scholarly journals Operationalisation of the Randomized Embedded Multifactorial Adaptive Platform for COVID-19 trials in a low and lower-middle income critical care learning health system.

2021 ◽  
Vol 6 ◽  
pp. 14
Author(s):  
Diptesh Aryal ◽  
Abi Beane ◽  
Arjen M. Dondorp ◽  
Cameron Green ◽  
Rashan Haniffa ◽  
...  
Keyword(s):  
Critical Care ◽  
Case Report Form ◽  
Public Health Importance ◽  
Middle Income ◽  
Learning Health System ◽  
Resource Limited ◽  
Hospitalised Patients ◽  
Context Specific ◽  
Training And Support ◽  
Network Collaboration

The Randomized Embedded Multifactorial Adaptive Platform (REMAP-CAP) adapted for COVID-19) trial is a global adaptive platform trial of hospitalised patients with COVID-19. We describe implementation in three countries under the umbrella of the Wellcome supported Low and Middle Income Country (LMIC) critical  care network: Collaboration for Research, Implementation and Training in Asia (CCA). The collaboration sought to overcome known barriers to multi centre-clinical trials in resource-limited settings. Methods described focused on six aspects of implementation: i, Strengthening an existing community of practice; ii, Remote study site recruitment, training and support; iii, Harmonising the REMAP CAP- COVID trial with existing care processes; iv, Embedding REMAP CAP- COVID case report form into the existing CCA registry platform, v, Context specific adaptation and data management; vi, Alignment with existing pandemic and critical care research in the CCA. Methods described here may enable other LMIC sites to participate as equal partners in international critical care trials of urgent public health importance, both during this pandemic and beyond.

scholarly journals Pakistan Registry of Intensive CarE (PRICE): Expanding a lower middle-income, clinician-designed critical care registry in South Asia

2018 ◽  
Vol 20 (3) ◽  
pp. 190-195 ◽  
Author(s):  
M Hashmi ◽  
A Beane ◽  
A Taqi ◽  
MI Memon ◽  
P Athapattu ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Real Time ◽  
National Registry ◽  
Service Improvement ◽  
Intensive Care Society ◽  
Middle Income ◽  
Resource Limited ◽  
Care Systems ◽  
And Training

Introduction In resource-limited settings – with inequalities in access to and outcomes for trauma, surgical and critical care – intensive care registries are uncommon. Aim The Pakistan Society of Critical Care Medicine, Intensive Care Society (UK) and the Network for Improving Critical Care Systems and Training (NICST) aim to implement a clinician-led real-time national intensive care registry in Pakistan: the Pakistan Registry of Intensive CarE (PRICE). Method This was adapted from a successful clinician co-designed national registry in Sri Lanka; ICU information has been linked to real-time dashboards, providing clinicians and administrators individual patient and service delivery activity respectively. Output Commenced in August 2017, five ICU’s (three administrative regions – 104 beds) were recruited and have reported over 1100 critical care admissions to PRICE. Impact and future PRICE is being rolled out nationally in Pakistan and will provide continuous granular healthcare information necessary to empower clinicians to drive setting-specific priorities for service improvement and research.

scholarly journals Context matters in understanding the vulnerability of women: perspectives from southwestern Uganda

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Neema Murembe ◽  
Teddy Kyomuhangi ◽  
Kimberly Manalili ◽  
Florence Beinempaka ◽  
Primrose Nakazibwe ◽  
...  
Keyword(s):  
Health Workers ◽  
Geographical Location ◽  
Middle Income ◽  
Extreme Poverty ◽  
Economic Class ◽  
Individual Interviews ◽  
Resource Limited ◽  
The People ◽  
The Individual ◽  
Southwestern Uganda

