Prevention and Treatment of Tuberculosis in Low- and Middle-Income Countries: Ethical Challenges

2019 ◽  
pp. 447-458
Author(s):  
Diego S. Silva ◽  
Michael Selgelid
Keyword(s):  
Resource Constraints ◽  
Third Party ◽  
Ethical Challenges ◽  
Lower Socioeconomic Status ◽  
Middle Income ◽  
Antitubercular Drugs ◽  
Middle Income Countries ◽  
Lower Socioeconomic ◽  
And Control ◽  
Low And Middle Income

Although tuberculosis (TB) affects people worldwide, particularly those of lower socioeconomic status, the vast majority of the burden is felt in low- and middle-income countries (LMICs). In turn, the ethical challenges posed by TB care and control are especially salient in LMICs faced with acute and chronic resource constraints. For some of these challenges, there is broad agreement about what ought to be done. TB prevention among close contacts of contagious patients, for example, is essential. Other challenges, however, are either new or refractory and require greater consideration. This chapter discusses three such key ethical challenges posed by TB care and control, particularly within the context of LMICs: isolation and involuntary isolation, third-party notification, and the introduction of new antitubercular drugs.

An Overview of the Ethics of Injury in Public Health

2019 ◽  
pp. 597-603
Author(s):  
Adnan A. Hyder
Keyword(s):  
Public Health ◽  
Injury Prevention ◽  
Prevention And Control ◽  
Public Health Ethics ◽  
Ethical Challenges ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Ethics ◽  
Prompt Attention ◽  
And Control

This chapter briefly introduces ethics issues in injury prevention and control in low- and middle-income countries (LMICs), using a series of examples that prompt attention to the ethical principles of autonomy and justice. The chapter also introduces the section of The Oxford Handbook of Public Health Ethics dedicated to an examination of injury and public health ethics, with attention given to the complex ethical challenges arising in injury prevention and control in LMICs. The section’s two chapters discuss public health ethics issues arising in the prevention and control of unintentional injuries and intentional injuries, respectively. Those chapters define a set of ethics issues within international injury work and provide an initial analysis of the nature of those ethics issues, their specificity, and potential pathways for addressing them.

scholarly journals The burgeoning role of global health diplomacy to alleviate suffering of cancer patients in low- and middle-income countries

2020 ◽  
Vol 12 (3) ◽  
pp. 231-233
Author(s):  
Melissa Adomako ◽  
Alaei Kamiar ◽  
Abdulla Alshaikh ◽  
Lyndsay S Baines ◽  
Desiree Benson ◽  
...  
Keyword(s):  
Global Health ◽  
Evidence Base ◽  
International Affairs ◽  
Global Health Diplomacy ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Diplomacy ◽  
Health Practitioners ◽  
And Control ◽  
Low And Middle Income

Abstract The science of global health diplomacy (GHD) consists of cross-disciplinary, multistakeholder credentials comprised of national security, public health, international affairs, management, law, economics and trade policy. GHD is well placed to bring about better and improved multilateral stakeholder leverage and outcomes in the prevention and control of cancer. It is important to create an evidence base that provides clear and specific guidance for health practitioners in low- and middle-income countries (LMICs) through involvement of all stakeholders. GHD can assist LMICs to negotiate across multilateral stakeholders to integrate prevention, treatment and palliative care of cancer into their commercial and trade policies.

scholarly journals Large-Scale Food Fortification and Biofortification in Low- and Middle-Income Countries: A Review of Programs, Trends, Challenges, and Evidence Gaps

2018 ◽  
Vol 39 (2) ◽  
pp. 315-331 ◽  
Author(s):  
Saskia J. M. Osendarp ◽  
Homero Martinez ◽  
Greg S. Garrett ◽  
Lynnette M. Neufeld ◽  
Luz Maria De-Regil ◽  
...  
Keyword(s):  
Large Scale ◽  
Food System ◽  
Food Fortification ◽  
Micronutrient Deficiencies ◽  
Middle Income ◽  
Middle Income Countries ◽  
Essential Components ◽  
Quality Of Delivery ◽  
And Control ◽  
Low And Middle Income

Background: Food fortification and biofortification are well-established strategies to address micronutrient deficiencies in vulnerable populations. However, the effectiveness of fortification programs is not only determined by the biological efficacy of the fortified foods but also by effective and sustainable implementation, which requires continual monitoring, quality assurance and control, and corrective measures to ensure high compliance. Objective: To provide an overview of efficacy, effectiveness, economics of food fortification and biofortification, and status of and challenges faced by large-scale food fortification programs in low- and middle-income countries (LMIC). Methods: A literature review of PubMed publications in English from 2000 to 2017, as well as gray literature, targeting nongovernmental organizations whose work focuses on this topic, complemented by national reports and a “snowball” process of citation searching. The article describes remaining technical challenges, barriers, and evidence gap and prioritizes recommendations and next steps to further accelerate progress and potential of impact. Results: The review identifies and highlights essential components of successful programs. It also points out issues that determine poor program performance, including lack of adequate monitoring and enforcement and poor compliance with standards by industry. Conclusions: In the last 17 years, large-scale food fortification initiatives have been reaching increasingly larger segments of populations in LMIC. Large-scale food fortification and biofortification should be part of other nutrition-specific and nutrition-sensitive efforts to prevent and control micronutrient deficiencies. There are remaining technical and food system challenges, especially in relation to improving coverage and quality of delivery and measuring progress of national programs.

