scholarly journals Defining hypoxemia from pulse oximeter measurements of oxygen saturation in well children at low altitude in Bangladesh: an observational study

2021 ◽  
Author(s):  
Eric D McCollum ◽  
Carina King ◽  
Salahuddin Ahmed ◽  
Abu AM Hanif ◽  
Arunangshu D Roy ◽  
...  
Keyword(s):  
Low Income ◽  
Pulse Oximeter ◽  
Health Workers ◽  
Respiratory Infections ◽  
Clinical Status ◽  
World Health ◽  
Older Children ◽  
Middle Income ◽  
Lower Altitude ◽  
Low Altitude

Background: The World Health Organization defines hypoxemia, a low peripheral oxyhemoglobin saturation (SpO2), as <90%. Although hypoxemia is an important risk factor for mortality of children with respiratory infections, the optimal SpO2 threshold for defining hypoxemia is uncertain in low-income and middle-income countries (LMICs). We derived a SpO2 threshold for hypoxemia from well children in Bangladesh residing at low altitude. Methods: We prospectively enrolled well, 3-35 month old children participating in a pneumococcal vaccine evaluation in Sylhet district, Bangladesh between June and August 2017. Trained health workers conducting community surveillance measured the SpO2 of children using a Masimo Rad-5 pulse oximeter with a wrap sensor. We used standard summary statistics to evaluate the SpO2 distribution, including whether the distribution differed by age or sex. We considered the 2.5th, 5th, and 10th percentiles of SpO2 as possible lower thresholds for hypoxemia. Results: Our primary analytical sample included 1,470 children (mean age 18.6 +/- 9.5 months). Median SpO2 was 98% (interquartile range, 96-99%), and the 2.5th, 5th, and 10th percentile SpO2 was 91%, 92%, and 94%. No child had a SpO2 <90%. Children 3-11 months old had a lower median SpO2 (97%) than 12-23 month olds (98%) and 24-35 month olds (98%) (p=0.039). The SpO2 distribution did not differ by sex (p=0.959). Conclusion: A SpO2 threshold for hypoxemia derived from the 2.5th, 5th, or 10th percentile of well children is higher than <90%. If a higher threshold than <90% is adopted into LMIC care algorithms then decision-making using SpO2 must also consider the childs clinical status to minimize misclassification of well children as hypoxemic. Younger children in lower altitude LMICs may require a different threshold for hypoxemia than older children. Evaluating the mortality risk of sick children using higher SpO2 thresholds for hypoxemia is a key next step.

scholarly journals Defining hypoxaemia from pulse oximeter measurements of oxygen saturation in well children at low altitude in Bangladesh: an observational study

2021 ◽  
Vol 8 (1) ◽  
pp. e001023
Author(s):  
Eric D McCollum ◽  
Carina King ◽  
Salahuddin Ahmed ◽  
Abu A M Hanif ◽  
Arunangshu D Roy ◽  
...  
Keyword(s):  
Low Income ◽  
Pulse Oximeter ◽  
Health Workers ◽  
Respiratory Infections ◽  
Clinical Status ◽  
Older Children ◽  
Middle Income ◽  
Lower Altitude ◽  
Low Altitude ◽  
Peripheral Arterial

BackgroundWHO defines hypoxaemia, a low peripheral arterial oxyhaemoglobin saturation (SpO2), as <90%. Although hypoxaemia is an important risk factor for mortality of children with respiratory infections, the optimal SpO2 threshold for defining hypoxaemia is uncertain in low-income and middle-income countries (LMICs). We derived a SpO2 threshold for hypoxaemia from well children in Bangladesh residing at low altitude.MethodsWe prospectively enrolled well, children aged 3–35 months participating in a pneumococcal vaccine evaluation in Sylhet district, Bangladesh between June and August 2017. Trained health workers conducting community surveillance measured the SpO2 of children using a Masimo Rad-5 pulse oximeter with a wrap sensor. We used standard summary statistics to evaluate the SpO2 distribution, including whether the distribution differed by age or sex. We considered the 2.5th, 5th and 10th percentiles of SpO2 as possible lower thresholds for hypoxaemia.ResultsOur primary analytical sample included 1470 children (mean age 18.6±9.5 months). Median SpO2 was 98% (IQR 96%–99%), and the 2.5th, 5th and 10th percentile SpO2 was 91%, 92% and 94%. No child had a SpO2 <90%. Children 3–11 months had a lower median SpO2 (97%) than 12–23 months (98%) and 24–35 months (98%) (p=0.039). The SpO2 distribution did not differ by sex (p=0.959).ConclusionA SpO2 threshold for hypoxaemia derived from the 2.5th, 5th or 10th percentile of well children is higher than <90%. If a higher threshold than <90% is adopted into LMIC care algorithms then decision-making using SpO2 must also consider the child’s clinical status to minimise misclassification of well children as hypoxaemic. Younger children in lower altitude LMICs may require a different threshold for hypoxaemia than older children. Evaluating the mortality risk of sick children using higher SpO2 thresholds for hypoxaemia is a key next step.

