Respiratory illness

2019 ◽  
pp. 631-646
Author(s):  
Aditya Nadimpalli ◽  
Philippa Boulle
Keyword(s):  
Cause Of Death ◽  
Low Income ◽  
Chronic Conditions ◽  
Respiratory Illness ◽  
Low Income Countries ◽  
Respiratory Illnesses ◽  
Low Resource Settings ◽  
Low Resource ◽  
Clinical Conditions ◽  
Respiratory Conditions

This chapter outlines the spectrum of respiratory illnesses seen in humanitarian and low-resource settings, including acute and chronic conditions, and presentations not commonly seen in more developed settings. The chapter focuses on respiratory conditions, which in humanitarian settings are the cause of death in low-income countries and precarious contexts. It details the challenges of diagnosis and treating respiratory pathologies in low-resource settings, including specific guidance for the most commonly encountered clinical conditions such as pneumonia, bronchiolitis, asthma, and pertussis.

scholarly journals Antimicrobial stewardship interventions in least developed and low-income countries: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047312
Author(s):  
Grace Wezi Mzumara ◽  
Michael Mambiya ◽  
Pui-Ying Iroh Tam
Keyword(s):  
Systematic Review ◽  
Antimicrobial Stewardship ◽  
Low Income ◽  
Age Groups ◽  
Quality Criteria ◽  
Low Income Countries ◽  
Development Assistance Committee ◽  
Low Resource Settings ◽  
Low Resource ◽  
Hospitalised Patients

IntroductionAntimicrobial resistance (AMR) is increasing in low resource settings. It complicates the management of infectious diseases and is an increasing cause of death. This is due to, among other things, lack of health resources for appropriate diagnosis and unregulated access to antimicrobials in the public sphere. Developing context-specific interventions that enable judicious use of antimicrobials is important to curb this problem.MethodsWe will conduct a systematic review of antimicrobial stewardship (AMS) approaches in Development Assistance Committee in least developed and low-income countries. The inclusion criteria are antimicrobial stewardship interventions in hospitalised patients of all age groups and exclusion criteria are community-based trials and studies that solely focus on viral, fungal or parasite infections. Antimicrobial stewardship interventions will be classified as structural, enabling, persuasive, restrictive or combined. Outcomes of included studies will be classified as clinical, microbiological or behavioural outcomes. The studies to be included will be randomised controlled trials, controlled before–after studies, interrupted time series trials, cohort and qualitative studies. Data will be extracted using forms adapted from the Cochrane collaboration data collection form. This systematic review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and risk of bias will be done according to the Integrated quality Criteria for Review of Multiple Study Designs.Ethics and disseminationOur findings will be presented to clinicians and policymakers, to support developing AMS protocols for low resource settings. We will publish our results in peer-reviewed journals.Trial registration numberCRD42020210634.

scholarly journals Staged implementation of a two-tiered hospital-based neonatal care package in a resource-limited setting in Eastern Uganda

2018 ◽  
Vol 3 (1) ◽  
pp. e000586 ◽  
Author(s):  
Kathy Burgoine ◽  
Juliet Ikiror ◽  
Sylivia Akol ◽  
Margaret Kakai ◽  
Sara Talyewoya ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Low Income ◽  
Low Cost ◽  
Neonatal Care ◽  
Health Facilities ◽  
Low Income Countries ◽  
Low Resource Settings ◽  
Low Resource ◽  
Care Package ◽  
Eastern Uganda

