Comparative evaluation of a low cost direct ophthalmoscope (Arclight) for red reflex assessment among healthcare workers in Malawi

We compared the diagnostic performance and ease of use of a new solar powered low-cost Arclight direct ophthalmoscope (AO) to a more expensive traditional direct ophthalmoscope (TDO) (Keeler Professional V.2.8) in detecting abnormal red reflexes in simulated eyes. Both devices were used by 19 optometry students and 17 paediatric doctors based in the Kamuzu Central Hospital Campus in Lilongwe, Malawi. Participants examined four normal and four abnormal red reflexes using the two devices in random order. We scored the participants on their ability to identify clinical signs and make a diagnosis. Participants scored each device for ‘ease of use’. There was no statistically significant difference in diagnostic performance or ‘ease of use’ between the AO and the TDO when attempting to detect abnormal red reflexes in simulated eyes. We conclude that AO is an inexpensive yet equally effective alternative to the TDO in detecting red reflexes and due to its low cost, portability and consumable independence is well suited for use in low-income and middle-income countries.

Download Full-text

Comparative evaluation of a novel solar powered low-cost ophthalmoscope (Arclight) by eye healthcare workers in Malawi

BMJ Innovations ◽

10.1136/bmjinnov-2017-000225 ◽

2018 ◽

Vol 4 (2) ◽

pp. 98-102 ◽

Cited By ~ 9

Author(s):

Rebecca Blundell ◽

David Roberts ◽

Evridiki Fioratou ◽

Carl Abraham ◽

Joseph Msosa ◽

...

Keyword(s):

Low Income ◽

Healthcare Workers ◽

Screening Tool ◽

Low Cost ◽

Clinical Signs ◽

Ease Of Use ◽

Middle Income ◽

Middle Income Countries ◽

Eye Disorders ◽

Solar Powered

This study compared a novel low-cost solar powered direct ophthalmoscope called the Arclight with a traditional direct ophthalmoscope (TDO). After appropriate training, 25 Malawian eye healthcare workers were asked to examine 12 retinal images placed in a teaching manikin head with both the Arclight ophthalmoscope and a traditional direct ophthalmoscope (Keeler Professional V.2.8). Participants were scored on their ability to identify clinical signs, to make a diagnosis and how long they took to make a diagnosis. They were also asked to score each ophthalmoscope for ‘ease of use’. Statistically significant differences were found in favour of the Arclight in the number of clinical signs identified, correct diagnoses made and ease of use. The ophthalmoscopes were equally effective as a screening tool for diabetic retinopathy, and there was no statistically difference in time to diagnosis. The authors conclude that the Arclight offers an easy to use, low cost alternative to the traditional direct ophthalmoscope to meet the demands for screening and diagnosis of visually impairing eye disorders in low-income and middle-income countries.

Download Full-text

Comparative evaluation of a new frugal binocular indirect ophthalmoscope

Eye ◽

10.1038/s41433-021-01901-7 ◽

2021 ◽

Author(s):

Obaid Kousha ◽

Sharma Ganesananthan ◽

Bayan Shahin ◽

John Ellis ◽

Andrew Blaikie

Keyword(s):

Low Cost ◽

Optical Quality ◽

Ease Of Use ◽

Rank Test ◽

Design Characteristic ◽

Signed Rank ◽

Significant Difference ◽

Signed Rank Test ◽

Solar Powered ◽

Indirect Ophthalmoscope

Abstract Objectives We compare the optical quality and design characteristic a new low cost solar powered binocular indirect ophthalmoscope (BIO), Holo, to Keeler BIO. Methods Twenty-four participants each examined 10 simulation eyes using both the Holo and the Keeler BIO with a 30-diopter condensing lens. Number of Lea symbols printed on the retina of simulation eyes seen and time taken to identify them was recorded. Stereoacuity of 12 participants was tested while using the BIOs. Using 7-point Likert scale, participants gave feedback on design characteristic of both BIOs. Results There was no statistical difference in number of Lea symbols correctly identified (15.63/20 for Holo vs. 15/20 for Keeler BIO, p = 0.366, paired t test) or time taken to correctly identify each symbol (Holo 0.39 s faster; 95% confidence interval −2.24 to 3.03 s, p = 0.763) using each device. 12 out of 12 participants achieved stereoacuity of 60 arcsec using the Holo while with the Keeler BIO 11 achieved 60 arcsec and one 90 arcsec. There was no statistically significant difference in the scores for clarity of view, quality of illumination, field of view, binocularity, eye strain and robustness between the two devices. The Holo, scored higher for ease of use (6.5 vs. 6, p = 0.00488, Wilcoxon signed-rank test), comfort of wear (6 vs. 5, p = 0.000337) and portability (7 vs. 6, p = 0.000148). Conclusion The Holo has the potential to be a clinically useful yet affordable diagnostic tool suitable for the first time of equipping eye care workers in low resource settings with a BIO at volume.

Download Full-text

Is palliative care cost-effective in low-income and middle-income countries? A mixed-methods systematic review

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-001499 ◽

2018 ◽

Vol 9 (2) ◽

pp. 120-129 ◽

Cited By ~ 12

Author(s):

Eleanor Anderson Reid ◽

Olga Kovalerchik ◽

Karen Jubanyik ◽

Stuart Brown ◽

Denise Hersey ◽

...

