% of essential care services for maternal and neonatal health. A substantial proportion of neonatal deaths occur among moderately low birth weight babies. What does this study add? It is possible to train a semi-literate person to facilitate early breastfeeding and to keep a baby warm. A large proportion of deaths among babies with birthweight ranging from 1500 to 2000 g are preventable with meager resources. How might this impact on clinical practice or future developments? The facilities facing shortage of nursing staff in low resource settings, may employ nurses’ aide to deliver basic newborn care.

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Outcomes Of Treatment With CHOP And EPOCH In Patients With HIV Associated NHL In A Low Resource Setting

10.21203/rs.3.rs-23153/v5 ◽

2020 ◽

Author(s):

Clement Dove Okello ◽

Abrahams Omoding ◽

Henry Ddungu ◽

Yusuf Mulumba ◽

Jackson Orem

Keyword(s):

Retrospective Study ◽

Adverse Events ◽

Overall Response Rate ◽

Survival Rates ◽

Curative Intent ◽

Low Resource Settings ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting ◽

One Year

Abstract Background: The optimal chemotherapy regimen for treating HIV associated NHL in low resource settings is unknown. We conducted a retrospective study to describe survival rates, treatment response rates and adverse events in patients with HIV associated NHL treated with CHOP and dose adjusted-EPOCH regimens at the Uganda Cancer Institute.Methods: A retrospective study of patients diagnosed with HIV and lymphoma and treated at the Uganda Cancer Institute from 2016 – 2018 was done.Results: One hundred eight patients treated with CHOP and 12 patients treated with DA-EPOCH were analysed. Patients completing 6 or more cycles of chemotherapy were 51 (47%) in the CHOP group and 8 (67%) in the DA-EPOCH group. One year overall survival (OS) rate in patients treated with CHOP was 54.5% (95% CI, 42.8 – 64.8) and 80.2% (95% CI, 40.3 – 94.8) in those treated with DA-EPOCH. Factors associated with favourable survival were BMI 18.5-24.9 kg/m2, (p=0.03) and completion of 6 or more cycles of chemotherapy, (p<0.001). The overall response rate was 40% in the CHOP group and 59% in the DA-EPOCH group. Severe adverse events occurred in 19 (18%) patients in the CHOP group and 3 (25%) in the DA-EPOCH group; these were neutropenia (CHOP=13, 12%; DA-EPOCH=2, 17%), anaemia (CHOP=12, 12%; DA-EPOCH=1, 8%), thrombocytopenia (CHOP=7, 6%; DA-EPOCH=0), sepsis (CHOP=1), treatment related death (DA-EPOCH=1) and hepatic encephalopathy (CHOP=1).Conclusion: Treatment of HIV associated NHL with curative intent using CHOP and infusional DA-EPOCH is feasible in low resource settings and associated with >50% one year survival.

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Outcomes of Treatment With CHOP and EPOCH in Patients With HIV Associated NHL in a Low Resource Setting

10.21203/rs.3.rs-23153/v4 ◽

2020 ◽

Author(s):

Clement Dove Okello ◽

Abrahams Omoding ◽

Henry Ddungu ◽

Yusuf Mulumba ◽

Jackson Orem

Keyword(s):

Retrospective Study ◽

Adverse Events ◽

Overall Response Rate ◽

Survival Rates ◽

Curative Intent ◽

Low Resource Settings ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting ◽

One Year

Abstract Background: The optimal chemotherapy regimen for treating HIV associated NHL in low resource settings is unknown. We conducted a retrospective study to describe survival rates, treatment response rates and adverse events in patients with HIV associated NHL treated with CHOP and dose adjusted-EPOCH regimens at the Uganda Cancer Institute. Methods: A retrospective study of patients diagnosed with HIV and lymphoma and treated at the Uganda Cancer Institute from 2016 – 2018 was done. Results: One hundred eight patients treated with CHOP and 12 patients treated with DA-EPOCH were analysed. Patients completing 6 or more cycles of chemotherapy were 51 (47%) in the CHOP group and 8 (67%) in the DA-EPOCH group. One year overall survival (OS) rate in patients treated with CHOP was 54.5% (95% CI, 42.8 – 64.8) and 80.2% (95% CI, 40.3 – 94.8) in those treated with DA-EPOCH. Factors associated with favourable survival were BMI 18.5-24.9 kg/m 2 , (p=0.03) and completion of 6 or more cycles of chemotherapy, (p<0.001). The overall response rate was 40% in the CHOP group and 59% in the DA-EPOCH group. Severe adverse events occurred in 19 (18%) patients in the CHOP group and 3 (25%) in the DA-EPOCH group; these were neutropenia (CHOP=13, 12%; DA-EPOCH=2, 17%), anaemia (CHOP=12, 12%; DA-EPOCH=1, 8%), thrombocytopenia (CHOP=7, 6%; DA-EPOCH=0), sepsis (CHOP=1), treatment related death (DA-EPOCH=1) and hepatic encephalopathy (CHOP=1). Conclusion: Treatment of HIV associated NHL with curative intent using CHOP and infusional DA-EPOCH is feasible in low resource settings and associated with >50% one year survival.