Neonatal mortality remains a major global challenge. Most neonatal deaths occur in low-income countries, but it is estimated that over two-thirds of these deaths could be prevented if achievable interventions are scaled up. To date, initiatives have focused on community and obstetric interventions, and there has been limited simultaneous drive to improve neonatal care in the health facilities where the sick neonates are being referred. Few data exist on the process of implementing of neonatal care packages and their impact. Evidence-based guidelines for neonatal care in health facilities in low-resource settings and direction on how to achieve these standards of neonatal care are therefore urgently needed. We used the WHO-Recommended Quality of Care Framework to build a strategy for quality improvement of neonatal care in a busy government hospital in Eastern Uganda. Twelve key interventions were designed to improve infrastructure, equipment, protocols and training to provide two levels of neonatal care. We implemented this low-cost, hospital-based neonatal care package over an 18-month period. This data-driven analysis paper illustrates how simple changes in practice, provision of basic equipment and protocols, ongoing training and dedicated neonatal staff can reduce neonatal mortality substantially even without specialist equipment. Neonatal mortality decreased from 48% to 40% (P=0.25) after level 1 care was implemented and dropped further to 21% (P<0.01) with level 2 care. In our experience, a dramatic impact on neonatal mortality can be made through modest and cost-effective interventions. We recommend that stakeholders seeking to improve neonatal care in low-resource settings adopt a similar approach.

scholarly journals Digitally-enabled approach to improving primary care in a rural and remote low-resource setting

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Ansell
Keyword(s):  
Primary Care ◽  
Public Sector ◽  
Low Income ◽  
Digital Health ◽  
Health Priorities ◽  
Rural And Remote ◽  
Low Resource Settings ◽  
Digital Platform ◽  
Low Resource ◽  
Out Of Pocket Payments

Abstract Introduction An innovative digitally-supported multi-sectoral solution for supporting end-to-end primary care for rural and remote low-income populations in Western Visayas, Philippines was examined to determine its efficacy in supporting health access. This solution brings together multisectoral stakeholders using a digital platform to coordinate the provision of a virtual primary care system. The solution also supports ordering and delivery of low-cost insurance and medicines, with the aim of reducing out-of-pocket payments and complementing public-sector services. Methods Processes and outputs for a novel data-driven digital health solution were documented and analyzed through a mixed methods approach. Researchers conducted interviews with a range of stakeholders, including program beneficiaries and partners. Quantitative data focusing on the project outputs were also examined. Results Through an integrated digital platform to coordinate inputs from the public sector (Department of Health); private sector (pharmaceutical, insurance, and telecom firms); and community (in the form of a peer-worker network), this model offers an example of an innovative approach to primary health delivery in low-resource settings. These inputs are leveraged and informed by a 'big-data' precision approach, based on detailed epidemiological profiles of community residents. This dataset allows for the evidence-based identification of village-specific health priorities and development of corresponding interventions. This approach has contributed to increased access to medicines; affordability of medicines and health services; and community resilience among the target populations. However, barriers involving a local shortage of health human resources and cumbersome eHealth regulations affect program impact. Conclusions This research provides evidence for the scale-up of a multisectoral digital approach to support the implementation of UHC targets in Philippines. Key messages Implementing digital health solutions in low-resource settings is possible. Changes are needed in Philippines health regulations for digital health to properly support UHC implementation.

scholarly journals The good and the bad: using C reactive protein to distinguish bacterial from non-bacterial infection among febrile patients in low-resource settings

2020 ◽  
Vol 5 (5) ◽  
pp. e002396 ◽  
Author(s):  
Camille Escadafal ◽  
Sandra Incardona ◽  
B Leticia Fernandez-Carballo ◽  
Sabine Dittrich
Keyword(s):  
Antimicrobial Resistance ◽  
Low Income ◽  
Bacterial Infections ◽  
Laboratory Diagnostics ◽  
Antibiotic Prescribing ◽  
Health Coverage ◽  
C Reactive Protein ◽  
Low Resource Settings ◽  
Low Resource ◽  
Reactive Protein

C reactive protein (CRP), a marker for the presence of an inflammatory process, is the most extensively studied marker for distinguishing bacterial from non-bacterial infections in febrile patients. A point-of-care test for bacterial infections would be of particular use in low-resource settings where other laboratory diagnostics are not always available, antimicrobial resistance rates are high and bacterial infections such as pneumonia are a leading cause of death. This document summarises evidence on CRP testing for bacterial infections in low-income and middle-income countries (LMICs). With a push for universal health coverage and prevention of antimicrobial resistance, it is important to understand if CRP might be able to do the job. The use of CRP polarised the global health community and the aim of this document is to summarise the ‘good and the bad’ of CRP in multiple settings in LMICs. In brief, the literature that was reviewed suggests that CRP testing may be beneficial in low-resource settings to improve rational antibiotic use for febrile patients, but the positive predictive value is insufficient to allow it to be used alone as a single tool. CRP testing may be best used as part of a panel of diagnostic tests and algorithms. Further studies in low-resource settings, particularly with regard to impact on antibiotic prescribing and cost-effectiveness of CRP testing, are warranted.

