A Virtual Skills Centre on Behaviour Management in Chronic Disease for Lay People in Low- and Middle-Income Countries (LMICs)

Introduction: Diabetes complications can be reduced and/or prevented by providing skills in behavioural management to lay people e.g. volunteers, family and friends. With a critical shortage of trained staff in lower- and middle-income countries (LMICs) to deliver these, lay people are a solution to fill this gap. Current programmes in LMICs are not suitable for lay people as they are (i) too complex i.e. for high education professionals and (ii) not easily accessible. We aim to address these two barriers through both a face to face and online virtual skills centre (VSC). Objectives: This paper describes the development of an online VSC that will provide access to those caring for people with diabetes within a community setting; examined the suitability and usability of the VSC using qualitative methods. Methods Drawing on the DoTTI framework for developing an online program, the VSC was i) designed and developed using psychological techniques and ii) tested for early iteration using participatory workshops. Results: A total of 23 participants from Bengaluru, India, both lay and clinicians, tested the VSC. The main themes identified were: empowerment for lay people; suitable for locals in a community setting; local services needed; user-friendly focused. Conclusion: This study found that a theory and evidence-based approach as the basis for an online behavioural management skills programme was acceptable to users. A substantive pilot will be conducted to examine whether the VSC is effective in reducing/preventing diabetes complications and how to implement into a community setting across other LMICs and chronic diseases.

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Triaging and adaptations of surveillance of cancer services in the COVID pandemic

Journal of Radiotherapy in Practice ◽

10.1017/s1460396920001004 ◽

2020 ◽

pp. 1-3

Author(s):

Shirley Lewis ◽

Lavanya Gurram ◽

Umesh Velu ◽

Krishna Sharan

Keyword(s):

Cancer Patients ◽

Clinical Examination ◽

Cancer Care ◽

Middle Income ◽

Face To Face ◽

Middle Income Countries ◽

Cancer Services ◽

Low Middle Income Countries

Abstract Introduction: Coronavirus disease (COVID-19) has significantly challenged the access to cancer care and follow-up for a patient with cancer. Methods: Based on published literature and our experiences, it is reasonable to presume that clinical examination and follow-up visits have been significantly curtailed worldwide in order to adhere to the new norms during the pandemic. Although telephonic and telemedicine consultations may help bridge a few gaps, completely dispensing with in-person consultation has its challenges, especially in low middle-income countries. Telephonic consultations could facilitate triaging of ambulatory cancer patients and allocation of face-to-face consultations for high priority patients. Conclusions: We propose a telephonic consultation-based triaging approach for ambulatory cancer patients in order to identify those needing in-hospital consultations.

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Lack of regulation over antibiotic prescription and dispensation: A prospective cohort in a community setting

Journal of Infection Prevention ◽

10.1177/17571774211033347 ◽

2021 ◽

pp. 175717742110333

Author(s):

Jacques Choucair ◽

Elie Haddad ◽

Gebrael Saliba ◽

Nabil Chehata ◽

Jennifer Makhoul

Keyword(s):

Bacterial Resistance ◽

Antibiotic Prescription ◽

Community Setting ◽

Care Physician ◽

Middle Income ◽

Middle Income Countries ◽

Health Authorities ◽

Amoxicillin Clavulanate ◽

Infectious Diseases Consultation ◽

Antibiotic Courses

Background: The emergence of bacterial resistance caused health authorities to attempt to implement strict regulations for rational antibiotic prescription. However, supervision is often neglected in low- and middle-income countries, leading to inappropriate administration of antibiotics. The objective of our study is to highlight the lack of monitoring in the community setting of a middle-income country. Material and methods: We asked 68 patients presenting to an infectious diseases consultation office to report the antibiotic courses they had taken in the three months preceding their visit. We assessed for treatment indication, molecule choice, dosing and duration, as well as microbial cultures, demographics and specialty of the prescriber. Results: Among the 68 patients included in our study, we counted a total of 95 outpatient antibiotic courses, mostly composed of quinolones (36%), followed by amoxicillin-clavulanate (21%). The prescriber was most commonly a primary care physician, but we reported several cases of auto-medication and dispensation of antibiotics by pharmacists. Only 30% of cases had true indications for antibiotics. Conclusion: In sum, our results indicate an evident lack of regulation over the administration of antibiotics. This easy accessibility needs to be promptly addressed as we run the risk of inevitable bacterial resistance.