A decentralized Offline Patient ID Generation and Matching Algorithm: The Nigeria phone-based model (Preprint)

2021 ◽  
Author(s):  
Emeka Chukwu ◽  
Lalit Garg ◽  
Iniobong Ekong
Keyword(s):  
Resource Constraints ◽  
Health Management ◽  
Health Service Delivery ◽  
Health Management Information System ◽  
Patient Identification ◽  
Network Resource ◽  
Middle Income ◽  
Middle Income Countries ◽  
Trade Offs ◽  
Low And Middle Income

UNSTRUCTURED Quality of health service delivery data remains sub-optimal in many developing countries despite over a decade of progress in digitization and Health Management Information System (HMIS). Uniquely identifying Patients within the care continuum is the only way to guarantee better outcomes hinged on shared health records. Many different strategies exist for uniquely identifying and tracking a patient in a health system, and they also have their trade-offs. Nigeria, a typical low-and-middle-income country is used to demonstrate the survey of how leading candidates for Patient identification fit in the digital Patient ID desirable attributes framework. The network resource constraints inherent in low-and-middle-income countries is illustrated. We show that no current Patient ID strategy simultaneously meets the six attributes of uniqueness, unchanging, uncontroversial, inexpensive, ubiquitous, and uncomplicated. We designed and prototyped decentralized algorithms for universal-offline, unique Patient ID generation with a dual deterministic and probabilistic patient matching model.

scholarly journals 2031. Impact of Education and Antibiotic Guidelines on Dispensing Antibiotics with Community Pharmacists in a Low- and Middle-Income Country

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S682-S682
Author(s):  
Smitha Gudipati ◽  
Deepak Bajracharya ◽  
Lenjana Jimee ◽  
Gina Maki ◽  
Marcus Zervos ◽  
...  
Keyword(s):  
Community Pharmacists ◽  
Antibiotic Use ◽  
Educational Assessment ◽  
The Body ◽  
Control Groups ◽  
Post Intervention ◽  
Middle Income ◽  
Middle Income Countries ◽  
And Control ◽  
Low And Middle Income

Abstract Background Non-prescription use of antibiotics in low- and middle-income countries has contributed to significant antimicrobial resistance (AMR). Henry Ford Health System has partnered with multinational organizations in Nepal to address the need for increasing awareness of AMR and implementation of effective antimicrobial stewardship. This partnership confirmed the importance of increasing knowledge and awareness regarding AMR and antibiotic use to community pharmacists. The present pilot study assessed if outpatient antibiotic dispensing guidelines given to community pharmacists could result in a reduction of unneeded antibiotic use. Methods Nine community pharmacies from Kathmandu were selected of which two were used as controls. Seven pharmacists were educated on the appropriate use of antibiotics, and outpatient dispensing before and after guidelines at all pharmacies were evaluated. The pharmacists were given guidelines on antibiotic use and duration needed for common bacterial infections encountered. Controls were not given guidelines. At baseline and post-intervention (1 week), pill counts were performed of the top six antibiotics that were dispensed by the pharmacist. Pharmacists were requested to keep a log of how many antibiotics were dispensed for one week. The pharmacists also were requested to fill out a post-intervention educational assessment to evaluate retention. Results Pill count pre-intervention was 15,856 and 1512 and post-intervention was 11,168 and 1,440 in the intervention and control groups respectively (Table 1). A post-intervention educational assessment revealed that both the intervention and control groups believed antibiotics can treat viruses (57% vs. 50%) and that antibiotics do not kill good bacteria that protect the body from infection (57% vs. 50%) (Table 2). Conclusion There was no difference in the dispensing of antibiotics between pre- and post-intervention. The findings of this study show significant room for improvement in continuing education about antibiotic use in outpatient pharmacies. Further studies are needed to target outpatient antibiotic dispensing with education and identifying economic or other incentives in hopes of reducing the burden of AMR in low- and middle-income countries. Disclosures All authors: No reported disclosures.

scholarly journals Antibiotic Use in Low and Middle-Income Countries and the Challenges of Antimicrobial Resistance in Surgery

Antibiotics ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 497
Author(s):  
Massimo Sartelli ◽  
Timothy C. Hardcastle ◽  
Fausto Catena ◽  
Alain Chichom-Mefire ◽  
Federico Coccolini ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Infection Prevention And Control ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Middle Income ◽  
Middle Income Countries ◽  
And Control ◽  
Low And Middle Income

