Implementing a Comprehensive Value-based Healthcare System to Improve Pregnancy and Childbirth Outcomes in Urban and Rural Kenya.

2021 ◽  
Author(s):  
Peter Dohmen ◽  
Teresa De Sanctis ◽  
Emma Waiyaiya ◽  
Wendy Janssens ◽  
Tobias F Rinke de Wit ◽  
...  
Keyword(s):  
Low Cost ◽  
Implementation Process ◽  
Time Frame ◽  
Theory Of Change ◽  
Local Context ◽  
Patient Journey ◽  
Middle Income ◽  
Pregnancy And Childbirth ◽  
Learning Cycles ◽  
Rural Kenya

Abstract Background: Maternal and neonatal mortality rates in many low- and middle-income countries (LMICs) are still far above the targets of Sustainable Development Goal (SDG) 3. Value-based healthcare (VBHC) could potentially surpass traditional input-oriented approaches to create a high-quality health system and to improve maternal, newborn and child health (MNCH) outcomes. This paper describes the implementation of VBHC in urban and rural Kenya with the aim to significantly improve MNCH outcomes.Methods: We developed a theory of change (ToC) and used an incremental cohort-based implementation approach to create short and long learning cycles along which different components of the VBHC framework were introduced and evaluated. We sought to leverage local resources and used a mobile phone-based platform to support pregnant women and MNCH providers throughout the patient journey, using the system for communication, payment and data collection. We created dashboards and used interviews and focus group discussions to gather feedback and to collect the data to describe the implementation process in this paper.Results: We implemented all elements of VBHC, starting small and expanding cohort by cohort. Short and long learning cycles between cohorts enabled implementation of the framework in a relatively short time frame. Data on outputs and outcomes show that the VBHC framework had impact on three levels: Mothers’ improved adherence to maternal healthcare, incentivizing providers to improve quality of care, and transparency of outcomes and costs. This paper describes the implementation process and while the evaluation of health outcomes is ongoing, first results show improved adherence to evidence-based care pathways at a low cost per enrolled person.Conclusion: This study has shown that implementation of the VBHC framework in an LMIC setting is possible with some adaptations to the local context. The incremental, cohort-based approach enabled an iterative learning process, which could support the restructuring of health systems in low resource settings going from a supply-driven model to a value-driven model.Trial registration: Not applicable

scholarly journals Under-Five Mortality Causes and Prevention

2021 ◽  
Author(s):  
Mehmet Tekin
Keyword(s):  
Low Income ◽  
Respiratory Infections ◽  
Low Cost ◽  
Perinatal Care ◽  
Low Income Countries ◽  
Middle Income ◽  
Under Five ◽  
Birth Complications ◽  
Pregnancy And Childbirth ◽  
Mortality Causes

The under-five mortality rate (U5MR) represents children who die before reaching the age of 5 per 1000 live births. It is directly related to the development and economic income levels of countries. For this reason, high rates are observed in low- and middle-income countries (LMICs). The neonatal period deserves more attention as the decline in mortality rates has recently stalled. The most common causes of death under 5 years old are acute respiratory infections, diarrhea, malaria, and birth complications. Although neonatal disorders and birth complications have recently come to the fore, among these reasons, deaths due to infections are still high in LMICs. The crucial topics in prevention are perinatal care and vaccination. Apart from these, access to medicine, food, and clean water is essential in preventing deaths under 5. For preventive services to achieve their goal, these services must reach everyone. Ending preventable child deaths is only possible by improving access to well-equipped healthcare professionals during pregnancy and childbirth, life-saving interventions such as vaccinations, breastfeeding and the provision of low-cost medicines, and access to water and sanitation, which are now lacking in low-income countries.

Natural Bioactive Compounds As Adjuvant Therapy For Hepatitis C Infection

2020 ◽  
Vol 16 ◽  
Author(s):  
Moema S. Santana ◽  
Rute Lopes ◽  
Isabela H. Peron ◽  
Carla R. Cruz ◽  
Ana M. M. Gaspar ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Bioactive Compounds ◽  
Low Cost ◽  
Chemical Diversity ◽  
Acute Hepatitis C ◽  
Hepatitis C Infection ◽  
Middle Income ◽  
Broad Perspective ◽  
Cost Of Production

