Lessons Learned From Implementation and Management of Skin Allograft Banking Programs in Low- and Middle-Income Countries: A Systematic Review

2020 ◽  
Vol 41 (6) ◽  
pp. 1271-1278
Author(s):  
Jeffrey L Roberson ◽  
Julie Pham ◽  
Jolie Shen ◽  
Kelly Stewart ◽  
Paa Ekow Hoyte-Williams ◽  
...  
Keyword(s):  
Tissue Banking ◽  
Lessons Learned ◽  
World Health ◽  
Tissue Banks ◽  
Skin Allograft ◽  
Middle Income ◽  
Middle Income Countries ◽  
Awareness Campaigns ◽  
The World ◽  
Low And Middle Income

Abstract Wound excision and temporary coverage with a biologic dressing can improve survival for patients with large burns. Healthcare systems in low- and middle-income countries (LMICs) rarely have access to allografts, which may contribute to the limited survival of patients with large burns in these settings. Therefore, we aimed to describe the lessons learned from the implementation and maintenance of tissue banks in LMICs to guide system planning and organization. PubMed, MEDLINE, CINAHL, and World Health Organization Catalog were systematically searched with database-specific language to represent a priori terms (eg, skin, allograft, and tissue bank) and all LMICs as defined by the World Bank. Data regarding tissue banking programs were extracted and described in a narrative synthesis. The search returned 3346 records, and 33 reports from 17 countries were analyzed. Commonly reported barriers to ideal or planned implementation included high capital costs and operational costs per graft, insufficient training opportunities, opt-in donation schemes, and sociocultural stigma around donation and transplantation. Many lessons were learned from the implementation and management of tissue banks around the world. The availability of skin allografts can be improved through strategic investments in governance and regulatory structures, international cooperation initiatives, training programs, standardized protocols, and inclusive public awareness campaigns. Furthermore, capacity-building efforts that involve key stakeholders may increase rates of pledges, donations, and transplantations. Some issues were ubiquitously reported and could be addressed by current and future tissue banking programs to ensure allograft availability for patients living in countries of all income levels.

542 Lessons Learned from Implementation and Management of Skin Allograft Banking Programs in Low- and Middle-income Countries: A Systematic Review

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S109-S110
Author(s):  
Jeffrey L Roberson ◽  
Julie Pham ◽  
Jolie Shen ◽  
Kelly Stewart ◽  
Emmanuel Adu ◽  
...  
Keyword(s):  
Tissue Banking ◽  
Program Planning ◽  
Lessons Learned ◽  
World Health ◽  
Tissue Banks ◽  
Skin Allograft ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World ◽  
Low And Middle Income

Abstract Introduction Wound excision and temporary coverage with a biologic dressing can improve survival for patients with large burns. Allograft skin possesses many of the ideal properties of biologic dressings and can play a major role in the management of large burns when autologous tissue is not available or the patient’s condition does not allow safe autografting. Healthcare systems in low- and middle-income countries (LMICs) rarely have access to allografts, which may contribute to limited survival in large burns. Therefore, we aimed to describe the lessons learned from the implementation and maintenance of tissue banks in LMICs to guide system planning. Methods PubMed, MEDLINE, CINAHL, and World Health Organization (WHO) Catalog were systematically searched with database-specific headings and language to represent a priori terms (e.g., skin, allograft, tissue bank) and all LMICs as defined by The World Bank. Data regarding tissue banking programs (e.g., date of creation, location, lead agency, functions, products), governance, capital investments, safety, maintenance and operations, costs per donation, ethics and sociocultural issues were extracted and described in a narrative synthesis. Results The search returned 3,346 records. After eliminating duplicates and non-relevant records, 33 reports were analyzed. The synthesis represented tissue banks from 17 countries. Commonly reported barriers to ideal or planned implementation included high capital costs and operational costs per graft, opt-in donation schemes, and sociocultural stigma around donation and grafting. Reports repeatedly recommended: i) developing a legal framework for oversight, accreditation and ethical practice; ii) engaging diverse stakeholders (e.g., government and non-governmental agencies, community and religious stakeholders, health officials) to improve donation and transplantation rates, iii) creating regional training hubs, and iv) facilitating international cooperation across tissue banking programs to improve transplantation efficiency. Conclusions Many lessons were learned from the development and management of tissue banks around the world. The availability of skin allografts can be improved through strategic investments in international governance and regulatory structures, regional cooperation and training initiatives, standardized protocols, and inclusive public awareness campaigns. Capacity-building efforts that involve key stakeholders may increase rates of transplantations. Applicability of Research to Practice Ubiquitous challenges in implementing and maintaining tissue banks represent important lessons in program planning to improve allograft availability for patients in countries of all national income levels.