Abstract Background Vulnerability at the individual, family, community or organization level affects access and utilization of health services, and is a key consideration for health equity. Several frameworks have been used to explore the concept of vulnerability and identified demographics including ethnicity, economic class, level of education, and geographical location. While the magnitude of vulnerable populations is not clearly documented and understood, specific indicators, such as extreme poverty, show that vulnerability among women is pervasive. Women in low and middle-income countries often do not control economic resources and are culturally disadvantaged, which exacerbates other vulnerabilities they experience. In this commentary, we explore the different understandings of vulnerability and the importance of engaging communities in defining vulnerability for research, as well as for programming and provision of maternal newborn and child health (MNCH) services. Methodology In a recent community-based qualitative study, we examined the healthcare utilization experiences of vulnerable women with MNCH services in rural southwestern Uganda. Focus group discussions were conducted with community leaders and community health workers in two districts of Southwestern Uganda. In addition, we did individual interviews with women living in extreme poverty and having other conventional vulnerability characteristics. Findings and discussion We found that the traditional criteria of vulnerability were insufficient to identify categories of vulnerable women to target in the context of MNCH programming and service provision in resource-limited settings. Through our engagement with communities and through the narratives of the people we interviewed, we obtained insight into how nuanced vulnerability can be, and how important it is to ground definitions of vulnerability within the specific context. We identified additional aspects of vulnerability through this study, including: women who suffer from alcoholism or have husbands with alcoholism, women with a history of home births, women that have given birth only to girls, and those living on fishing sites. Conclusion Engaging communities in defining vulnerability is critical for the effective design, implementation and monitoring of MNCH programs, as it ensures these services are reaching those who are most in need.

scholarly journals Fatal drowning in the Western Cape, South Africa: a 7-year retrospective, epidemiological study

2018 ◽  
Vol 25 (6) ◽  
pp. 529-534 ◽  
Author(s):  
Colleen Jayne Saunders ◽  
Robyn Adriaanse ◽  
Abigail Simons ◽  
Ashley van Niekerk
Keyword(s):  
South Africa ◽  
Young Adult ◽  
Low Income ◽  
Western Cape ◽  
Middle Income ◽  
Registration System ◽  
Drowning Prevention ◽  
Adult Men ◽  
Context Specific ◽  
Public Holidays

IntroductionDrowning is a neglected public health threat in low-income and middle-income countries where the greatest drowning burden is observed. There is a paucity of drowning surveillance data from low-resource settings, particularly in Africa. Understanding local epidemiological factors will enable the development of context-specific drowning prevention initiatives and the appropriate allocation of resources.AimThe primary aim of this study was to describe the epidemiology of fatal drowning in the Western Cape, South Africa.MethodThis retrospective study describes fatal drowning incidents captured in the Western Cape vital registration system between 2010 and 2016. Data were obtained from the Forensic Pathology Services of the Western Cape Government. One-way analysis of variance was performed to detect a trend in mean drowning mortality rates between 2010 and 2016. χ2 tests for independence were performed to detect differences in the distribution of variables between groups.ResultsA total of 1391 fatal drownings occurred in the Western Cape between 2010 and 2016, with an age-adjusted drowning mortality rate of 3.2 per 100 000 population. Rates were fourfold higher in men compared with women. Children, particularly young children aged 0–4 years, and young adult men between 20 and 34 years of age were identified to be at high risk of fatal drowning. Drowning occurred predominantly in large, open bodies of water with concentrations in summer and public holidays.ConclusionsThe Western Cape drowning prevention strategy should prioritise interventions to reduce drowning in children and young adult men, with a targeted focus on festive periods such as public holidays.

scholarly journals Investigating Capnography Innovation for Better Patient Monitoring in the Resource Limited Surgical Setting

2018 ◽  
Vol 26 (1) ◽  
pp. 124-128 ◽  
Author(s):  
Maziar M. Nourian ◽  
Patrick Kolbay ◽  
Soeren Hoehne ◽  
Ahrash E. Poursaid ◽  
Ann E. Rowley ◽  
...  
Keyword(s):  
In Silico ◽  
Low Cost ◽  
Sampling Rate ◽  
Middle Income ◽  
Resource Limited ◽  
Industry Standards ◽  
Environmental Sensor ◽  
Available Technology ◽  
Surgical Setting ◽  
Lung Simulation

