scholarly journals Maximising uptake and utilization of molecular diagnostics: lessons from implementation evaluation of tuberculosis diagnostics

2020 ◽  
Author(s):  
Nyanda Elias Ntinginya ◽  
Fred Orina ◽  
Ivan Mwebaza ◽  
Alphonce Liyoyo ◽  
Barbara Miheso ◽  
...  
Keyword(s):  
Molecular Diagnostics ◽  
Test Performance ◽  
Severe Disease ◽  
Healthcare Facility ◽  
World Health ◽  
Hospital Level ◽  
African Countries ◽  
Factors Affecting ◽  
Health Technologies ◽  
Health Organization

Abstract Background: Tuberculosis (TB), a treatable disease claims over a million lives every year. Accurate rapid diagnosis is crucial for early treatment initiation and prevention of severe disease. Despite over 10 years approval of molecular diagnostics for routine use, an estimated 3 million TB cases go undetected per year. We investigated the barriers and opportunities to maximise uptake and utilization of molecular diagnostics in routine healthcare settings. Methods: We deployed surveys, healthcare facility audits, focus group discussions, in-depth interviews, and policymaker dialogues to unravel factors affecting the uptake and utilization of TB molecular diagnostics in three East African countries. The benchmark was the World Health Organization approved Xpert MTB/RIF and Line Probe Assay (LPA) implemetation at district and regional hospital level respectively. Results: 190 district and county health officers participated in the survey. The survey findings were corroborated by 145 healthcare facility (HCF) audits and 11 policymaker engagement workshops. At 66% coverage, Xpert MTB/RIF fell behind microscopy and clinical diagnosis by 33% and 1% respectively across 190 districts/counties. Stratified by HCF type, Xpert MTB/RIF implementation was 56%, 96% and 95% at district-, regional- and national referral- hospital level. LPA coverage was 4%, 3% below culture across the three countries. Out of 111 HCFs with Xpert MTB/RIF, 37 (33%) utilized it to full capacity, performing ≥8 tests per day of which 51% of these were level five (zonal consultant and national referral) HCFs. Likewise, 75% of LPA test performance was at level five HCFs. Underutilization of Xpert MTB/RIF and LPA was mainly attributed to inadequate- human resource, 22% and utilities, 26% respectively. Absence of the diagnostic services was attributed to under financing. Lack of awareness was second to underfinancing as reason underlying absence of LPA service. Creation of a health tax and decentralising collection and management of this tax to district/county level was proposed by policymakers as means to boost domestic financing for uptake of health technologies. Conclusion Our findings show higher uptake and utilization of molecular and other diagnostics at tertiary- than primary-secondary- level HCFs. Innovative implementation models to ensure quality access at lower level HCFs are urgently needed.

The International Transfer of Medical Technology—An Analysis and a Proposal for Effective Monitoring

1977 ◽  
Vol 7 (3) ◽  
pp. 443-458 ◽  
Author(s):  
Michael B. Bader
Keyword(s):  
Technology Transfer ◽  
Foreign Aid ◽  
Medical Technology ◽  
Technical Assistance ◽  
Code Of Conduct ◽  
World Health ◽  
Health Technologies ◽  
Four Levels ◽  
Aid Programs ◽  
Health Organization

The international transfer of medical technology to the developing countries occurs at four levels-medical education, research, and missions; multinational corporate transactions; technical assistance projects sponsored by the World Health Organization; and bilateral foreign aid programs. In this article, a proposal is made for effective monitoring of international medical technology transfer through political and legal means, including a specific code of conduct for corporations engaged in medical technology transfer. The development of “intermediate health technologies” along the lines suggested by E. F. Schumacher, and the advantages of such an innovation in terms of population issues and economic development are also discussed.

Factors Affecting Resiliency Among Volunteers in Disasters: A Systematic Literature Review

2020 ◽  
pp. 1-7
Author(s):  
Hasan Ghodsi ◽  
Sanaz Sohrabizadeh ◽  
Reaza Khani Jazani ◽  
Amir Kavousi
Keyword(s):  
Disaster Response ◽  
Final Analysis ◽  
International Committee ◽  
World Health ◽  
Red Cross ◽  
Factors Affecting ◽  
Search Terms ◽  
Main Factors ◽  
Relief Operations ◽  
Health Organization

