scholarly journals Development of the ‘REadiness SElf-assessment (RESEA) guide’ to assist low and middle-income countries with establishing safe and sustainable radiotherapy services: a pragmatic sequential mixed qualitative methods project

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Andrew Donkor ◽  
Tim Luckett ◽  
Sanchia Aranda ◽  
Verna Vanderpuye ◽  
Jane L. Phillips
Keyword(s):  
Qualitative Methods ◽  
Epidemiological Data ◽  
Building Blocks ◽  
World Health ◽  
Structured Interviews ◽  
Self Assessment ◽  
Data Set ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Background Improving access to radiotherapy services in low and middle-income countries (LMICs) is challenging. Many LMICs’ radiotherapy initiatives fail because of multi-faceted barriers leading to significant wastage of scarce resources. Supporting LMICs to self-assess their readiness for establishing radiotherapy services will help to improve cancer outcomes by ensuring safe, effective and sustainable evidenced-based cancer care. The aim of the study was to develop practical guidance for LMICs on self-assessing their readiness to establish safe and sustainable radiotherapy services. Methods The Access to Radiotherapy for Cancer treatment (ARC) Project was a pragmatic sequential mixed qualitative methods design underpinned by the World Health Organisation’s ‘Innovative Care for Chronic Conditions Framework’ and ‘Health System Building Blocks Framework for Action’ conceptual frameworks. This paper reports on the process of overall data integration and meta-inference from previously published components comprising a systematic review and two-part qualitative study (semi-structured interviews and a participant validation process). The meta-inferences enabled a series of radiotherapy readiness self-assessment requirements to be generated, formalised as a REadiness SElf-Assessment (RESEA) Guide’ for use by LMICs. Findings The meta-inferences identified a large number of factors that acted as facilitators and/or barriers, depending on the situation, which include: awareness and advocacy; political leadership; epidemiological data; financial resources; basic physical infrastructure; radiation safety legislative and regulatory framework; project management; and radiotherapy workforce training and education. ‘Commitment’, ‘cooperation’, ‘capacity’ and ‘catalyst’ were identified as the key domains enabling development of radiotherapy services. Across these four domains, the RESEA Guide included 37 requirements and 120 readiness questions that LMICs need to consider and answer as part of establishing a new radiotherapy service. Conclusions The RESEA Guide provides a new resource for LMICs to self-assess their capacity to establish safe and sustainable radiotherapy services. Future evaluation of the acceptability and feasibility of the RESEA Guide is needed to inform its validity. Further work, including field study, is needed to inform further refinements. Exploratory and confirmatory factor analyses are required to reduce the data set and test the fit of the four-factor structure (commitment, cooperation, capacity and catalyst) found in the current study.

scholarly journals Development of the ‘REadiness SElf-Assessment (RESEA) Guide’ to assist low and middle-income countries with establishing safe and sustainable radiotherapy services: a pragmatic sequential mixed qualitative methods project

2020 ◽  
Author(s):  
Andrew Donkor ◽  
Tim Luckett ◽  
Sanchia Aranda ◽  
Verna Vanderpuye ◽  
Jane L Phillips
Keyword(s):  
Qualitative Methods ◽  
Building Blocks ◽  
World Health ◽  
Structured Interviews ◽  
Self Assessment ◽  
Middle Income ◽  
Middle Income Countries ◽  
Evidenced Based ◽  
Future Evaluation ◽  
Low And Middle Income