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 Scoping review assessing the evidence used to support the adoption of mobile health (mHealth) technologies for the education and training of community health workers (CHWs) in low-income and middle-income countries

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e019827 ◽  
Author(s):  
Niall Winters ◽  
Laurenz Langer ◽  
Anne Geniets
Keyword(s):  
Systematic Reviews ◽  
Scoping Review ◽  
Low Income ◽  
Health Workers ◽  
Education And Training ◽  
Evidence Base ◽  
Mobile Technologies ◽  
Middle Income ◽  
And Training ◽  
Formal Theories

ObjectivesUndertake a systematic scoping review to determine how a research evidence base, in the form of existing systematic reviews in the field of mobile health (mHealth), constitutes education and training for community health workers (CHWs) who use mobile technologies in everyday work. The review was informed by the following research questions: does educational theory inform the design of the education and training component of mHealth interventions? How is education and training with mobile technology by CHWs in low-income and middle-income countries categorised by existing systematic reviews? What is the basis for this categorisation?SettingThe review explored the literature from 2000 to 2017 to investigate how mHealth interventions have been positioned within the available evidence base in relation to their use of formal theories of learning.ResultsThe scoping review found 24 primary studies that were categorised by 16 systematic reviews as supporting CHWs’ education and training using mobile technologies. However, when formal theories of learning from educational research were used to recategorise these 24 primary studies, only four could be coded as such. This identifies a problem with how CHWs’ education and training using mobile technologies is understood and categorised within the existing evidence base. This is because there is no agreed on, theoretically informed understanding of what counts as learning.ConclusionThe claims made by mHealth researchers and practitioners regarding the learning benefits of mobile technology are not based on research results that are underpinned by formal theories of learning. mHealth suffers from a reductionist view of learning that underestimates the complexities of the relationship between pedagogy and technology. This has resulted in miscategorisations of what constitutes CHWs’ education and training within the existing evidence base. This can be overcome by informed collaboration between the health and education communities.

scholarly journals How to do (or not to do)… Measuring health worker motivation in surveys in low- and middle-income countries

2017 ◽  
Vol 33 (2) ◽  
pp. 192-203 ◽  
Author(s):  
J Borghi ◽  
J Lohmann ◽  
E Dale ◽  
F Meheus ◽  
J Goudge ◽  
...  
Keyword(s):  
Health Worker ◽  
Low Income ◽  
Health Workers ◽  
Poor Quality ◽  
Validity And Reliability ◽  
High Quality Research ◽  
Quality Health Care ◽  
Middle Income ◽  
Health Worker Motivation ◽  
Worker Motivation

Abstract A health system’s ability to deliver quality health care depends on the availability of motivated health workers, which are insufficient in many low income settings. Increasing policy and researcher attention is directed towards understanding what drives health worker motivation and how different policy interventions affect motivation, as motivation is key to performance and quality of care outcomes. As a result, there is growing interest among researchers in measuring motivation within health worker surveys. However, there is currently limited guidance on how to conceptualize and approach measurement and how to validate or analyse motivation data collected from health worker surveys, resulting in inconsistent and sometimes poor quality measures. This paper begins by discussing how motivation can be conceptualized, then sets out the steps in developing questions to measure motivation within health worker surveys and in ensuring data quality through validity and reliability tests. The paper also discusses analysis of the resulting motivation measure/s. This paper aims to promote high quality research that will generate policy relevant and useful evidence.

scholarly journals Edukasi dan Deteksi Dini Komplikasi Kehamilan dengan Pemeriksaan Laboratorium

2020 ◽  
Vol 1 (2) ◽  
pp. 43-49
Author(s):  
Rochany Septiyaningsih ◽  
Dhiah Dwi Kusumawati ◽  
Frisca Dewi Yunadi ◽  
Septiana Indratmoko
Keyword(s):  
Pregnant Women ◽  
Health Workers ◽  
World Health ◽  
Maternal Deaths ◽  
Middle Income ◽  
Pregnancy And Childbirth ◽  
Delivery Assistance ◽  
The World ◽  
Laboratory Examinations ◽  
Health Organization

