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

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.

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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.

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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.

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

BMJ Innovations ◽

10.1136/bmjinnov-2019-000361 ◽

2020 ◽

Vol 6 (3) ◽

pp. 113-116 ◽

Cited By ~ 1

Author(s):

Eleanor Dooley ◽

Obaid Kousha ◽

Joseph Msosa ◽

Eric Ndaule ◽

Carl Abraham ◽

...

Keyword(s):

Low Income ◽

Diagnostic Performance ◽

Low Cost ◽

Clinical Signs ◽

Random Order ◽

Ease Of Use ◽

Middle Income ◽

Middle Income Countries ◽

Significant Difference ◽

Solar Powered

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.

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