scholarly journals Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries

2021 ◽  
Vol 18 (5) ◽  
pp. 2439
Author(s):  
Brendon Stubbs ◽  
Kamran Siddiqi ◽  
Helen Elsey ◽  
Najma Siddiqi ◽  
Ruimin Ma ◽  
...  
Keyword(s):  
Health Survey ◽  
Low Income ◽  
World Health ◽  
Low Income Countries ◽  
Multivariable Logistic Regression Analysis ◽  
World Health Survey ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World ◽  
Low And Middle Income

Tuberculosis (TB) is a leading cause of mortality in low- and middle-income countries (LMICs). TB multimorbidity [TB and ≥1 non-communicable diseases (NCDs)] is common, but studies are sparse. Cross-sectional, community-based data including adults from 21 low-income countries and 27 middle-income countries were utilized from the World Health Survey. Associations between 9 NCDs and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Eight out of 9 NCDs (all except visual impairment) were associated with TB (odds ratio (OR) ranging from 1.38–4.0). Prevalence of self-reported TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and ≥5 NCDs had 2.61 (95% confidence interval (CI) = 2.14–3.22), 4.71 (95%CI = 3.67–6.11), 6.96 (95%CI = 4.95–9.87), 10.59 (95%CI = 7.10–15.80), and 19.89 (95%CI = 11.13–35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs were three times higher than in people without multimorbidity or TB, and a third of the YLDs were attributable to NCDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed.

scholarly journals The potential of low-intensity and online interventions for depression in low- and middle-income countries

2016 ◽  
Vol 3 ◽  
Author(s):  
C. L. H. Bockting ◽  
A. D. Williams ◽  
K. Carswell ◽  
A. E. Grech
Keyword(s):  
Mental Health ◽  
World Health ◽  
Online Interventions ◽  
Treatment Protocols ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Intensity ◽  
The World ◽  
Health Gap ◽  
Low And Middle Income

The World Health Organization (WHO) reports that low- and middle-income countries (LMICs) are confronted with a serious ‘mental health gap’, indicating an enormous disparity between the number of individuals in need of mental health care and the availability of professionals to provide such care (WHO in 2010). Traditional forms of mental health services (i.e. face-to-face, individualised assessments and interventions) are therefore not feasible. We propose three strategies for addressing this mental health gap: delivery of evidence-based, low-intensity interventions by non-specialists, the use of transdiagnostic treatment protocols, and strategic deployment of technology to facilitate access and uptake. We urge researchers from all over the world to conduct feasibility studies and randomised controlled studies on the effect of low-intensity interventions and technology supported (e.g. online) interventions in LMICs, preferably using an active control condition as comparison, to ensure we disseminate effective treatments in LMICs.

scholarly journals Characteristics of a Nationwide Voluntary Antibiotic Resistance Awareness Campaign in India; Future Paths and Pointers for Resource Limited Settings/Low and Middle Income Countries

2019 ◽  
Vol 16 (24) ◽  
pp. 5141
Author(s):  
Ashok J. Tamhankar ◽  
Ramesh Nachimuthu ◽  
Ravikant Singh ◽  
Jyoti Harindran ◽  
Gautam Kumar Meghwanshi ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Use ◽  
World Health ◽  
Awareness Campaign ◽  
Resource Limited Settings ◽  
Middle Income ◽  
Middle Income Countries ◽  
Awareness Campaigns ◽  
Resource Limited ◽  
Low And Middle Income

