scholarly journals A Landscape Study Highlights the Urgent Need for Evidence Based Strategies to Enable Electronic Health Records Integration in the National Healthcare Systems of Low- and Middle-Income Countries

2021 ◽  
Vol 16 (3) ◽  
pp. 140-142
Author(s):  
Joanne M. Muellenbach
Keyword(s):  
Electronic Health Records ◽  
Grey Literature ◽  
Healthcare Systems ◽  
Health Records ◽  
Middle Income ◽  
Middle Income Countries ◽  
National Healthcare ◽  
Electronic Health ◽  
International Experts ◽  
Low And Middle Income

A Review of: Kumar, M., & Mostafa, J. (2020). Electronic health records for better health in lower- and middle-income countries: A landscape study. Library Hi Tech, 38(4), 751–767. https://doi.org/10.1108/LHT-09-2019-0179  Abstract Objective – To identify how low- and middle-income countries (LMICs) approached the development of national and subnational electronic health records (EHRs) and to understand the challenges related to EHR research priorities and sustainability. Design – Landscape study consisting of a review of the scientific literature, country-focused grey literature, and consultation with international experts.   Setting – Hospitals and healthcare systems within LMICs.  Subjects – The 402 publications retrieved through a systematic search of four scientific electronic databases along with 49 publications found through a country-focused analysis of grey literature and 14 additional publications found through consultation with two international experts.  Methods – On 15 May 2019, the authors comprehensively searched four major scientific databases: Global Health, PubMed, Scopus, and Web of Science. They also searched the grey literature and repositories in consultation with country-based international digital health experts. The authors subsequently used Mendeley reference management software to organize and remove duplicate publications. Peer-reviewed publications that focused on developing national EHRs within LMIC healthcare systems were included for the title and abstract screening. Data analysis was mainly qualitative, and the results were organized to highlight stakeholders, health information architecture (HIA), and sustainability. Main Results – The results were presented in three subsections. The first two described critical stakeholders for developing national and subnational EHRs and HIA, including country eHealth foundations, EHRs, and subsystems. The third section presented and discussed pressing challenges related to EHR sustainability. The findings of the three subsections were further explored through the presentation of three LMIC case studies that described stakeholders, HIA, and sustainability challenges. Conclusion – The results of this landscape study highlighted the scant evidence available to develop and sustain national and subnational EHRs within LMICs. The authors noted that there appears to be a gap in understanding how EHRs impact patient-level and population outcomes within the LMICs. The study revealed that EHRs were primarily designed to support monitoring and evaluating health programs focused on a particular disease or group of diseases rather than common health problems. While national governments and international donors focused on the role of EHRs to improve patient care, the authors highlighted the urgent need for further research on the development of EHRs, with a focus on efficiency, evaluation, monitoring, and quality within the national healthcare enterprise.

Electronic health records for better health in the lower- and middle-income countries

2020 ◽  
Vol 38 (4) ◽  
pp. 751-767
Author(s):  
Manish Kumar ◽  
Javed Mostafa
Keyword(s):  
Electronic Health Records ◽  
Health Information ◽  
Digital Health ◽  
Information Architecture ◽  
Health Records ◽  
Middle Income ◽  
Content Type ◽  
Middle Income Countries ◽  
Use Of Data ◽  
Electronic Health

PurposeElectronic health records (EHR) can enable collection and use of data for achieving better health both at the patient and population health levels. The World Health Organization's (WHO) draft 2019 four-year global digital health strategy aims to “improve health for everyone, everywhere by accelerating the adoption of appropriate digital health” and EHRs are key to achieving better health goals. Despite the fact that EHRs can help to achieve better health, there is lack of evidence explaining national and sub-national EHR development in the limited resource settings.Design/methodology/approachWe conducted a landscape study to describe the EHR development and use in the low- and middle-income countries for achieving better health. We reviewed literature from four scientific databases and analyzed gray literature identified in consultation with 17 international experts.FindingsThe findings of this literature review are presented in three subsections. The first two subsections describe key stakeholders for development of national and sub-national EHR and health information architecture which includes status of ehealth foundations, EHR, and sub-systems in the country. The third subsection presents and discusses key challenges related to sustainability of national and sub-national EHRs. The findings in these three subsections are further explored through examples of health information flow in Uganda, and electronic medical record/EHR implementation in Sierra Leone and Malawi. These examples briefly describe stakeholders, information architecture, and sustainability challenges.Originality/valueThis paper fills an important research gap and clearly explains the urgent research need to build context-specific EHR development models to enable use of data for better health.

