scholarly journals Contextualizing Evidence for Action on Diabetes in Low-Resource Settings—Project CEAD Part-II, Strengthening the Health System: A Mixed-Methods Study Protocol

2021 ◽  
Vol 18 (7) ◽  
pp. 3391
Author(s):  
Mari Carmen Bernal-Soriano ◽  
Francisco Barrera-Guarderas ◽  
Alfonso Alonso-Jaquete ◽  
Elisa Chilet-Rosell ◽  
Ikram Benazizi ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Diabetes Care ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Community Members ◽  
Middle Income ◽  
Low Resource Settings ◽  
Low Resource ◽  
Middle Income Countries ◽  
Underlying Causes

Diabetes is a major public health problem, increasingly affecting low- and middle-income countries. The project CEAD (Contextualizing Evidence for Action in Diabetes in low-resource settings) aims to evaluate the implementation of comprehensive diabetes care in two low-resource settings in Ecuador and to stimulate context-led health systems innovations to improve diabetes care and reduce inequity. The mixed-methods approach includes a 24-month retrospective study to assess the current level of implementation of comprehensive diabetes care and participants will be followed up prospectively for two years to assess changes in healthcare and clinical outcomes from the outset of the research. We will include individuals diagnosed with type-2 diabetes aged over 18 years, who are accessing diabetes care in health facilities in the study districts. Varied stakeholders (patients and family members, community members, healthcare workers and decision-makers) will interpret the underlying causes of the observed weaknesses and propose solutions to strengthen diabetes-related healthcare in focus group discussions (FG). A second set of FG will analyze perceived improvements in healthcare based on prospective cohort findings and consider the success/failure of any context-led innovations occurring throughout the research. Our study will demonstrate how evidence can be contextualized to stimulate local innovations and overcome weaknesses of diabetes-related healthcare in low resource settings.

scholarly journals A framework for designing medical devices resilient to low-resource settings

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Davide Piaggio ◽  
Rossana Castaldo ◽  
Marco Cinelli ◽  
Sara Cinelli ◽  
Alessia Maccaro ◽  
...  
Keyword(s):  
Delphi Study ◽  
Middle Income ◽  
Low Resource Settings ◽  
Health Technologies ◽  
Low Resource ◽  
Middle Income Countries ◽  
High Resource ◽  
International Experts ◽  
Global Population ◽  
Different Parts

Abstract Background To date (April 2021), medical device (MD) design approaches have failed to consider the contexts where MDs can be operationalised. Although most of the global population lives and is treated in Low- and Middle-Income Countries (LMCIs), over 80% of the MD market share is in high-resource settings, which set de facto standards that cannot be taken for granted in lower resource settings. Using a MD designed for high-resource settings in LMICs may hinder its safe and efficient operationalisation. In the literature, many criteria for frameworks to support resilient MD design were presented. However, since the available criteria (as of 2021) are far from being consensual and comprehensive, the aim of this study is to raise awareness about such challenges and to scope experts’ consensus regarding the essentiality of MD design criteria. Results This paper presents a novel application of Delphi study and Multiple Criteria Decision Analysis (MCDA) to develop a framework comprising 26 essential criteria, which were evaluated and chosen by international experts coming from different parts of the world. This framework was validated by analysing some MDs presented in the WHO Compendium of innovative health technologies for low-resource settings. Conclusions This novel holistic framework takes into account some domains that are usually underestimated by MDs designers. For this reason, it can be used by experts designing MDs resilient to low-resource settings and it can also assist policymakers and non-governmental organisations in shaping the future of global healthcare.

scholarly journals Antiparasitic phytotherapy perspectives, scope and current development

Infectio ◽  
2019 ◽  
Vol 23 (2) ◽  
pp. 189 ◽  
Author(s):  
Jhon Carlos Castaño Osorio ◽  
Alejandra María Giraldo García
Keyword(s):  
Low Income ◽  
Public Health Problem ◽  
Cost Effective ◽  
Prolonged Treatment ◽  
Major Public Health Problem ◽  
Middle Income ◽  
Middle Income Countries ◽  
Commercial Markets ◽  
Health And Economic Development ◽  
New Treatments