ABSTRACT Objective: Volunteers need considerable resiliency to cope with formidable challenges during their operations in disaster scenes. The present study was conducted to identify factors affecting the different aspects of resiliency among volunteers in disasters. Material and Methods: The databases of Web of Science, Scopus, PubMed, ProQuest, Google Scholar, World Health Organization Library, International Committee of the Red Cross (ICRC) Library, PsycArticles, and SafetyLit were searched until September 29, 2018. The main search terms were resiliency, disaster, humanitarian aid worker, and volunteer. Results: A total of 548 documents were obtained and screened based on the inclusion and exclusion criteria. A number of 8 documents was selected for the final analysis. The main factors contributing to the resilience of volunteers at the 3 stages of pre-, during, and post-disasters were classified into 3 groups of individual, environmental, and organizational. Important factors affecting resilience of volunteers in disasters included previous disaster response experience and disaster-related training. Conclusion: Resiliency should be deemed integral to relief operations. Considering the main factors affecting volunteers’ resiliency, it is highly suggested that organizations active in humanitarian endeavors explore the factors impacting on resilience among their volunteers via various research methods and seek to select those with higher degrees of resilience in order to avert untoward consequences in their missions.

scholarly journals The Incidence of Bleeding and the Factors That Influence Its Development among Patients Admitted With Dengue Fever

2017 ◽  
Vol 9 (2) ◽  
pp. 23-28
Author(s):  
Krishna Bahadur Thapa ◽  
Namrata KC ◽  
T Koirala ◽  
A Bhatttarai
Keyword(s):  
Platelet Count ◽  
Dengue Fever ◽  
Medical Center ◽  
Adult Population ◽  
World Health ◽  
Chi Square ◽  
Factors Affecting ◽  
Female Sex ◽  
Unit Increase ◽  
Health Organization

Background: Dengue virus is now classified as a major global health threat by the World Health Organization. Bleeding is a common complication and is one of the most feared. There is an increase incidence in the adult population, hence, the focus of this study.Objectives: To determine the incidence of bleeding and the factors that influence its development among patients admitted with dengue fever at Fatima Medical Center, Phillipines from January 2009 to December 2011.Methods: This is a case control study using chart review. The incidence of bleeding is calculated using risk ratio. Factors affecting bleeding are determined using chi square for qualitative variables and T-test or ANOVA for quantitative variables. Simultaneous determination of factors association with bleeding will be analyzed using multiple logistic regression. Level of significance will be set at alpha = 0.05.Results: The female sex is significantly more prone to develop bleeding (p=0.044). There is no significant increase in bleeding in patients who have co-morbidities (p=0.447). In every one unit increase in WBC (1 x 109) the odds of bleeding decrease by 15%. For every one unit increase in hematocrit the odds of bleeding decreases by 6.8%. For every one unit increase in platelet count the odds of bleeding decreases by 3% that is every 10 unit increase in platelet count the odds of bleeding decrease by 22.9%.Conclusions: Female sex, a low initial WBC and platelet count will increase a patient’s propensity to develop bleeding.Journal of Gandaki Medical College Volume, 09, Number 2, July December  2016, page: 23-28

scholarly journals A Scoping Review of Policies Related to the Prevention and Control of Overweight and Obesity in Africa

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 4028
Author(s):  
Theodosia Adom ◽  
Anniza De Villiers ◽  
Thandi Puoane ◽  
André Pascal Kengne
Keyword(s):  
Scoping Review ◽  
Population Level ◽  
Overweight And Obesity ◽  
World Health ◽  
Environmental Drivers ◽  
African Countries ◽  
Food Industries ◽  
Nutrition And Diet ◽  
Health Organization ◽  
And Control

To address the issue of obesity, the World Health Organization (WHO) recommends a set of comprehensive programmes aimed at changing the obesogenic environments to provide opportunities for healthy food options and increased physical activity in the school, home, and at the population level. The objectives of this study were to examine the nature and range of policies related to overweight and obesity prevention in Africa, and to assess how they align with international guidelines. An existing methodological framework was adapted for this scoping review. A search of publicly available national documents on overweight/obesity, general health, and non-communicable diseases (NCDs) was undertaken from relevant websites, including WHO, ministries, and Google Scholar. Additional requests were sent to key contacts at relevant ministries about existing policy documents. The documents were reviewed, and the policies were categorised, using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. The framework categorises the environmental drivers of obesity into four domains (physical, economic, legislative, and socio-cultural) and two scales: macro (national, regional, sectors, food industries, media, etc.) and micro (household, institutional, and community). This review included documents from 41 African countries. The policy initiatives to prevent overweight/obesity target the school, family and community settings, and macro environments, and broadly align with global recommendations. The NCD documents were in the majority, with only two on obesity. The majority of the documents detailed strategies and key interventions on unhealthy diets and physical inactivity. The physical, legislative, and sociocultural domains were largely featured, with less emphasis on the economic domain. Additionally, nutrition- and diet-related policies were in the majority. Overlaps and interactions of policies were observed in the application of the ANGELO framework. This study has provided information on national policies and programmes in Africa and can be useful as a first point of call for policymakers. The overlapping and interaction in the initiatives demonstrate the importance of multi-sectoral partnerships in providing supportive environments for healthy behaviours.