Abstract Background: Improving access to radiotherapy services in low and middle-income countries (LMICs) is challenging. Many LMICs’ radiotherapy initiatives fail because of multi-faceted barriers leading to significant wastage of scarce resources. Supporting LMICs to self-assess their readiness for establishing radiotherapy services will help to improve cancer outcomes by ensuring safe, effective and sustainable evidenced-based cancer care. The aim of the study was to develop practical guidance for LMICs on self-assessing their readiness to establish safe and sustainable radiotherapy services.Methods: The Access to Radiotherapy for Cancer treatment (ARC) Project was a pragmatic sequential mixed qualitative methods design underpinned by the World Health Organisation’s ‘Innovative Care for Chronic Conditions Framework’ and ‘Health System Building Blocks Framework for Action’ conceptual frameworks. This paper reports on the process of overall data integration and meta-inference from previously published components comprising a systematic review and two-part qualitative study (semi-structured interviews and a participant validation process). The meta-inferences enabled a series of radiotherapy readiness self-assessment requirements to be generated, formalised as a REadiness SElf-Assessment (RESEA) Guide’ for use by LMICs.Findings: The meta-inferences identified a large number of factors that acted as facilitators and/or barriers, depending on the situation. ‘Commitment’, ‘cooperation’, ‘capacity’ and ‘catalyst’ were identified as the key domains enabling development of radiotherapy services. Across these four domains, the RESEA Guide included 37 requirements and 120 readiness questions that LMICs need to consider and answer as part of establishing a new radiotherapy service.Conclusions: The RESEA Guide provides a new resource for LMICs to self-assess their capacity to establish safe and sustainable radiotherapy services. Future evaluation of the acceptability and feasibility of the RESEA Guide is needed to inform further refinements.

scholarly journals Evidence of integrated primary-secondary health care in low-and middle-income countries: protocol for a scoping review

2020 ◽  
Author(s):  
Md Zabir Hasan ◽  
Shalini Singh ◽  
Dinesh Arora ◽  
Nishant Jain ◽  
Shivam Gupta
Keyword(s):  
Health Systems ◽  
Scoping Review ◽  
Grey Literature ◽  
Building Blocks ◽  
World Health ◽  
Final Report ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Delivery ◽  
Low And Middle Income

Abstract Background: Integrated care is a people-centered health delivery approach that ensures the comprehensiveness, quality, and continuity of service across the settings and levels of health systems. The World Health Organization (WHO) recommends integration across levels and building-blocks of health systems as a prerequisite of Universal Health Coverage (UHC). While health systems of low and middle-income countries (LMICs) are often fragmented and led by siloed service delivery structure, several LMICs – including India – have attempted health system integration. Several systematic reviews of evidence on healthcare integration from developed countries exist, but no synthesis from LMICs was reported to date. This review will overview the existing evidence of Primary-Secondary care Integration (PSI) in the context of LMICs, aiming to support policy decisions for the effective integration of health delivery systems in India. Methods: The review will be conducted following the six steps recommend by Arksey and O'Malley. Scientific and grey literature will be systematically selected from PubMed, Embase, Scopus, Web of Science, Global Index Medicus, and electronic repositories (such as WHO, World Bank, Health Policy Plus, and OpenGrey). Using a comprehensive search strategy, literature written in English and published between 2000-2020 will be selected, and two independent authors will screen their titles and abstracts. The result will be charted using a data extraction form and reported using tables, figures, and narrative forms. Discussion: No ethical approval is necessary for the review. The final report will be developed with the consultation of other stakeholders and disseminated through workshops, conference papers, and peer review articles. The review will serve as a guiding tool to approach, implement, and test the PSI models in India and other LMICs.Scoping review registration: https://osf.io/kjhzt

scholarly journals Evidence of integrated primary-secondary health care in low-and middle-income countries: protocol for a scoping review

2020 ◽  
Author(s):  
Md Zabir Hasan ◽  
Shalini Singh ◽  
Dinesh Arora ◽  
Nishant Jain ◽  
Shivam Gupta
Keyword(s):  
Health Systems ◽  
Grey Literature ◽  
Building Blocks ◽  
Developed Countries ◽  
World Health ◽  
Final Report ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Delivery ◽  
Low And Middle Income