Background: Hepatitis C virus infection is a significant global health burden, which causes acute or chronic hepatitis. The acute hepatitis C is generally asymptomatic and progresses to cure, while persistent infection can progress to chronic liver disease and extrahepatic manifestations. Standard treatment is expensive, poorly tolerated, and has variable sustained virologic responses amongst the different viral genotypes. New therapies involve direct acting antivirals; however, it is also very expensive and may not be accessible for all patients worldwide. In order to provide a complementary approach to the already existing therapies, natural bioactive compounds are investigated as to their several biologic activities, such as direct antiviral properties against hepatitis C, and effects on mitigating chronic progression of the disease, which includes hepatoprotective, antioxidant, anticarcinogenic and anti-inflammatory activities; additionally, these compounds present advantages, as chemical diversity, low cost of production and milder or inexistent side effects. Objective: To present a broad perspective on hepatitis C infection, the chronic disease, and natural compounds with promising anti-HCV activity. Methods: This review consists of a systematic review study about the natural bioactive compounds as a potential therapy for hepatitis C infection. Results: The quest for natural products have yielded compounds with biologic activity, including viral replication inhibition in vitro, demonstrating antiviral activity against hepatitis C. Conclusion: One of the greatest advantages of using natural molecules from plant extracts is the low cost of production, not requiring chemical synthesis, which can lead to less expensive therapies available to low and middle-income countries.

scholarly journals A Review of the Community Health Club Literature Describing Water, Sanitation, and Hygiene Outcomes

2021 ◽  
Vol 18 (4) ◽  
pp. 1880
Author(s):  
Jason Rosenfeld ◽  
Ruth Berggren ◽  
Leah Frerichs
Keyword(s):  
Social Capital ◽  
Collective Action ◽  
Community Health ◽  
Theory Of Change ◽  
Health Promotion Program ◽  
Review Of The Literature ◽  
Middle Income ◽  
Health Club ◽  
Qualitative Evidence ◽  
Sanitation And Hygiene

The Community Health Club (CHC) model is a community-based health promotion program that utilizes water, sanitation, and hygiene (WASH) education as the first stage of a longitudinal development process. Although the CHC model has been implemented in fourteen countries over 20 years, this is the first review of the literature describing the model’s outcomes and impact. We conducted a review of the literature that provided quantitative or qualitative evidence of CHC interventions focused on WASH in low- and middle-income countries. We identified 25 articles that met our inclusion criteria. We found six major outcomes: WASH behaviors and knowledge, social capital, collective action, health, and cost or cost-effectiveness. The most consistent evidence was associated with WASH behaviors and knowledge, with significant effects on defecation practices, hand washing behaviors, and WASH knowledge. We also found qualitative evidence of impact on social capital and collective action. CHCs catalyze favorable changes in WASH behaviors and knowledge, yielding outcomes commensurate with other WASH promotion strategies. This review provides insights into the model’s theory of change, helping identify areas for further investigation. The CHC model’s holistic focus and emphasis on individual and collective change offer promising potential to address multiple health and development determinants.

scholarly journals Characterisation of a highly potent and near pan-neutralising anti-HIV monoclonal antibody expressed in tobacco plants

Retrovirology ◽  
2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Catherine M. Moore ◽  
Melanie Grandits ◽  
Clemens Grünwald-Gruber ◽  
Friedrich Altmann ◽  
Maria Kotouckova ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Low Cost ◽  
Leaf Tissue ◽  
Glycosylation Site ◽  
People Living With Hiv ◽  
Middle Income ◽  
Effector Cells ◽  
Extraction And Purification ◽  
Important Health ◽  
Different Strains

Abstract Background HIV remains one of the most important health issues worldwide, with almost 40 million people living with HIV. Although patients develop antibodies against the virus, its high mutation rate allows evasion of immune responses. Some patients, however, produce antibodies that are able to bind to, and neutralise different strains of HIV. One such ‘broadly neutralising’ antibody is ‘N6’. Identified in 2016, N6 can neutralise 98% of HIV-1 isolates with a median IC50 of 0.066 µg/mL. This neutralisation breadth makes N6 a very promising therapeutic candidate. Results N6 was expressed in a glycoengineered line of N. benthamiana plants (pN6) and compared to the mammalian cell-expressed equivalent (mN6). Expression at 49 mg/kg (fresh leaf tissue) was achieved in plants, although extraction and purification are more challenging than for most plant-expressed antibodies. N-glycoanalysis demonstrated the absence of xylosylation and a reduction in α(1,3)-fucosylation that are typically found in plant glycoproteins. The N6 light chain contains a potential N-glycosylation site, which was modified and displayed more α(1,3)-fucose than the heavy chain. The binding kinetics of pN6 and mN6, measured by surface plasmon resonance, were similar for HIV gp120. pN6 had a tenfold higher affinity for FcγRIIIa, which was reflected in an antibody-dependent cellular cytotoxicity assay, where pN6 induced a more potent response from effector cells than that of mN6. pN6 demonstrated the same potency and breadth of neutralisation as mN6, against a panel of HIV strains. Conclusions The successful expression of N6 in tobacco supports the prospect of developing a low-cost, low-tech production platform for a monoclonal antibody cocktail to control HIV in low-to middle income countries. Graphic abstract

scholarly journals Barriers to training in laparoscopic surgery in low- and middle-income countries: A systematic review