scholarly journals Suicide trends and characteristics in Brazil

2006 ◽  
Vol 3 (1) ◽  
pp. 5-7
Author(s):  
Carolina de Mello-Santos ◽  
José Manoel Bertolote ◽  
Yuan-Pang Wang
Keyword(s):  
Suicide Rate ◽  
World Health ◽  
Economic Factors ◽  
Factors Affecting ◽  
Youth Population ◽  
Self Harm ◽  
Health Organization ◽  
Populous Country ◽  
Related Mortality ◽  
Socio Economic Factors

Brazil is the largest and most populous country in South America (in 2002 the population was approximately 175 million). Although life expectancy in Brazil has increased, suicide and other forms of injury-related mortality, such as homicide and accident, have increased as a proportion of overall mortality (Oswaldo Cruz Foundation, 1984; Brazil Ministry of Health, 2001). The suicide rate in Brazil (3.0–4.0 per 100 000 inhabitants) is not considered high in global terms (World Health Organization, 1999). Nevertheless, it has followed the world tendency towards growth: during 1980–2000, the suicide rate in Brazil increased by 21%. Elderly people present the highest suicide rates in absolute numbers, but the alarming finding in the Brazilian data is that the youth population is increasingly dying by suicide (Mello-Santos et al, 2005). This statistic partially confirms a forecast by Diekstra & Guilbinat (1993) that the number of deaths by suicide would dramatically increase over the next decades, mainly in developing countries, including Latin America. In these regions, socio-economic factors (such as an increase in divorce and unemployment and a decrease in religiosity) increase the risk of self-harm. We discuss the reasons for the low suicide rate in Brazil and highlight the socio-economic factors affecting its increase among the youth population in particular.

scholarly journals Comparative Analysis of Pediatric COVID-19 Infection in Southeast Asia, South Asia, Japan, and China

2021 ◽  
Author(s):  
Judith Ju Ming Wong ◽  
Qalab Abbas ◽  
Soo Lin Chuah ◽  
Ririe Fachrina Malisie ◽  
Kah Min Pon ◽  
...  
Keyword(s):  
Risk Factors ◽  
South Asia ◽  
Cultural Practices ◽  
Severe Disease ◽  
Clinical Manifestations ◽  
World Health ◽  
Logistic Regression Models ◽  
Clinical Presentations ◽  
The Common ◽  
Health Organization

There is a scarcity of data regarding coronavirus disease 2019 (COVID-19) infection in children from southeast and south Asia. This study aims to identify risk factors for severe COVID-19 disease among children in the region. This is an observational study of children with COVID-19 infection in hospitals contributing data to the Pediatric Acute and Critical Care COVID-19 Registry of Asia. Laboratory-confirmed COVID-19 cases were included in this registry. The primary outcome was severity of COVID-19 infection as defined by the World Health Organization (WHO) (mild, moderate, severe, or critical). Epidemiology, clinical and laboratory features, and outcomes of children with COVID-19 are described. Univariate and multivariable logistic regression models were used to identify risk factors for severe/critical disease. A total of 260 COVID-19 cases from eight hospitals across seven countries (China, Japan, Singapore, Malaysia, Indonesia, India, and Pakistan) were included. The common clinical manifestations were similar across countries: fever (64%), cough (39%), and coryza (23%). Approximately 40% of children were asymptomatic, and overall mortality was 2.3%, with all deaths reported from India and Pakistan. Using the multivariable model, the infant age group, presence of comorbidities, and cough on presentation were associated with severe/critical COVID-19. This epidemiological study of pediatric COVID-19 infection demonstrated similar clinical presentations of COVID-19 in children across Asia. Risk factors for severe disease in children were age younger than 12 months, presence of comorbidities, and cough at presentation. Further studies are needed to determine whether differences in mortality are the result of genetic factors, cultural practices, or environmental exposures.

