Implementation of m-health applications in botswana: telemedicine and education on mobile devices in a low resource setting

2013 ◽  
Vol 19 (2) ◽  
pp. 120-125 ◽  
Author(s):  
Ryan Littman-Quinn ◽  
Chikoti Mibenge ◽  
Cynthia Antwi ◽  
Amit Chandra ◽  
Carrie L Kovarik
Keyword(s):  
Mobile Devices ◽  
Healthcare Providers ◽  
Medical Knowledge ◽  
University Of Pennsylvania ◽  
Middle Income ◽  
Social Challenges ◽  
University Of Botswana ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Specialized Care

Although Botswana has recently been categorised as an upper middle income country, it is burdened by a scarcity of resources, both human and technological. There are barriers to patients’ access to specialized care and healthcare providers’ access to medical knowledge. Over the past three years, the Botswana-University of Pennsylvania Partnership (BUP) has piloted four mobile telemedicine projects in the specialties of women's health (cervical cancer screening utilizing visual inspection with acetic acid), radiology, oral medicine and dermatology. Mobile telemedicine has been used in 11 locations in Botswana, training a total of 24 clinicians and successfully contributing to the management of 643 cases. In addition to mobile telemedicine, BUP has initiated an m-learning programme with the University of Botswana School of Medicine. While successfully providing patients and providers with improved access to healthcare resources, the m-health projects have faced numerous technical and social challenges. These include malfunctioning mobile devices, unreliable IT infrastructure, accidental damage to mobile devices, and cultural misalignment between IT and healthcare providers. BUP has worked with its local partners to develop solutions to these problems. To ensure sustainability, m-health programmes must have strategic goals that are aligned with those of the national health and education system, and the initiatives must be owned and led by local stakeholders. Whenever possible, open source technology and local IT expertise and infrastructure should be employed.

scholarly journals Advancing Age in Africa, the Urgent Need for Institutional Geriatric Care in a Low Resource Setting: A Case Report

2021 ◽  
Vol 12 (2) ◽  
pp. 416-420
Author(s):  
Emmanuel Kobina Mesi Edzie ◽  
Klenam Dzefi-Tettey ◽  
Philip Narteh Gorleku ◽  
Frank Naku Ghartey ◽  
Madison Adanusa ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Geriatric Care ◽  
Health Concern ◽  
Healthcare Personnel ◽  
Healthcare Industry ◽  
Middle Income ◽  
Middle Income Countries ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Low And Middle Income

Background: The demand for geriatric care has been on the increase throughout the world, especially in the developing, low- and middle-income countries (LMICs), due to increasing life expectancy, improvement in technology in healthcare industry coupled with increasing numbers of healthcare personnel. Nonetheless, these increases in the resources to the healthcare industry are still woefully inadequate in the developing and LMICs, compared to the high demand for such services, thereby exposing the drastic challenges and gaps in geriatric services in these countries. Case Presentation: A 74-year-old woman apparently well, who was relocated from the rural area by her biological daughter, with the intention of giving her better care in a comfortable city environment. She was initially appreciative of the relocation. However, the situation went sour when her daughter and son-in-law resumed work after their annual leave period. They started locking her up in a well-furnished mansion with everything she may need until they returned from work. Consistently for eight working days, she was kept under lock and key because they did not want her to roam around the community, they thought was not familiar to her with the intention of keeping her safe. Everything was fine until they returned from work one day to find that she had soiled the house with her excrement, apparently as a protest against her consistent lock-up. This necessitated their visit to the hospital. A diagnosis of social isolation was made after clinical and mental state examination and appropriate interventions were instituted. The patient consequently became fine in the new environment. Conclusion: This case has been presented in order to emphasize the need to improve the systems for geriatric care which is of public health concern, especially as the life expectancy of the developing, low- and middle-income countries keep improving.

scholarly journals Unravelling ‘low-resource settings’: a systematic scoping review with qualitative content analysis

2021 ◽  
Vol 6 (6) ◽  
pp. e005190
Author(s):  
Chanel van Zyl ◽  
Marelise Badenhorst ◽  
Susan Hanekom ◽  
Martin Heine
Keyword(s):  
Content Analysis ◽  
Scoping Review ◽  
Qualitative Content Analysis ◽  
Middle Income ◽  
Low Resource Settings ◽  
Low Resource ◽  
Middle Income Countries ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Low Middle Income Countries