Tropical protozoan diseases are currently a major public health problem throughout the world and are strongly linked with poverty, this combined with a lack of commercial markets for potential drugs has created a large burden on the health and economic development of low-income and middle-income countries in Africa, Asia, and the Americas. Due to the low research interest and the high increase of resistance against the existing treatments, as well as increasing inefficiency, toxicity, prolonged treatment schedules and costs, there is an urgent need for cost-effective, safe and easy-to-administer, new effective compounds with novel mechanisms of action. Several studies of crude plant extracts have already identified potential compounds to treat Chagas’ disease, Leishmaniasis, Toxoplasmosis, Giardiasis, and Malaria among other protozoan parasites. Natural compounds of medicinal plants have shown lower toxicity together with higher specificity, creating an optimistic view of new treatments for diseases. Out of 1010 new active substances approved as drugs for medical conditions by regulatory agencies during the past 25 years, 490(48.5%) were from a natural origin.

scholarly journals Malaria and Intestinal Parasites among Children in Muslim Schools, Port Harcourt, Rivers State, Nigeria

2021 ◽  
pp. 8-16
Author(s):  
Eze, Chinwe Nwadiuto ◽  
Owhoeli Ovutor ◽  
Olasunkanmi, Rukayat Motunrayo
Keyword(s):  
Intestinal Parasites ◽  
Public Health Problem ◽  
Strongyloides Stercoralis ◽  
Major Public Health Problem ◽  
Middle Income ◽  
Middle Income Countries ◽  
Port Harcourt ◽  
Ancylostoma Duodenale ◽  
Rivers State ◽  
Age Range

Introduction: Malaria and intestinal helminthes infections are major public health problem in low and middle-income countries affecting over 2 million people across the globe. Objectives: This survey was carried out to determine the prevalence of malaria and intestinal parasites among Muslim school children in Port Harcourt, Rivers State. Methodology: Four Muslim schools: kab model school Rumuagolu, Manbaul hikma Eliozu, An-nur school Rumuodomaya and Al-ameen school Eneka. One hundred and fifty (150) blood and stool samples were collected randomly from the pupils (70 males and 80 female; age range 5-12 years) and examined between the Months of May to July 2018. Results: The overall prevalence of 50.7%, and 43.3% was recorded for malaria and intestinal helminthes respectively. The prevalence for malaria was 32.5%, 63.0%, 58.0% and 50.0%. Intestinal helminthes was 30%, 53.3%, 42.0% and 53.0% for kab, Manbaul hikma, An-nur and Al-ameen Schools respectively. The frequency of parasites encountered was as follows, Strongyloides stercoralis 8.7%, Ascaris lumbricoides 14.0%, Enterobious vermicularis 1.3%, Necator americanus 5.3%, Ancylostoma duodenale 4.7%, and Trichuris trichuria 9.3%. Malaria and intestinal helminthes infection was highest in females with 51.2% and 45.0% respectively. Pupils between ages 9-10 had the highest infection rate of (54.0%) for malaria while ages 7-8 had the highest prevalence of 47.7% for intestinal helminthes. Co-infection was 22.0%, 23.0%, 22.0% and 32.0% for kab, Manbaul hikma, An-nur and Al-ameen Schools Respectively. Conclusions: The overall infection for malaria and intestinal helminthes was high. Therefore, regular de-worming of the pupils by parents, and health education are necessary to keep the prevalence in check. This study may also be used to predict risk for communities under consideration.

scholarly journals Six-minute walk test protocol variations in low-resource settings – A scoping review

2021 ◽  
Vol 77 (1) ◽  
Author(s):  
Brittany L. Fell ◽  
Susan Hanekom ◽  
Martin Heine
Keyword(s):  
Common Reason ◽  
Walk Test ◽  
Test Protocol ◽  
Middle Income ◽  
Low Resource Settings ◽  
Low Resource ◽  
Middle Income Countries ◽  
Functional Exercise ◽  
Course Length ◽  
Exercise Programmes

Background: The 6-min walk test (6MWT) is a validated tool, of submaximal intensity, used to objectively measure functional exercise capacity. In 2002, the American Thoracic Society (ATS) developed guidelines on standardising the implementation of the 6MWT. Despite the relative ease of conducting the 6MWT as per these guidelines, adaptations are implemented.Objectives: Identify (1) what 6MWT adaptations to the ATS guidelines have been described in low-resource settings (LRS), (2) the purpose of the adapted 6MWT and (3) the reported argumentation for making these adaptations in relation to the specific context.Methods: Five databases were searched from inception until February 2021. Studies that adapted and conducted the 6MWT in LRS were included. Data concerning the study source, participants, 6MWT: purpose, variations, outcome and rationale were extracted.Results: A total of 24 studies were included. The majority of studies (n = 18; 75%) were conducted in lower-middle income countries. The most common adaptation implemented was variation to course length. Eight studies provided a rationale for adapting the 6MWT. Space constraint was the most common reason for adaptation.Conclusion: The most common reason (space constraints) for adapting the 6MWT in LRS was addressed through adaptations in course length and/or configuration. The results of this review suggest that the value of the ATS-guided 6MWT in LRS may need to be re-evaluated.Clinical implications: Using adapted forms of the 6MWT may lead to an underestimation of a patient’s abilities, misinformed discharge and developing inappropriate exercise programmes. Additionally, diverting from ATS guidelines may affect the continuity of care.

