scholarly journals Multiple sclerosis in resource-limited settings

Neurology ◽  
2019 ◽  
Vol 93 (4) ◽  
pp. 176-180 ◽  
Author(s):  
Farrah J. Mateen
Keyword(s):  
Multiple Sclerosis ◽  
Low Income ◽  
Care Delivery ◽  
Point Of Care ◽  
Models Of Care ◽  
Low Income Countries ◽  
Resource Limited Settings ◽  
Middle Income ◽  
Clinical Registries ◽  
Resource Limited

This position piece is meant to extend the humanitarian argument for assisting people with multiple sclerosis (MS) in resource-limited settings, in this case, through research. It is also meant to highlight areas of strength of some low- and middle-income countries (LMICs), and therefore emphasize how the field of MS could best be served globally by more research with and for resource-limited populations. Possible areas of particular strength include (1) ethnicity, genetic diversity, and migration studies; (2) analysis of possibly emerging environmental and lifestyle-related risk factors; (3) understanding the immune system when exposed to novel pathogens and various infectious agents; (4) reverse innovation to promote better point-of-care diagnostic tests; (5) high participation rates in clinical registries and research; (6) appreciation of MS in special populations including a higher focus on pediatrics and pregnancy; (7) culturally adept means of treatment and rehabilitating disability; (8) models of care delivery for chronic, complex neurologic diseases; and (9) use of off-label, generic, and less commonly implemented disease-modifying therapy sequences. Strategies for strengthening the MS research landscape include (1) creation of centers of research excellence in LMICs and twinning of institutions between high- and low-income countries; (2) standardization of research procedures and reduction of bureaucracies; (3) consensus meetings and network building; (4) opening additional avenues for publications and expanding the types of available publications; (5) identifying and establishing dedicated funding mechanisms; (6) focus on local relevance; and (7) setting expectations to include patients from LMICs in international clinical trials. These underutilized opportunities build an argument that global partnerships for research and knowledge coordination could better reach across populations, geographies, economies, and expertise.

scholarly journals Point of Care Diagnostics in Resource-Limited Settings: A Review of the Present and Future of PoC in Its Most Needed Environment

Biosensors ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 133
Author(s):  
Benjamin Heidt ◽  
Williane Siqueira ◽  
Kasper Eersels ◽  
Hanne Diliën ◽  
Bart van Grinsven ◽  
...  
Keyword(s):  
Low Income ◽  
Value Chain ◽  
Point Of Care ◽  
Healthcare Providers ◽  
Low Income Countries ◽  
Patient Treatment ◽  
Resource Limited Settings ◽  
Widespread Application ◽  
Resource Limited ◽  
Fundamental Research

Point of care (PoC) diagnostics are at the focus of government initiatives, NGOs and fundamental research alike. In high-income countries, the hope is to streamline the diagnostic procedure, minimize costs and make healthcare processes more efficient and faster, which, in some cases, can be more a matter of convenience than necessity. However, in resource-limited settings such as low-income countries, PoC-diagnostics might be the only viable route, when the next laboratory is hours away. Therefore, it is especially important to focus research into novel diagnostics for these countries in order to alleviate suffering due to infectious disease. In this review, the current research describing the use of PoC diagnostics in resource-limited settings and the potential bottlenecks along the value chain that prevent their widespread application is summarized. To this end, we will look at literature that investigates different parts of the value chain, such as fundamental research and market economics, as well as actual use at healthcare providers. We aim to create an integrated picture of potential PoC barriers, from the first start of research at universities to patient treatment in the field. Results from the literature will be discussed with the aim to bring all important steps and aspects together in order to illustrate how effectively PoC is being used in low-income countries. In addition, we discuss what is needed to improve the situation further, in order to use this technology to its fullest advantage and avoid “leaks in the pipeline”, when a promising device fails to take the next step of the valorization pathway and is abandoned.

3D Printing of Microfluidics for Point of Care Diagnosis

2017 ◽  
Author(s):  
John P. Sibbitt ◽  
Mei He
Keyword(s):  
3D Printing ◽  
Low Income ◽  
Point Of Care ◽  
Low Cost ◽  
High Sensitivity ◽  
Disease Diagnosis ◽  
Low Income Countries ◽  
3D Design ◽  
Resource Limited ◽  
Production Techniques