Abstract Background: Integrated care is a people-centered health delivery approach that ensures the comprehensiveness, quality, and continuity of service across the settings and levels of health systems. The World Health Organization (WHO) recommends integration across levels and building-blocks of health systems as a prerequisite of Universal Health Coverage (UHC). While health systems of low and middle-income countries (LMICs) are often fragmented and led by siloed service delivery structure, several LMICs – including India – have attempted health system integration. Several systematic reviews of evidence on healthcare integration from developed countries exist, but to date, no synthesis from LMICs was reported. This review will provide an overview of existing Integrated Primary Secondary Care Systems (IPSCS) in the context of LMICs, aiming to support policy decisions for the effective integration of health delivery systems in India. Methods: The review will be conducted following the six steps recommend by Arksey and O’Malley. Scientific and grey literature will be systematically selected from PubMed, Embase, Scopus, Web of Science, Global Index Medicus, and electronic repositories of the WHO, World Bank, Health Policy Plus, and OpenGrey. Using a comprehensive search strategy, literature written in English and published between 2000-2019 will be selected, and two independent authors will screen their titles and abstracts. The result will be charted using a data extraction form and reported using tables, figures, and in narrative form. Discussion: No ethical approval is necessary for the review. The review will be conducted between December 2019 and April 2020. The final report will be developed with the consultation of other stakeholders and disseminated through workshops, conference papers, and peer review articles. The review will serve as a guiding tool to approach, implement, and test the IPSCS model in India and other LMICs.

scholarly journals Evidence of integrated primary-secondary health care in low-and middle-income countries: protocol for a scoping review

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Md Zabir Hasan ◽  
Shalini Singh ◽  
Dinesh Arora ◽  
Nishant Jain ◽  
Shivam Gupta
Keyword(s):  
Health Systems ◽  
Scoping Review ◽  
Grey Literature ◽  
Building Blocks ◽  
World Health ◽  
Final Report ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Delivery ◽  
Low And Middle Income

Abstract Background Integrated care is a people-centered health delivery approach that ensures the comprehensiveness, quality, and continuity of service across the settings and levels of health systems. The World Health Organization (WHO) recommends integration across levels and building-blocks of health systems as a prerequisite of Universal Health Coverage (UHC). While health systems of low- and middle-income countries (LMICs) are often fragmented and led by siloed service delivery structure, several LMICs—including India—have attempted health system integration. Several systematic reviews of evidence on healthcare integration from developed countries exist, but no synthesis from LMICs was reported to date. This review will overview the existing evidence of primary-secondary care integration (PSI) in the context of LMICs, aiming to support policy decisions for the effective integration of health delivery systems in India. Methods The review will be conducted following the six steps recommend by Arksey and O'Malley. Scientific and grey literature will be systematically selected from PubMed, Embase, Scopus, Web of Science, Global Index Medicus, and electronic repositories (such as WHO, World Bank, Health Policy Plus, and OpenGrey). Using a comprehensive search strategy, literature written in English and published between 2000 and 2020 will be selected, and two independent authors will screen their titles and abstracts. The result will be charted using a data extraction form and reported using tables, figures, and narrative forms. Discussion No ethical approval is necessary for the review. The final report will be developed with the consultation of other stakeholders and disseminated through workshops, conference papers, and peer review articles. The review will serve as a guiding tool to approach, implement, and test the PSI models in India and other LMICs. Scoping review registration https://osf.io/kjhzt.

scholarly journals Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries

2021 ◽  
Vol 18 (5) ◽  
pp. 2439
Author(s):  
Brendon Stubbs ◽  
Kamran Siddiqi ◽  
Helen Elsey ◽  
Najma Siddiqi ◽  
Ruimin Ma ◽  
...  
Keyword(s):  
Health Survey ◽  
Low Income ◽  
World Health ◽  
Low Income Countries ◽  
Multivariable Logistic Regression Analysis ◽  
World Health Survey ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World ◽  
Low And Middle Income

Tuberculosis (TB) is a leading cause of mortality in low- and middle-income countries (LMICs). TB multimorbidity [TB and ≥1 non-communicable diseases (NCDs)] is common, but studies are sparse. Cross-sectional, community-based data including adults from 21 low-income countries and 27 middle-income countries were utilized from the World Health Survey. Associations between 9 NCDs and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Eight out of 9 NCDs (all except visual impairment) were associated with TB (odds ratio (OR) ranging from 1.38–4.0). Prevalence of self-reported TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and ≥5 NCDs had 2.61 (95% confidence interval (CI) = 2.14–3.22), 4.71 (95%CI = 3.67–6.11), 6.96 (95%CI = 4.95–9.87), 10.59 (95%CI = 7.10–15.80), and 19.89 (95%CI = 11.13–35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs were three times higher than in people without multimorbidity or TB, and a third of the YLDs were attributable to NCDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed.