Antimicrobial resistance (AMR) is a phenomenon resulting from the natural evolution of microbes. Nonetheless, human activities accelerate the pace at which microorganisms develop and spread resistance. AMR is a complex and multidimensional problem, threatening not only human and animal health, but also regional, national, and global security, and the economy. Inappropriate use of antibiotics, and poor infection prevention and control strategies are contributing to the emergence and dissemination of AMR. All healthcare providers play an important role in preventing the occurrence and spread of AMR. The organization of healthcare systems, availability of diagnostic testing and appropriate antibiotics, infection prevention and control practices, along with prescribing practices (such as over-the-counter availability of antibiotics) differs markedly between high-income countries and low and middle-income countries (LMICs). These differences may affect the implementation of antibiotic prescribing practices in these settings. The strategy to reduce the global burden of AMR includes, among other aspects, an in-depth modification of the use of existing and future antibiotics in all aspects of medical practice. The Global Alliance for Infections in Surgery has instituted an interdisciplinary working group including healthcare professionals from different countries with different backgrounds to assess the need for implementing education and increasing awareness about correct antibiotic prescribing practices across the surgical pathways. This article discusses aspects specific to LMICs, where pre-existing factors make surgeons’ compliance with best practices even more important.

scholarly journals Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. Executive Summary of the Global Neurosurgery Initiative at the Program in Global Surgery and Social Change

2019 ◽  
Vol 130 (4) ◽  
pp. 1055-1064 ◽  
Author(s):  
Michael C. Dewan ◽  
Abbas Rattani ◽  
Graham Fieggen ◽  
Miguel A. Arraez ◽  
Franco Servadei ◽  
...  
Keyword(s):  
Southeast Asia ◽  
Surgical Care ◽  
Median Number ◽  
Third Party ◽  
Published Data ◽  
Executive Summary ◽  
Middle Income ◽  
Middle Income Countries ◽  
Surgical Workforce ◽  
Low And Middle Income

OBJECTIVEWorldwide disparities in the provision of surgical care result in otherwise preventable disability and death. There is a growing need to quantify the global burden of neurosurgical disease specifically, and the workforce necessary to meet this demand.METHODSResults from a multinational collaborative effort to describe the global neurosurgical burden were aggregated and summarized. First, country registries, third-party modeled data, and meta-analyzed published data were combined to generate incidence and volume figures for 10 common neurosurgical conditions. Next, a global mapping survey was performed to identify the number and location of neurosurgeons in each country. Finally, a practitioner survey was conducted to quantify the proportion of disease requiring surgery, as well as the median number of neurosurgical cases per annum. The neurosurgical case deficit was calculated as the difference between the volume of essential neurosurgical cases and the existing neurosurgical workforce capacity.RESULTSEvery year, an estimated 22.6 million patients suffer from neurological disorders or injuries that warrant the expertise of a neurosurgeon, of whom 13.8 million require surgery. Traumatic brain injury, stroke-related conditions, tumors, hydrocephalus, and epilepsy constitute the majority of essential neurosurgical care worldwide. Approximately 23,300 additional neurosurgeons are needed to address more than 5 million essential neurosurgical cases—all in low- and middle-income countries—that go unmet each year. There exists a gross disparity in the allocation of the surgical workforce, leaving large geographic treatment gaps, particularly in Africa and Southeast Asia.CONCLUSIONSEach year, more than 5 million individuals suffering from treatable neurosurgical conditions will never undergo therapeutic surgical intervention. Populations in Africa and Southeast Asia, where the proportion of neurosurgeons to neurosurgical disease is critically low, are especially at risk. Increasing access to essential neurosurgical care in low- and middle-income countries via neurosurgical workforce expansion as part of surgical system strengthening is necessary to prevent severe disability and death for millions with neurological disease.

scholarly journals The Impact of Trauma Care Systems in Low- and Middle-Income Countries

2017 ◽  
Vol 38 (1) ◽  
pp. 507-532 ◽  
Author(s):  
Teri A. Reynolds ◽  
Barclay Stewart ◽  
Isobel Drewett ◽  
Stacy Salerno ◽  
Hendry R. Sawe ◽  
...  
Keyword(s):  
Trauma Care ◽  
Resource Constraints ◽  
Inclusion Criteria ◽  
Middle Income ◽  
Policy Makers ◽  
Middle Income Countries ◽  
Care Systems ◽  
Outcome Type ◽  
The Impact ◽  
Low And Middle Income

Injury is a leading cause of death globally, and organized trauma care systems have been shown to save lives. However, even though most injuries occur in low- and middle-income countries (LMICs), most trauma care research comes from high-income countries where systems have been implemented with few resource constraints. Little context-relevant guidance exists to help policy makers set priorities in LMICs, where resources are limited and where trauma care may be implemented in distinct ways. We have aimed to review the evidence on the impact of trauma care systems in LMICs through a systematic search of 11 databases. Reports were categorized by intervention and outcome type and summarized. Of 4,284 records retrieved, 71 reports from 32 countries met inclusion criteria. Training, prehospital systems, and overall system organization were the most commonly reported interventions. Quality-improvement, costing, rehabilitation, and legislation and governance were relatively neglected areas. Included reports may inform trauma care system planning in LMICs, and noted gaps may guide research and funding agendas.

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