scholarly journals Building a Sustainable Comprehensive Multiple Myeloma Program in Western Kenya

2021 ◽  
pp. 400-407
Author(s):  
Mercy A. Oduor ◽  
Teresa C. Lotodo ◽  
Terry A. Vik ◽  
Kelvin M. Manyega ◽  
Patrick Loehrer ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Patient Outcomes ◽  
Support Group ◽  
Healthcare Professionals ◽  
Treatment Strategies ◽  
Middle Income ◽  
Western Kenya ◽  
Middle Income Countries ◽  
Set Up ◽  
Future Plans

Despite improved treatment strategies for multiple myeloma (MM), patient outcomes in low- and middle-income countries remain poor, unlike high-income countries. Scarcity of specialized human resources and diagnostic, treatment, and survivorship infrastructure are some of the barriers that patients with MM, clinicians, and policymakers have to overcome in the former setting. To improve outcomes of patients with MM in Western Kenya, the Academic Model Providing Access to Healthcare (AMPATH) MM Program was set up in 2012. In this article, the program's activities, challenges, and future plans are described distilling important lessons that can be replicated in similar settings. Through the program, training on diagnosis and treatment of MM was offered to healthcare professionals from 35 peripheral health facilities across Western Kenya in 2018 and 2019. Access to antimyeloma drugs including novel agents was secured, and pharmacovigilance systems were developed. Finally, patients were supported to obtain health insurance in addition to receiving peer support through participation in support group meetings. This article provides an implementation blueprint for similar initiatives aimed at increasing access to care for patients with MM in underserved areas.

scholarly journals Development of immunohistochemistry services for cancer care in western Kenya: Implications for low- and middle-income countries

2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Kirtika Patel ◽  
R. Matthew Strother ◽  
Francis Ndiangui ◽  
David Chumba ◽  
William Jacobson ◽  
...  
Keyword(s):  
Cancer Care ◽  
Cost Model ◽  
Tertiary Care ◽  
Care Hospital ◽  
Middle Income ◽  
Western Kenya ◽  
Middle Income Countries ◽  
Resource Limited ◽  
Limited Setting ◽  
Low And Middle Income

Background: Cancer is becoming a major cause of mortality in low- and middle-income countries. Unlike infectious disease, malignancy and other chronic conditions require significant supportive infrastructure for diagnostics, staging and treatment. In addition to morphologic diagnosis, diagnostic pathways in oncology frequently require immunohistochemistry (IHC) for confirmation. We present the experience of a tertiary-care hospital serving rural western Kenya, which developed and validated an IHC laboratory in support of a growing cancer care service.Objectives, methods and outcomes: Over the past decade, in an academic North-South collaboration, cancer services were developed for the catchment area of Moi Teaching and Referral Hospital in western Kenya. A major hurdle to treatment of cancer in a resource-limited setting has been the lack of adequate diagnostic services. Building upon the foundations of a histology laboratory, strategic investment and training were used to develop IHC services. Key elements of success in this endeavour included: translation of resource-rich practices to are source-limited setting, such as using manual, small-batch IHC instead of disposable- and maintenance-intensive automated machinery, engagement of outside expertise to develop reagent-efficient protocols and supporting all levels of staff to meet the requirements of an external quality assurance programme.Conclusion: Development of low- and middle-income country models of services, such as the IHC laboratory presented in this paper, is critical for the infrastructure in resource-limited settings to address the growing cancer burden. We provide a low-cost model that effectively develops these necessary services in a challenging laboratory environment.

Smartphone-based DIY home microsurgical training with 3D printed microvascular clamps and Japanese noodles

2021 ◽  
Author(s):  
Zhi Yang Ng ◽  
Calum Honeyman ◽  
Alexandre G Lellouch ◽  
Ankur Pandya ◽  
Theodora Papavasiliou
Keyword(s):  
Back Wall ◽  
Internal Validation ◽  
Middle Income ◽  
Face To Face ◽  
Middle Income Countries ◽  
Video Recordings ◽  
Low Middle Income Countries ◽  
Konjac Flour ◽  
3D Printed ◽  
Set Up