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Smartphone-based DIY home microsurgical training with 3D printed microvascular clamps and Japanese noodles

European Surgical Research ◽

10.1159/000521439 ◽

2021 ◽

Author(s):

Zhi Yang Ng ◽

Calum Honeyman ◽

Alexandre G Lellouch ◽

Ankur Pandya ◽

Theodora Papavasiliou

Keyword(s):

Back Wall ◽

Internal Validation ◽

Middle Income ◽

Face To Face ◽

Middle Income Countries ◽

Video Recordings ◽

Low Middle Income Countries ◽

Konjac Flour ◽

3D Printed ◽

Set Up

We have recently incorporated simple modifications of the konjac flour noodle model to enable DIY home microsurgical training by (i) placing a smartphone on a mug to act as a microscope with at least 3.5-5x magnification, and (ii) rather than cannulating with a 22G needle as described by others, we have found that cannulation with a 23G needle followed by a second pass with an 18G needle will create a lumen (approx. 0.83 mm) without an overly thick and unrealistic “vessel” wall. The current set-up however, did not allow realistic evaluation of anastomotic patency as the noodles became macerated after application of standard microvascular clamps, which also did not facilitate practice of back-wall anastomoses. In order to simulate the actual operative environment as much as possible, we introduced the use of 3D printed microvascular clamps. These were modified from its previous iteration (suitable for use in silastic and chicken thigh vessels) and video recordings were submitted for internal validation by senior surgeons. A “wet” operative field where the knojac noodle lumen can be distended or collapsed, unlike other non-living models, was noted by senior surgeons. With the 3D clamps, the noodle could now be flipped over for back-wall anastomosis and allowed patency testing upon completion as it did not become macerated, unlike that from clinical microvascular clamps. The perceived advantages of this model are numerous. Not only does it comply with the 3Rs of simulation-based training, it can also reduce the associated costs of training by up to a hundred-fold or more when compared to a traditional rat course, and potentially, be extended to low-middle income countries (LMICs) without routine access to microsurgical training for capacity development. That it can be utilised remotely also bodes well with the current limitations on face to-face training due to COVID restrictions and lockdowns.

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Strengthening Noncommunicable Disease Research Capacity and Chronic Disease Outcomes in Low- and Middle-Income Countries in South Asia: Implementation and Evaluation of the ASCEND Program

Asia Pacific Journal of Public Health ◽

10.1177/1010539519867791 ◽

2019 ◽

Vol 31 (6) ◽

pp. 536-547

Author(s):

Allison Byrnes ◽

Tilahun Nigatu Haregu ◽

Naanki Pasricha ◽

Kavita Singh ◽

Sathish Thirunavukkarasu ◽

...

Keyword(s):

Online Learning ◽

Communicable Disease ◽

Research Capacity ◽

Lessons Learned ◽

Early Career ◽

Noncommunicable Disease ◽

Middle Income ◽

Face To Face ◽

Middle Income Countries ◽

Low And Middle Income

This article describes the design, outcomes, challenges, and lessons learned from the ASian Collaboration for Excellence in Non-Communicable Disease (ASCEND) program, implemented between 2011 and 2015 in India, Sri Lanka, and Malaysia. The program involved a blended-delivery model, incorporating online and face-to-face training, mentoring, and supervision of trainees’ research projects. Evaluation data were collected at baseline, 6, 12, 18, and 24 months. Intended outcomes, lessons, and challenges were summarized using a logic model. During the program period, 48 participants were trained over 2 cohorts in June 2011 and 2012. The trainees published 83 peer-reviewed articles between 2011 and 2015. Additionally, 154 presentations were given by trainees at national and international conferences. Underutilization of the online learning management system was an important challenge. Utilizing a combination of intensive face-to-face and online learning and mentoring of early career researchers in low- and middle-income countries has great potential to enhance the research capacity, performance, and outputs.

