scholarly journals Pilot Educational Intervention and Feasibility Assessment of Breast Ultrasound in Rural South Africa

2017 ◽  
Vol 3 (5) ◽  
pp. 502-508 ◽  
Author(s):  
Lindsay K. Dickerson ◽  
Anne F. Rositch ◽  
Susan Lucas ◽  
Susan C. Harvey
Keyword(s):  
Breast Cancer ◽  
South Africa ◽  
Knowledge Acquisition ◽  
Self Efficacy ◽  
Breast Ultrasound ◽  
Perceived Usefulness ◽  
Middle Income ◽  
Middle Income Countries ◽  
Post Test ◽  
Low And Middle Income

Purpose Breast cancer is the leading cause of cancer death in women worldwide, with high mortality in low- and middle-income countries because of a lack of detection, diagnosis, and treatment. With mammography unavailable, ultrasound offers an alternative for downstaging. The literature reports successful training in various domains, but a focus on the breast is novel. We assessed the feasibility (knowledge acquisition, perceived usefulness, and self-efficacy) of breast ultrasound training for nonphysician providers. Methods Training was implemented for 12 providers at Hlokomela Clinic in Hoedspruit, South Africa, over 3 weeks. Didactic presentations and example cases were followed by a presurvey and test (n = 12). All providers received hands-on training with nurses as models; five providers trained with patients. A post-test (n = 12) assessed knowledge acquisition and a postsurvey (n = 10) assessed perceived program usefulness and provider self-efficacy. Results The pre- to post-test averages improved by 68% in total and in four competencies (foundational knowledge, descriptive categories, benign v malignant, and lesion identification). On the postsurvey, providers expressed that ultrasound could significantly influence breast cancer detection (9.1 out of 10), treatment (7.9 out of 10), and survival (8.7 out of 10) in their community and endorsed moderate confidence in their scanning (6.3 out of 10) and interpreting abilities (5.6 out of 10). Conclusion Our research supports the feasibility of breast ultrasound training as part of a breast education program in low- and middle-income countries. Pre- and post-test results and observed proficiency indicate that training nonphysician providers is achievable; postsurvey responses indicate program acceptance, community-based ownership, and provider self-efficacy with ultrasound. Future work may show that breast ultrasound is viable for early detection where mammography is unavailable.

scholarly journals An Educational Intervention and Feasibility Assessment of Breast Ultrasound in Rural South Africa

2018 ◽  
Vol 4 (Supplement 3) ◽  
pp. 14s-14s
Author(s):  
Lindsay K. Dickerson ◽  
Anne F. Rositch ◽  
Susan Lucas ◽  
Lisa A. Mullen ◽  
Susan C. Harvey
Keyword(s):  
Breast Cancer ◽  
South Africa ◽  
Early Detection ◽  
Self Efficacy ◽  
Conflicts Of Interest ◽  
Knowledge Retention ◽  
Middle Income ◽  
Feasibility Assessment ◽  
Post Test ◽  
Ibm Watson

Purpose Breast cancer is the leading cause of cancer death in women worldwide, with a strikingly high mortality in low- and middle-income countries (LMICs) as a result of the scarcity of detection, diagnosis, and treatment. With mammography unavailable, ultrasound (US) offers a viable alternative. The literature reports successful training in various domains, but a curriculum focused on the breast is novel. We assessed the feasibility—knowledge acquisition, perceived utility, and self-efficacy—of a breast US training program for the detection of breast cancer by nonphysician providers. Methods Training was implemented for 12 providers, including professional nurses, nursing assistants, and lay counselors, at Hlokomela clinic in Hoedspruit, South Africa, over 3 weeks. Didactic presentations and example cases were followed by a presurvey (n = 12) that characterized providers’ initial attitudes toward early detection and a pretest (n = 12) that determined immediate retention of knowledge and areas for focused training. All providers received hands-on training with nurses as models. Five providers trained with patients. A post-test (n = 12) assessed overall knowledge retention and acquisition, and a postsurvey (n = 10) gauged program acceptance and provider self-efficacy with breast US. Results Pretest to post-test averages improved by 68% overall and in four competencies—foundational knowledge, descriptive categories, benign versus malignant, and lesion identification. On the postsurvey, providers expressed the belief that US could significantly affect breast cancer detection (9.1/10), treatment (7.9/10), and survival (8.7/10) in their communities and endorsed moderate confidence in their scanning (6.3/10) and interpreting abilities (5.6/10). Conclusion There is a pressing need for a paradigm shift in breast cancer care in LMICs, with early detection critical to improving outcomes. Our research supports the feasibility of breast US training as part of a breast education program in LMICs. Pretest and post-test results and observed proficiency indicate that training nonphysician providers is achievable. Postsurvey responses indicate program acceptance, provider self-efficacy with US, and community-based ownership of a breast cancer screening and awareness initiative. Follow-up work that is focused on quality improvement and sustainability is ongoing. Future work may show that breast US is viable for early detection when mammography is unavailable. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Susan C. Harvey Consulting or Advisory Role: IBM Watson, Hologic Inc Research Funding: IBM Watson