IntroductionThe effects of healthcare-related inequalities are most evident in low-resource settings. Such settings are often not explicitly defined, and umbrella terms which are easier to operationalise, such as ‘low-to-middle-income countries’ or ‘developing countries’, are often used. Without a deeper understanding of context, such proxies are pregnant with assumptions, insinuate homogeneity that is unsupported and hamper knowledge translation between settings.MethodsA systematic scoping review was undertaken to start unravelling the term ‘low-resource setting’. PubMed, Africa-Wide, Web of Science and Scopus were searched (24 June 2019), dating back ≤5 years, using terms related to ‘low-resource setting’ and ‘rehabilitation’. Rehabilitation was chosen as a methodological vehicle due to its holistic nature (eg, multidisciplinary, relevance across burden of disease, and throughout continuum of care) and expertise within the research team. Qualitative content analysis through an inductive approach was used.ResultsA total of 410 codes were derived from 48 unique articles within the field of rehabilitation, grouped into 63 content categories, and identified nine major themes relating to the term ‘low-resource setting’. Themes that emerged relate to (1) financial pressure, (2) suboptimal healthcare service delivery, (3) underdeveloped infrastructure, (4) paucity of knowledge, (5) research challenges and considerations, (6) restricted social resources, (7) geographical and environmental factors, (8) human resource limitations and (9) the influence of beliefs and practices.ConclusionThe emerging themes may assist with (1) the groundwork needed to unravel ‘low-resource settings’ in health-related research, (2) moving away from assumptive umbrella terms like ‘low-to-middle-income countries’ or ‘low/middle-income countries’ and (3) promoting effective knowledge transfer between settings.

scholarly journals “It’s extremely hard but it’s not a burden”: A qualitative study of family caregiving for people living with dementia in Vietnam

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259788
Author(s):  
Huong Nguyen ◽  
Trang Nguyen ◽  
Duyen Tran ◽  
Ladson Hinton
Keyword(s):  
Family Caregivers ◽  
Family Caregiving ◽  
Help Seeking ◽  
Healthcare Providers ◽  
Structured Interviews ◽  
Resource Setting ◽  
Vietnamese Women ◽  
Low Resource Setting ◽  
The Family ◽  
Multiple Challenges

Background Vietnam is one of the fastest-aging countries in the world with a rising number of people with Alzheimer’s disease and related dementias (ADRD). Families in Vietnam provide most of the care for persons living with dementia, yet our understanding of their experiences and needs is limited. This study examined the family caregiving experience in a semi-rural region outside of central Hanoi from the perspectives of family caregivers and other key informants. Materials Semi-structured interviews were conducted with 21 key stakeholders (12 family caregivers and 9 healthcare providers and community leaders). A descriptive, thematic analysis was conducted. Results Qualitative data analysis revealed four themes related to the family caregiving experience: 1) perceptions of dementia symptoms as a normal part of aging rather than a disease, 2) caregiving as a moral and expected familial obligation, 3) patterns of caregiving that are heavily influenced by both gender and sibling order, and 4) multiple challenges or hardships, including time constraints, loss of income, increased social isolation, a toll on their perceived physical health, and emotional distress. Caregivers rejected the notion that caregiving was a “burden” and expressed their distress through terms such as frustration, sadness, and exhaustion. Conclusions In this low-resource setting, the stress of family caregiving may be amplified by lack of community resources, cultural stigma discouraging outside help-seeking, and economic impact of care provision. The study highlights the vulnerability and predicament of Vietnamese women who often face multiple challenges in their caregiving role as well as the urgent need for the development of community-based programs and supports.

Ethics of Public Mental Health in Developing Societies

2015 ◽  
Author(s):  
Buddhika Lalanie Fernando ◽  
Athula Sumathipala
Keyword(s):  
Mental Health ◽  
Public Mental Health ◽  
Psychiatric Research ◽  
Ethical Perspective ◽  
Middle Income ◽  
Ethics Framework ◽  
Middle Income Countries ◽  
Curative Care ◽  
Resource Setting ◽  
Low Resource Setting

Half of the world’s population lives in countries with one psychiatrist to serve 200,000 people and in low and middle income countries (LAMICs), even most people with severe mental disorders remain untreated. As curative care is prioritized, public mental health is inundated with deep-seated problems, primarily due to the lack of funding. From an ethical perspective, such underlying issues in public mental health exist regardless of income levels; they are, however, further exacerbated by the lack of resources and awareness in LAMICs. Ironically, the ethics of public mental health have received much less attention than that of psychiatric research. We therefore use a public health ethics framework to broaden the ethical perspective in public mental health and examine it from a low-resource setting viewpoint. Next, we examine public mental health from a social justice perspective. Third, we examine issues critical to ensuring better access to mental health services in LAMICs.

scholarly journals Effect of a Neonatal Resuscitation Course on Healthcare Providers’ Performances Assessed by Video Recording in a Low-Resource Setting