Microfluidic lab-on-a-chip (MLOC) technology is a promising approach for point-of-care (POC) diagnosis; low reagent consumption, high sensitivity and quick analysis time are the most prominent benefits. However, microfabrication of MLOCs utilizes specialized techniques and infrastructure, making conventional fabrication time consuming and difficult. While relatively inexpensive production techniques exist for POC diagnoses, such as replication of polymer-based (e.g., PDMS) microfluidic POC devices on lithographic molds, this approach has limitations including: further hydrophilic surface modifications of PDMS, inability to change lithographic mold Z dimensions, and slow prototyping. In contrast, stereo-lithographical (SLA) printing can integrate all of the necessary fabrication resources in one instrument, allowing highly versatile microfluidic devices to be made at low cost. In this paper, we report two microfabrication approaches of microfluidics utilizing (SLA) 3D printing technology: I) Direct SLA printing of channels and structures of a monolithic microfluidic POC device; II) Indirect fabrication, utilizing SLA 3D printed molds for PDMS based microfluidic device replication. Additionally, we discuss previous work providing a proof of concept of applications in POC diagnosis, using direct 3D printing fabrication (approach I). The robustness and simplicity of these protocols allow integrating 3D design and microfabrication with smartphone-based disease diagnosis as a stand-alone system, offering strong adaptability for establishing diagnostic capacity in resource-limited areas and low-income countries.

scholarly journals Laparoscopy in Low-Income Countries: 10-Year Experience and Systematic Literature Review

2021 ◽  
Vol 18 (11) ◽  
pp. 5796
Author(s):  
Damiano Pizzol ◽  
Mike Trott ◽  
Igor Grabovac ◽  
Mario Antunes ◽  
Anna Claudia Colangelo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Income ◽  
Health Workers ◽  
Open Appendectomy ◽  
Low Income Countries ◽  
Middle Income ◽  
Resource Limited ◽  
Stay Time ◽  
Operative Recovery ◽  
Operative Costs

Laparoscopy is a procedure that ultimately reduces hospital stay time and speeds up post-operative recovery. It is mainly performed in high-income countries but its implementation in many low- and middle-income countries (LMICs) is increasing. However, no aggregate data exist regarding the outcomes of this procedure in resource-limited settings. We retrospectively reviewed all cases of laparoscopy recorded from January 2007 to March 2017 at the Department of Surgery of Beira to assess the related outcomes. Moreover, we performed a systematic review of the laparoscopic practices and outcomes in low-income countries. Data from the Department of Surgery of Beira identified 363 laparoscopic procedures, mainly relating to gynecological diseases, cholelithiasis, and appendicectomy with only a 1.6% complication rate (6 cases) and a 1.9% conversion rate (7 cases) to open surgery. The systematic review showed a pooled risk of overall complications significantly lower in laparoscopic vs. open appendicectomy (OR = 0.43; 95% CI 0.19–0.97; I2 = 85.7%) and a significantly lower risk of infection (OR = 0.53; 95% CI 0.43–0.65; I2 = 0.00%). The pooled SMD in operation duration in laparoscopic vs. open appendectomy was 0.58 (95% CI −0.00; 1.15; I2 = 96.52), while the pooled SMD in hospitalization days was −1.35 (95% CI −1.87; −0.82; I2 = 96.41). Laparoscopy is an expensive procedure to adopt as it requires new equipment and specialized trained health workers. However, it could reduce post-operative costs and complications, especially in terms of infections. It is crucial to increase its accessibility, acceptability, and quality particularly in LMICs, especially during this COVID-19 era when the reduction of patient hospitalization is essential.

scholarly journals Global surgery: Improving health in low-income countries

2021 ◽  
Vol 20 (3) ◽  
pp. 483-486
Author(s):  
Orhan Alimoglu ◽  
Nuray Colapkulu
Keyword(s):  
Low Income ◽  
Medical Science ◽  
Surgical Care ◽  
Global Surgery ◽  
Low Income Countries ◽  
Middle Income ◽  
Resource Limited ◽  
Surgical Workforce ◽  
Surgical Conditions ◽  
Definition Of

The aim of this report is to examine the definition of global surgery, discuss the problems and propose some suggestions. Global surgery aims to improve the surgical conditions to maintain a standard and equal surgical care, especially in low- and middle-income countries where burden of surgical diseases are increasing over the years. According to Lancet Commission on Global Surgery, 1.27 million more surgical healthcare workers will be required to provide minimal surgical workforce, by 2030. In resource-limited settings of the world-wide where medical education and post-graduation training programs are disrupted due to brain drain, instable conditions and economic reasons, sustaining a standard and accessible surgical care are possible by training surgeons. Bangladesh Journal of Medical Science Vol.20(3) 2021 p.483-486

scholarly journals Approaches to Improve the Surveillance, Monitoring, and Management of Noncommunicable Diseases in HIV-Infected Persons: Viewpoint (Preprint)

