Towards Continuing Interprofessional Education: Interaction patterns of health professionals in a resource-limited setting

There are challenges related to collaboration among health professionals in resource-limited settings. Continuing Interprofessional Education initiatives grounded on workplace dynamics, structure and the prevailing attitudes and biases of targeted health professionals may be a vehicle to develop collaboration among health professionals. Workplace dynamics are revealed as health professionals interact. We argue that insights into the interaction patterns of health professionals in the workplace could provide guidance for improving the design and value of CIPE initiative. The study was conducted through rapid ethnography and data were collected from non-participant observations. The data were transcribed and analysed through an inductive iterative process. Appropriate ethical principles were applied throughout the study. Three themes emerged namely “Formed professional identities influencing interprofessional interaction”, “Diversity in communication networks and approaches” and “Professional practice and care in resource limited contexts”. This study revealed poor interaction patterns among health professionals within the workplace. These poor interaction patterns were catalyzed by the pervasive professional hierarchy, the protracted health professional shortages, limited understanding of professional roles and the lack of a common language of communication among the health professionals. Several recommendations were made regarding the design and development of Continuing Interprofessional Education initiatives for resource-limited settings.

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Health Data Management Practice and Associated Factors Among Health Professionals Working at Public Health Facilities in Resource Limited Settings

Advances in Medical Education and Practice ◽

10.2147/amep.s320769 ◽

2021 ◽

Vol Volume 12 ◽

pp. 855-862

Author(s):

Habtamu Setegn Ngusie ◽

Atsede Mazengia Shiferaw ◽

Adina Demissie Bogale ◽

Mohammedjud Hassen Ahmed

Keyword(s):

Public Health ◽

Data Management ◽

Health Professionals ◽

Associated Factors ◽

Management Practice ◽

Health Data ◽

Health Facilities ◽

Resource Limited Settings ◽

Public Health Facilities ◽

Resource Limited

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Prenatal diagnosis lowers neonatal cardiac care costs in resource-limited settings

Cardiology in the Young ◽

10.1017/s104795112100487x ◽

2022 ◽

pp. 1-7

Author(s):

Balu Vaidyanathan ◽

Karthika Rani ◽

Farooq Kunde ◽

Stephy Thomas ◽

Abish Sudhakar ◽

...

Keyword(s):

Prenatal Diagnosis ◽

Study Groups ◽

Cardiac Care ◽

Resource Limited Settings ◽

Resource Limited ◽

Income Ratio ◽

Modifiable Factor ◽

The Impact ◽

Care Costs ◽

Limited Setting

Abstract Background: Prenatal diagnosis of critical CHDs and planned peripartum care is an emerging concept in resource-limited settings. Objective: To report the impact of prenatal diagnosis and planned peripartum care on costs of neonatal cardiac care in a resource-limited setting. Methods: Prospective study (October 2019 to October 2020). Consecutive neonates undergoing surgery or catheter-based interventions included. Patients were divided into prenatal (prenatal diagnosis) and post-natal (diagnosis after birth) groups. Costs of cardiac care (total, direct, and indirect) and health expenses to income ratio were compared between study groups; factors impacting costs were analysed. Results: A total of 105 neonates were included, including 33 in prenatal group. Seventy-seven neonates (73.3%) underwent surgical procedures while the rest needed catheter-based interventions. Total costs were 16.2% lower in the prenatal group (p = 0.008). Direct costs were significantly lower in the prenatal group (18%; p = 0.02), especially in neonates undergoing surgery (20.4% lower; p = 0.001). Health expenses to income ratio was also significantly lower in the prenatal group (2.04 (1.03–2.66) versus post-natal:2.58 (1.55–5.63), p = 0.01);, particularly in patients undergoing surgery (prenatal: 1.58 (1.03–2.66) vs. post-natal: 2.99 (1.91–6.02); p = 0.002). Prenatal diagnosis emerged as the only modifiable factor impacting costs on multivariate analysis. Conclusion: Prenatal diagnosis and planned peripartum care of critical CHD is feasible in resource-limited settings and is associated with significantly lower costs of neonatal cardiac care. The dual benefit of improved clinical outcomes and lower costs of cardiac care should encourage policymakers in resource-limited settings towards developing more prenatal cardiac services.