scholarly journals Peritoneal Dialysis Utilization Globally and Opportunities in Lower Income Countries

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Fredric Finkelstein ◽  
Qamar Khan
Keyword(s):  
Peritoneal Dialysis ◽  
Low Income ◽  
Low Income Countries ◽  
Dramatic Improvement ◽  
Middle Income ◽  
Low Resource ◽  
Number Of Patients ◽  
The Government ◽  
Global Increase ◽  
End Stage

There has been an expansion of peritoneal dialysis (PD) utilization globally over the past several years. This has occurred for several reasons. First, there has been a global increase in the number of patients receiving end-stage kidney disease (ESKD) treatment in high income, middle income and low income countries. Second, recent studies have emphasized the reduced cost of PD compared to hemodialysis (HD) if PD supplies can be acquired at a reasonable cost.  Thirdly, it is now widely accepted that since PD is much simpler to do than HD (that is, it does not require large amounts of water, complex water treatment systems, electricity, and machinery), the use of PD in low resource countries has certain obvious advantages. Fourthly, it has become clear from experiences in Hong Kong and Thailand that have developed PD First programs (i.e. the government paying for ESKD care only if PD eligible patients start on PD rather than HD) and programs in Mexico (where there has been limited availability of HD centers) that the vast majority of patients with ESKD, even in low resource countries, are able to successfully be cared for with PD.  And, importantly, as programs expand in low resource countries and experience is gained, outcomes of  PD improve.  Lastly, the International Society of Peritoneal Dialysis (ISPD) has developed comprehensive guidelines for the care of PD patients that has resulted in a dramatic improvement in outcomes for PD patients over the last several years.

scholarly journals Improving Information and Communications Technology (ICT) Knowledge and Skills to Develop Health Research Capacity in Kenya

2019 ◽  
Vol 11 (3) ◽  
Author(s):  
Aliza Monroe-Wise ◽  
John Kinuthia ◽  
Sherrilynne Fuller ◽  
Matthew Dunbar ◽  
David Masuda ◽  
...  
Keyword(s):  
Data Management ◽  
Low Income ◽  
Clinical Care ◽  
Research Capacity ◽  
Information And Communications Technology ◽  
Learning Program ◽  
Knowledge And Skills ◽  
Low Resource Settings ◽  
Low Resource ◽  
Ict Tools

ObjectivesInformation and communication technology (ICT) tools are increasingly important for clinical care, research, data management, international collaborations, and dissemination. Many technologies would be particularly useful for healthcare workers in resource-limited settings; however, these individuals are the least likely to utilize ICT tools, in part because they lack knowledge and skills necessary to use them. Our program aimed to train researchers in low-resource settings on using ICT tools.MethodsWe conducted a tiered, blended learning program for researchers in Kenya on three areas of ICT: geographic information systems, data management, and communication tools. Tiers included didactic online courses for 100-300 students for each topic, skills workshops for 30 students, and mentored projects for 10. Concurrently, a training of trainers course comprised of an online course and a skills workshop to ensure sustainable ongoing training.ResultsCourse ratings were high, particularly when participants engaged in hands-on skill building activities. Teaching that incorporated local examples was most valuable. Discussion boards were sometimes distracting, depending on multiple factors. Mentored projects were most useful when there were clear expectations, pre-existing projects or data, and clear timelines.DiscussionTraining in the use of ICT tools is essential to improve their use among researchers in low-income settings. However, very few training courses have been described. Our students demonstrated acquisition of new skills and felt these skills to be valuable in their workplaces.ConclusionsFurther and ongoing training in ICT skills should be considered in other low-resource settings, and could use our program as a foundational model.