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Assessing usability of QIAreach QuantiFERON® platform in a high Tuberculosis prevalence low-resource setting

ERJ Open Research ◽

10.1183/23120541.00511-2021 ◽

2021 ◽

pp. 00511-2021

Author(s):

Conceptor Kaaba ◽

Maria Ruperez ◽

Barry Kosloff ◽

Nduku Ndunda ◽

Kwame Shanaube ◽

...

Keyword(s):

User Satisfaction ◽

Test Sample ◽

Ease Of Use ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting ◽

Task Time ◽

Laboratory Workers ◽

Set Up ◽

Tuberculosis Prevalence

BackgroundWe aimed to assess the usability of QIAreach QuantiFERON® platform in a high Tuberculosis prevalence low-resource setting. Assay usability was assessed across 6 laboratories in Zambia.MethodsUsability of QIAreach QuantiFERON and training needs for assay implementation were assessed across three domains: effectiveness, efficiency, and user satisfaction. Nine laboratory workers participated in the study. For each task, metrics on success (pass, fail, pass with hints), total task time, and ease of use rating (five-point Likert scale) were collected.ResultsOverall tasks completion rate was from 89–100%. 1/9 participants, could not understand software instructions. Average time from set up to results ranged from 22 to 40 min. Users with experience performing the QFT-plus assay completed the test faster than users without experience, 26 min versus 35 min. Two participants had difficulty loading the sample on QIAreach eStick. Two participants could not adjust the pipette to the required volume of 150 µL. Two participants did not mix the test sample properly. One participant transferred the sample buffer twice and added insufficient plasma to the sample processing tube. Two participants added the test sample to eStick sample port many times. One participant added wrong information in the software. User satisfaction ranged from 2 to 5.ConclusionThe QIAreach QFT assay is suitable to be implemented in remote areas with limited infrastructure. Further studies are needed to establish assay's performances as well as the feasibility of introducing this new assay at larger scale to improve TB control in regions with limited infrastructure.

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Outcome of infants with 10 min Apgar scores of 0–1 in a low-resource setting

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2021-322545 ◽

2021 ◽

pp. fetalneonatal-2021-322545

Author(s):

Thorkild Tylleskär ◽

Francesco Cavallin ◽

Susanna Myrnerts Höök ◽

Nicolas J Pejovic ◽

Clare Lubulwa ◽

...

Keyword(s):

Delivery Room ◽

Apgar Scores ◽

Low Resource Settings ◽

Low Resource ◽

High Resource ◽

Resource Setting ◽

Low Resource Setting ◽

Mulago National Referral Hospital ◽

Term Newborns

BackgroundIn high-resource settings, postponing the interruption of cardiopulmonary resuscitation from 10 to 20 min after birth has been recently suggested, but data from low-resource settings are lacking. We investigated the outcome of newborns with Apgar scores of 0–1 at 10 min of resuscitative efforts in a low-resource setting.MethodsThis observational substudy from the NeoSupra trial included all 49 late preterm/full-term newborns with Apgar scores of 0–1 at 10 min of resuscitation. The study was carried out at Mulago National Referral Hospital (Kampala, Uganda) between May 2018 and August 2019. Outcome measures were mortality and hypoxic-ischaemic encephalopathy in the first week of life. All resuscitations were video recorded and daily reviewed by trial researchers.ResultsMedian duration of resuscitation was 32 min (IQR 17–37). Advanced resuscitation was provided to 21/49 neonates (43%). Overall, 48 neonates (98%) died within 2 days of life (44 in the delivery room, three on the first day and one on the second day) and one survived at 1 week with severe hypoxic-ischaemic encephalopathy.ConclusionOur study adds information from a low-resource setting to the recent evidence from high-resource settings about prolonging the resuscitation in infants with Apgar scores of 0–1 at 10 min. The vast majority died in the delivery room despite prolonged resuscitative efforts. We confirm that duration of resuscitation should be tailored to the setting, while the focus in low-resource settings should be improving the quality of antenatal and immediately after birth care.

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