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Facing up to (online) fashion and fads … Face-to-face contact is here to stay in M&E capacity building. Evidence from 35 National Evaluation Societies

African Evaluation Journal ◽

10.4102/aej.v4i1.158 ◽

2016 ◽

Vol 4 (1) ◽

Cited By ~ 1

Author(s):

Sara Dewachter ◽

Nathalie Holvoet

Keyword(s):

Communities Of Practice ◽

Capacity Building ◽

Supply And Demand ◽

Qualitative Comparative Analysis ◽

Monitoring And Evaluation ◽

Evaluation Capacity Building ◽

Middle Income ◽

Evaluation Capacity ◽

Face To Face ◽

Middle Income Countries

Background: Over the years, Communities of Practice have gained popularity as a capacity-building method among Monitoring and Evaluation practitioners. Yet, thus far, relatively little is known about their effectiveness.Objectives: This article focuses on National Evaluation Societies as Communities of Practice that aim to contribute to the monitoring and evaluation capacity building of their members.Method: Drawing upon a survey of 35 National Evaluation Societies in 33 low- and middle-income countries, we explore to what extent capacity building efforts have been successful and what factors explain the relative success or failure in capacity building. We rely upon Qualitative Comparative Analysis as we are particularly interested in different pathways to ensure successful National Evaluation Societies.Results: Our findings highlight that regular face-to-face contact is a particularly important element. This does not entirely come as a surprise, as monitoring and evaluation capacity building often implies tacit knowledge that is most effectively shared face-to-face. Furthermore, capacity building in conducting and, particularly, using evaluations entails building networks among the monitoring and evaluation supply and demand side which can most easily be done through regular face-to-face interaction.Conclusion: Our findings are not only theoretically interesting, they are also policy relevant; they hint at the fact that in an era of quick advances in technology, investing in face-to-face contact among members remains important.

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Epidemiology and factors associated with diarrhoea among children under five years of age in the Engela District in the Ohangwena Region, Namibia

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v12i1.2361 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Maria F. Bauleth ◽

Honore K. Mitonga ◽

Lusia N. Pinehas

Keyword(s):

Informal Settlement ◽

Acute Diarrhoea ◽

Public Health Problem ◽

Epidemiological Data ◽

Cross Sectional Study ◽

Cross Sectional ◽

Middle Income ◽

Face To Face ◽

Factors Associated ◽

Middle Income Countries

Background: Diarrhoea remains a public health problem and an important cause of morbidity and mortality amongst children, mainly in low- and middle-income countries. In Namibia, the national prevalence of diarrhoea was 17%; it was responsible for 5% of all deaths in children under 5 years old and is the second leading cause of death.Aim: The purpose of this study was to assess the epidemiology and factors associated with acute diarrhoea amongst children less than 5 years of age in Engela district in the Ohangwena region, Namibia.Setting: The study was conducted in Ohangwena Region in Namibia which extends east to west along the borders of the southern part of Angola.Methods: A cross-sectional study was conducted. A structured questionnaire was administered through face-to-face interviews. Descriptive statistics were used to describe the socio-demographic and epidemiological data of diarrhoea and logistic regression analysis was used to determine the factors associated with the prevalence of diarrhoea.Results: The study found a prevalence of 23.8% for diarrhoea in the 2 weeks period preceding the survey amongst children aged under 5 years. The prevalence of diarrhoea was statistically significantly associated with children (p 0.05). The strongest predictor of the prevalence of diarrhoea was the residential area ‘informal settlement’, with an odds ratio of 36.42. This implies that children living in the informal settlement are 36.42 times at risk of contracting diarrhoea as compared to those living in other residential areas.Conclusion: epidemiology; factors; diarrhoea; under-5 years children; Engela district; Ohangwena region; Namibia.

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Online synchronous Focus Groups and research continuity during the COVID-19 pandemic (Preprint)

10.2196/preprints.30293 ◽

2021 ◽

Author(s):

Maria Gabriela Calvo-Valderrama ◽

Arturo Marroquín-Rivera ◽

Erin Burn ◽

Laura Ospina-Pinillos ◽

Victoria Bird ◽

...