Stock-Outs of Essential Medicines Among Community Health Workers (CHWs) In Low- And Middle-Income Countries (LMICs): A Systematic Literature Review of The Extent, Reasons, And Consequences

2021 ◽  
Author(s):  
Abimbola Olaniran ◽  
Jane Briggs ◽  
Ami Pradhan ◽  
Erin Bogue ◽  
Benjamin Schreiber ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Grey Literature ◽  
Community Level ◽  
Health Centers ◽  
Essential Medicines ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Background: This paper explores the extent of community-level stock-out of essential medicines among Community Health Workers (CHWs) in Low- and Middle-Income Countries (LMICs) and identifies the reasons for and consequences of essential medicine stock-outs. Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Five electronic databases were searched with a prespecified strategy and the grey literature examined, January 2006 - March 2021. Papers containing information on (i) the percentage of CHWs stocked out or (ii) reasons for stock-outs along the supply chain and consequences of stock-out were included and appraised for risk of bias. Outcomes were quantitative data on the extent of stock-out, summarized using descriptive statistics, and qualitative data regarding reasons for and consequences of stock-outs, analyzed using thematic content analysis and narrative synthesis. Results: Two reviewers screened 1083 records; 78 evaluations were included. Over the last fifteen years, CHWs experienced stock-outs of essential medicines nearly one third of the time and at a significantly (p < 0.01) higher rate than the health centers to which they are affiliated (28.93% [CI 95%: 28.79 - 29.07] vs 9.17 % [CI 95%: 8.64 - 9.70], respectively). A comparison of the period 2006-2015 and 2016-2021 showed a significant (p < 0.01) increase in CHW stock-out level from 26.36% [CI 95%: 26.22 -26.50] to 48.65% [CI 95%: 48.02- 49.28] while that of health centers increased from 7.79% [95% CI: 7.16 - 8.42] to 14.28% [95% CI: 11.22- 17.34]. Distribution barriers were the most cited reasons for stock-outs. Ultimately, patients were the most affected: stock-outs resulted in out-of-pocket expenses to buy unavailable medicines, poor adherence to medicine regimes, dissatisfaction, and low service utilization. Conclusion: Community-level stock-out of essential medicines constitutes a serious threat to achieving universal health coverage and equitable improvement of health outcomes. This paper suggests stock-outs are getting worse, and that there are particular barriers at the last mile. There is an urgent need to address the health and non-health system constraints that prevent the essential medicines procured for LMICs by international and national stakeholders from reaching the people who need them the most.

scholarly journals Validity of acute cardiovascular outcome diagnoses in European electronic health records: a systematic review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031373 ◽  
Author(s):  
Jennifer Anne Davidson ◽  
Amitava Banerjee ◽  
Rutendo Muzambi ◽  
Liam Smeeth ◽  
Charlotte Warren-Gash
Keyword(s):  
Systematic Review ◽  
Electronic Health Records ◽  
Predictive Value ◽  
Grey Literature ◽  
Cochrane Library ◽  
Free Text ◽  
Health Records ◽  
Coronary Syndrome ◽  
Validation Measure ◽  
Electronic Health

IntroductionCardiovascular diseases (CVDs) are among the leading causes of death globally. Electronic health records (EHRs) provide a rich data source for research on CVD risk factors, treatments and outcomes. Researchers must be confident in the validity of diagnoses in EHRs, particularly when diagnosis definitions and use of EHRs change over time. Our systematic review provides an up-to-date appraisal of the validity of stroke, acute coronary syndrome (ACS) and heart failure (HF) diagnoses in European primary and secondary care EHRs.Methods and analysisWe will systematically review the published and grey literature to identify studies validating diagnoses of stroke, ACS and HF in European EHRs. MEDLINE, EMBASE, SCOPUS, Web of Science, Cochrane Library, OpenGrey and EThOS will be searched from the dates of inception to April 2019. A prespecified search strategy of subject headings and free-text terms in the title and abstract will be used. Two reviewers will independently screen titles and abstracts to identify eligible studies, followed by full-text review. We require studies to compare clinical codes with a suitable reference standard. Additionally, at least one validation measure (sensitivity, specificity, positive predictive value or negative predictive value) or raw data, for the calculation of a validation measure, is necessary. We will then extract data from the eligible studies using standardised tables and assess risk of bias in individual studies using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Data will be synthesised into a narrative format and heterogeneity assessed. Meta-analysis will be considered when a sufficient number of homogeneous studies are available. The overall quality of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation tool.Ethics and disseminationThis is a systematic review, so it does not require ethical approval. Our results will be submitted for peer-review publication.PROSPERO registration numberCRD42019123898

