Feasibility of an At-Home Adult Stool Specimen Collection Method in Rural Cambodia

The human microbiome has received significant attention over the past decade regarding its potential impact on health. Epidemiological and intervention studies often rely on at-home stool collection methods designed for high-resource settings, such as access to an improved toilet with a modern toilet seat. However, this is not always appropriate or applicable to low-resource settings. Therefore, the design of a user-friendly stool collection kit for low-resource rural settings is needed. We describe the development, assembly, and user experience of a simple and low-cost at-home stool collection kit for women living in rural Cambodia as part of a randomized controlled trial in 2020. Participants were provided with the stool collection kit and detailed verbal instruction. Enrolled women (n = 480) provided two stool specimens (at the start of the trial and after 12 weeks) at their home and brought them to the health centre that morning in a sterile collection container. User specimen collection compliance was high, with 90% (n = 434) of women providing a stool specimen at the end of the trial (after 12 weeks). This feasible and straightforward method has strong potential for similar or adapted use among adults residing in other rural or low-resource contexts.

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Assessment of Local Supply Chains and Stock Management Practices for Trauma Care Resources in Ghana: A Comparative Cross-Sectional Study

10.21203/rs.3.rs-19987/v1 ◽

2020 ◽

Author(s):

Godfred Boakye ◽

Adam Gyedu ◽

Melissa Stewart ◽

Peter Donkor ◽

Charles Mock ◽

...

Keyword(s):

Supply Chain ◽

Resource Availability ◽

Trauma Care ◽

Management Practices ◽

Low Cost ◽

The United States ◽

Major Public Health Problem ◽

Stock Management ◽

Low Resource ◽

High Resource

Abstract Background: Injuries are a major public health problem globally. With sound planning and organization, essential trauma care can be reliably provided with relatively low-cost equipment and supplies. However, availability of these resources requires an effective and efficient supply chain and good stock management practices. Therefore, we study aimed to assess trauma care resource-related supply management structures and processes at health facilities in Ghana. By doing so, the findings may allow us to identify specific structures and processes that could be improved to facilitate higher quality and more timely care.Methods: Ten hospitals were purposively selected using results from a previously performed national trauma care capacity assessment of hospitals of all levels in Ghana. Five hospitals with low resource availability and 5 hospitals with high resource availability were assessed using the United States Agency for International Development (USAID) Logistics Indicators Assessment Tool and stock ledger review. Data were described and stock management practices were correlated with resource availability.Results: There were differences in stock management practices between low and high resource availability hospitals, including frequency of reporting and audit, number of stock-outs on day of assessment (median 9 vs 2 stock-outs, range 3 – 57 vs 0 – 9 stock-outs, respectively; p=0.05), duration of stock-outs (median 171 vs 8 days, range 51 – 1,268 vs 0 – 182 days, respectively; p=0.02), and fewer of up-to-date stock cards (24 vs 31 up-to-date stock cards, respectively; p=0.07). Stock-outs were common even among low-cost, essential resources (e.g., nasal cannulas and oxygen masks, endotracheal tubes, syringes, sutures, sterile gloves). Increased adherence to stock management guidelines and higher percentage of up-to-date stock cards were correlated with higher trauma resource availability scores. However, the variance in trauma resource availability scores was poorly explained by these individual factors or when analyzed in a multivariate regression model (r2=0.72; p value for each covariate between 0.17 – 0.34).Conclusions: Good supply chain and stock management practices are correlated with high trauma care resource availability. The findings from this study demonstrate several opportunities to improve stock management practices, particularly at low resource availability hospitals

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Assessment of Local Supply Chains and Stock Management Practices for Trauma Care Resources in Ghana: A Comparative Small Sample Cross-Sectional Study

10.21203/rs.3.rs-19987/v3 ◽

2021 ◽

Author(s):

Godfred Boakye ◽

Adam Gyedu ◽

Melissa Stewart ◽

Peter Donkor ◽

Charles Mock ◽

...

Keyword(s):

Supply Chain ◽

Resource Availability ◽

Trauma Care ◽

Management Practices ◽

Low Cost ◽

The United States ◽

Small Sample ◽

Stock Management ◽

Low Resource ◽

High Resource

Abstract Background: Injuries are a major public health problem globally. With sound planning and organization, essential trauma care can be reliably provided with relatively low-cost equipment and supplies. However, availability of these resources requires an effective and efficient supply chain and good stock management practices. Therefore, we study aimed to assess trauma care resource-related supply management structures and processes at health facilities in Ghana. By doing so, the findings may allow us to identify specific structures and processes that could be improved to facilitate higher quality and more timely care. Methods: Ten hospitals were purposively selected using results from a previously performed national trauma care capacity assessment of hospitals of all levels in Ghana. Five hospitals with low resource availability and 5 hospitals with high resource availability were assessed using the United States Agency for International Development (USAID) Logistics Indicators Assessment Tool and stock ledger review. Data were described and stock management practices were correlated with resource availability. Results: There were differences in stock management practices between low and high resource availability hospitals, including frequency of reporting and audit, number of stock-outs on day of assessment (median 9 vs 2 stock-outs, range 3 – 57 vs 0 – 9 stock-outs, respectively; p=0.05), duration of stock-outs (median 171 vs 8 days, range 51 – 1,268 vs 0 – 182 days, respectively; p=0.02), and fewer of up-to-date stock cards (24 vs 31 up-to-date stock cards, respectively; p=0.07). Stock-outs were common even among low-cost, essential resources (e.g., nasal cannulas and oxygen masks, endotracheal tubes, syringes, sutures, sterile gloves). Increased adherence to stock management guidelines and higher percentage of up-to-date stock cards were correlated with higher trauma resource availability scores. However, the variance in trauma resource availability scores was poorly explained by these individual factors or when analyzed in a multivariate regression model (r 2 =0.72; p value for each covariate between 0.17 – 0.34). Conclusions: Good supply chain and stock management practices are correlated with high trauma care resource availability. The findings from this study demonstrate several opportunities to improve stock management practices, particularly at low resource availability hospitals.

