Tropical Medicine for Anaesthetists

2020 ◽  
pp. 297-318
Author(s):  
Victoria Howell
Keyword(s):  
Clinical Features ◽  
Tropical Medicine ◽  
Tropical Diseases ◽  
Middle Income ◽  
Low Resource ◽  
Middle Income Countries ◽  
High Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Significant Burden

Many tropical diseases will be unfamiliar to anaesthetists from high-resource settings but are common in low- and middle-income countries. They lead to a significant burden of morbidity and mortality, and some knowledge of the commonly presenting ones and how they might impact on conduct of anaesthesia is essential to anaesthetists practising in these settings. The chapter covers the essentials of several tropical diseases including malaria, tuberculosis, cholera, and typhoid. The chapter outlines for each disease the aetiology, pathophysiology, clinical features, diagnosis, management, and anaesthetic implications. Diseases that are also found in high-resource settings, such as diarrhoea and HIV, are also covered on the basis that they are much more likely to be encountered in a low-resource setting.

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

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.

scholarly journals A framework for designing medical devices resilient to low-resource settings

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Davide Piaggio ◽  
Rossana Castaldo ◽  
Marco Cinelli ◽  
Sara Cinelli ◽  
Alessia Maccaro ◽  
...  
Keyword(s):  
Delphi Study ◽  
Middle Income ◽  
Low Resource Settings ◽  
Health Technologies ◽  
Low Resource ◽  
Middle Income Countries ◽  
High Resource ◽  
International Experts ◽  
Global Population ◽  
Different Parts

Abstract Background To date (April 2021), medical device (MD) design approaches have failed to consider the contexts where MDs can be operationalised. Although most of the global population lives and is treated in Low- and Middle-Income Countries (LMCIs), over 80% of the MD market share is in high-resource settings, which set de facto standards that cannot be taken for granted in lower resource settings. Using a MD designed for high-resource settings in LMICs may hinder its safe and efficient operationalisation. In the literature, many criteria for frameworks to support resilient MD design were presented. However, since the available criteria (as of 2021) are far from being consensual and comprehensive, the aim of this study is to raise awareness about such challenges and to scope experts’ consensus regarding the essentiality of MD design criteria. Results This paper presents a novel application of Delphi study and Multiple Criteria Decision Analysis (MCDA) to develop a framework comprising 26 essential criteria, which were evaluated and chosen by international experts coming from different parts of the world. This framework was validated by analysing some MDs presented in the WHO Compendium of innovative health technologies for low-resource settings. Conclusions This novel holistic framework takes into account some domains that are usually underestimated by MDs designers. For this reason, it can be used by experts designing MDs resilient to low-resource settings and it can also assist policymakers and non-governmental organisations in shaping the future of global healthcare.

scholarly journals Advancing Age in Africa, the Urgent Need for Institutional Geriatric Care in a Low Resource Setting: A Case Report

2021 ◽  
Vol 12 (2) ◽  
pp. 416-420
Author(s):  
Emmanuel Kobina Mesi Edzie ◽  
Klenam Dzefi-Tettey ◽  
Philip Narteh Gorleku ◽  
Frank Naku Ghartey ◽  
Madison Adanusa ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Geriatric Care ◽  
Health Concern ◽  
Healthcare Personnel ◽  
Healthcare Industry ◽  
Middle Income ◽  
Middle Income Countries ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Low And Middle Income

Background: The demand for geriatric care has been on the increase throughout the world, especially in the developing, low- and middle-income countries (LMICs), due to increasing life expectancy, improvement in technology in healthcare industry coupled with increasing numbers of healthcare personnel. Nonetheless, these increases in the resources to the healthcare industry are still woefully inadequate in the developing and LMICs, compared to the high demand for such services, thereby exposing the drastic challenges and gaps in geriatric services in these countries. Case Presentation: A 74-year-old woman apparently well, who was relocated from the rural area by her biological daughter, with the intention of giving her better care in a comfortable city environment. She was initially appreciative of the relocation. However, the situation went sour when her daughter and son-in-law resumed work after their annual leave period. They started locking her up in a well-furnished mansion with everything she may need until they returned from work. Consistently for eight working days, she was kept under lock and key because they did not want her to roam around the community, they thought was not familiar to her with the intention of keeping her safe. Everything was fine until they returned from work one day to find that she had soiled the house with her excrement, apparently as a protest against her consistent lock-up. This necessitated their visit to the hospital. A diagnosis of social isolation was made after clinical and mental state examination and appropriate interventions were instituted. The patient consequently became fine in the new environment. Conclusion: This case has been presented in order to emphasize the need to improve the systems for geriatric care which is of public health concern, especially as the life expectancy of the developing, low- and middle-income countries keep improving.

