Quality of Malaria Care Service Delivery by Treatment Cascades in 25 Low-Income and Middle-Income Countries

IntroductionCritical care in low-income and low-middle income countries (LLMICs) is an underdeveloped component of the healthcare system. Given the increasing growth in demand for critical care services in LLMICs, understanding the current capacity to provide critical care is imperative to inform policy on service expansion. Thus, our aim is to describe the provision of critical care in LLMICs with respect to patients, providers, location of care and services and interventions delivered.Methods and analysisWe will search PubMed/MEDLINE, Web of Science and EMBASE for full-text original research articles available in English describing critical care services that specify the location of service delivery and describe patients and interventions. We will restrict our review to populations from LLMICs (using 2016 World Bank classifications) and published from 1 January 2008 to 1 January 2020. Two-reviewer agreement will be required for both title/abstract and full text review stages, and rate of agreement will be calculated for each stage. We will extract data regarding the location of critical care service delivery, the training of the healthcare professionals providing services, and the illnesses treated according to classification by the WHO Universal Health Coverage Compendium.Ethics and disseminationReviewed and exempted by the Stanford University Office for Human Subjects Research and IRB on 20 May 2020. The results of this review will be disseminated through scholarly publication and presentation at regional and international conferences. This review is designed to inform broader WHO, International Federation for Emergency Medicine and partner efforts to strengthen critical care globally.PROSPERO registration numberCRD42019146802.

Download Full-text

Psychological interventions for bipolar disorder in low- and middle-income countries: systematic review

BJPsych Open ◽

10.1192/bjo.2018.46 ◽

2018 ◽

Vol 4 (5) ◽

pp. 375-384 ◽

Cited By ~ 6

Author(s):

Mekdes Demissie ◽

Charlotte Hanlon ◽

Rahel Birhane ◽

Lauren Ng ◽

Girmay Medhin ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Bipolar Disorder ◽

Low Income ◽

Hospital Admissions ◽

Psychological Interventions ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

BackgroundAdjunctive psychological interventions for bipolar disorder have demonstrated better efficacy in preventing or delaying relapse and improving outcomes compared with pharmacotherapy alone.AimsTo evaluate the efficacy of psychological interventions for bipolar disorder in low- and middle-income countries.MethodA systematic review was conducted using PubMed, PsycINFO, Medline, EMBASE, Cochrane database for systematic review, Cochrane central register of controlled trials, Latin America and Caribbean Center on Health Science Literature and African Journals Online databases with no restriction of language or year of publication. Methodological heterogeneity of studies precluded meta-analysis.ResultsA total of 18 adjunctive studies were identified: psychoeducation (n = 14), family intervention (n = 1), group cognitive–behavioural therapy (CBT) (n = 2) and group mindfulness-based cognitive therapy (MBCT) (n = 1). In total, 16 of the 18 studies were from upper-middle-income countries and none from low-income countries. All used mental health specialists or experienced therapists to deliver the intervention. Most of the studies have moderately high risk of bias. Psychoeducation improved treatment adherence, knowledge of and attitudes towards bipolar disorder and quality of life, and led to decreased relapse rates and hospital admissions. Family psychoeducation prevented relapse, decreased hospital admissions and improved medication adherence. CBT reduced both depressive and manic symptoms. MBCT reduced emotional dysregulation.ConclusionsAdjunctive psychological interventions alongside pharmacotherapy appear to improve the clinical outcome and quality of life of people with bipolar disorder in middle-income countries. Further studies are required to investigate contextual adaptation and the role of non-specialists in the provision of psychological interventions to ensure scalability and the efficacy of these interventions in low-income country settings.Declaration of interestNone.

Download Full-text

Level of confidence in and endorsement of the health system among internet users in 12 low-income and middle-income countries

BMJ Global Health ◽

10.1136/bmjgh-2019-002205 ◽

2020 ◽

Vol 5 (8) ◽

pp. e002205

Author(s):

Sanam Roder-DeWan ◽

Anna Gage ◽

Lisa R Hirschhorn ◽

Nana A Y Twum-Danso ◽

Jerker Liljestrand ◽

...