The Economic Cost of Violence Against Women and Girls in Low- and Middle-Income Countries: A Systematic Review of the Evidence

2021 ◽  
pp. 152483802110160
Author(s):  
Seema Vyas ◽  
Melissa Meinhart ◽  
Katrina Troy ◽  
Hannah Brumbaum ◽  
Catherine Poulton ◽  
...  
Keyword(s):  
South Africa ◽  
Systematic Review ◽  
Violence Against Women ◽  
Economic Burden ◽  
Data Availability ◽  
Female Genital Cutting ◽  
Middle Income ◽  
Middle Income Countries ◽  
Women And Girls ◽  
Low And Middle Income

Evidence demonstrating the economic burden of violence against women and girls can support policy and advocacy efforts for investment in violence prevention and response programming. We undertook a systematic review of evidence on the costs of violence against women and girls in low- and middle-income countries published since 2005. In addition to understanding costs, we examined the consistency of methodological approaches applied and identified and assessed common methodological issues. Thirteen articles were identified, eight of which were from sub-Saharan Africa. Eight studies estimated costs associated with domestic or intimate partner violence, others estimated the costs of interpersonal violence, female genital cutting, and sexual assaults. Methodologies applied to estimate costs were typically based on accounting approaches. Our review found that out-of-pocket expenditures to individuals for seeking health care after an episode of violence ranged from US$29.72 (South Africa) to US$156.11 (Romania) and that lost productivity averaged from US$73.84 to US$2,151.48 (South Africa) per facility visit. Most studies that estimated provider costs of service delivery presented total programmatic costs, and there was variation in interventions, scale, and resource inputs measured which hampered comparability. Variations in methodological assumptions and data availability also made comparisons across countries and settings challenging. The limited scope of studies in measuring the multifaceted impacts of violence highlights the challenges in identifying cost metrics that extend beyond specific violence episodes. Despite the limited evidence base, our assessment leads us to conclude that the estimated costs of violence against women and girls are a fraction of its true economic burden.

scholarly journals Breast Cancer in Low- and Middle-Income Countries: An Emerging and Challenging Epidemic

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Arafat Tfayli ◽  
Sally Temraz ◽  
Rachel Abou Mrad ◽  
Ali Shamseddine
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Low Income ◽  
Therapeutic Interventions ◽  
Low Income Countries ◽  
Middle Income ◽  
Major Health ◽  
Middle Income Countries ◽  
Low And Middle Income

Breast cancer is a major health care problem that affects more than one million women yearly. While it is traditionally thought of as a disease of the industrialized world, around 45% of breast cancer cases and 55% of breast cancer deaths occur in low and middle income countries. Managing breast cancer in low income countries poses a different set of challenges including access to screening, stage at presentation, adequacy of management and availability of therapeutic interventions. In this paper, we will review the challenges faced in the management of breast cancer in low and middle income countries.

scholarly journals Using pictorial action instructions to build a basic humanitarian engineering project

2019 ◽  
Vol 14 (1) ◽  
pp. 60-70
Author(s):  
Kathleen Paco Cadman ◽  
Du Feng
Keyword(s):  
Self Efficacy ◽  
Intervention Group ◽  
Control Group ◽  
Low Literacy ◽  
Engineering Project ◽  
Middle Income ◽  
Middle Income Countries ◽  
Humanitarian Engineering ◽  
Engineering Projects ◽  
Low And Middle Income