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Stemming the Medical Brain Drain: A Personal Perspective on a Global Problem

Einstein Journal of Biology and Medicine ◽

10.23861/ejbm201631745 ◽

2017 ◽

Vol 31 (1&2) ◽

pp. 11

Author(s):

Saate Shakil

Keyword(s):

Global Health ◽

Brain Drain ◽

Health Professionals ◽

Relevant Literature ◽

Health Inequities ◽

Developed Countries ◽

Personal Perspective ◽

Brain Circulation ◽

Resource Limited Settings ◽

Resource Limited

The term “medical brain drain” refers to the international migration of physicians from the developing world to developed countries. This loss of health professionals contributes significantly to global health inequities. The issue has been framed in terms of ethical, financial, and infrastructural issues, and many attempts have been made to pose solutions that address the respective arms of this multifaceted phenomenon. This article seeks to explore the medical brain drain from a migrant physician’s personal perspective, contextualized with data and analysis from relevant literature. I conclude that adopting the mindset of “brain circulation” rather than “brain drain” will be a component in paving the way for multidisciplinary solutions to the problems that promote the migration of physicians from resource-limited settings.

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Performance of Metagenomic Next-Generation Sequencing for the Diagnosis of Viral Meningoencephalitis in a Resource-Limited Setting

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa046 ◽

2020 ◽

Vol 7 (3) ◽

Cited By ~ 3

Author(s):

Nguyen Thi Thu Hong ◽

Nguyen To Anh ◽

Nguyen Thi Hoang Mai ◽

Ho Dang Trung Nghia ◽

Le Nguyen Truc Nhu ◽

...

Keyword(s):

Next Generation Sequencing ◽

Infectious Diseases ◽

Wide Spectrum ◽

Mumps Virus ◽

Resource Limited Setting ◽

Next Generation ◽

Resource Limited Settings ◽

Resource Limited ◽

Generation Sequencing ◽

Limited Setting

Abstract Background Meningoencephalitis is a devastating disease worldwide. Current diagnosis fails to establish the cause in ≥50% of patients. Metagenomic next-generation sequencing (mNGS) has emerged as pan-pathogen assays for infectious diseases diagnosis, but few studies have been conducted in resource-limited settings. Methods We assessed the performance of mNGS in the cerebrospinal fluid (CSF) of 66 consecutively treated adults with meningoencephalitis in a tertiary referral hospital for infectious diseases in Vietnam, a resource-limited setting. All mNGS results were confirmed by viral-specific polymerase chain reaction (PCR). As a complementary analysis, 6 viral PCR-positive samples were analyzed using MinION-based metagenomics. Results Routine diagnosis could identify a virus in 15 (22.7%) patients, including herpes simplex virus (HSV; n = 7) and varicella zoster virus (VZV; n = 1) by PCR, and mumps virus (n = 4), dengue virus (DENV; n = 2), and Japanese encephalitis virus (JEV; n = 1) by serological diagnosis. mNGS detected HSV, VZV, and mumps virus in 5/7, 1/1, and 1/4 of the CSF positive by routine assays, respectively, but it detected DENV and JEV in none of the positive CSF. Additionally, mNGS detected enteroviruses in 7 patients of unknown cause. Metagenomic MinION-Nanopore sequencing could detect a virus in 5/6 PCR-positive CSF samples, including HSV in 1 CSF sample that was negative by mNGS, suggesting that the sensitivity of MinION is comparable with that of mNGS/PCR. Conclusions In a single assay, metagenomics could accurately detect a wide spectrum of neurotropic viruses in the CSF of meningoencephalitis patients. Further studies are needed to determine the value that real-time sequencing may contribute to the diagnosis and management of meningoencephalitis patients, especially in resource-limited settings where pathogen-specific assays are limited in number.