We have recently incorporated simple modifications of the konjac flour noodle model to enable DIY home microsurgical training by (i) placing a smartphone on a mug to act as a microscope with at least 3.5-5x magnification, and (ii) rather than cannulating with a 22G needle as described by others, we have found that cannulation with a 23G needle followed by a second pass with an 18G needle will create a lumen (approx. 0.83 mm) without an overly thick and unrealistic “vessel” wall. The current set-up however, did not allow realistic evaluation of anastomotic patency as the noodles became macerated after application of standard microvascular clamps, which also did not facilitate practice of back-wall anastomoses. In order to simulate the actual operative environment as much as possible, we introduced the use of 3D printed microvascular clamps. These were modified from its previous iteration (suitable for use in silastic and chicken thigh vessels) and video recordings were submitted for internal validation by senior surgeons. A “wet” operative field where the knojac noodle lumen can be distended or collapsed, unlike other non-living models, was noted by senior surgeons. With the 3D clamps, the noodle could now be flipped over for back-wall anastomosis and allowed patency testing upon completion as it did not become macerated, unlike that from clinical microvascular clamps. The perceived advantages of this model are numerous. Not only does it comply with the 3Rs of simulation-based training, it can also reduce the associated costs of training by up to a hundred-fold or more when compared to a traditional rat course, and potentially, be extended to low-middle income countries (LMICs) without routine access to microsurgical training for capacity development. That it can be utilised remotely also bodes well with the current limitations on face to-face training due to COVID restrictions and lockdowns.

scholarly journals Prevalence and factors associated with poor mental health among healthcare professionals in low- and lower-middle-income countries: a systematic review protocol

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Julia Lohmann ◽  
Denny John ◽  
Aso Dzay
Keyword(s):  
Mental Health ◽  
Healthcare Professionals ◽  
Health Workers ◽  
Poor Mental Health ◽  
Psychological Wellbeing ◽  
Health Issues ◽  
Middle Income ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Mental Health Issues

Abstract Background A healthy and productive health workforce is central to a well-functioning health system. However, health workers are at high risk of poor psychological wellbeing due to their particularly strenuous work demands. While mental health of health workers is a well-researched issue in high-income countries, research from low- and lower-middle-income countries (LLMIC) has begun to emerge only recently. The review aims to synthesize this body of research, specifically to assess the prevalence of mental health issues among health workers in LLMIC, to identify factors associated with good or poor mental health, and to highlight gaps in knowledge. Methods We will perform a systematic search of the published English and French language literature (from inception onwards) in MEDLINE, EMBASE, and PsycINFO. Eligible for inclusion are observational studies (e.g., cross-sectional, case-control, or cohort) and control arms of randomized controlled trials reporting investigations on the nature, prevalence, and factors associated with mental health or psychological wellbeing among formally trained health professionals and health associate professionals delivering health services in formal healthcare facilities in LLMIC. The primary outcomes will be burnout, depression, and general psychological wellbeing. Secondary outcomes include other specific mental health diagnoses, as well as general psychological stress, distress and/or trauma if work-related and explicitly framed as a mental health issue. Two authors will independently examine the studies against the eligibility criteria in the stages of title, abstract, and full-text study selection, as well as assess the risk of bias in included studies using standard checklists depending on study design. Disagreements will be resolved in discussion with the third author. Data will be extracted from included studies using a predefined and piloted coding framework. Given the anticipated heterogeneity of studies, we do not expect to be able to conduct meta-analysis and plan to summarize the extracted data in narrative form. The framework method will be used to organize narrative data by subthemes and explore patterns. Discussion In assessing the prevalence of mental health issues among healthcare professionals in LLMIC and identifying factors associated with positive or poor mental health, the review aims to synthesize all possible available information for policy makers and health system managers on a potentially highly important but not yet much-discussed issue and to highlight gaps in currently available knowledge. Systematic review registration International Prospective Register of Systematic Reviews PROSPERO (registration number CRD42019140036)

scholarly journals Comparing use and acceptability of menstrual cups and sanitary pads by schoolgirls in rural Western Kenya

2019 ◽  
Vol 8 (8) ◽  
pp. 2974
Author(s):  
Linda Mason ◽  
Elizabeth Nyothach ◽  
Anna Maria Van Eijk ◽  
David Obor ◽  
Kelly T. Alexander ◽  
...  
Keyword(s):  
Linear Trend ◽  
Prior Experience ◽  
Middle Income ◽  
Western Kenya ◽  
Middle Income Countries ◽  
Product Use ◽  
Sanitary Pads ◽  
Menstrual Products ◽  
Over Time

Background: Girls in low and middle-income countries (LMIC) lack access to hygienic and affordable menstrual products. We explore Kenyan schoolgirls’ use and views of the cup compared to girls provided with disposable sanitary pads for a feasibility study.Methods: Schoolgirls aged 14-16 years, received a menstrual cup in 10 schools or 16 pads/month in another10 schools. All were trained by nurses on puberty, hand washing, and product use. They self-completed a net book survey at baseline and twice a term during a year follow-up. We examined their reported ease of insertion and removal, also comfort, soreness, and pain with product use. An aggregate ‘acceptability’ score was compiled for each product and girls’ socio-demographic and menstrual characteristics were compared.Results: 195 participants received cups and 255 pads. Mean age was 14.6 years, menarchial age was 13.6 years, with an average 3.8 days menses per month. Cup use was 39% in month 1, rising to 80% by month 12 (linear trend p<0.001). Pad use rose from 85% to 92% (linear trend p=0.15). Measures of cup acceptability demonstrated girls had initial problems using the cup but reported difficulties with insertion, removal and comfort reduced over time. Girls using pads reported fewer acceptability issues. At baseline, approximately a quarter of girls in the pad arm reported inserting pads intravaginally although this was significantly lower among girls with prior experience of pad use (aRR 0.62; 0.45-0.87).Conclusions: While a smaller proportion of girls provided with cups used them in the first months compared to girls given pads, reported use was similar by study-end, and early acceptability issues reduced over time. Girls in LMIC may successfully and comfortably use cups, but require instruction, support and some persistence.

