Development of a novel device for objective respiratory rate measurement in low-resource settings

2018 ◽  
Vol 4 (4) ◽  
pp. 185-191 ◽  
Author(s):  
Hayley Turnbull ◽  
Masumbuko Claude Kasereka ◽  
Israel Amirav ◽  
Sivasivugha Eugénie Sahika ◽  
Ian Solomon ◽  
...  
Keyword(s):  
Respiratory Rate ◽  
Low Income ◽  
Health Workers ◽  
Limits Of Agreement ◽  
Low Resource Settings ◽  
Low Resource ◽  
Novel Device ◽  
Prototype Development ◽  
Lower Limits ◽  
Adult Volunteers

ObjectiveTo evaluate a novel device (Respimometer) for objective measurement of respiratory rate (RR) in low-resource settings.DesignDescription of prototype development, with proof-of-concept pilot field study at four paediatric healthcare facilities in Butembo, Democratic Republic of the Congo (DRC). The instrument was tested in healthy adult volunteers (n=10) and Congolese children (n=42) and compared with timed breaths (adults) or by reference comparator capnography (children). Correlation and Bland-Altman plots were generated for paired measurements.ResultsThe Respimometer is shaped like an oral thermometer and is placed in the mouth of the participants. RR is measured by thermistors positioned at the nasal outlet, which detect the temperature change between inhaled and exhaled breaths. In adult volunteers, the correlation coefficient between the delivered RR and the Respimometer measurement was median 0.992 (IQR 0.980–0.999). Measurement bias was −0.50 min−1 (95% CI −1.1 to +0.07, p=0.093), with upper and lower limits of agreement of −5.2 min−1 and 4.2 min−1, respectively. Among Congolese children, there was no evidence of bias: mean difference in RR +1.0 min−1 (95% CI −2.1 to +4.1, p=0.52). The upper and lower limits of agreement were −18 and +20 min−1, respectively.ConclusionThe Respimometer can accurately measure the RR in healthy adults and children in DRC. A simple and accurate instrument could facilitate the diagnosis of pneumonia by community health workers in low-income and middle-income countries, leading to reduced pneumonia-related deaths.

scholarly journals Developing Medical Technologies for Low-Resource Settings: Lessons From a Wireless Wearable Vital Signs Monitor–neoGuard

2021 ◽  
Vol 3 ◽  
Author(s):  
Assumpta Nantume ◽  
Sona Shah ◽  
Teresa Cauvel ◽  
Matthew Tomback ◽  
Ryan Kilpatrick ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Medical Technology ◽  
Health Workers ◽  
Vital Signs ◽  
Clinical Validation ◽  
Saturation Pulse ◽  
Low Resource Settings ◽  
Low Resource ◽  
Medical Technologies

The neoGuard™ technology is a wireless wearable vital signs monitor attached to a patient's forehead to continuously measure oxygen saturation, pulse rate, respiratory rate and temperature. Developed with feedback from more than 400 health workers, primarily in East Africa, the product has been designed to meet the unique constraints of low-resource settings. This perspective piece by the innovators of neoGuard™ and some of their key partners examines the complicated journey of taking a medical technology from concept through clinical validation and finally to market. By shedding light on some of the most critical steps and common challenges encountered along the pathway to commercialization, the authors hope that their experiences will provide some valuable insights to other aspiring innovators in this space.

