scholarly journals Unlocking the health system barriers to maximise the uptake and utilisation of molecular diagnostics in low-income and middle-income country setting

2021 ◽  
Vol 6 (8) ◽  
pp. e005357
Author(s):  
Nyanda Elias Ntinginya ◽  
Davis Kuchaka ◽  
Fred Orina ◽  
Ivan Mwebaza ◽  
Alphonce Liyoyo ◽  
...  
Keyword(s):  
Molecular Diagnostics ◽  
Low Income ◽  
Healthcare Facility ◽  
Middle Income ◽  
Early Access ◽  
Healthcare Settings ◽  
Barriers And Opportunities ◽  
Healthcare Administrators ◽  
Probe Assay ◽  
Tb Diagnostics

BackgroundEarly access to diagnosis is crucial for effective management of any disease including tuberculosis (TB). We investigated the barriers and opportunities to maximise uptake and utilisation of molecular diagnostics in routine healthcare settings.MethodsUsing the implementation of WHO approved TB diagnostics, Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) and Line Probe Assay (LPA) as a benchmark, we evaluated the barriers and how they could be unlocked to maximise uptake and utilisation of molecular diagnostics.ResultsHealth officers representing 190 districts/counties participated in the survey across Kenya, Tanzania and Uganda. The survey findings were corroborated by 145 healthcare facility (HCF) audits and 11 policy-maker engagement workshops. Xpert MTB/RIF coverage was 66%, falling behind microscopy and clinical diagnosis by 33% and 1%, respectively. Stratified by HCF type, Xpert MTB/RIF implementation was 56%, 96% and 95% at district, regional and national referral hospital levels. LPA coverage was 4%, 3% below culture across the three countries. Out of 111 HCFs with Xpert MTB/RIF, 37 (33%) used it to full capacity, performing ≥8 tests per day of which 51% of these were level five (zonal consultant and national referral) HCFs. Likewise, 75% of LPA was available at level five HCFs. Underutilisation of Xpert MTB/RIF and LPA was mainly attributed to inadequate—utilities, 26% and human resource, 22%. Underfinancing was the main reason underlying failure to acquire molecular diagnostics. Second to underfinancing was lack of awareness with 33% healthcare administrators and 49% practitioners were unaware of LPA as TB diagnostic. Creation of a national health tax and decentralising its management was proposed by policy-makers as a booster of domestic financing needed to increase access to diagnostics.ConclusionOur findings suggest higher uptake and utilisation of molecular diagnostics at tertiary level HCFs contrary to the WHO recommendation. Country-led solutions are crucial for unlocking barriers to increase access to diagnostics.

scholarly journals OC 8713 MAXIMISING RESEARCH IMPACT TO STRENGTHEN PUBLIC HEALTHCARE

2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A16.1-A16
Author(s):  
Wilber Sabiiti ◽  
Nyanda E Ntinginya ◽  
Elizabeth Fb Msoka ◽  
Fred Orina ◽  
Ivan Mwebaza ◽  
...  
Keyword(s):  
Cultural Beliefs ◽  
Research Impact ◽  
Public Healthcare ◽  
Policy And Practice ◽  
Healthcare Facilities ◽  
Early Communication ◽  
Care Givers ◽  
Barriers And Opportunities ◽  
Probe Assay ◽  
Tb Diagnostics

BackgroundBillions of dollars are spent on research globally every year, yet little is translated to public use through policy and/or commercialisation. For the few research findings that make it to policy, evidence in most LMICs shows they hardly see the light of implementation. Our EDCTP-funded TWENDE consortium used implementation of tuberculosis (TB) molecular diagnostics as a model to investigate the barriers, and opportunities to unlock them in order to maximise uptake of health research innovations into policy and practice.MethodsMixed methods approach including surveys, audits, in-depth interviews and focus group discussions (FGDs), policymaker dialogues to unravel the bottlenecks and how to overcome them.Results1119 respondents representing from Uganda, Kenya and Tanzania participated in the study. 19% were district/county health officers, 12% healthcare audits, 58% one-on-one interviews and FGDs with healthcare practitioners, community leaders, TB patients and survivors, and care givers, and 11% policymaker workshops. Barriers: government poverty, family/individual poverty, incompatibility of technologies to existing infrastructure, low awareness and socio-cultural beliefs in the community were found. Stigma at community and healthcare levels was rife. Consequently, TB diagnostics were underimplemented and underutilised. Xpert MTB/RIF test was fully utilised in ∼10% of healthcare facilities (conducting 8 tests per day) whilst Line probe assay was implemented in less than 1% of the facilities.ConclusionBased on our findings, we believe overcoming the barriers presents the opportunity to maximise research impact of public healthcare. This could be achieved through sustained public and practitioners’ sensitisation to remove stigma to increase demand and utilisation of services; early interaction of researchers and policymakers to increase sense of ownership and acceptability of research innovations; early communication between developers and end-users to align the tools with the needs and existing infrastructure capacity; and increased affordability of innovations through socioeconomic empowerment programmes.