Antibiotic resistance has reached alarming proportions globally, prompting the World Health Organization to advise nations to take up antibiotic awareness campaigns. Several campaigns have been taken up worldwide, mostly by governments. The government of India asked manufacturers to append a ‘redline’ to packages of antibiotics as identification marks and conducted a campaign to inform the general public about it and appropriate antibiotic use. We investigated whether an antibiotic resistance awareness campaign could be organized voluntarily in India and determined the characteristics of the voluntarily organized campaign by administering a questionnaire to the coordinators, who participated in organizing the voluntary campaign India. The campaign characteristics were: multiple electro–physical pedagogical and participatory techniques were used, 49 physical events were organized in various parts of India that included lectures, posters, booklet/pamphlet distribution, audio and video messages, competitions, and mass contact rallies along with broadcast of messages in 11 local languages using community radio stations (CRS) spread all over India. The median values for campaign events were: expenditure—3000 Indian Rupees/day (US$~47), time for planning—1 day, program spread—4 days, program time—4 h, direct and indirect reach of the message—respectively 250 and 500 persons/event. A 2 min play entitled ‘Take antibiotics as prescribed by the doctor’ was broadcast 10 times/day for 5 days on CRS with listener reach of ~5 million persons. More than 85%ofcoordinators thought that the campaign created adequate awareness about appropriate antibiotic use and antibiotic resistance. The voluntary campaign has implications for resource limited settings/low and middle income countries.

scholarly journals A Symptom-based COVID-19 Diagnostic Tool in case of Limited Testing Facilities

2020 ◽  
pp. 71-75
Author(s):  
Raiiq Ridwan ◽  
Md Robed Amin ◽  
Md Ridwanur Rahman
Keyword(s):  
World Health ◽  
Atypical Pneumonia ◽  
New Disease ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World ◽  
Health Organization ◽  
Transmission Of Disease ◽  
Limited Testing ◽  
Low And Middle Income

Since December 2019, when a cluster of atypical pneumonia cases were identified in Wuhan, China a new disease has spread across the world. COVID-19 has since become the biggest pandemic in a century, touching lives in almost every country in the world. At the outset of COVID-19, the World Health Organization advised for testing to become a priority so that patients with COVID-19 could be quickly identified, isolated and treated to interrupt transmission of disease. However, testing shortages have been an increasing problem in low and middle income countries. Even when tests are available, it has proved time-consuming. Therefore, we propose a symptom-based tool to assist in the diagnosis of COVID-19 management in low and middle income Countries. It is based on the symptoms that have so far been described in the literature and advises the frontline healthcare worker on how to diagnose the likelihood of having COVID-19 and separate the patient into Red (very likely), Yellow (possible) and Green (unlikely) categories. J Bangladesh Coll Phys Surg 2020; 38(0): 71-75

scholarly journals Cervical cancer screening – The challenges of complete pathways of care in low-income countries: Focus on Malawi

2020 ◽  
Vol 16 ◽  
pp. 174550652091480
Author(s):  
Heather A Cubie ◽  
Christine Campbell
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
World Health ◽  
Middle Income ◽  
Low Resource ◽  
Middle Income Countries ◽  
The World ◽  
Health Organization ◽  
Pathways Of Care ◽  
Low And Middle Income

Cervical cancer is the fourth most common cancer among women globally, with approximately 580,000 new diagnoses in 2018. Approximately, 90% of deaths from this disease occur in low- and middle-income countries, especially in areas of high HIV prevalence, and largely due to limited prevention and screening opportunities and scarce treatment options. In this overview, we describe the opportunities and challenges faced in many low- and middle-income countries in delivery of cervical cancer detection, treatment and complete pathways of care. In particular, drawing on our experience and that of colleagues, we describe cervical screening and pathways of care provision in Malawi, as a case study of a low-resource country with high incidence and mortality rates of cervical cancer. Screening methods such as cytology – although widely used in high-income countries – have limited relevance in many low-resource settings. The World Health Organization recommends screening using human papillomavirus testing wherever possible; however, although human papillomavirus primary testing is more sensitive and detects precancers and cancers earlier than cytology, there are currently costs, infrastructure considerations and specificity issues that limit its use in low- and middle-income countries. The World Health Organization accepts the alternative screening approach of visual inspection with acetic acid as part of ‘screen and treat’ programmes as a simple and inexpensive test that can be undertaken by trained health workers and hence give wider screening coverage; however, subjectivity and variability in interpretation of findings between providers raise issues of false positives and overtreatment. Cryotherapy using either nitrous oxide or carbon dioxide is an established treatment for precancerous lesions within ‘screen and treat’ programmes; more recently, thermal ablation has been recognized as suitable to low-resource settings due to lightweight equipment, short treatment times, and hand-held battery-operated and solar-powered models. For larger lesions and cancers, complete clinical pathways (including loop excision, surgery, radiotherapy, chemotherapy and palliative care) are required for optimal care of women. However, provision of each of these components of cancer control is often limited due to limited infrastructure and lack of trained personnel. Hence, global initiatives to reduce cervical mortality need to adopt a holistic approach to health systems strengthening.

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