scholarly journals The impact of pulse oximetry on diagnosis, management and outcomes of acute febrile illness in low-income and middle-income countries: a systematic review

2021 ◽  
Vol 6 (11) ◽  
pp. e007282
Author(s):  
Rusheng Chew ◽  
Meiwen Zhang ◽  
Arjun Chandna ◽  
Yoel Lubell
Keyword(s):  
Pulse Oximetry ◽  
Patient Outcomes ◽  
Febrile Illness ◽  
Risk Of Bias ◽  
Acute Febrile Illness ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
Hospital Referral ◽  
The Impact

BackgroundAcute fever is a common presenting symptom in low/middle-income countries (LMICs) and is strongly associated with sepsis. Hypoxaemia predicts disease severity in such patients but is poorly detected by clinical examination. Therefore, including pulse oximetry in the assessment of acutely febrile patients may improve clinical outcomes in LMIC settings.MethodsWe systematically reviewed studies of any design comparing one group where pulse oximetry was used and at least one group where it was not. The target population was patients of any age presenting with acute febrile illness or associated syndromes in LMICs. Studies were obtained from searching PubMed, EMBASE, CABI Global Health, Global Index Medicus, CINAHL, Cochrane CENTRAL, Web of Science and DARE. Further studies were identified through searches of non-governmental organisation websites, snowballing and input from a Technical Advisory Panel. Outcomes of interest were diagnosis, management and patient outcomes. Study quality was assessed using the Cochrane Risk of Bias 2 tool for Cluster Randomised Trials and Risk of Bias in Non-randomized Studies of Interventions tools, as appropriate.ResultsTen of 4898 studies were eligible for inclusion. Their small number and heterogeneity prevented formal meta-analysis. All studies were in children, eight only recruited patients with pneumonia, and nine were conducted in Africa or Australasia. Six were at serious risk of bias. There was moderately strong evidence for the utility of pulse oximetry in diagnosing pneumonia and identifying severe disease requiring hospital referral. Pulse oximetry used as part of a quality-assured facility-wide package of interventions may reduce pneumonia mortality, but studies assessing this endpoint were at serious risk of bias.ConclusionsVery few studies addressed this important question. In LMICs, pulse oximetry may assist clinicians in diagnosing and managing paediatric pneumonia, but for the greatest impact on patient outcomes should be implemented as part of a health systems approach. The evidence for these conclusions is not widely generalisable and is of poor quality.

scholarly journals Root Causes of Fungal Coinfections in COVID-19 Infected Patients

2021 ◽  
Vol 13 (4) ◽  
pp. 1018-1035
Author(s):  
Arman Amin ◽  
Artin Vartanian ◽  
Nicole Poladian ◽  
Alexander Voloshko ◽  
Aram Yegiazaryan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Mechanical Ventilation ◽  
Patient Outcomes ◽  
Fungal Pathogens ◽  
Healthcare Providers ◽  
Clinical Manifestations ◽  
Middle Income ◽  
Middle Income Countries ◽  
Favorable Conditions

COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has infected over 200 million people, causing over 4 million deaths. COVID-19 infection has been shown to lead to hypoxia, immunosuppression, host iron depletion, hyperglycemia secondary to diabetes mellitus, as well as prolonged hospitalizations. These clinical manifestations provide favorable conditions for opportunistic fungal pathogens to infect hosts with COVID-19. Interventions such as treatment with corticosteroids and mechanical ventilation may further predispose COVID-19 patients to acquiring fungal coinfections. Our literature review found that fungal coinfections in COVID-19 infected patients were most commonly caused by Aspergillus, Candida species, Cryptococcus neoformans, and fungi of the Mucorales order. The distribution of these infections, particularly Mucormycosis, was found to be markedly skewed towards low- and middle-income countries. The purpose of this review is to identify possible explanations for the increase in fungal coinfections seen in COVID-19 infected patients so that physicians and healthcare providers can be conscious of factors that may predispose these patients to fungal coinfections in order to provide more favorable patient outcomes. After identifying risk factors for coinfections, measures should be taken to minimize the dosage and duration of drugs such as corticosteroids, immunosuppressants, and antibiotics.