The World Health Organization (WHO) states that maternal mortality worldwide due to complications during pregnancy and childbirth in 2017 is estimated at around 810 cases. Between 2000 and 2017 there was a decline in the ratio of MMR around the world by 38%. WHO also states that 94% of global maternal deaths occur in low and middle income countries. In Indonesia, maternal deaths due to complications from pregnancy or childbirth every year are estimated at 20,000 mothers died from five million births. Delivery assistance by trained health workers in health facilities can be an effort to reduce MMR and IMR. In addition, awareness of pregnant women is also important for the importance of having a pregnancy with a health worker. This community service aims to increase the knowledge of pregnant women about anemia and to detect early pregnancy complications by laboratory examinations. The target of this activity is 15 pregnant women. The dedication activity is conducting educational activities, laboratory examinations in Tambakreja Village, Cilacap Regency. Based on the results of this activity it was concluded that there was an increase in knowledge of pregnant women about anemia and found 2 pregnant women experiencing anemia from 15 pregnant women and urine examination found all negative pregnant women

scholarly journals How primary healthcare workers obtain information during consultations to aid safe prescribing in low-income and lower middle-income countries: a systematic review

2020 ◽  
Vol 5 (4) ◽  
pp. e002094 ◽  
Author(s):  
Chris Smith ◽  
Michelle Helena van Velthoven ◽  
Nguyen Duc Truong ◽  
Nguyen Hai Nam ◽  
Vũ Phan Anh ◽  
...  
Keyword(s):  
Low Income ◽  
Primary Healthcare ◽  
Healthcare Workers ◽  
Health Workers ◽  
Internet Access ◽  
Sources Of Information ◽  
Quality Of Reporting ◽  
Middle Income ◽  
Middle Income Countries ◽  
Registration Number

BackgroundWe systematically reviewed the evidence on how primary healthcare workers obtain information during consultations to support decision-making for prescribing in low and lower middle-income countries.MethodsWe searched electronic databases, consulted the Healthcare Information For All network, hand searched reference lists, ran citation searches of included studies and emailed authors of identified papers. Two reviewers extracted data and appraised quality with relevant tools.ResultsOf 60 497 records found, 23 studies met our inclusion criteria. Fourteen studies were observational and nine were interventional. Frequently mentioned sources of information were books, leaflets, guidelines, aids and the internet. These sources were sometimes out of date and health workers reported being confused which to use. Internet access varied and even when it was available, use was limited by technical issues. Of the five electronic tools that were assessed, four had positive outcomes. Tools assisted prescribers with medicine selection and dosage calculations, which increased prescribing accuracy. The quality of reporting varied but was overall low.DiscussionStudies indicated a lack of up-to-date and relevant medicine information in low and lower middle-income settings. Internet-based sources appeared to be useful when it is possible to download content for offline use and to update when there is internet access. Electronic tools showed promise, but their accuracy needs to be validated and they should focus on giving actionable advice to guide prescribers.PROSPERO registration numberCRD42018091088.

scholarly journals Adaptation and validation for Colombia of the WHO safe childbirth checklist

2018 ◽  
Vol 49 (3) ◽  
pp. 201-212
Author(s):  
Ana Carolina Amaya Arias ◽  
Óscar Zuluaga ◽  
Douglas Idárraga ◽  
Javier Hernando Eslava Schmalbach
Keyword(s):  
Low Income ◽  
Health Workers ◽  
Low Cost ◽  
Neonatal Morbidity ◽  
Neonatal Care ◽  
World Health ◽  
Low Income Countries ◽  
Safe Childbirth Checklist ◽  
Health Organization ◽  
Safe Childbirth

Introduction: Most maternal deaths that occur in developing countries are considered unfair and can be avoided. In 2008, The World Health Organization (WHO) proposed a checklist for childbirth care, in order to assess whether a simple, low-cost intervention had an impact on maternal and neonatal mortality in low-income countries. Objective: To translate, adapt and validate the content of the WHO Safe Childbirth Checklist (SCC) for its use in Colombia Methods: The checklist was translated and adapted to the Colombian context. It was subsequently validated by a panel of experts composed of 17 health workers with experience in maternal and neonatal care and safety. Reliability among judges was estimated (Rwg) and items were modified or added to each section of the list according to the results. Results: Modifications were made to 28 items, while 19 new items were added, and none was removed. The most important modifications were made to the management guidelines included in each item, and the items added refer to risks inherent to our environment. Conclusion: The Colombian version of the SCC will be a useful tool to improve maternal and neonatal care and thereby contribute to reducing maternal and neonatal morbidity and mortality in our country.

scholarly journals Barriers and facilitators of implementation of a community cardiovascular disease prevention programme in Mukono and Buikwe districts in Uganda using the Consolidated Framework for Implementation Research

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Rawlance Ndejjo ◽  
Rhoda K. Wanyenze ◽  
Fred Nuwaha ◽  
Hilde Bastiaens ◽  
Geofrey Musinguzi
Keyword(s):  
Cardiovascular Disease ◽  
Low Income ◽  
Implementation Research ◽  
Health Workers ◽  
Scale Up ◽  
Barriers And Facilitators ◽  
Prevention Programme ◽  
Intervention Implementation ◽  
Design Quality ◽  
Middle Income