scholarly journals Rumor surveillance in support of minimally invasive tissue sampling for diagnosing the cause of child death in low-income countries: A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244552
Author(s):  
Md Saiful Islam ◽  
Abdullah Al-Masud ◽  
Maria Maixenchs ◽  
Saquina Cossa ◽  
Rui Guilaze ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Cause Of Death ◽  
Low Income ◽  
Child Death ◽  
The Body ◽  
Low Income Countries ◽  
Tissue Sampling ◽  
Middle Income ◽  
Additional Information ◽  
Tissue Specimens

In low-and middle-income countries, determining the cause of death of any given individual is impaired by poor access to healthcare systems, resource-poor diagnostic facilities, and limited acceptance of complete diagnostic autopsies. Minimally invasive tissue sampling (MITS), an innovative post-mortem procedure based on obtaining tissue specimens using fine needle biopsies suitable for laboratory analysis, is an acceptable proxy of the complete diagnostic autopsy, and thus could reduce the uncertainty of cause of death. This study describes rumor surveillance activities developed and implemented in Bangladesh, Mali, and Mozambique to identify, track and understand rumors about the MITS procedure. Our surveillance activities included observations and interviews with stakeholders to understand how rumors are developed and spread and to anticipate rumors in the program areas. We also engaged young volunteers, local stakeholders, community leaders, and study staff to report rumors being spread in the community after MITS launch. Through community meetings, we also managed and responded to rumors. When a rumor was reported, the field team purposively conducted interviews and group discussions to track, verify and understand the rumor. From July 2016 through April 2018, the surveillance identified several rumors including suspicions of organs being harvested or transplanted; MITS having been performed on a living child, and concerns related to disrespecting the body and mistrust related to the study purpose. These rumors, concerns, and cues of mistrust were passed by word of mouth. We managed the rumors by modifying the consent protocol and giving additional information and support to the bereaved family and to the community members. Rumor surveillance was critical for anticipating and readily identifying rumors and managing them. Setting up rumor surveillance by engaging community residents, stakeholders, and volunteers could be an essential part of any public health program where there is a need to identify and react in real-time to public concern.

scholarly journals International Neurotrauma Training Based on North-South Collaborations: Results of an Inter-institutional Program in the Era of Global Neurosurgery

2021 ◽  
Vol 8 ◽  
Author(s):  
Andrés M. Rubiano ◽  
Dylan P. Griswold ◽  
P. David Adelson ◽  
Raul A. Echeverri ◽  
Ahsan A. Khan ◽  
...  
Keyword(s):  
Medical Students ◽  
Low Income ◽  
Health Research ◽  
Systems Of Care ◽  
Academic Support ◽  
High Income ◽  
Global Health Research ◽  
Fellowship Program ◽  
Low Resource Settings ◽  
Low Resource

Objective: Shortage of general neurosurgery and specialized neurotrauma care in low resource settings is a critical setback in the national surgical plans of low and middle-income countries (LMIC). Neurotrauma fellowship programs typically exist in high-income countries (HIC), where surgeons who fulfill the requirements for positions regularly stay to practice. Due to this issue, neurosurgery residents and medical students from LMICs do not have regular access to this kind of specialized training and knowledge-hubs. The objective of this paper is to present the results of a recently established neurotrauma fellowship program for neurosurgeons of LMICs in the framework of global neurosurgery collaborations, including the involvement of specialized parallel education for neurosurgery residents and medical students.Methods: The Global Neurotrauma Fellowship (GNTF) program was inaugurated in 2015 by a multi-institutional collaboration between a HIC and an LMIC. The course organizers designed it to be a 12-month program based on adapted neurotrauma international competencies with the academic support of the Barrow Neurological Institute at Phoenix Children's Hospital and Meditech Foundation in Colombia. Since 2018, additional support from the UK, National Institute of Health Research (NIHR) Global Health Research in Neurotrauma Project from the University of Cambridge enhanced the infrastructure of the program, adding a research component in global neurosurgery and system science.Results: Eight fellows from Brazil, Venezuela, Cuba, Pakistan, and Colombia have been trained and certified via the fellowship program. The integration of international competencies and exposure to different systems of care in high-income and low-income environments creates a unique environment for training within a global neurosurgery framework. Additionally, 18 residents (Venezuela, Colombia, Ecuador, Peru, Cuba, Germany, Spain, and the USA), and ten medical students (the United Kingdom, USA, Australia, and Colombia) have also participated in elective rotations of neurotrauma and critical care during the time of the fellowship program, as well as in research projects as part of an established global surgery initiative.Conclusion: We have shown that it is possible to establish a neurotrauma fellowship program in an LMIC based on the structure of HIC formal training programs. Adaptation of the international competencies focusing on neurotrauma care in low resource settings and maintaining international mentoring and academic support will allow the participants to return to practice in their home-based countries.