2018 ◽  
Author(s):  
Pragna Patel ◽  
Keith Sabin ◽  
Peter Godfrey-Faussett
Keyword(s):  
Low Income ◽  
Healthy Aging ◽  
Care Delivery ◽  
Models Of Care ◽  
Sub Saharan Africa ◽  
Noncommunicable Diseases ◽  
Renal Diseases ◽  
Middle Income ◽  
Chronic Respiratory Diseases ◽  
Persons Living With Hiv

UNSTRUCTURED Low-income and middle-income countries (LMICs) are undergoing an epidemiological transition, in which the burden of noncommunicable diseases (NCDs) is rising and mortality will shift from infectious diseases to NCDs. Specifically, cardiovascular disease, diabetes, renal diseases, chronic respiratory diseases, and cancer are becoming more prevalent. In some regions, particularly sub-Saharan Africa, the dual HIV and NCD epidemics will pose challenges because their joint burden will have adverse effects on the quality of life and will likely increase global inequities. Given the austere clinical infrastructure in many LMICs, innovative models of care delivery are needed to provide comprehensive care in resource-limited settings. Improved data collection and surveillance of NCDs among HIV-infected persons in LMICs are necessary to inform integrated NCD-HIV prevention, care, and treatment models that are effective across a range of geographic settings. These efforts will preserve the considerable investments that have been made to prevent the number of lives lost to HIV, promote healthy aging of persons living with HIV, and contribute to meeting United Nations Sustainable Development Goals.

scholarly journals 590Online + In-person: A Model for the Instruction of Contemporary Epidemiologic Methods in Resource-Limited Settings

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Vivian Avelino-silva ◽  
Aggrey Semeere ◽  
Miriam Laker-Oketta ◽  
Helen Byakwaga ◽  
Mark Pletcher ◽  
...  
Keyword(s):  
Small Group ◽  
Low Income ◽  
Epidemiologic Methods ◽  
Low Cost ◽  
Group Discussion ◽  
Low Income Countries ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
High Level ◽  
The U.S

Abstract Focus of Presentation Many low-income countries cannot support faculty to develop contemporary graduate-level courses in epidemiology and biostatistics. There are also insufficient resources to support all students who are interested in traveling abroad to study in resource-rich settings. To address this, we describe our experience with training a few students from resource-limited countries in the U.S. who have subsequently returned to their home countries and became instructors in a novel online plus in-person teaching model. Findings Most courses at our major U.S. training program in epidemiology videotape lectures for viewing on one’s own and post all other materials (e.g., homework) on the course’s website. The weekly learning cycle culminates with an in-person high-level small group discussion, led by a faculty member who facilitates 10-15 students. For the past 5 years, non-U.S. scholars from Africa and South America who have taken our courses in the U.S. have travelled back to their countries and become small group leaders for our courses. Identical to U.S. students, the students in these international venues view videotaped lectures, access other materials online, and have weekly in-person small group discussions. These international students represent another concurrent small group for the U.S-based course; they have identical access and evaluation. Conclusions By pairing online resources from a resource-rich setting with local in-person instruction, we provide students in resource-limited settings access to contemporary instruction in epidemiology at very low cost. Key messages Online plus local in-person teaching is a feasible model for providing instruction regarding epidemiologic methods in resource-limited settings.

Optimizing public health strategies in low-income countries: epidemiology, ecology and evolution for the control of malaria

2018 ◽  
Author(s):  
Eve Miguel ◽  
Florence Fournet ◽  
Serge Yerbanga ◽  
Nicolas Moiroux ◽  
Franck Yao ◽  
...  
Keyword(s):  
Low Income ◽  
Evolutionary Biology ◽  
World Health ◽  
Low Income Countries ◽  
Health Improvement ◽  
Middle Income ◽  
Resource Limited ◽  
Spatio Temporal ◽  
Health Organization ◽  
Public Health Strategies

During the 20th century, health inequalities among countries have increased. Several factors explain this pattern, such as immunization and massive antibiotherapy, but nutrition, housing and hygiene are key parameters for health improvement. This heterogeneity among countries is well illustrated by malaria, although disappeared from many high-income countries, is still endemic and prevalent in low- and middle-income countries. We question these differences and detail the recommendations proposed by the World Health Organization to tackle malaria. We investigate the optimal combination of actions to deploy in resource-limited countries and the best spatio-temporal window to target. We propose a new framework for health program management based on evolutionary biology approaches to tailor global programs, to improve their local efficiency and avoid resistance. Thus, we explore all components of the ecological niche of the parasite (human, vector and environment) and consider the magnitude of actions to deploy to reach its local.

scholarly journals Anticipating the future: prognostic tools as a complementary strategy to improve care for patients with febrile illnesses in resource-limited settings