scholarly journals Foundations of the Severe Acute Respiratory Syndrome Preparedness and Response Plan for Healthcare Facilities

2004 ◽  
Vol 25 (12) ◽  
pp. 1020-1025 ◽  
Author(s):  
Arjun Srinivasan ◽  
Lawrence C. McDonald ◽  
Daniel Jernigan ◽  
Rita Helfand ◽  
Kathleen Ginsheimer ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Healthcare Facility ◽  
Lessons Learned ◽  
Healthcare Facilities ◽  
Airborne Infection ◽  
Healthcare Settings ◽  
Control And Prevention ◽  
Response Plan ◽  
Healthcare Administrators ◽  
Staffing Needs

AbstractObjective:To help facilities prepare for potential future cases of severe acute respiratory syndrome (SARS).Design and Participants:The Centers for Disease Control and Prevention (CDC), assisted by members of professional societies representing public health, healthcare workers, and healthcare administrators, developed guidance to help facilities both prepare for and respond to cases of SARS.Interventions:The recommendations in the CDC document were based on some of the important lessons learned in healthcare settings around the world during the SARS outbreak of 2003, including that (1) a SARS outbreak requires a coordinated and dynamic response by multiple groups; (2) unrecognized cases of SARS-associated coronavirus are a significant source of transmission; (3) restricting access to the healthcare facility can minimize transmission; (4) airborne infection isolation is recommended, but facilities and equipment may not be available; and (5) staffing needs and support will pose a significant challenge.Conclusions:Healthcare facilities were at the center of the SARS outbreak of 2003 and played a key role in controlling the epidemic. Recommendations in the CDC's SARS preparedness and response guidance for healthcare facilities will help facilities prepare for possible future outbreaks of SARS.

scholarly journals Global implementation survey of Integrated Management of Childhood Illness (IMCI): 20 years on

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e019079 ◽  
Author(s):  
Cynthia Boschi-Pinto ◽  
Guilhem Labadie ◽  
Thandassery Ramachandran Dilip ◽  
Nicholas Oliphant ◽  
Sarah L Dalglish ◽  
...  
Keyword(s):  
Low Income ◽  
Integrated Management ◽  
Data File ◽  
Childhood Illness ◽  
Cross Sectional ◽  
Middle Income ◽  
Country Level ◽  
Health Related ◽  
Barriers And Opportunities ◽  
Three Components

ObjectiveTo assess the extent to which Integrated Management of Childhood Illness (IMCI) has been adopted and scaled up in countries.SettingThe 95 countries that participated in the survey are home to 82% of the global under-five population and account for 95% of the 5.9 million deaths that occurred among children less than 5 years of age in 2015; 93 of them are low-income and middle-income countries (LMICs).MethodsWe conducted a cross-sectional self-administered survey. Questionnaires and data analysis focused on (1) giving a general overview of current organisation and financing of IMCI at country level, (2) describing implementation of IMCI’s three original components and (3) reporting on innovations, barriers and opportunities for expanding access to care for children. A single data file was created using all information collected. Analysis was performed using STATA V.11.ParticipantsIn-country teams consisting of representatives of the ministry of health and country offices of WHO and Unicef.ResultsEighty-one per cent of countries reported that IMCI implementation encompassed all three components. Almost half (46%; 44 countries) reported implementation in 90% or more districts as well as all three components in place (full implementation). These full-implementer countries were 3.6 (95% CI 1.5 to 8.9) times more likely to achieve Millennium Development Goal 4 than other (not full implementer) countries. Despite these high reported implementation rates, the strategy is not reaching the children who need it most, as implementation is lowest in high mortality countries (39%; 7/18).ConclusionThis survey provides a unique opportunity to better understand how implementation of IMCI has evolved in the 20 years since its inception. Results can be used to assist in formulating strategies, policies and activities to support improvements in the health and survival of children and to help achieve the health-related, post-2015 Sustainable Development Goals.