Humanitarian engineering projects mitigate environmental hazards disproportionately affecting health in low- and middle-income countries. However, widespread literacy deficits can create barriers in training low-literacy adults to construct these projects, indicating a need for literacy-adapted training materials. A randomized control trial in rural Guatemala tested the usability of pictorial action instructions, compared to demonstration-only methods, in training low-literacy adults (N = 60; n = 30 per group) to construct a solar bottle bulb. Fourteen days after the training, participants individually constructed the solar bottle bulb. The intervention group received pictorial action instructions to guide them, and the control group completed construction based on memory. Usability was evaluated by measuring the effectiveness and efficiency of construction, as well as user satisfaction and self-efficacy levels. Effectiveness and self-efficacy were significantly better among those in the intervention group compared to the control group. Considering this, the findings support the use of pictorial action instructions in training low-literacy adults to construct humanitarian engineering projects. This method may allow more individuals in rural regions of low- and middle-income countries to successfully construct their own humanitarian engineering projects in a way that is sustainable and scalable. Further research is needed to test these instructions in different settings, on a larger scale, as well as to test the long-term effects of using pictorial action instructions. 

scholarly journals Breast Cancer in Low- and Middle-Income Countries

2018 ◽  
Vol 38 (1) ◽  
pp. 161-173 ◽  
Author(s):  
Yehoda M. Martei ◽  
Lydia E. Pace ◽  
Jane E. Brock ◽  
Lawrence N. Shulman
Keyword(s):  
Breast Cancer ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Factors that influence patient empowerment in inpatient chronic care: early thoughts on a diabetes care intervention in South Africa

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Nina Abrahams ◽  
Lucy Gilson ◽  
Naomi S. Levitt ◽  
Joel A. Dave
Keyword(s):  
South Africa ◽  
Diabetes Care ◽  
Chronic Care ◽  
Patient Empowerment ◽  
Self Management ◽  
Inpatient Setting ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Background The burden of non-communicable diseases is growing rapidly in low- and middle-income countries. Research suggests that health interventions that aim to improve patient self-management and empower patients to care actively for their disease will improve health outcomes over the long-term. There is, however, a gap in the literature about the potential role of the inpatient setting in supporting chronic care. This is particularly important in low-and-middle income countries where hospitals may be a rare prolonged point of contact between patient and health provider. The aim of this small scale, exploratory study was to understand what factors within the inpatient setting may affect patients’ feelings of empowerment in relation to their chronic disease care and provides recommendations for future inpatient-based interventions to support self-management of disease. Methods This study was based in a public, academic hospital in South Africa. Eighteen qualitative, semi-structured interviews were conducted with multiple participants with experience of diabetes care: inpatients and health professionals such as nurses, endocrinologists, and dieticians. Findings were analysed using a broad, exploratory, thematic approach, guided by self-management and chronic care literature. Results Interviews with both patients and providers suggest that patients living in low socio-economic contexts are likely to struggle to access appropriate healthcare information and services, and may often have financial and emotional priorities that take precedence over their chronic illness. Younger people may also be more dependent on their family and community, giving them less ability to take control of their disease care and lifestyle. In addition, hospital care remains bound by an acute care model; and the inpatient setting of focus is characterised by perceived staff shortages and ineffective communication that undermine the implementation of patient empowerment-focused interventions. Conclusions Patient and provider contexts are likely to make supporting patient engagement in long-term chronic care difficult in lower income settings. However, knowledge of these factors can be harnessed to improve chronic care interventions in South Africa and other similar countries.

scholarly journals Developing a Breast Cancer Screening Program in Nigeria: Evaluating Current Practices, Perceptions, and Possible Barriers

2017 ◽  
Vol 3 (5) ◽  
pp. 490-496 ◽  
Author(s):  
Olalekan Olasehinde ◽  
Carla Boutin-Foster ◽  
Olusegun I. Alatise ◽  
Adewale O. Adisa ◽  
Oladejo O. Lawal ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Low Income ◽  
Screening Program ◽  
Cross Sectional Survey ◽  
Middle Income ◽  
Screening Programs ◽  
Middle Income Countries ◽  
Low And Middle Income