scholarly journals Effectiveness of Breastfeeding Support Packages in Low- and Middle-Income Countries for Infants under Six Months: A Systematic Review

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 681
Author(s):  
Ritu Rana ◽  
Marie McGrath ◽  
Ekta Sharma ◽  
Paridhi Gupta ◽  
Marko Kerac
Keyword(s):  
At Risk ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
World Health ◽  
Cochrane Library ◽  
Breastfeeding Support ◽  
Middle Income ◽  
Middle Income Countries ◽  
Breastfeeding Practices ◽  
Low And Middle Income

Small and nutritionally at-risk infants under six months, defined as those with wasting, underweight, or other forms of growth failure, are at high-risk of mortality and morbidity. The World Health Organisation 2013 guidelines on severe acute malnutrition highlight the need to effectively manage this vulnerable group, but programmatic challenges are widely reported. This review aims to inform future management strategies for small and nutritionally at-risk infants under six months in low- and middle-income countries (LMICs) by synthesising evidence on existing breastfeeding support packages for all infants under six months. We searched PubMed, CINAHL, Cochrane Library, EMBASE, and Global Health databases from inception to 18 July 2018. Intervention of interest were breastfeeding support packages. Studies reporting breastfeeding practices and/or caregivers’/healthcare staffs’ knowledge/skills/practices for infants under six months from LMICs were included. Study quality was assessed using NICE quality appraisal checklist for intervention studies. A narrative data synthesis using the Synthesis Without Meta-analysis (SWiM) reporting guideline was conducted and key features of successful programmes identified. Of 15,256 studies initially identified, 41 were eligible for inclusion. They were geographically diverse, representing 22 LMICs. Interventions were mainly targeted at mother–infant pairs and only 7% (n = 3) studies included at-risk infants. Studies were rated to be of good or adequate quality. Twenty studies focused on hospital-based interventions, another 20 on community-based and one study compared both. Among all interventions, breastfeeding counselling (n = 6) and education (n = 6) support packages showed the most positive effect on breastfeeding practices followed by breastfeeding training (n = 4), promotion (n = 4) and peer support (n = 3). Breastfeeding education support (n = 3) also improved caregivers’ knowledge/skills/practices. Identified breastfeeding support packages can serve as "primary prevention" interventions for all infants under six months in LMICs. For at-risk infants, these packages need to be adapted and formally tested in future studies. Future work should also examine impacts of breastfeeding support on anthropometry and morbidity outcomes. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO 2018 CRD42018102795).

scholarly journals The impact of COVID-19 on the care of people living with noncommunicable diseases in low- and middle-income countries: an online survey of physicians and pharmacists in nine countries

2021 ◽  
Vol 22 ◽  
Author(s):  
Chris Bullen ◽  
Jessica McCormack ◽  
Amanda Calder ◽  
Varsha Parag ◽  
Kannan Subramaniam ◽  
...  
Keyword(s):  
Public Health ◽  
Healthcare Workers ◽  
Online Survey ◽  
World Health ◽  
Noncommunicable Diseases ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Measures ◽  
The Impact ◽  
Low And Middle Income

Abstract Background: The global COVID-19 pandemic has disrupted healthcare worldwide. In low- and middle-income countries (LMICs), where people may have limited access to affordable quality care, the COVID-19 pandemic has the potential to have a particularly adverse impact on the health and healthcare of individuals with noncommunicable diseases (NCDs). A World Health Organization survey found that disruption of delivery of healthcare for NCDs was more significant in LMICs than in high-income countries. However, the study did not elicit insights into the day-to-day impacts of COVID-19 on healthcare by front-line healthcare workers (FLHCWs). Aim: To gain insights directly from FLHCWs working in countries with a high NCD burden, and thereby identify opportunities to improve the provision of healthcare during the current pandemic and in future healthcare emergencies. Methods: We recruited selected frontline healthcare workers (general practitioners, pharmacists, and other medical specialists) from nine countries to complete an online survey (n = 1347). Survey questions focused on the impact of COVID-19 pandemic on clinical practice and NCDs; barriers to clinical care during the pandemic; and innovative responses to the many challenges presented by the pandemic. Findings: The majority of FLHCWs responding to our survey reported that their care of patients had been impacted both adversely and positively by the public health measures imposed. Most FLHCs (95%) reported a deterioration in the mental health of their patients. Conclusions: Continuity of care for NCDs as part of pandemic preparedness is needed so that chronic conditions are not exacerbated by public health measures and the direct impacts of the pandemic.