Ethics of Public Mental Health in Developing Societies

2015 ◽  
Author(s):  
Buddhika Lalanie Fernando ◽  
Athula Sumathipala
Keyword(s):  
Mental Health ◽  
Public Mental Health ◽  
Psychiatric Research ◽  
Ethical Perspective ◽  
Middle Income ◽  
Ethics Framework ◽  
Middle Income Countries ◽  
Curative Care ◽  
Resource Setting ◽  
Low Resource Setting

Half of the world’s population lives in countries with one psychiatrist to serve 200,000 people and in low and middle income countries (LAMICs), even most people with severe mental disorders remain untreated. As curative care is prioritized, public mental health is inundated with deep-seated problems, primarily due to the lack of funding. From an ethical perspective, such underlying issues in public mental health exist regardless of income levels; they are, however, further exacerbated by the lack of resources and awareness in LAMICs. Ironically, the ethics of public mental health have received much less attention than that of psychiatric research. We therefore use a public health ethics framework to broaden the ethical perspective in public mental health and examine it from a low-resource setting viewpoint. Next, we examine public mental health from a social justice perspective. Third, we examine issues critical to ensuring better access to mental health services in LAMICs.

scholarly journals Liver abscess: diagnostic and management issues found in the low resource setting

2019 ◽  
Vol 132 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Gaetan Khim ◽  
Sokhom Em ◽  
Satdin Mo ◽  
Nicola Townell
Keyword(s):  
Liver Abscess ◽  
Pyogenic Liver Abscess ◽  
Amoebic Liver Abscess ◽  
Diagnostic Strategy ◽  
Middle Income ◽  
Low Resource ◽  
Liver Abscesses ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Low Middle Income Countries

Abstract Introduction Liver abscesses are mainly caused by parasitic or bacterial infection and are an important cause of hospitalization in low-middle income countries (LMIC). The pathophysiology of abscesses is different depending on the etiology and requires different strategies for diagnosis and management. This paper discusses pathophysiology and epidemiology, the current diagnostic approach and its limitations and management of liver abscess in low resource settings. Sources of data We searched PubMed for relevant reviews by typing the following keywords: ‘amoebic liver abscess’ and ‘pyogenic liver abscess’. Areas of agreement Amoebic liver abscess can be treated medically while pyogenic liver abscess usually needs to be percutaneously drained and treated with effective antibiotics. Areas of controversy In an LMIC setting, where misuse of antibiotics is a recognized issue, liver abscesses are a therapeutic conundrum, leaving little choices for treatment for physicians in low capacity settings. Growing points As antimicrobial resistance awareness and antibiotic stewardship programs are put into place, liver abscess management will likely improve in LMICs provided that systematic adapted guidelines are established and practiced. Areas timely for developing research The lack of a quick and reliable diagnostic strategy in the majority of LMIC makes selection of appropriate treatment challenging.

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

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.

Evaluation of a New Protocol of Insulin Dose Adjustment in a Low-Resource Setting

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 93-LB
Author(s):  
EDDY JEAN BAPTISTE ◽  
PHILIPPE LARCO ◽  
MARIE-NANCY CHARLES LARCO ◽  
JULIA E. VON OETTINGEN ◽  
EDDLYS DUBOIS ◽  
...  
Keyword(s):  
Dose Adjustment ◽  
Insulin Dose ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting

scholarly journals Right paraduodenal hernia with extensive bowel gangrene treated with staged surgery: a Bogota bag followed by resection in a low-resource setting

2021 ◽  
Vol 14 (4) ◽  
pp. e239250
Author(s):  
Vijay Anand Ismavel ◽  
Moloti Kichu ◽  
David Paul Hechhula ◽  
Rebecca Yanadi
Keyword(s):  
Plastic Material ◽  
Successful Outcome ◽  
Paraduodenal Hernia ◽  
Transparent Plastic ◽  
Low Resource ◽  
Entire Small Bowel ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Right Paraduodenal Hernia ◽  
Bowel Gangrene

We report a case of right paraduodenal hernia with strangulation of almost the entire small bowel at presentation. Since resection of all bowel of doubtful viability would have resulted in too little residual length to sustain life, a Bogota bag was fashioned using transparent plastic material from an urine drainage bag and the patient monitored intensively for 18 hours. At re-laparotomy, clear demarcation lines had formed with adequate length of viable bowel (100 cm) and resection with anastomosis was done with a good outcome on follow-up, 9 months after surgery. Our description of a rare cause of strangulated intestinal obstruction and a novel method of maximising length of viable bowel is reported for its successful outcome in a low-resource setting.

scholarly journals Humanitarian Surgical Missions in Times of COVID-19: Recommendations to Safely Return to a Sub-Saharan Africa Low-Resource Setting

2021 ◽  
Author(s):  
Víctor Lopez-Lopez ◽  
Ana Morales ◽  
Elisa García-Vazquez ◽  
Miguel González ◽  
Quiteria Hernandez ◽  
...  
Keyword(s):  
Sub Saharan Africa ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Sub Saharan
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