Purpose In low- and middle-income countries like Nigeria, women present with advanced breast cancer at an earlier age. Given the limited resources, development of screening programs that parallel resource capabilities of low- and middle-income countries is imperative. The objective of this study was to evaluate the perceptions, practices, and barriers regarding clinical breast examination (CBE) screening in a low-income community in Nigeria. Materials and Methods A cross-sectional survey of women age 40 years or older in Ife, Nigeria, using multistaged sampling was performed. Information on sociodemographics, knowledge of breast cancer, screening practices, and willingness to participate in CBE screening was obtained using an interviewer-administered questionnaire. Results A total of 1,169 women whose ages ranged from 40 to 86 years (mean age, 47.7 years; standard deviation, 8.79 years) were interviewed. The majority of women (94%) knew about breast cancer, whereas 27.5% knew someone who had had breast cancer, the majority of whom (64.5%) had died of the disease. Of the 36% of women who had breast screening recommended to them, only 19.7% had an actual CBE. Of these, only 6% had it in the last year. The majority of women (65.4%) were willing to have regular CBEs and did not care about the sex of the examiner in most instances. Lack of perceived need was the reason cited by women unwilling to participate. Conclusion The majority of women were aware of breast cancer and knew it as a fatal disease. With the relatively encouraging number of those willing to be examined, a carefully designed CBE program coupled with advocacy to correct uneducated beliefs seems promising.

scholarly journals Breast Oncoplasty Surgery in Low- and Middle-Income Countries: Lessons From India

2018 ◽  
Vol 4 (Supplement 3) ◽  
pp. 22s-22s
Author(s):  
Chaitanyanand B. Koppiker ◽  
Santosh Dixit ◽  
Aijaz Ul Noor ◽  
Laleh Busheri ◽  
Gail Lebovic ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Degree Program ◽  
Health Clinic ◽  
Middle Income ◽  
Middle Income Countries ◽  
Patient Reported ◽  
Hospitalization Costs ◽  
Hands On ◽  
Low And Middle Income

Purpose Breast cancer is the most common cancer in India, affecting all socio-economic strata. Despite its growing global acceptance, Breast Oncoplasty Surgery (BOS) remains nascent in India, necessitating local context-specific innovative delivery models for clinicians and the general public. Here, we present experiences from Orchids Breast Health Clinic (OBHC; Pune, India) with the implementation of BOS clinical services, training, and research and community outreach. Methods OBHC, a dedicated breast unit, has established the first dedicated BOS clinic in India, conducted hands-on training workshops for trainee surgeons, developed an MCh degree program in breast oncoplasty with the University of East Anglia (Norwich, United Kingdom), undertaken BOS research in Indian patients, and created outreach programs to popularize BOS. Results A cost-effective one surgeon–dual role concept wherein the same surgeon performs onco- and plastic surgery and one-stage implant-based breast reconstruction has been adopted. Since 2013, BOS cases included BCS (n = 440), breast reconstruction (n = 210), and therapeutic mammoplasty (n = 135). The unavailability of acellular dermal matrices has prompted the innovation of a surgical technique, termed Advanced Autologous Dermal Sling, which uses vascularized local tissue as implant cover. Significant improvement in postsurgery outcomes and protection against radiation complications has been observed. BOS hospitalization costs have been reduced by 50% thereby, which has led to high rates of acceptance (80%) of BOS in patients at OBHC. Young breast surgeons from across India and South Asian Association for Regional Cooperation countries have enrolled in the MCh degree program, which involves an embedded curriculum with online didactic modules and hands-on training workshops in Pune, India. Longitudinal follow-up after 1, 3, and 5 years postsurgery in the study cohorts is undertaken for post-BOS outcomes using clinical assessment (Bakers scale) and patient-reported outcomes measures (BREAST-Q questionnaire). Multiple research projects are undergoing peer-review before publication. To increase awareness of BOS among Indian women, community awareness campaigns with the theme of Losing Is Not an Option are underway via public talks, symposia, marathon, and op-eds in electronic and print media. Conclusion The OBHC model of Affordable Excellence in BOS, developed in the Indian context, can be extrapolated to benefit patients with breast cancer from other low- and middle-income countries. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.

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