PLoS ONE ◽  
2015 ◽  
Vol 10 (12) ◽  
pp. e0144443 ◽  
Author(s):  
Daniele Trevisanuto ◽  
Federica Bertuola ◽  
Paolo Lanzoni ◽  
Francesco Cavallin ◽  
Eduardo Matediana ◽  
...  
Keyword(s):  
Video Recording ◽  
Healthcare Providers ◽  
Neonatal Resuscitation ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting

scholarly journals Planned early delivery for late preterm pre-eclampsia in a low- and middle-income setting: a feasibility study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Alice Beardmore-Gray ◽  
Nicola Vousden ◽  
Sergio A. Silverio ◽  
Umesh Charantimath ◽  
Geetanjali Katageri ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Controlled Trial ◽  
Healthcare Providers ◽  
Complex Interventions ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Middle Income ◽  
Resource Setting ◽  
Adverse Pregnancy ◽  
Low And Middle Income

Abstract Background Pre-eclampsia is a leading cause of maternal and perinatal mortality and morbidity globally. Planned delivery between 34+0 and 36+6 weeks may reduce adverse pregnancy outcomes but is yet to be evaluated in a low and middle-income setting. Prior to designing a randomised controlled trial to evaluate this in India and Zambia, we carried out a 6-month feasibility study in order to better understand the proposed trial environment and guide development of our intervention. Methods We used mixed methods to understand the disease burden and current management of pre-eclampsia at our proposed trial sites and explore the acceptability of the intervention. We undertook a case notes review of women with pre-eclampsia who delivered at the proposed trial sites over a 3-month period, alongside facilitating focus group discussions with women and partners and conducting semi-structured interviews with healthcare providers. Descriptive statistics were used to analyse audit data. A thematic framework analysis was used for qualitative data. Results Case notes data (n = 326) showed that in our settings, 19.5% (n = 44) of women with pre-eclampsia delivering beyond 34 weeks experienced an adverse outcome. In women delivering between 34+0 and 36+6 weeks, there were similar numbers of antenatal stillbirths [n = 3 (3.3%)] and neonatal deaths [n = 3 (3.4%)]; median infant birthweight was 2.2 kg and 1.9 kg in Zambia and India respectively. Lived experience of women and healthcare providers was an important facilitator to the proposed intervention, highlighting the serious consequences of pre-eclampsia. A preference for spontaneous labour and limited neonatal resources were identified as potential barriers. Conclusions This study demonstrated a clear need to evaluate the intervention and highlighted several challenges relating to trial context that enabled us to adapt our protocol and design an acceptable intervention. Our study demonstrates the importance of assessing feasibility when developing complex interventions, particularly in a low-resource setting. Additionally, it provides a unique insight into the management of pre-eclampsia at our trial settings and an understanding of the knowledge, attitudes and beliefs underpinning the acceptability of planned early delivery.

scholarly journals Addressing Adolescent Depression in Tanzania: Positive Primary Care Workforce Outcomes Using a Training Cascade Model

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Stan Kutcher ◽  
Yifeng Wei ◽  
Heather Gilberds ◽  
Adena Brown ◽  
Omary Ubuguyu ◽  
...  
Keyword(s):  
Training Program ◽  
Low Income ◽  
Help Seeking ◽  
Adolescent Depression ◽  
Healthcare Providers ◽  
Cascade Model ◽  
Diagnosis And Treatment ◽  
Resource Setting ◽  
Primary Care Workforce ◽  
Low Resource Setting

Background. This is a report on the outcomes of a training program for community clinic healthcare providers in identification, diagnosis, and treatment of adolescent Depression in Tanzania using a training cascade model. Methods. Lead trainers adapted a Canadian certified adolescent Depression program for use in Tanzania to train clinic healthcare providers in the identification, diagnosis, and treatment of Depression in young people. As part of this training program, the knowledge, attitudes, and a number of other outcomes pertaining to healthcare providers and healthcare practice were assessed. Results. The program significantly, substantially, and sustainably improved provider knowledge and confidence. Further, healthcare providers’ personal help-seeking efficacy also significantly increased as well as the clinicians’ reported number of adolescent patients identified, diagnosed, and treated for Depression. Conclusion. To our knowledge, this is the first study reporting positive outcomes of a training program addressing adolescent Depression in Tanzanian community clinics. These results suggest that the application of this training cascade approach may be a feasible model for developing the capacity of healthcare providers to address youth Depression in a low-income, low-resource setting.