scholarly journals Experiences and impact of international medical volunteering: a multi-country mixed methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e041599 ◽  
Author(s):  
Mary McCauley ◽  
Joanna Raven ◽  
Nynke van den Broek
Keyword(s):  
Low Income ◽  
Online Survey ◽  
Positive Impact ◽  
Healthcare Providers ◽  
International Medical ◽  
Middle Income ◽  
Use Of Resources ◽  
The Uk ◽  
Medical Volunteers ◽  
The Impact

ObjectiveTo assess the experience and impact of medical volunteers who facilitated training workshops for healthcare providers in maternal and newborn emergency care in 13 countries.SettingsBangladesh, Ghana, India, Kenya, Malawi, Namibia, Nigeria, Pakistan, Sierra Leone, South Africa, Tanzania, UK and Zimbabwe.ParticipantsMedical volunteers from the UK (n=162) and from low-income and middle-income countries (LMIC) (n=138).Outcome measuresExpectations, experience, views, personal and professional impact of the experience of volunteering on medical volunteers based in the UK and in LMIC.ResultsUK-based medical volunteers (n=38) were interviewed using focus group discussions (n=12) and key informant interviews (n=26). 262 volunteers (UK-based n=124 (47.3%), and LMIC-based n=138 (52.7%)) responded to the online survey (62% response rate), covering 506 volunteering episodes. UK-based medical volunteers were motivated by altruism, and perceived volunteering as a valuable opportunity to develop their skills in leadership, teaching and communication, skills reported to be transferable to their home workplace. Medical volunteers based in the UK and in LMIC (n=244) reported increased confidence (98%, n=239); improved teamwork (95%, n=232); strengthened leadership skills (90%, n=220); and reported that volunteering had a positive impact for the host country (96%, n=234) and healthcare providers trained (99%, n=241); formed sustainable partnerships (97%, n=237); promoted multidisciplinary team working (98%, n=239); and was a good use of resources (98%, n=239). Medical volunteers based in LMIC reported higher satisfaction scores than those from the UK with regards to impact on personal and professional development.ConclusionHealthcare providers from the UK and LMIC are highly motivated to volunteer to increase local healthcare providers’ knowledge and skills in low-resource settings. Further research is necessary to understand the experiences of local partners and communities regarding how the impact of international medical volunteering can be mutually beneficial and sustainable with measurable outcomes.

scholarly journals Socioeconomic Disparities in Foods/Beverages and Nutrients Consumed by U.S. Adolescents When Snacking: National Health and Nutrition Examination Survey 2005–2018

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2530
Author(s):  
Navika Gangrade ◽  
Janet Figueroa ◽  
Tashara M. Leak
Keyword(s):  
National Health ◽  
Low Socioeconomic Status ◽  
Low Income ◽  
High Income ◽  
Future Research ◽  
Nutrition Examination Survey ◽  
Middle Income ◽  
Low Socioeconomic ◽  
Health And Nutrition ◽  
Income Ratio

Snacking contributes a significant portion of adolescents’ daily energy intake and is associated with poor overall diet and increased body mass index. Adolescents from low socioeconomic status (SES) households have poorer snacking behaviors than their higher-SES counterparts. However, it is unclear if the types of food/beverages and nutrients consumed during snacking differ by SES among adolescents. Therefore, this study examines SES disparities in the aforementioned snacking characteristics by analyzing the data of 7132 adolescents (12–19 years) from the National Health and Nutrition Examination Survey 2005–2018. Results reveal that adolescents from low-income households (poverty-to-income ratio (PIR) ≤ 1.3) have lower odds of consuming the food/beverage categories “Milk and Dairy” (aOR: 0.74; 95% CI: 0.58-0.95; p = 0.007) and “Fruits” (aOR: 0.62, 95% CI: 0.50–0.78; p = 0.001) as snacks and higher odds of consuming “Beverages” (aOR: 1.45; 95% CI: 1.19-1.76; p = 0.001) compared to those from high-income households (PIR > 3.5). Additionally, adolescents from low- and middle-income (PIR > 1.3–3.5) households consume more added sugar (7.98 and 7.78 g vs. 6.66 g; p = 0.012, p = 0.026) and less fiber (0.78 and 0.77 g vs. 0.84 g; p = 0.044, p = 0.019) from snacks compared to their high-income counterparts. Future research is necessary to understand factors that influence snacking among adolescents, and interventions are needed, especially for adolescents from low-SES communities.

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