Abstract Background In low- and middle-income countries, there is an increasing attention towards community approaches to deal with the growing burden of cardiovascular disease (CVD). However, few studies have explored the implementation processes of such interventions to inform their scale up and sustainability. Using the consolidated framework for implementation research (CFIR), we examined the barriers and facilitators influencing the implementation of a community CVD programme led by community health workers (CHWs) in Mukono and Buikwe districts in Uganda. Methods This qualitative study is a process evaluation of an ongoing type II hybrid stepped wedge cluster trial guided by the CFIR. Data for this analysis were collected through regular meetings and focus group discussions (FGDs) conducted during the first cycle (6 months) of intervention implementation. A total of 20 CHWs participated in the implementation programme in 20 villages during the first cycle. Meeting reports and FGD transcripts were analysed following inductive thematic analysis with the aid of Nvivo 12.6 to generate emerging themes and sub-themes and thereafter deductive analysis was used to map themes and sub-themes onto the CFIR domains and constructs. Results The barriers to intervention implementation were the complexity of the intervention (complexity), compatibility with community culture (culture), the lack of an enabling environment for behaviour change (patient needs and resources) and mistrust of CHWs by community members (relative priority). In addition, the low community awareness of CVD (tension for change), competing demands (other personal attributes) and unfavourable policies (external policy and incentives) impeded intervention implementation. On the other hand, facilitators of intervention implementation were availability of inputs and protective equipment (design quality and packaging), training of CHWs (Available resources), working with community structures including leaders and groups (process—opinion leaders), frequent support supervision and engagements (process—formally appointed internal implementation leaders) and access to quality health services (process—champions). Conclusion Using the CFIR, we identified drivers of implementation success or failure for a community CVD prevention programme in a low-income context. These findings are key to inform the design of impactful, scalable and sustainable CHW programmes for non-communicable diseases prevention and control.

scholarly journals Human Resources in Healthcare and Health Outcomes in India

2020 ◽  
Vol 11 (2) ◽  
pp. 133-159
Author(s):  
Venkatanarayana Motkuri ◽  
Udaya S. Mishra
Keyword(s):  
Human Resources ◽  
Health Outcomes ◽  
Census Data ◽  
Health Workers ◽  
Human Resources For Health ◽  
Size Composition ◽  
Healthcare Services ◽  
World Health ◽  
Middle Income ◽  
Minimum Requirement

Human resources for health including health professionals and skilled health workers are crucial in shaping health outcomes. But the shortage of human resources in healthcare services is a reality and hence it has been a cause of concern in lower-middle income countries like India. The present exercise based on census data is a situation analysis of size, composition and distribution of human resources available in the Indian healthcare services. It also explores the relationship between educational development and health workers availability alongside the association between density of health workers and health outcomes across states of India. It is observed that despite the remarkable improvement in health workers density particularly during 2001–2011, the country is falling short of the World Health Organization’s (WHO) need-based minimum requirement (4.45 health workers per 1,000 population) of health workers. The exploratory verification asserts that there is a significant and strong positive relationship/association between the density of health workers and health outcomes.

scholarly journals Patent Buy-Outs for Global Disease Innovations for Low-and Middle-Income Countries

2006 ◽  
Vol 32 (2-3) ◽  
pp. 159-173 ◽  
Author(s):  
Kevin Outterson
Keyword(s):  
Low Income ◽  
Drug Price ◽  
Marginal Cost ◽  
Cost Effective ◽  
World Health ◽  
Low Income Countries ◽  
Significant Variable ◽  
Generic Competition ◽  
Middle Income ◽  
Cost Of Production

The World Health Organization’s CHOICE program analyzes the cost effectiveness of various health interventions related to the Millennium Development Goals. The program identifies the best strategies for improving health in low-income countries, using a standard set of methodological assumptions. These studies evaluate interventions in many areas, including child health and HIV/AIDS.For some of these treatments, drug costs are a significant variable: if the drug price doubles, the intervention becomes less cost effective. But if the drug price is reduced by 90%, then more therapies become affordable.Drug prices are uniquely susceptible to radical price reductions through generic competition. Patented pharmaceuticals may be priced at more than 30 times the marginal cost of production; the excess is the patent rent collected by the drug company while the patent and exclusive marketing periods remain. Patent rents are significant. AIDS drugs which sell for US$10,000 per person per year in the US are sold generically for less than US$200. If patented drugs could be sold at the marginal cost of production, cost effective treatments would become even more attractive, and other interventions would become affordable.

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