Tropical Medicine for Anaesthetists

2020 ◽  
pp. 297-318
Author(s):  
Victoria Howell
Keyword(s):  
Clinical Features ◽  
Tropical Medicine ◽  
Tropical Diseases ◽  
Middle Income ◽  
Low Resource ◽  
Middle Income Countries ◽  
High Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Significant Burden

Many tropical diseases will be unfamiliar to anaesthetists from high-resource settings but are common in low- and middle-income countries. They lead to a significant burden of morbidity and mortality, and some knowledge of the commonly presenting ones and how they might impact on conduct of anaesthesia is essential to anaesthetists practising in these settings. The chapter covers the essentials of several tropical diseases including malaria, tuberculosis, cholera, and typhoid. The chapter outlines for each disease the aetiology, pathophysiology, clinical features, diagnosis, management, and anaesthetic implications. Diseases that are also found in high-resource settings, such as diarrhoea and HIV, are also covered on the basis that they are much more likely to be encountered in a low-resource setting.

scholarly journals Liver abscess: diagnostic and management issues found in the low resource setting

2019 ◽  
Vol 132 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Gaetan Khim ◽  
Sokhom Em ◽  
Satdin Mo ◽  
Nicola Townell
Keyword(s):  
Liver Abscess ◽  
Pyogenic Liver Abscess ◽  
Amoebic Liver Abscess ◽  
Diagnostic Strategy ◽  
Middle Income ◽  
Low Resource ◽  
Liver Abscesses ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Low Middle Income Countries

Abstract Introduction Liver abscesses are mainly caused by parasitic or bacterial infection and are an important cause of hospitalization in low-middle income countries (LMIC). The pathophysiology of abscesses is different depending on the etiology and requires different strategies for diagnosis and management. This paper discusses pathophysiology and epidemiology, the current diagnostic approach and its limitations and management of liver abscess in low resource settings. Sources of data We searched PubMed for relevant reviews by typing the following keywords: ‘amoebic liver abscess’ and ‘pyogenic liver abscess’. Areas of agreement Amoebic liver abscess can be treated medically while pyogenic liver abscess usually needs to be percutaneously drained and treated with effective antibiotics. Areas of controversy In an LMIC setting, where misuse of antibiotics is a recognized issue, liver abscesses are a therapeutic conundrum, leaving little choices for treatment for physicians in low capacity settings. Growing points As antimicrobial resistance awareness and antibiotic stewardship programs are put into place, liver abscess management will likely improve in LMICs provided that systematic adapted guidelines are established and practiced. Areas timely for developing research The lack of a quick and reliable diagnostic strategy in the majority of LMIC makes selection of appropriate treatment challenging.

scholarly journals An innovative model for management of cardiovascular disease risk factors in the low resource setting of Cambodia

2020 ◽  
Author(s):  
Nazaneen Nikpour Hernandez ◽  
Samiha Ismail ◽  
Hen Heang ◽  
Maurits van Pelt ◽  
Miles D Witham ◽  
...  
Keyword(s):  
Cox Regression ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Fasting Blood Glucose ◽  
Attrition Rate ◽  
Middle Income ◽  
Loss To Follow Up ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Control Of Diabetes

Abstract Non-communicable diseases are increasing in developing countries and control of diabetes and hypertension is needed to reduce rates of the leading causes of morbidity and mortality, stroke and ischaemic heart disease. We evaluated a programme in Cambodia, financed by a revolving drug fund, which utilizes Peer Educators to manage diabetes and hypertension in the community. We assessed clinical outcomes and retention in the programme. For all people enrolled in the programme between 2007 and 2016, the average change in blood pressure (BP) and percentage with controlled hypertension (BP < 140/<90 mmHg) or diabetes (fasting blood glucose (BG) < 7mg/dl, post-prandial BG < 130 mg/dl, or HBA1C < 7%) was calculated every 6 months from enrolment.  Attrition rate in the nth year of enrolment was calculated; associations with loss to follow-up were explored using cox regression. A total of 9139 patients enrolled between January 2007 and March 2016. For all people with hypertension, mean change in systolic and diastolic BP within the first year was −15.1 mmHg (SD 23.6, P < 0.0001) and −8.6 mmHg (SD 14.0, P < 0.0001), respectively. BP control was 50.5% at year 1, peaking at 70.6% at 5.5 years. 41.3% of people with diabetes achieved blood sugar control at 6 months and 44.4% at 6.5 years.  An average of 2.3 years [SD 1.9] was spent in programme. Attrition rate within year 1 of enrolment ranged from 29.8% to 61.5% with average of 44.1% [SD 10.3] across 2008–15. Patients with hypertension were more likely to leave the program compared to those with diabetes and males more likely than females. The programme shows a substantial and sustained rate of diabetes and hypertension control for those who remain in the program and could be a model for implementation in other low middle-income settings, however, further work is needed to improve patient retention.

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