scholarly journals Medical equipment donation in low-resource settings: a review of the literature and guidelines for surgery and anaesthesia in low-income and middle-income countries

2019 ◽  
Vol 4 (5) ◽  
pp. e001785 ◽  
Author(s):  
Isobel H Marks ◽  
Hannah Thomas ◽  
Marize Bakhet ◽  
Edward Fitzgerald
Keyword(s):  
Low Income ◽  
Medical Equipment ◽  
Grey Literature ◽  
National Guidelines ◽  
Middle Income ◽  
Low Resource Settings ◽  
Low Resource ◽  
User Training ◽  
Biomedical Equipment ◽  
Donation Process

BackgroundMedical equipment donation to low-resource settings is a frequently used strategy to address existing disparities, but there is a paucity of reported experience and evaluation. Challenges such as infrastructure gaps, lack of technological and maintenance capabilities, and non-prioritisation of essential supplies have previously been highlighted. This pragmatic review summarises existing guidelines and literature relevant to surgical and anaesthesia equipment, with recommendations for future initiatives and research.MethodsRetrospective literature review including both academic and grey literature from 1980 to 2018. We conducted a narrative synthesis to identify key factors that were condensed thematically.ResultsThirty-three biomedical equipment donation guidelines were identified from governments, WHO, World Bank, academic colleges and non-governmental organisations, and 36 relevant studies in peer-reviewed literature. These highlighted the need to consider all stages of the donation process, including planning, sourcing, transporting, training, maintaining and evaluating equipment donation. Donors were advised to consult national guidelines to ensure equipment was appropriate, desirable and non-costly to both parties. User training and access to biomechanical engineers were suggested as necessary for long-term sustainability. Finally, equitable partnerships between donors and recipients were integral to reducing inappropriate donations and to improve follow-up and evaluation.ConclusionThere is a paucity of evidence on the causes of success or failure in medical equipment donation, despite its domination of equipment sourcing across many low-resource settings. Equitable partnerships, consultation of policies and guidelines, and careful planning may improve equipment usability and life span. A concerted effort is required to increase awareness of guidelines among health professionals worldwide.

scholarly journals Effects of Disaster on Primary Health Care in Low Income Countries

2019 ◽  
Vol 17 (01) ◽  
pp. 1-8
Author(s):  
Kirti Ray ◽  
Jagadishwor Ghimire ◽  
Rajendra Kumar BC
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Disaster Management ◽  
Low Income ◽  
Low Income Countries ◽  
Primary Health Care System ◽  
High Exposure ◽  
Low Resource ◽  
Primary Health ◽  
The People

Primary health care is considered to be a practical approach to provide basic curative, preventive and promotive health care as an accessible medium for the people particularly in low resource income countries in an affordable way. This paper reviewed that an integrated primary health care system could reduce fundamental vulnerability of disasters; thereafter protect the health facilities and services for providing health programs. Further it focused on the increased uptake on health services to build resilience among individuals of low resource countries having high exposure to disasters. It also provides an idea on the practices adapted for gaining resilience of primary health care of low resource regions like Africa, South and South East Asia which are frequently exposed to disasters. However, this study did not focus on the health governance, pre-hospital disaster management and funding policies which are limited at present in low income countries affected by frequent disasters.Keywords: Disasters; disaster management; low income countries; primary health care; resilience.

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