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A Lung Ultrasound Scanning Technique for Children and Adults in Low-Resource Settings: Preliminary Experiences in Sub-Saharan Africa

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.20-0272 ◽

2021 ◽

Author(s):

Matthew Fentress ◽

Phillip Ezibon ◽

Akuot Bulabek ◽

Carla Schwanfelder ◽

David Schrift ◽

...

Keyword(s):

Lung Ultrasound ◽

Sub Saharan Africa ◽

Ultrasound Scanning ◽

Resource Limited Settings ◽

Scanning Technique ◽

Resource Limited ◽

Adults And Children ◽

Chest X Ray ◽

Sub Saharan ◽

Limited Setting

Lung ultrasound is increasingly used as a diagnostic tool for pulmonary pathologies by nonspecialist clinicians in resource-limited settings where chest X-ray may not be readily available. However, the optimal technique for lung ultrasound in these settings is not yet clearly defined. We describe here our experience of implementing a standardized, focused six-zone, 12-view lung ultrasound scanning technique with a high-frequency probe in both adults and children in a resource-limited setting in sub-Saharan Africa. Our experience suggests that this may be a feasible technique to rapidly introduce lung ultrasound to new learners that can be adapted to emergency or outbreak settings. However, research is needed to determine how this technique compares with clinical examination and other available tests for the diagnosis of pathology commonly encountered in resource-limited settings.

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Tenofovir for prevention of mother to child transmission of hepatitis B in migrant women in a resource-limited setting on the Thailand-Myanmar border: a commentary on challenges of implementation

International Journal for Equity in Health ◽

10.1186/s12939-020-01268-3 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

M. Bierhoff ◽

M. J. Rijken ◽

W. Yotyingaphiram ◽

M. Pimanpanarak ◽

M. van Vugt ◽

...

Keyword(s):

Hepatitis B ◽

Point Of Care ◽

Resource Limited Setting ◽

High Uptake ◽

Child Transmission ◽

Resource Limited Settings ◽

Resource Limited ◽

Rapid Tests ◽

Mother To Child ◽

Limited Setting

Abstract Background The aim of this manuscript is to highlight challenges in the implementation of maternal tenofovir disoproxil fumarate (tenofovir) for prevention of mother to child transmission (PMTCT) of hepatitis B virus (HBV) in resource limited setting. Current preventive strategies in resource-limited settings fail mainly due to prohibitive costs of hepatitis B immunoglobulin (HBIG) and a high proportion of homebirths, meaning both HBIG and hepatitis B birth dose vaccine are not given. A new strategy for PMTCT without the necessity of HBIG, could be daily tenofovir commenced early in gestation. Implementation challenges to early tenofovir for PMTCT can provide insight to elimination strategies of HBV as the burden of disease is high in resource-limited settings. Methods Challenges encountered during implementation of a study of tenofovir for PMTCT before 20 weeks gestation in rural and resource-limited areas on the Thailand-Myanmar border were identified informally from trial study logbooks and formally from comments from patients and staff at monthly visits. ClinicalTrials.gov Identifier: NCT02995005. Main body During implementation 171 pregnant women were hepatitis B surface antigen (HBsAg) positive by point of-care test over 19 months (May-2018 until Dec-2019). In this resource-limited setting where historically no clinic has provided tenofovir for PMTCT of HBV, information provided by staff resulted in a high uptake of study screening (95.5% (84/88) when offered to pregnant women. False positive point-of-care rapid tests hinder a test and treat policy for HBV and development of improved rapid tests that include HBeAg and/or HBV DNA would increase efficiency. Integrated care of HBV to antenatal care, transport assistance and local agreements to facilitate access, could increase healthcare at this critical stage of the life course. As safe storage of medication in households in resource-limited setting may not be ideal, interactive counseling about this must be a routine part of care. Conclusion Despite challenges, results from the study to date suggest tenofovir can be offered to HBV-infected women in resource-limited settings before 20 weeks gestation with a high uptake of screening, high drug accountability and follow-up, with provision of transportation support. This commentary has highlighted practical implementation issues with suggestions for strategies that support the objective of PMTCT and the World Health Organization goal of HBV elimination by 2030.

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