scholarly journals Unravelling ‘low-resource settings’: a systematic scoping review with qualitative content analysis

2021 ◽  
Vol 6 (6) ◽  
pp. e005190
Author(s):  
Chanel van Zyl ◽  
Marelise Badenhorst ◽  
Susan Hanekom ◽  
Martin Heine
Keyword(s):  
Content Analysis ◽  
Scoping Review ◽  
Qualitative Content Analysis ◽  
Middle Income ◽  
Low Resource Settings ◽  
Low Resource ◽  
Middle Income Countries ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Low Middle Income Countries

IntroductionThe effects of healthcare-related inequalities are most evident in low-resource settings. Such settings are often not explicitly defined, and umbrella terms which are easier to operationalise, such as ‘low-to-middle-income countries’ or ‘developing countries’, are often used. Without a deeper understanding of context, such proxies are pregnant with assumptions, insinuate homogeneity that is unsupported and hamper knowledge translation between settings.MethodsA systematic scoping review was undertaken to start unravelling the term ‘low-resource setting’. PubMed, Africa-Wide, Web of Science and Scopus were searched (24 June 2019), dating back ≤5 years, using terms related to ‘low-resource setting’ and ‘rehabilitation’. Rehabilitation was chosen as a methodological vehicle due to its holistic nature (eg, multidisciplinary, relevance across burden of disease, and throughout continuum of care) and expertise within the research team. Qualitative content analysis through an inductive approach was used.ResultsA total of 410 codes were derived from 48 unique articles within the field of rehabilitation, grouped into 63 content categories, and identified nine major themes relating to the term ‘low-resource setting’. Themes that emerged relate to (1) financial pressure, (2) suboptimal healthcare service delivery, (3) underdeveloped infrastructure, (4) paucity of knowledge, (5) research challenges and considerations, (6) restricted social resources, (7) geographical and environmental factors, (8) human resource limitations and (9) the influence of beliefs and practices.ConclusionThe emerging themes may assist with (1) the groundwork needed to unravel ‘low-resource settings’ in health-related research, (2) moving away from assumptive umbrella terms like ‘low-to-middle-income countries’ or ‘low/middle-income countries’ and (3) promoting effective knowledge transfer between settings.

scholarly journals Contextualizing Evidence for Action on Diabetes in Low-Resource Settings—Project CEAD Part I: A Mixed-Methods Study Protocol

2020 ◽  
Vol 17 (2) ◽  
pp. 569
Author(s):  
Elisa Chilet-Rosell ◽  
Nora Piay ◽  
Ildefonso Hernández-Aguado ◽  
Blanca Lumbreras ◽  
Francisco Barrera-Guarderas ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Local Knowledge ◽  
Health Workers ◽  
Epidemiological Data ◽  
Diabetes Risk ◽  
Mixed Methods Study ◽  
Cross Sectional ◽  
Middle Income ◽  
Low Resource Settings ◽  
Low Resource

Challenges remain for policy adoption and implementation to tackle the unprecedented and relentless increase in obesity, diabetes and other non-communicable diseases (NCDs), especially in low- and middle-income countries. The aim of this mixed-methods study is to analyse the contextual relevance and applicability to low-resource settings of a sample of evidence-based healthy public policies, using local knowledge, perceptions and pertinent epidemiological data. Firstly, we will identify and prioritise policies that have the potential to reduce the burden of diabetes in low-resource settings with a scoping review and modified Delphi method. In parallel, we will undertake two cross-sectional population surveys on diabetes risk and morbidity in two low-resource settings in Ecuador. Patients, community members, health workers and policy makers will analyse the contextual relevance and applicability of the policy actions and discuss their potential for the reduction in inequities in diabetes risk and morbidity in their population. This study tackles one of the greatest challenges in global health today: how to drive the implementation of population-wide preventative measures to fight NCDs in low resource settings. The findings will demonstrate how local knowledge, perceptions and pertinent epidemiological data can be used to analyse the contextual relevance and applicability of potential policy actions.