Vaccine hesitancy and implications on childhood immunisation in Malaysia

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Noor Hazilah Abd Manaf ◽  
Mohd Azahadi Omar ◽  
Fatin Husna Suib
Keyword(s):  
World Health ◽  
Health Concern ◽  
Vaccine Hesitancy ◽  
Personal Choice ◽  
Childhood Immunisation ◽  
Content Type ◽  
Factors Affecting ◽  
Parental Decision ◽  
Islamic Medicine ◽  
Health Organization

PurposeThe World Health Organization identified vaccine hesitancy as one of the ten threats to global health in 2019. The purpose of this paper is to evaluate the implications and factors affecting parental decision on childhood immunisation in Malaysia.Design/methodology/approachThis paper reviews literature on vaccine hesitancy and evaluation of factors affecting parental decision on childhood immunisation in Malaysia.FindingsVaccine hesitancy is a growing public health concern in Malaysia with factors such as influence of Internet and social media, personal choice and individual right, conspiracy theory, religious reasons and alternative medicine as among the influencing dynamics. An urban, educated demography operating within a postmodern medical paradigm compounds the diminishing value of vaccines.Originality/valueThis paper provides a comprehensive examination of vaccine hesitancy in Malaysia. Critical appraisal on personal choice over societal responsibility within an Asian/Muslim collectivist society has not been discussed in previous studies. The acceptance of homeopathy as an Islamic medicine alternative is peculiar to multi-ethnic, multi-cultural Malaysia.

scholarly journals A Systematic Review of the Incremental Costs of Implementing a New Vaccine in the Expanded Program of Immunization in Sub-Saharan Africa

2019 ◽  
Vol 4 (2) ◽  
pp. 238146831989454
Author(s):  
Joe Brew ◽  
Christophe Sauboin
Keyword(s):  
Systematic Review ◽  
Data Collection ◽  
Interquartile Range ◽  
Sub Saharan Africa ◽  
World Health ◽  
African Countries ◽  
Vaccine Type ◽  
Sub Saharan ◽  
Health Organization ◽  
The Cost

Background. The World Health Organization is planning a pilot introduction of a new malaria vaccine in three sub-Saharan African countries. To inform considerations about including a new vaccine in the vaccination program of those and other countries, estimates from the scientific literature of the incremental costs of doing so are important. Methods. A systematic review of scientific studies reporting the costs of recent vaccine programs in sub-Saharan countries was performed. The focus was to obtain from each study an estimate of the cost per dose of vaccine administered excluding the acquisition cost of the vaccine and wastage. Studies published between 2000 and 2018 and indexed on PubMed could be included and results were standardized to 2015 US dollars (US$). Results. After successive screening of 2119 titles, and 941 abstracts, 58 studies with 80 data points (combinations of country, vaccine type, and vaccination approach–routine v. campaign) were retained. Most studies used the so-called ingredients approach as costing method combining field data collection with documented unit prices per cost item. The categorization of cost items and the extent of detailed reporting varied widely. Across the studies, the mean and median cost per dose administered was US$1.68 and US$0.88 with an interquartile range of US$0.54 to US$2.31. Routine vaccination was more costly than campaigns, with mean cost per dose of US$1.99 and US$0.88, respectively. Conclusion. Across the studies, there was huge variation in the cost per dose delivered, between and within countries, even in studies using consistent data collection tools and analysis methods, and including many health facilities. For planning purposes, the interquartile range of US$0.54 to US$2.31 may be a sufficiently precise estimate.

scholarly journals Elimination of onchocerciasis in Africa by 2025: an ambitious target requires ambitious interventions

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Robert Colebunders ◽  
Wilma A. Stolk ◽  
Joseph Nelson Siewe Fodjo ◽  
Charles D. Mackenzie ◽  
Adrian Hopkins
Keyword(s):  
Intervention Strategies ◽  
World Health ◽  
Health Programs ◽  
African Countries ◽  
Tailored Interventions ◽  
Evaluation Procedures ◽  
Primary Health ◽  
Mental Health Programs ◽  
Health Organization ◽  
African Setting

Abstract To achieve the elimination of onchocerciasis transmission in all African countries will entail enormous challenges, as has been highlighted by the active discussion around onchocerciasis intervention strategies and evaluation procedures in this journal. Serological thresholds for onchocerciasis elimination, adapted for the African setting, need to be established. The Onchocerciasis Technical Advisory Subgroup of the World Health Organization is currently developing improved guidelines to allow country elimination committees to make evidence-based decisions. Importantly, onchocerciasis-related morbidity should not be forgotten when debating elimination prospects. A morbidity management and disease prevention (MMDP) strategy similar to that for lymphatic filariasis will need to be developed. This will require collaboration between the onchocerciasis elimination program, the community and other partners including primary health and mental health programs. In order to reach the goal of onchocerciasis elimination in most African countries by 2025, we should prioritize community participation and advocate for tailored interventions which are scientifically proven to be effective, but currently considered to be too expensive.

Sign in / Sign up

Export Citation Format

Share Document