Keyword(s):

Palliative Care ◽

Cost Effectiveness ◽

Low Income ◽

Low Cost ◽

Healthcare Utilisation ◽

High Income ◽

Original Research ◽

Middle Income ◽

Middle Income Countries ◽

Patient Reported

IntroductionOf the 40 million people globally in need of palliative care (PC), just 14% receive it, predominantly in high-income countries. Within fragile health systems that lack PC, incurable illness is often marked by pain and suffering, as well as burdensome costs. In high-income settings, PC decreases healthcare utilisation, thus enhancing value. Similar cost-effectiveness models are lacking in low-income and middle-income countries and with them, the impetus and funding to expand PC delivery.MethodsWe conducted a systematic search of seven databases to gather evidence of the cost-effectiveness of PC in low-income and middle-income countries. We extracted and synthesised palliative outcomes and economic data from original research studies occurring in low-income and middle-income countries. This review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and includes a quality appraisal.ResultsOur search identified 10 eligible papers that included palliative and economic outcomes in low-income and middle-income countries. Four provided true cost-effectiveness analyses in comparing the costs of PC versus alternative care, with PC offering cost savings, favourable palliative outcomes and positive patient-reported and family-reported outcomes.ConclusionsDespite the small number of included studies, wide variety of study types and lack of high-quality studies, several patterns emerged: (1) low-cost PC delivery in low-income and middle-income countries is possible, (2) patient-reported outcomes are favourable and (3) PC is less costly than the alternative. This review highlights the extraordinary need for robust cost-effectiveness analysis of PC in low-income and middle-income countries in order to develop health economic models for the delivery of PC, direct resource allocation and guide healthcare policy for PC delivery in low-income and middle-income countries.

Download Full-text

Double standards in healthcare innovations: the case of mosquito net mesh for hernia repair

BMJ Innovations ◽

10.1136/bmjinnov-2020-000535 ◽

2020 ◽

pp. bmjinnov-2020-000535

Author(s):

Mark Skopec ◽

Alessandra Grillo ◽

Alvena Kureshi ◽

Yasser Bhatti ◽

Matthew Harris

Keyword(s):

Hernia Repair ◽

Low Income ◽

Low Cost ◽

Surgical Care ◽

Biomechanical Properties ◽

Double Standard ◽

Healthcare Sector ◽

Mosquito Net ◽

Middle Income ◽

Middle Income Countries

With over two decades of evidence available including from randomised clinical trials, we explore whether the use of low-cost mosquito net mesh for inguinal hernia repair, common practice only in low-income and middle-income countries, represents a double standard in surgical care. We explore the clinical evidence, biomechanical properties and sterilisation requirements for mosquito net mesh for hernia repair and discuss the rationale for its use routinely in all settings, including in high-income settings. Considering that mosquito net mesh is as effective and safe as commercial mesh, and also with features that more closely resemble normal abdominal wall tissue, there is a strong case for its use in all settings, not just low-income and middle-income countries. In the healthcare sector specifically, either innovations should be acceptable for all contexts, or none at all. If such a double standard exists and worse, persists, it raises serious questions about the ethics of promoting healthcare innovations in some but not all contexts in terms of risks to health outcomes, equitable access, and barriers to learning.

Download Full-text

Hypothermia for encephalopathy in low-income and middle-income countries: feasibility of whole-body cooling using a low-cost servo-controlled device

BMJ Paediatrics Open ◽

10.1136/bmjpo-2017-000245 ◽

2018 ◽

Vol 2 (1) ◽

pp. e000245 ◽

Cited By ~ 9

Author(s):

Vânia Oliveira ◽

Jaya Raman Kumutha ◽

Narayanan E ◽

Jagadish Somanna ◽

Naveen Benkappa ◽

...

Keyword(s):

Low Income ◽

Low Cost ◽

Whole Body ◽

Middle Income ◽

Middle Income Countries ◽

Body Cooling ◽

Whole Body Cooling

Download Full-text

Prevalence of Human Sapovirus in Low and Middle Income Countries

Advances in Virology ◽

10.1155/2018/5986549 ◽

2018 ◽

Vol 2018 ◽

pp. 1-12 ◽

Cited By ~ 5

Author(s):

Mpho Magwalivha ◽

Jean-Pierre Kabue ◽

Afsatou Ndama Traore ◽

Natasha Potgieter

Keyword(s):

Low Income ◽

Acute Gastroenteritis ◽

Age Groups ◽

Diarrhoeal Disease ◽

Health Concern ◽

Middle Income ◽

Middle Income Countries ◽

Hospitalised Patients ◽

Significant Difference ◽

Low And Middle Income

Background. Sapovirus (SV) infection is a public health concern which plays an important role in the burden of diarrhoeal diseases, causing acute gastroenteritis in people of all ages in both outbreaks and sporadic cases worldwide. Objective/Study Design. The purpose of this report is to summarise the available data on the detection of human SV in low and middle income countries. A systematic search on PubMed and ScienceDirect database for SV studies published between 2004 and 2017 in low and middle income countries was done. Studies of SV in stool and water samples were part of the inclusion criteria. Results. From 19 low and middle income countries, 45 published studies were identified. The prevalence rate for SV was 6.5%. A significant difference (P=0) in SV prevalent rate was observed between low income and middle income countries. Thirty-three (78.6%) of the studies reported on children and 8 (19%) studies reported on all age groups with diarrhoea. The majority (66.7%) of studies reported on hospitalised patients with acute gastroenteritis. Sapovirus GI was shown as the dominant genogroup, followed by SV-GII. Conclusion. The detection of human SV in low and middle income countries is evident; however the reports on its prevalence are limited. There is therefore a need for systematic surveillance of the circulation of SV, and their role in diarrhoeal disease and outbreaks, especially in low and middle income countries.

Download Full-text