2021 ◽  
Vol 6 (7) ◽  
pp. e006057
Author(s):  
Arjun Chandna ◽  
Jennifer Osborn ◽  
Quique Bassat ◽  
David Bell ◽  
Sakib Burza ◽  
...  
Keyword(s):  
Low Income ◽  
New Technologies ◽  
Febrile Illness ◽  
Use Cases ◽  
Resource Limited Settings ◽  
Middle Income ◽  
Prognostic Research ◽  
Stakeholder Consultation ◽  
Middle Income Countries ◽  
Resource Limited

In low-income and middle-income countries, most patients with febrile illnesses present to peripheral levels of the health system where diagnostic capacity is very limited. In these contexts, accurate risk stratification can be particularly impactful, helping to guide allocation of scarce resources to ensure timely and tailored care. However, reporting of prognostic research is often imprecise and few prognostic tests or algorithms are translated into clinical practice.Here, we review the often-conflated concepts of prognosis and diagnosis, with a focus on patients with febrile illnesses. Drawing on a recent global stakeholder consultation, we apply these concepts to propose three use-cases for prognostic tools in the management of febrile illnesses in resource-limited settings: (1) guiding referrals from the community to higher-level care; (2) informing resource allocation for patients admitted to hospital and (3) identifying patients who may benefit from closer follow-up post-hospital discharge. We explore the practical implications for new technologies and reflect on the challenges and knowledge gaps that must be addressed before this approach could be incorporated into routine care settings.Our intention is that these use-cases, alongside other recent initiatives, will help to promote a harmonised yet contextualised approach for prognostic research in febrile illness. We argue that this is especially important given the heterogeneous settings in which care is often provided for patients with febrile illnesses living in low-income and middle-income countries.

scholarly journals Validation of a point-of-care rapid diagnostic test for hepatitis C for use in resource-limited settings

2019 ◽  
Vol 11 (4) ◽  
pp. 314-315
Author(s):  
James S Leathers ◽  
Maria Belen Pisano ◽  
Viviana Re ◽  
Gertine van Oord ◽  
Amir Sultan ◽  
...  
Keyword(s):  
Point Of Care ◽  
Low Cost ◽  
Rapid Diagnosis ◽  
Direct Acting Antivirals ◽  
Resource Limited Settings ◽  
Rapid Diagnosis Test ◽  
Resource Limited ◽  
Specificity And Sensitivity ◽  
Hcv Screening ◽  
Direct Acting

Abstract Background Treatment of HCV with direct-acting antivirals has enabled the discussion of HCV eradication worldwide. Envisioning this aim requires implementation of mass screening in resource-limited areas, usually constrained by testing costs. Methods We validated a low-cost, rapid diagnosis test (RDT) for HCV in three different continents in 141 individuals. Results The HCV RDT showed 100% specificity and sensitivity across different samples regardless of genotype or viral load (in samples with such information, 90%). Conclusions The HCV test validated in this study can allow for HCV screening in areas of need when properly used.

scholarly journals Aptamer-Based Diagnostic Systems for the Rapid Screening of TB at the Point-of-Care

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1352
Author(s):  
Darius Riziki Martin ◽  
Nicole Remaliah Sibuyi ◽  
Phumuzile Dube ◽  
Adewale Oluwaseun Fadaka ◽  
Ruben Cloete ◽  
...  
Keyword(s):  
Low Income ◽  
Point Of Care ◽  
Health Care Systems ◽  
Cost Effective ◽  
Rapid Screening ◽  
Low Income Countries ◽  
Sputum Smear ◽  
Diagnostic Systems ◽  
Molecular Tests ◽  
Rapid Tests

The transmission of Tuberculosis (TB) is very rapid and the burden it places on health care systems is felt globally. The effective management and prevention of this disease requires that it is detected early. Current TB diagnostic approaches, such as the culture, sputum smear, skin tuberculin, and molecular tests are time-consuming, and some are unaffordable for low-income countries. Rapid tests for disease biomarker detection are mostly based on immunological assays that use antibodies which are costly to produce, have low sensitivity and stability. Aptamers can replace antibodies in these diagnostic tests for the development of new rapid tests that are more cost effective; more stable at high temperatures and therefore have a better shelf life; do not have batch-to-batch variations, and thus more consistently bind to a specific target with similar or higher specificity and selectivity and are therefore more reliable. Advancements in TB research, in particular the application of proteomics to identify TB specific biomarkers, led to the identification of a number of biomarker proteins, that can be used to develop aptamer-based diagnostic assays able to screen individuals at the point-of-care (POC) more efficiently in resource-limited settings.

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