Keyword(s):

Health System ◽

Low Income ◽

Internet Survey ◽

Health Coverage ◽

Middle Income ◽

Middle Income Countries ◽

Internet Users ◽

Effective Care ◽

Universal Health

IntroductionPeople’s confidence in and endorsement of the health system are key measures of system performance, yet are undermeasured in low-income and middle-income countries (LMICs). We explored the prevalence and predictors of these measures in 12 countries.MethodsWe conducted an internet survey in Argentina, China, Ghana, India, Indonesia, Kenya, Lebanon, Mexico, Morocco, Nigeria, Senegal and South Africa collecting demographics, ratings of quality, and confidence in and endorsement of the health system. We used multivariable logistic regression to assess the association between confidence/endorsement and self-reported quality of recent healthcare.ResultsOf 13 489 respondents, 62% reported a health visit in the past year. Applying population weights, 32% of these users were very confident that they could receive effective care if they were to ‘become very sick tomorrow’; 30% endorsed the health system, that is, agreed that it ‘works pretty well and only needs minor changes’. Reporting high quality in the last visit was associated with 4.48 and 2.69 greater odds of confidence (95% CI 3.64 to 5.52) and endorsement (95% CI 2.33 to 3.11). Having health insurance was positively associated with confidence and endorsement (adjusted odds ratio (AOR) 1.68, 95% CI 1.49 to 1.90 and AOR 1.34, 95% CI 1.22 to 1.48), while experiencing discrimination in healthcare was negatively associated (AOR 0.67, 95% CI 0.56 to 0.80 and AOR 0.63, 95% CI 0.53 to 0.76).ConclusionConfidence and endorsement of the health system were low across 12 LMICs. This may hinder efforts to gain support for universal health coverage. Positive patient experience was strongly associated with confidence in and endorsement of the health system.

Download Full-text

Primary healthcare system performance in low-income and middle-income countries: a scoping review of the evidence from 2010 to 2017

BMJ Global Health ◽

10.1136/bmjgh-2019-001551 ◽

2019 ◽

Vol 4 (Suppl 8) ◽

pp. e001551 ◽

Cited By ~ 10

Author(s):

Asaf Bitton ◽

Jocelyn Fifield ◽

Hannah Ratcliffe ◽

Ami Karlage ◽

Hong Wang ◽

...

Keyword(s):

Service Delivery ◽

Scoping Review ◽

Low Income ◽

Primary Healthcare ◽

Recent Literature ◽

Future Research ◽

Topic Area ◽

Middle Income ◽

Ample Evidence ◽

Middle Income Countries

IntroductionThe 2018 Astana Declaration reaffirmed global commitment to primary healthcare (PHC) as a core strategy to achieve universal health coverage. To meet this potential, PHC in low-income and middle-income countries (LMIC) needs to be strengthened, but research is lacking and fragmented. We conducted a scoping review of the recent literature to assess the state of research on PHC in LMIC and understand where future research is most needed.MethodsGuided by the Primary Healthcare Performance Initiative (PHCPI) conceptual framework, we conducted searches of the peer-reviewed literature on PHC in LMIC published between 2010 (the publication year of the last major review of PHC in LMIC) and 2017. We also conducted country-specific searches to understand performance trajectories in 14 high-performing countries identified in the previous review. Evidence highlights and gaps for each topic area of the PHCPI framework were extracted and summarised.ResultsWe retrieved 5219 articles, 207 of which met final inclusion criteria. Many PHC system inputs such as payment and workforce are well-studied. A number of emerging service delivery innovations have early evidence of success but lack evidence for how to scale more broadly. Community-based PHC systems with supportive governmental policies and financing structures (public and private) consistently promote better outcomes and equity. Among the 14 highlighted countries, most maintained or improved progress in the scope of services, quality, access and financial coverage of PHC during the review time period.ConclusionOur findings revealed a heterogeneous focus of recent literature, with ample evidence for effective PHC policies, payment and other system inputs. More variability was seen in key areas of service delivery, underscoring a need for greater emphasis on implementation science and intervention testing. Future evaluations are needed on PHC system capacities and orientation toward social accountability, innovation, management and population health in order to achieve the promise of PHC.

Download Full-text

Systematic review of early abortion services in low- and middle-income country primary care: potential for reverse innovation and application in the UK context

Globalization and Health ◽

10.1186/s12992-020-00613-z ◽

2020 ◽

Vol 16 (1) ◽

Author(s):

Jacy Zhou ◽

Rebecca Blaylock ◽

Matthew Harris

Keyword(s):