scholarly journals Vitamin and Mineral Supplementation During Pregnancy on Maternal, Birth, Child Health and Development Outcomes in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 491 ◽  
Author(s):  
Christina Oh ◽  
Emily C. Keats ◽  
Zulfiqar A. Bhutta
Keyword(s):  
Systematic Review ◽  
Vitamin D ◽  
Child Health ◽  
Low Birthweight ◽  
Grey Literature ◽  
Micronutrient Supplementation ◽  
Maternal Anemia ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Almost two billion people are deficient in key vitamins and minerals, mostly women and children in low- and middle-income countries (LMICs). Deficiencies worsen during pregnancy due to increased energy and nutritional demands, causing adverse outcomes in mother and child, but could be mitigated by interventions like micronutrient supplementation. To our knowledge, this is the first systematic review that aimed to compile evidence from both efficacy and effectiveness trials, evaluating different supplementation interventions on maternal, birth, child health, and developmental outcomes. We evaluated randomized controlled trials and quasi-experimental studies published since 1995 in peer-reviewed and grey literature that assessed the effects of calcium, vitamin A, iron, vitamin D, and zinc supplementation compared to placebo/no treatment; iron-folic (IFA) supplementation compared to folic acid only; multiple micronutrient (MMN) supplementation compared to IFA; and lipid-based nutrient supplementation (LNS) compared to MMN supplementation. Seventy-two studies, which collectively involved 314 papers (451,723 women), were included. Meta-analyses showed improvement in several key birth outcomes, such as preterm birth, small-for-gestational age (SGA) and low birthweight with MMN supplementation, compared to IFA. MMN also improved child outcomes, including diarrhea incidence and retinol concentration, which are findings not previously reported. Across all comparisons, micronutrient supplementation had little to no effect on mortality (maternal, neonatal, perinatal, and infant) outcomes, which is consistent with other systematic reviews. IFA supplementation showed notable improvement in maternal anemia and the reduction in low birthweight, whereas LNS supplementation had no apparent effect on outcomes; further research that compares LNS and MMN supplementation could help understand differences with these commodities. For single micronutrient supplementation, improvements were noted in only a few outcomes, mainly pre-eclampsia/eclampsia (calcium), maternal anemia (iron), preterm births (vitamin D), and maternal serum zinc concentration (zinc). These findings highlight that micronutrient-specific supplementation should be tailored to specific groups or needs for maximum benefit. In addition, they further contribute to the ongoing discourse of choosing antenatal MMN over IFA as the standard of care in LMICs.

scholarly journals A systematic review of employment outcomes from youth skills training programmes in agriculture in low- and middle-income countries

Nature Food ◽  
2020 ◽  
Vol 1 (10) ◽  
pp. 605-619 ◽  
Author(s):  
W. H. Eugenie Maïga ◽  
Mohamed Porgo ◽  
Pam Zahonogo ◽  
Cocou Jaurès Amegnaglo ◽  
Doubahan Adeline Coulibaly ◽  
...  
Keyword(s):  
Systematic Review ◽  
Grey Literature ◽  
Skills Training ◽  
Urban Migration ◽  
Youth Engagement ◽  
Middle Income ◽  
Middle Income Countries ◽  
Positive Effects ◽  
Training Programmes ◽  
Low And Middle Income

Abstract Engagement of youth in agriculture in low- and middle-income countries may offer opportunities to curb underemployment, urban migration, disillusionment of youth and social unrest, as well as to lift individuals and communities from poverty and hunger. Lack of education or skills training has been cited as a challenge to engage youth in the sector. Here we systematically interrogate the literature for the evaluation of skills training programmes for youth in low- and middle-income countries. Sixteen studies—nine quantitative, four qualitative and three mixed methods—from the research and grey literature documented the effects of programmes on outcomes relating to youth engagement, including job creation, income, productivity and entrepreneurship in agriculture. Although we find that skills training programmes report positive effects on our chosen outcomes, like previous systematic reviews we find the topic to chronically lack evaluation. Given the interest that donors and policymakers have in youth engagement in agriculture, our systematic review uncovers a gap in the knowledge of their effectiveness.