The Identification and Evaluation of Methodologies to Assess the Quality of mHealth apps in High, Low & Middle-Income Countries: a Rapid Review (Preprint)

2021 ◽  
Author(s):  
Fionn Woulfe ◽  
Philip Kayode Fadahunsi ◽  
Simon Smith ◽  
Griphin Baxter Chirambo ◽  
Emma Larsson ◽  
...  
Keyword(s):  
Quality Assessment ◽  
Healthcare Professionals ◽  
Rapid Review ◽  
Screening Process ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
Mhealth Apps ◽  
Low And Middle Income

BACKGROUND There has been a rapid growth in the availability and use of mobile health (mHealth) apps around the world in recent years. However, consensus regarding an accepted standard to assess the quality of such apps does not exist. Differing interpretations of quality add to this problem. Consequently, it has become increasingly difficult for healthcare professionals to distinguish apps of high quality from those of lower quality. This exposes both patients and healthcare professionals to unnecessary risk. Despite progress, limited understanding of contributions by those in low- and middle- income countries (LMIC) on this topic exists. As such, the applicability of quality assessment methodologies in LMIC settings remains unexplored. OBJECTIVE The objectives of this rapid review are to; 1) Identify current methodologies within the literature to assess the quality of mHealth apps. 2) Understand what aspects of quality these methodologies address. 3) Determine what input has been made by authors from LMICs. 4) Examine the applicability of such methodologies in low- and middle- income settings. METHODS The review is registered with Prospero (CRD42020205149). A search of PubMed, EMBASE, Web of Science and Scopus was performed for papers relating to mHealth app quality assessment methodologies, published in English between 2005 and the 28th of December, 2020. A thematic and descriptive analysis of methodologies and papers was performed. RESULTS Electronic database searches identified 841 papers. After the screening process, 53 papers remained for inclusion; 6 proposed novel methodologies which could be used to evaluate mHealth apps of diverse medical areas of interest; 8 proposed methodologies which could be used to assess apps concerned with a specific medical focus; 39 used methodologies developed by other published authors to evaluate the quality of various groups of mHealth apps. Authors of 3 papers were solely affiliated to institutes in LMICs. A further 8 papers had at least one co-author affiliated to an institute in a LMIC. CONCLUSIONS Quality assessment of mHealth apps is complex in nature and at times, subjective. Despite growing research on this topic, to date an all-encompassing, appropriate means for evaluating the quality of mHealth apps does not exist. There has been engagement with authors affiliated to institutes in LMICs, however limited consideration of current generic methodologies for application in a LMIC settings have been identified.

scholarly journals Economic evaluations of HBV testing and treatment strategies and applicability to low and middle-income countries

2017 ◽  
Vol 17 (S1) ◽  
Author(s):  
Shevanthi Nayagam ◽  
Elisa Sicuri ◽  
Maud Lemoine ◽  
Philippa Easterbrook ◽  
Lesong Conteh ◽  
...  
Keyword(s):  
Treatment Strategies ◽  
Economic Evaluations ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

‘Everyone is exhausted and frustrated’: exploring psychosocial impacts of the lack of access to safe water and adequate sanitation in Usoma, Kenya

2016 ◽  
Vol 6 (2) ◽  
pp. 205-214 ◽  
Author(s):  
Elijah Bisung ◽  
Susan J. Elliott
Keyword(s):  
Health Issues ◽  
Group Discussions ◽  
Water And Sanitation ◽  
Middle Income ◽  
Western Kenya ◽  
Safe Water ◽  
Middle Income Countries ◽  
Psychosocial Concerns ◽  
Psychosocial Impacts ◽  
Negative Identity

The lack of access to safe water and adequate sanitation pose significant health challenges for many individuals and communities in low and middle-income countries. Aside from direct health issues, the lack of access to safe water and adequate sanitation is increasingly associated with psychosocial concerns that affect the wellbeing of individuals and communities. However, the nature of these concerns has received little attention in peer-reviewed literature. This paper draws on environmental stress and ecosocial theories to explore psychosocial concerns related to water and sanitation in Usoma, a lakeshore community in Western Kenya. The study used qualitative key informant interviews (n = 9) and focus group discussions (n = 10). Results reveal deep feelings of anxiety and frustration, embarrassment, negative identity, feelings of marginalization, and lack of self-efficacy. These stressors were a byproduct of daily lived experiences associated with lack of access to safe water and adequate sanitation, as well as the coping strategies people adopted. The paper suggests that benefits of water interventions transcend disease reduction to improved wellbeing through complex social pathways. The findings contribute to knowledge gaps within the water–health nexus and direct policy responses toward largely unexplored psychosocial concerns associated with water and sanitation.

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