2021 ◽  
pp. 004947552199818
Author(s):  
Ellen Wilkinson ◽  
Noel Aruparayil ◽  
J Gnanaraj ◽  
Julia Brown ◽  
David Jayne
Keyword(s):  
Laparoscopic Surgery ◽  
Low Cost ◽  
Surgical Care ◽  
Successful Implementation ◽  
Middle Income ◽  
Middle Income Countries ◽  
Technological Advances ◽  
Local Access ◽  
And Training ◽  
Low And Middle Income

Laparoscopic surgery has the potential to improve care in resource-deprived low- and-middle-income countries (LMICs). This study aims to analyse the barriers to training in laparoscopic surgery in LMICs. Medline, Embase, Global Health and Web of Science were searched using ‘LMIC’, ‘Laparoscopy’ and ‘Training’. Two researchers screened results with mutual agreement. Included papers were in English, focused on abdominal laparoscopy and training in LMICs. PRISMA guidelines were followed; 2992 records were screened, and 86 full-text articles reviewed to give 26 key papers. Thematic grouping identified seven key barriers: funding; availability and maintenance of equipment; local access to experienced laparoscopic trainers; stakeholder dynamics; lack of knowledge on effective training curricula; surgical departmental structure and practical opportunities for trainees. In low-resource settings, technological advances may offer low-cost solutions in the successful implementation of laparoscopic training and improve access to surgical care.

scholarly journals Decision-making process for introduction of maternal vaccines in Kenya, 2017–2018

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Nancy A. Otieno ◽  
Fauzia A. Malik ◽  
Stacy W. Nganga ◽  
Winnie N. Wairimu ◽  
Dominic O. Ouma ◽  
...  
Keyword(s):  
Decision Making ◽  
Policy Development ◽  
Implementation Process ◽  
Policy Formulation ◽  
Advisory Group ◽  
Decision Making Process ◽  
Middle Income ◽  
Maternal Immunization ◽  
Negative Impacts ◽  
High Level

Abstract Background Maternal immunization is a key strategy for reducing morbidity and mortality associated with infectious diseases in mothers and their newborns. Recent developments in the science and safety of maternal vaccinations have made possible development of new maternal vaccines ready for introduction in low- and middle-income countries. Decisions at the policy level remain the entry point for maternal immunization programs. We describe the policy and decision-making process in Kenya for the introduction of new vaccines, with particular emphasis on maternal vaccines, and identify opportunities to improve vaccine policy formulation and implementation process. Methods We conducted 29 formal interviews with government officials and policy makers, including high-level officials at the Kenya National Immunization Technical Advisory Group, and Ministry of Health officials at national and county levels. All interviews were recorded and transcribed. We analyzed the qualitative data using NVivo 11.0 software. Results All key informants understood the vaccine policy formulation and implementation processes, although national officials appeared more informed compared to county officials. County officials reported feeling left out of policy development. The recent health system decentralization had both positive and negative impacts on the policy process; however, the negative impacts outweighed the positive impacts. Other factors outside vaccine policy environment such as rumours, sociocultural practices, and anti-vaccine campaigns influenced the policy development and implementation process. Conclusions Public policy development process is complex and multifaceted by its nature. As Kenya prepares for introduction of other maternal vaccines, it is important that the identified policy gaps and challenges are addressed.

scholarly journals “It Is Like Medicine”: Using Sports to Promote Adult Women’s Health in Rural Kenya

2021 ◽  
Vol 18 (5) ◽  
pp. 2347
Author(s):  
Francis Barchi ◽  
Millan A. AbiNader ◽  
Samantha C. Winter ◽  
Lena M. Obara ◽  
Daniel Mbogo ◽  
...  
Keyword(s):  
Access To Health Care ◽  
Sleep Problems ◽  
Health Benefits ◽  
Adult Women ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Middle Income ◽  
Aerobic Activity ◽  
Effective Interventions ◽  
Rural Kenya

Despite the well-documented health benefits of recreational sports, few opportunities exist in lower- and middle-income countries for adult women to participate in recreational physical activities. An explanatory sequential mixed methods approach was used to explore associations between an innovative soccer program for adult women and self-reported health status. Cross-sectional survey data were collected in 2018–2019 from 702 women in the Nikumbuke Project, a health and literacy program in southeastern rural Kenya, followed by focus group discussions with 225 women who also participated in the Project’s soccer program. Quantitative findings suggest that women who participated in soccer had 67% greater odds of reporting good or excellent health than their non-soccer playing peers. Thematic analysis of qualitative data indicated that women credited soccer with less pain, fatigue, and stress, as well as weight loss and reduced dependence on medicine for hypertension, pain, and sleep problems. Women equated health benefits with greater ease and efficiency in completing chores, reduced worries, youthful energy, male-like strength, and pleased husbands. Soccer programs for adult women may be particularly effective interventions in settings where access to health care is limited and where lack of opportunity to engage in physical aerobic activity increases women’s risks for poor health outcomes.