Keyword(s):

Focus Groups ◽

Future Research ◽

Web Conferencing ◽

Middle Income ◽

Face To Face ◽

Middle Income Countries ◽

Public Health Emergencies ◽

Global Pandemic ◽

Technical Issues ◽

E Mail

BACKGROUND Although focus groups are a valuable qualitative research tool, face-to-face meetings may be difficult to arrange and time consuming. This has been further compounded by the COVID-19 global pandemic, where the subsequent lockdown and physical distancing measures implemented, caused exceptional challenges to all human activity. Online Focus Groups (OFGs) are an example of one alternative strategy, requiring investigation. At present, OFGs have mostly been studied and used in high-income countries with little information relating to their implementation in Low-and Middle-Income Countries (LMICs). OBJECTIVE Our aim is to share our experiences of conducting OFGs through a web conferencing service and provide recommendations for future research. METHODS As part of a broader study, OFGs were developed with adults and adolescents (13-16) in Colombia during the COVID-19 pandemic. Through a convenience sampling method, we invited eligible participants via e-mail in two different cities of Colombia to take part in OFGs conducted via Microsoft Teams®. Researcher notes and discussion were used to capture the participant and facilitator experiences as well as practical considerations. RESULTS We conducted 10 OFGs with a total of 42 participants. Data obtained met our expectations and the online methodology did not compromise the quality of our results. Technical issues arose but different measures were taken to minimize them: using a web conferencing service that was familiar to participants, sending written instructions and performing a trial meeting prior to the OFG. Adolescent participants unlike their adult counterparts, were fluent in using web conferencing platforms and did not encounter technical challenges. CONCLUSIONS OFGs have great potential in research settings especially during the current and any future public health emergencies. It is important to keep in mind that even with the advantages that they offer, technical issues (i.e., internet speed and access to technology) are major obstacles in LMICs. Further research is required and should carefully consider the appropriateness of OFGs in different settings.

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Uncovering TAPS strategies of the tobacco industry at PoS in low- and middle-income countries: the case of Turkey

European Journal of Public Health ◽

10.1093/eurpub/ckaa067 ◽

2020 ◽

Vol 30 (5) ◽

pp. 996-1001

Author(s):

Fatih Uznay ◽

Sevtap Gumus

Keyword(s):

Tobacco Industry ◽

Tobacco Product ◽

Tobacco Products ◽

Middle Income ◽

Face To Face ◽

Middle Income Countries ◽

Survey Form ◽

Margin Of Error ◽

Product Displays ◽

The City

Abstract Background This study aims to uncover strategies executed by the tobacco industry against tobacco advertising, promotion and sponsorship (TAPS) bans at points of sale (PoS) in Turkey. Methods The data are based on a field study conducted in the city of Izmir. There are 10 750 PoS in all of Izmir; the 6200 PoS in the 11 central districts were considered as potential subjects. Using a proportional sampling method (95% confidence interval, 5% margin of error), it was calculated that 384 PoS could adequately represent the whole. Face-to-face interviews were conducted with PoS administrators, using survey form consisting of 53 questions. Descriptive statistics methods have been used to analyze the data. Results Of a total of 384 PoS visited; 96.4% featured at least one type of display/TAPS ban violation, 94.5% featured display settings creating brand dominance on display units, 76.7% received promotional payments and 14.8% received free tobacco products for featured display settings. Additionally, 29.2% of PoS had tobacco product displays visible from outside, 26.8% sold tobacco products on the counter, 24.7% featured advertising items on display units, 19.3% sold tobacco products as single stick and 11.7% had price tags with fonts larger than the legally fixed 20 pt. Conclusions An official institution specializing in tobacco control must be established to continually inspect the tobacco market. Tobacco products must stay hidden, in closed cupboards or under the counter, and communication between PoS and tobacco industry must be limited. In addition, tobacco products must be distributed by government institutions rather than the industry.

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Communication barriers in maternity care - a questionnaire study among migrants to Norway

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.765 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

S Bains ◽

J Sundby ◽

B V Lindskog ◽

S Vangen ◽

L M Diep ◽

...