scholarly journals Rise and Fall of Therapeutic Hypothermia in Low-Resource Settings: Lessons from the HELIX Trial

2021 ◽  
Author(s):  
Vaisakh Krishnan ◽  
Vijay Kumar ◽  
Seetha Shankaran ◽  
Sudhin Thayyil
Keyword(s):  
Intensive Care ◽  
Brain Injury ◽  
Therapeutic Hypothermia ◽  
Neonatal Intensive Care ◽  
Controlled Cooling ◽  
Middle Income ◽  
Low Resource Settings ◽  
Low Resource ◽  
Middle Income Countries ◽  
Cooling Devices

AbstractIn the past decade, therapeutic hypothermia using a variety of low-cost devices has been widely implemented in India and other low-and middle-income countries (LMIC) without adequate evidence of either safety or efficacy. The recently reported data from the world’s largest cooling trial (HELIX - hypothermia for encephalopathy in low- and middle-income countries) in LMIC provides definitive evidence of harm of cooling therapy with increase in mortality (number to harm 9) and lack of neuroprotection. Although the HELIX participating centers were highly selected tertiary neonatal intensive care units in South Asia with facilities for invasive ventilation, cardiovascular support, and 3 Tesla magnetic resonance imaging (MRI), and the trial used state-of-the-art automated servo-controlled cooling devices, a therapy that is harmful under such optimal conditions cannot be safe in low-resource settings that cannot even afford servo-controlled cooling devices.The HELIX trial has set a new benchmark for conducting high quality randomized controlled trials in terms of research governance, consent, ethics, follow-up rates, and involvement of parents. The standard care for neonatal encephalopathy in LMIC should remain normothermia, with close attention to prevention of hyperthermia. There is no role for therapeutic hypothermia in LMIC as the efficacy of hypothermia is dependent on the population, and not merely on the level of neonatal intensive care facilities. Future research should explore timings and origins of brain injury and prevention of brain injury in LMIC, with a strong emphasis on academic research capacity building and patient and public engagement.

General and Urological Surgery

2020 ◽  
pp. 229-238
Author(s):  
Lara Herbert ◽  
Ruth Tighe
Keyword(s):  
Hydatid Cyst ◽  
Spinal Anaesthesia ◽  
Bladder Stone ◽  
Middle Income ◽  
Low Resource Settings ◽  
Cyst Excision ◽  
Low Resource ◽  
Middle Income Countries ◽  
Risks And Benefits ◽  
Urological Surgery

The chapter covers some of the general and urological conditions likely to be encountered by anaesthetists working in low-resource settings. Some such conditions are familiar to all anaesthetists, but the resources to manage them may be different: this chapter therefore particularly includes a description of laparotomy under spinal anaesthesia and a consideration of the risks and benefits of this technique. In addition some surgeries more commonly performed in low- and middle-income countries, e.g. bladder stone excision, non-traumatic splenectomy, and hydatid cyst excision are outlined, together with appropriate approaches and techniques for the non-specialist anaesthetist. Both elective and emergency conditions are included.

scholarly journals Anaemia among Kenyan children: a call for improved monitoring and intervention in school-aged children

2020 ◽  
Vol 114 (8) ◽  
pp. 627-631
Author(s):  
Emelda A Okiro ◽  
Noel K Joseph ◽  
Caroline W Gitonga ◽  
Robert W Snow
Keyword(s):  
Public Health ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Age Group ◽  
Nutrition And Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
School Aged Children ◽  
Poor Nutrition ◽  
Moderate Anaemia

Abstract Background Anaemia has long been recognised as a major public health problem among young children in lower- and middle-income countries and is an indicator of both poor nutrition and health status. There has been little progress towards improvement of anaemia in part due to its complex aetiology. An added impediment to the progress is that the monitoring of anaemia does not routinely target the whole population, with school-aged children (SAC) largely overlooked. Methods We re-examined data on the prevalence of anaemia among children aged <15 y sampled from 2008–2015 in Kenya. Results Approximately one in four Kenyan children aged <15 y were described as anaemic, including 12% with WHO-defined moderate anaemia and 1% who were severely anaemic. Average haemoglobin concentrations increased with age and the risk of having anaemia decreased with age. However, one in five SAC in Kenya were suffering from anaemia; most were either mild (11.4%) or moderately (10.9%) anaemic. Conclusions The monitoring of anaemia in SAC continues to be a neglected area limiting a careful articulation of the need to target interventions in this age group.

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