scholarly journals Development and feasibility testing of a play-based psychosocial intervention for reduced patient stress in a pediatric care setting: experiences from Pakistan

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Muneera A. Rasheed ◽  
Vardah Bharuchi ◽  
Waliyah Mughis ◽  
Ayesha Hussain
Keyword(s):  
Parental Stress ◽  
Psychosocial Intervention ◽  
Tertiary Care ◽  
Theory Of Change ◽  
Pediatric Care ◽  
Clinical Psychologist ◽  
Play Intervention ◽  
Middle Income ◽  
Psychology Trainees ◽  
Parent Interactions

Abstract Background Hospitalization can be a source of great stress for children and their families. In high-income countries, there are specialized staff to help children cope using different techniques including play. However, it is a major challenge in low and middle-income countries (LMIC) due to financial constraints and untrained human resource. The objective of study was to develop and test the feasibility and acceptance of a psychology trainee-delivered model postulated on employing play as a means of enhancing child-parent interactions leading to reduced stress during hospitalization. Methods This study was conducted in the paediatric ward of a tertiary care private hospital in Pakistan. Pre-intervention survey revealed that parental stress stemmed mainly from seeing their child irritable, distressed, or in pain. Using a theory of change model, a play-based psychosocial intervention was developed to address these factors. The intervention approach was informed by principles of Nurturing Care Framework and play therapy. Children between birth and 6 years admitted in the acute care ward were eligible. The intervention was delivered between March 2019 and December 2020 by psychology trainees who were supervised by a clinical psychologist. The play-based sessions were delivered at the bedside and ranged from 20 to 40 min. Parents receiving the intervention were later interviewed for their stress, child emotions, and feedback about the service using structured surveys administered by psychology graduates. The trainees delivering the intervention were requested to provide their feedback as a written qualitative open-ended narrative. These narratives were analyzed using an inductive approach. Results The survey was conducted with 223 families with about half of the sample having children under 2 years of age. Forty-five percent of parents reported play intervention to be one of 3 key factors in improving their experience during hospital stay. Only 5% of parents reported feeling stressed about the child illness after the intervention. Ninety to 96% parents felt respected, listened to, and understood by the therapists. Thematic analysis of the feedback by trainees indicated the internship to be a useful experience and a new avenue for professional life whereas physicians appreciated the interventions. Conclusions The authors conclude that psychology trainees can feasibly deliver a play-based intervention under supervision for reduced stress in children and their parents during hospitalization with mutual benefits.

Increasing vaccine uptake in Sudan: Development of a web-based intervention (Preprint)

2021 ◽  
Author(s):  
Majdi Sabahelzain ◽  
Rik Crutzen ◽  
Mohamed Moukhyer ◽  
Hans Bosma ◽  
Bart van den Borne
Keyword(s):  
User Experience ◽  
Vaccine Safety ◽  
Arabic Language ◽  
Essential Elements ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Local Context ◽  
Middle Income ◽  
Web Based ◽  
Content Quality

BACKGROUND WHO described Vaccine hesitancy in 2019 as one of the top 10 threats to global health in high, and low, and middle-income countries. Various communication approaches have been used to engage the public about vaccines and immunization such as mass media and e-health strategies. With the expansion in the use of communication technologies in health in recent years, websites have increasingly been used to support vaccine acceptance and demand and thus increase vaccine uptake. We recently established a web-based intervention called the Tat3im initiative website in Sudan. It aims to increase uptake of vaccines in Sudan by increasing knowledge and addressing issues related to vaccine hesitancy and vaccine safety in the Arabic language OBJECTIVE This article describes the processes that we used to develop and improve this website including the creation of its content. METHODS These processes were informed by using and combining three sources including, Garrett’s user experience framework as a basis for the development, the WHO Vaccine Safety Net's (VSN) criteria for good information practices (i.e. credibility, content (quality and quantity), design and accessibility criteria), and previous relevant research that assessed the local context in Sudan. RESULTS We found that using such evidence as well as combining the VSN's criteria and previous research findings in the five planes of Garrett's framework enabled us to cover many essential elements of user experience and to address issues related to the website’s strategy and content. CONCLUSIONS As the website may be limited due to the high rates of illiteracy as well as relatively low internet use in Sudan, we suggest using social marketing to promote the use of the website as well as monitoring and evaluating the website and users’ experience using different approaches such as visitor traffic and qualitative measures.

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