Primary Care ◽

Service Delivery ◽

Middle Income ◽

Middle Income Countries ◽

Service Delivery Models ◽

Primary Care Settings ◽

The Uk ◽

Delivery Models ◽

Low And Middle Income

Abstract Background In the UK, according to the 1967 Abortion Act, all abortions must be approved by two doctors, reported to the Department of Health and Social Care (DHSC), and be performed by doctors within licensed premises. Removing abortion from the criminal framework could permit new service delivery models. We explore service delivery models in primary care settings that can improve accessibility without negatively impacting the safety and efficiency of abortion services. Novel service delivery models are common in low-and-middle income countries (LMICs) due to resource constraints, and services are sometimes provided by trained, mid-level providers via “task-shifting”. The aim of this study is to explore the quality of early abortion services provided in primary care of LMICs and explore the potential benefits of extending their application to the UK context. Methods We searched MEDLINE, EMBASE, Global Health, Maternity and Infant Care, CINAHL, and HMIC for studies published from September 1994 to February 2020, with search terms “nurses”, “midwives”, “general physicians”, “early medical/surgical abortion”. We included studies that examined the quality of abortion care in primary care settings of low-and-middle-income countries (LMICs), and excluded studies in countries where abortion is illegal, and those of services provided by independent NGOs. We conducted a thematic analysis and narrative synthesis to identify indicators of quality care at structural, process and outcome levels of the Donabedian model. Results A total of 21 indicators under 8 subthemes were identified to examine the quality of service provision: law and policy, infrastructure, technical competency, information provision, client-provider interactions, ancillary services, complete abortions, client satisfaction. Our analysis suggests that structural, process and outcome indicators follow a mediation pathway of the Donabedian model. This review showed that providing early medical abortion in primary care services is safe and feasible and “task-shifting” to mid-level providers can effectively replace doctors in providing abortion. Conclusion The way services are organised in LMICs, using a task-shifted and decentralised model, results in high quality services that should be considered for adoption in the UK. Collaboration with professional medical bodies and governmental departments is necessary to expand services from secondary to primary care.

Download Full-text

Using unannounced standardised patients to obtain data on quality of care in low-income and middle-income countries: key challenges and opportunities

BMJ Global Health ◽

10.1136/bmjgh-2019-001908 ◽

2019 ◽

Vol 4 (5) ◽

pp. e001908 ◽

Cited By ~ 1

Author(s):

Virginia Wiseman ◽

Mylene Lagarde ◽

Roxanne Kovacs ◽

Luh Putu Lila Wulandari ◽

Timothy Powell-Jackson ◽

...

Keyword(s):

Quality Of Care ◽

Low Income ◽

Middle Income ◽

Middle Income Countries ◽

Challenges And Opportunities ◽

Standardised Patients

Download Full-text

Enhancing quality of medical care in low income and middle income countries through simulation-based initiatives: recommendations of the Simnovate Global Health Domain Group

BMJ Simulation and Technology Enhanced Learning ◽

10.1136/bmjstel-2016-000180 ◽

2017 ◽

Vol 3 (Suppl 1) ◽

pp. S15-S22 ◽

Cited By ~ 6

Author(s):

Lekha Puri ◽

Jishnu Das ◽

Madhukar Pai ◽

Priya Agrawal ◽

J Edward Fitzgerald ◽

...

Keyword(s):

Quality Of Care ◽

Global Health ◽

Medical Care ◽

Low Income ◽

Middle Income ◽

Health Domain ◽

Middle Income Countries ◽

Simulation Based ◽

Quality Of Medical Care

BackgroundQuality of medical care in low income and middle income countries (LMICs) is variable, resulting in significant medical errors and adverse patient outcomes. Integration of simulation-based training and assessment may be considered to enhance quality of patient care in LMICs. The aim of this study was to consider the role of simulation in LMICs, to directly impact health professions education, measurement and assessment.MethodsThe Simnovate Global Health Domain Group undertook three teleconferences and a direct face-to-face meeting. A scoping review of published studies using simulation in LMICs was performed and, in addition, a detailed survey was sent to the World Directory of Medical Schools and selected known simulation centres in LMICs.ResultsStudies in LMICs employed low-tech manikins, standardised patients and procedural simulation methods. Low-technology manikins were the majority simulation method used in medical education (42%), and focused on knowledge and skills outcomes. Compared to HICs, the majority of studies evaluated baseline adherence to guidelines rather than focusing on improving medical knowledge through educational intervention. There were 46 respondents from the survey, representing 21 countries and 28 simulation centres. Within the 28 simulation centres, teachers and trainees were from across all healthcare professions.DiscussionBroad use of simulation is low in LMICs, and the full potential of simulation-based interventions for improved quality of care has yet to be realised. The use of simulation in LMICs could be a potentially untapped area that, if increased and/or improved, could positively impact patient safety and the quality of care.

Download Full-text