scholarly journals Tobacco Control in Low- and Middle-Income Countries: Changing the Present to Help the Future

2018 ◽  
Vol 13 (4) ◽  
pp. 187-188 ◽  
Author(s):  
Bethany Hipple Walters ◽  
Ionela Petrea ◽  
Harry Lando
Keyword(s):  
World Health Organization ◽  
World Health ◽  
Second Hand Smoke ◽  
Vulnerable Children ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Past ◽  
Second Hand Smoke Exposure ◽  
Health Organization ◽  
Low And Middle Income

While the global smoking rate has dropped in the past 30 years (from 41.2% of men in 1980 to 31.1% in 2012 and from 10.6% of women in 1980 to 6.2% in 2012), the number of tobacco smokers has increased due to population growth (Ng et al., 2014). This tobacco use and second-hand smoke exposure continue to harm people worldwide. Those harmed are often vulnerable: children, those living in low- and middle-income countries (LMICs), those with existing diseases, etc. As noted by the World Health Organization (WHO), nearly 80% of those who smoke live in a LMIC (World Health Organization, 2017). Furthermore, it is often those who are more socio-economically disadvantaged or less educated in LMICs that are exposed to second-hand smoke at home and work (Nazar, Lee, Arora, & Millett, 2015).

scholarly journals Implementation research training for learners in low- and middle-income countries: Evaluating behavior change after participating in a massive online open course

2020 ◽  
Author(s):  
Pascal Launois ◽  
Dermot Maher ◽  
Edith Certain ◽  
Bella Ross ◽  
Michael J. Penkunas
Keyword(s):  
Professional Practice ◽  
Implementation Research ◽  
Online Survey ◽  
Training Programs ◽  
Research Training ◽  
Critical Role ◽  
World Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Background Implementation research (IR) can play a critical role in the delivery of disease control interventions, particularly in low- and middle-income countries (LMICs). The growing demand for IR training has led to the development of a range of training programs and university courses, the majority of which can not be accessed by learners in LMICs. This article reports on the evaluation of a massive open online course (MOOC) developed by the Special Programme for Research and Training in Tropical Diseases hosted by the World Health Organization on the topic of IR with a focus on infectious diseases of poverty. This study followed Kirkpatrick’s Model to evaluate training programs with a specific focus on post-training changes in behavior. Methods MOOC participants were invited to take part in an anonymous online survey examining their IR knowledge and how they applied it in their professional practice approximately 1-1.5 years after completing the MOOC. The survey contained 43 open-ended, multiple choice and Likert-type questions. Descriptive statistics were calculated for the quantitative data and responses to the open-ended questions were thematically coded. Results A total of 748 MOOC participants responded to the survey. The demographic profile of the survey respondents aligned with that of the MOOC participants, with nearly 70% of respondents originating from Africa. Responses to the quantitative and open-ended survey questions revealed that respondents’ IR knowledge had improved to a large extent as a result of the MOOC, and that they used the knowledge and skills gained in their professional lives frequently. Respondents most often cited changes in their conceptual understanding of IR and understanding of the research process as substantial areas of change influenced by participating in the MOOC. Conclusions These findings indicate that the MOOC was successful in targeting learners from LMICs, in strengthening their IR knowledge and in contributing to their ability to apply it in their professional practice. The utility of MOOCs for providing IR training to learners in LMICs, where implementation challenges are encountered often, makes this platform an ideal standalone learning tool or one that could be combined with other training formats.

Sign in / Sign up

Export Citation Format

Share Document