scholarly journals Impact of Dietary Interventions during Pregnancy on Maternal, Neonatal, and Child Outcomes in Low- and Middle-Income Countries

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 531
Author(s):  
Zohra S Lassi ◽  
Zahra A Padhani ◽  
Amna Rabbani ◽  
Fahad Rind ◽  
Rehana A. Salam ◽  
...  
Keyword(s):  
Birth Weight ◽  
Obesity Prevention ◽  
Data Extraction ◽  
Child Outcomes ◽  
Grey Literature ◽  
Food Distribution ◽  
Dietary Interventions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Optimal nutrition plays a crucial role in pregnancy. Maternal malnutrition is a risk factor for maternal, fetal, and neonatal complications and is more prevalent in low and middle-income countries (LMICs). This review aims to study the effectiveness of antenatal macronutrient nutritional interventions on maternal, neonatal, and child outcomes. We searched the CENTRAL, PubMed, Embase, and other databases for randomized controlled trials and quasi-experimental designs on healthy pregnant women in LMICs. We also searched grey literature and reports from Google Scholar, Web of Science, and websites of different organizations. Title/abstract screening, full-text screening, and data extraction filtered 15 studies for inclusion. Balanced energy protein (BEP) supplementation (n = 8) studies showed a reduced incidence of perinatal mortality, stillbirths, low birth weight (LBW) infants, small for gestational age (SGA) babies and increased birth weight. Food distribution programs (FDPs) (n =5) witnessed reduced rates of SGA, stunting, wasting, and increased birth weight and birth length. Studies on intervention for obesity prevention (n = 2) showed reductions in birth weight. Other findings were statistically insignificant. Subgroup analyses were conducted to study the effectiveness of supplementation between regions, location, the timing of supplementation and nutritional status; however, there were a limited number of studies in each subgroup. Data from our review supports the antenatal supplementation of BEP and FDP for the prevention of adverse maternal, neonatal, and child outcomes that can be utilized for future policymaking. However, more research is required before recommending obesity prevention programs.

scholarly journals Multimorbidity of chronic non-communicable diseases and its models of care in low- and middle-income countries: a scoping review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e033320 ◽  
Author(s):  
Fantu Abebe Eyowas ◽  
Marguerite Schneider ◽  
Biksegn Asrat Yirdaw ◽  
Fentie Ambaw Getahun
Keyword(s):  
Scoping Review ◽  
Grey Literature ◽  
Communicable Diseases ◽  
Multiple Chronic Conditions ◽  
Middle Income ◽  
Non Communicable Diseases ◽  
Middle Income Countries ◽  
Co Morbidity ◽  
Scoping Reviews ◽  
Low And Middle Income

IntroductionMultimorbidity is the coexistence of two or more chronic non-communicable diseases (NCDs) in a given individual. Multimorbidity is increasing in low- and middle-income countries (LMICs) and challenging health systems. Individuals with multimorbidity are facing the risk of premature mortality, lower quality of life and greater use of healthcare services. However, despite the huge challenge multimorbidity brings in LMICs, gaps remain in mapping and synthesising the available knowledge on the issue. The focus of this scoping review will be to synthesise the extent, range and nature of studies on the epidemiology and models of multimorbidity care in LMICs.MethodsPubMed (MEDLINE) will be the main database to be searched. For articles that are not indexed in the PubMed, Scopus, PsycINFO and Cochrane databases will be searched. Grey literature databases will also be explored. There will be no restrictions on study setting or year of publication. Articles will be searched using key terms, including comorbidity, co-morbidity, multimorbidity, multiple chronic conditions and model of care. Relevant articles will be screened by two independent reviewers and data will be charted accordingly. The result of this scoping review will be presented using the Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist and reporting guideline.Ethics and disseminationThis scoping review does not require ethical approval. Findings will be published in peer-reviewed journal and presented at scientific conferences.

Sign in / Sign up

Export Citation Format

Share Document