Background. Access to basic anesthetic monitoring in the developing world is lacking, which contributes to the 100 times greater anesthesia-related mortality in low- and middle-income countries. We hypothesize that an environmental sensor with a lower sampling rate could provide some clinical utility by providing CO2 levels, respiratory rate, and support in detection of clinical abnormalities. Materials and Methods. A bench-top lung simulation was created to replicate CO2 waveforms, and an environmental sensor was compared with industry-available technology. Sensor response time and respiratory rates were compared between devices. Additionally, an in silico model was created to replicate capnography pathology as waveforms would appear using the environmental sensor. Results and Conclusion. Breath simulations using the bench-top lung simulation produced similar results to industry standards with a degree of variability. Respiratory rates did not differ between the environmental sensor and all other devices tested. Finally, pathological waveforms created in silico carried a certain level of detail regarding ventilatory pathology, which could provide some clinical insight to an anesthesiologist. We believe our prototype is the first step toward making low-cost and portable capnography available in the resource-limited setting, and future efforts should focus on bridging the gap to safer anesthesia and surgery globally.

scholarly journals Recent advances in understanding and preventing human papillomavirus-related disease

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 269 ◽  
Author(s):  
Karin Hellner ◽  
Lucy Dorrell
Keyword(s):  
Antiviral Agents ◽  
Intraepithelial Neoplasia ◽  
Human Papillomaviruses ◽  
Surgical Approaches ◽  
Therapeutic Vaccines ◽  
Middle Income ◽  
Recent Advances ◽  
Resource Limited ◽  
Technological Advances ◽  
Prophylactic Vaccination

High-risk human papillomaviruses (hrHPV) are responsible for anogenital and oropharyngeal cancers, which together account for at least 5% of cancers worldwide. Industrialised nations have benefitted from highly effective screening for the prevention of cervical cancer in recent decades, yet this vital intervention remains inaccessible to millions of women in low- and middle-income countries (LMICs), who bear the greatest burden of HPV disease. While there is an urgent need to increase investment in basic health infrastructure and rollout of prophylactic vaccination, there are now unprecedented opportunities to exploit recent scientific and technological advances in screening and treatment of pre-invasive hrHPV lesions and to adapt them for delivery at scale in resource-limited settings. In addition, non-surgical approaches to the treatment of cervical intraepithelial neoplasia and other hrHPV lesions are showing encouraging results in clinical trials of therapeutic vaccines and antiviral agents. Finally, the use of next-generation sequencing to characterise the vaginal microbial environment is beginning to shed light on host factors that may influence the natural history of HPV infections. In this article, we focus on recent advances in these areas and discuss their potential for impact on HPV disease.

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.

Peritoneal Dialysis for AKI in Cameroon: Commercial Vs Locally-Made Solutions

2018 ◽  
Vol 38 (4) ◽  
pp. 246-250 ◽  
Author(s):  
Dennis Palmer ◽  
William J. Lawton ◽  
Charles Barrier ◽  
B.D. Fine ◽  
Hayden Hemphill ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
High Mortality ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Resource Limited Settings ◽  
Significant Cost ◽  
Middle Income ◽  
Middle Income Countries ◽  
Resource Limited ◽  
Baptist Hospital

Background Acute kidney injury (AKI) is common in low- and middle-income countries, and is associated with a high mortality. The high mortality rate is in large part due to the inability to perform dialysis in resource-limited settings. Due to significant cost advantages, peritoneal dialysis (PD) has been used to treat AKI in these settings. The costs, however, remain high when commercial solutions are used. Methods This is a retrospective cohort study of the outcome, and of the peritonitis rates, of patients with AKI treated with either commercially manufactured PD solutions or locally-made PD solutions. A program to treat AKI with PD was started at Mbingo Baptist Hospital in Cameroon. Between May 2013 and January 2015, solutions and connection sets were provided by the Saving Young Lives Program. From January 2015 through March 2017, solutions were locally produced and available tubing was used. Results Mortality in hospitalized AKI patients was 28% during the period when commercial solutions and tubing were utilized, and 33% when locally produced solutions and available tubing were utilized. In both groups, peritonitis occurred in 16% of treatment courses. Conclusions Locally produced PD solutions, used with locally available tubing, were used to treat AKI with PD. The mortality and peritonitis rates were similar whether locally produced or commercial supplies were used.

Critical care outcomes in resource-limited settings

2018 ◽  
Vol 24 (5) ◽  
pp. 421-427 ◽  
Author(s):  
Marija Vukoja ◽  
Elisabeth D. Riviello ◽  
Marcus J. Schultz
Keyword(s):  
Critical Care ◽  
Critical Care Outcomes ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Care Outcomes
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