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 Effectiveness of App-Based Cognitive Screening for Dementia by Lay Health Workers in Low Resource Settings. A Validation and Feasibility Study in Rural Tanzania

2020 ◽  
pp. 089198872095710
Author(s):  
Stella-Maria Paddick ◽  
Marcella Yoseph ◽  
William K. Gray ◽  
Damas Andrea ◽  
Robyn Barber ◽  
...  
Keyword(s):  
Health Workers ◽  
Geriatric Medicine ◽  
Screening Tools ◽  
Sub Saharan Africa ◽  
Low Resource Settings ◽  
Low Resource ◽  
Dsm 5 ◽  
Dementia Screening ◽  
Rural Tanzania ◽  
Cognitive Screen

Background: The majority of people with dementia live in low-and middle-income countries (LMICs). In sub-Saharan Africa (SSA) human-resource shortages in mental health and geriatric medicine are well recognized. Use of technological solutions may improve access to diagnosis. We aimed to assess the diagnostic accuracy of a brief dementia screening mobile application (app) for non-specialist workers in rural Tanzania against blinded gold-standard diagnosis of DSM-5 dementia. The app includes 2 previously-validated culturally appropriate low-literacy screening tools for cognitive (IDEA cognitive screen) and functional impairment (abbreviated IDEA-IADL questionnaire). Methods: This was a 2-stage community-based door-to-door study. In Stage1, rural primary health workers approached all individuals aged ≥60 years for app-based dementia screening in 12 villages in Hai district, Kilimanjaro Tanzania. In Stage 2, a stratified sub-sample were clinically-assessed for dementia blind to app screening score. Assessment included clinical history, neurological and bedside cognitive assessment and collateral history. Results: 3011 (of 3122 eligible) older people consented to screening. Of these, 610 were evaluated in Stage 2. For the IDEA cognitive screen, the area under the receiver operating characteristic (AUROC) curve was 0.79 (95% CI 0.74-0.83) for DSM-5 dementia diagnosis (sensitivity 84.8%, specificity 58.4%). For those 358 (44%) completing the full app, AUROC was 0.78 for combined cognitive and informant-reported functional assessment. Conclusions: The pilot dementia screening app had good sensitivity but lacked specificity for dementia when administered by non-specialist rural community workers. This technological approach may be a promising way forward in low-resource settings, specialist onward referral may be prioritized.

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 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 Ethical issues raised by cluster randomised trials conducted in low-resource settings: identifying gaps in the Ottawa Statement through an analysis of the PURE Malawi trial

2019 ◽  
Vol 45 (6) ◽  
pp. 388-393 ◽  
Author(s):  
Tiwonge K Mtande ◽  
Charles Weijer ◽  
Mina C Hosseinipour ◽  
Monica Taljaard ◽  
Mitch Matoga ◽  
...  
Keyword(s):  
Ethical Issues ◽  
Health Workers ◽  
National Standards ◽  
Guidance Document ◽  
Randomised Trials ◽  
Low Resource Settings ◽  
Low Resource ◽  
Cluster Randomised Trials ◽  
Cluster Randomised ◽  
Resource Setting

The increasing use of cluster randomised trials in low-resource settings raises unique ethical issues. The Ottawa Statement on the Ethical Design and Conduct of Cluster Randomised Trials is the first international ethical guidance document specific to cluster trials, but it is unknown if it adequately addresses issues in low-resource settings. In this paper, we seek to identify any gaps in the Ottawa Statement relevant to cluster trials conducted in low-resource settings. Our method is (1) to analyse a prototypical cluster trial conducted in a low-resource setting (PURE Malawi trial) with the Ottawa Statement; (2) to identify ethical issues in the design or conduct of the trial not captured adequately and (3) to make recommendations for issues needing attention in forthcoming revisions to the Ottawa Statement. Our analysis identified six ethical aspects of cluster randomised trials in low-resource settings that require further guidance. The forthcoming revision of the Ottawa Statement should provide additional guidance on these issues: (1) streamlining research ethics committee review for collaborating investigators who are affiliated with other institutions; (2) the classification of lay health workers who deliver study interventions as health providers or research participants; (3) the dilemma experienced by investigators when national standards seem to prohibit waivers of consent; (4) the timing of gatekeeper engagement, particularly when researchers face funding constraints; (5) providing ancillary care in health services or implementation trials when a routine care control arm is known to fall below national standards and (6) defining vulnerable participants needing protection in low-resource settings.

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