Keyword(s):

Language Proficiency ◽

Maternity Care ◽

Communication Barriers ◽

Middle Income ◽

Face To Face ◽

Recent Migrant ◽

Middle Income Countries ◽

Professional Interpreter ◽

Adult Family Member

Abstract Background Sub-optimal maternity care among migrants has been reported in a number of European countries. Explanations are multifactorial; however, communication barriers have been suggested as a major factor. Our aim was to explore recent migrant women's reported need for interpreter, actual interpreter use and the understanding of information provided during maternity care in Norway. Methods As part of the multidisciplinary, mixed method MiPreg-project, we applied a quantitative questionnaire, using a modified version of Migrant Friendly Maternity Care Questionnaire. We included recently (≤ 5 years) migrated women born in low or middle-income countries giving birth in urban Oslo, Norway, during 2019. Face-to-face interviews in women's own language of choice were conducted postpartum. Results We included 401 women from 65 countries. The five most frequent languages spoken at home were English, Polish, Arabic, Urdu and Tigrinya. The Norwegian proficiency was low; 23% not at all, 39% with difficulty, 39% good. Two thirds of women would have understood the information during maternity care better in another language. Two out of five felt a need for interpreting services and of these 44% and 81% were not offered interpreter during pregnancy and birth, respectively. The woman's partner or other adult family member interpreted most frequently, followed by professional interpreter and healthcare professionals. The women themselves often felt they understood the information provided; 78% always, 20% sometimes and 2% rarely/never. Increased length of residency and higher education was associated with better understanding, also after adjusting for maternal age and immigrant status. Discussions Several communication barriers exist for recent migrant women, with possible consequences for quality of maternity care. Recommended standards for interpretation services were not followed. To address barriers, increased use of interpreter and multilingual antenatal courses could be effective. Key messages Low language proficiency and use of interpreter may contribute to disparities in maternity care for migrants. The unmet needs for interpretation services must be addressed with appropriate actions.

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Parental involvement, learning participation and online learning commitment of adolescent learners during the COVID-19 lockdown

Research in Learning Technology ◽

10.25304/rlt.v29.2544 ◽

2021 ◽

Vol 29 ◽

Author(s):

Kehinde Clement Lawrence ◽

Olubusayo Victor Fakuade

Keyword(s):

Online Learning ◽

Parental Involvement ◽

Teaching And Learning ◽

Online Survey ◽

Future Research ◽

Positive Role ◽

Middle Income ◽

Face To Face ◽

Middle Income Countries ◽

Commitment Level

During the escalating coronavirus disease-2019 (COVID-19) pandemic, attempting to contain its spread, a large number of educational institutions shut down face-to-face teaching and learning activities globally due to a complete lockdown. This lockdown revealed emerging vulnerabilities of education systems in the low- and middle-income countries of the world, with Nigeria being no exception. Given these concerns, this research study assessed parental involvement, learning participation and the commitment to online learning of adolescent learners during the COVID-19 lockdown in Nigeria. An online survey questionnaire was employed to examine the level of online learning commitment and the contributory roles of each of the factors to online learning commitment of adolescent learners. In total, 1407 adolescents (male = 38.8%; female 61.2%) aged between 12 and 20 years (mean = 15: SD = 4.24) responded to the online survey, which was open for 2 months. Data were analysed using descriptive statistics of frequency distribution and inferential statistics of multiple regression. The findings revealed that the commitment level of adolescent learners to online learning was high. The findings further yielded a coefficient of R = 0.439 and R2 = 0.192 variance in the prediction of the outcome measure. Parental involvement contributed 32% (β = 0.322, p < 0.05) and learning participation contributed 23% (β = 0.234, p < 0.05) towards online learning. The study concludes that parental involvement and learning participation played a significant and positive role in the commitment of adolescent learners towards online learning during the COVID-19 lockdown in Nigeria. The authors suggest that parents be encouraged to synergise with the digitalised revolution, while the need for further in-depth research on the subject is emphasised in the suggestions for future research.

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