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Eye-tracking-based assessment of cognitive function in low-resource settings

Archives of Disease in Childhood ◽

10.1136/archdischild-2016-310525 ◽

2016 ◽

Vol 102 (4) ◽

pp. 301.1-302 ◽

Cited By ~ 23

Author(s):

Linda Forssman ◽

Per Ashorn ◽

Ulla Ashorn ◽

Kenneth Maleta ◽

Andrew Matchado ◽

...

Keyword(s):

Cognitive Function ◽

Eye Tracking ◽

Low Income ◽

Health Centre ◽

Assessment Tools ◽

Completion Rates ◽

Low Resource ◽

High Resource ◽

Resource Setting ◽

Test Completion

BackgroundEarly development of neurocognitive functions in infants can be compromised by poverty, malnutrition and lack of adequate stimulation. Optimal management of neurodevelopmental problems in infants requires assessment tools that can be used early in life, and are objective and applicable across economic, cultural and educational settings.Objective and designThe present study examined the feasibility of infrared eye tracking as a novel and highly automated technique for assessing visual-orienting and sequence-learning abilities as well as attention to facial expressions in young (9-month-old) infants. Techniques piloted in a high-resource laboratory setting in Finland (N=39) were subsequently field-tested in a community health centre in rural Malawi (N=40).ResultsParents' perception of the acceptability of the method (Finland 95%, Malawi 92%) and percentages of infants completing the whole eye-tracking test (Finland 95%, Malawi 90%) were high, and percentages of valid test trials (Finland 69–85%, Malawi 68–73%) satisfactory at both sites. Test completion rates were slightly higher for eye tracking (90%) than traditional observational tests (87%) in Malawi. The predicted response pattern indicative of specific cognitive function was replicated in Malawi, but Malawian infants exhibited lower response rates and slower processing speed across tasks.ConclusionsHigh test completion rates and the replication of the predicted test patterns in a novel environment in Malawi support the feasibility of eye tracking as a technique for assessing infant development in low-resource setting. Further research is needed to the test–retest stability and predictive validity of the eye-tracking scores in low-income settings.

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Systematic review of clinical effectiveness, components, and delivery of pulmonary rehabilitation in low-resource settings

npj Primary Care Respiratory Medicine ◽

10.1038/s41533-020-00210-y ◽

2020 ◽

Vol 30 (1) ◽

Author(s):

GM Monsur Habib ◽

Roberto Rabinovich ◽

Kalyani Divgi ◽

Salahuddin Ahmed ◽

Samir Kumar Saha ◽

...

Keyword(s):

Pulmonary Rehabilitation ◽

Low Cost ◽

Mode Of Delivery ◽

Well Being ◽

Chronic Obstructive ◽

Low Resource Settings ◽

Chronic Respiratory Diseases ◽

Low Resource ◽

Breathing Exercises ◽

High Resource

AbstractPulmonary rehabilitation (PR) is a guideline-recommended multifaceted intervention that improves the physical and psychological well-being of people with chronic respiratory diseases (CRDs), though most of the evidence derives from trials in high-resource settings. In low- and middle-income countries, PR services are under-provided. We aimed to review the effectiveness, components and mode of delivery of PR in low-resource settings. Following Cochrane methodology, we systematically searched (1990 to October 2018; pre-publication update March 2020) MEDLINE, EMBASE, CABI, AMED, PUBMED, and CENTRAL for controlled clinical trials of adults with CRD (including but not restricted to chronic obstructive pulmonary disease) comparing PR with usual care in low-resource settings. After duplicate selection, we extracted data on exercise tolerance, health-related quality of life (HRQoL), breathlessness, included components, and mode of delivery. We used Cochrane risk of bias (RoB) to assess study quality and synthesised data narratively. From 8912 hits, we included 13 studies: 11 were at high RoB; 2 at moderate RoB. PR improved functional exercise capacity in 10 studies, HRQoL in 12, and breathlessness in 9 studies. One of the two studies at moderate RoB showed no benefit. All programmes included exercise training; most provided education, chest physiotherapy, and breathing exercises. Low cost services, adapted to the setting, used limited equipment and typically combined outpatient/centre delivery with a home/community-based service. Multicomponent PR programmes can be delivered in low-resource settings, employing a range of modes of delivery. There is a need for a high-quality trial to confirm the positive findings of these high/moderate RoB studies.

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Towards biomarker-based tests that can facilitate decisions about prevention and management of preeclampsia in low-resource settings

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2015-0069 ◽

2016 ◽

Vol 54 (1) ◽

Cited By ~ 11

Author(s):

Nathalie Acestor ◽

Jane Goett ◽

Arthur Lee ◽

Tara M. Herrick ◽

Susheela M. Engelbrecht ◽

...

Keyword(s):

Health Care Providers ◽

Clinical Performance ◽

Point Of Care ◽

Low Cost ◽

Care Providers ◽

Low Resource Settings ◽

Low Resource ◽

High Resource ◽

Rapid Assays ◽

Urine Biomarkers

AbstractIn recent years, an increasing amount of literature is emerging on candidate urine and blood-based biomarkers associated with incidence and severity of preeclampsia (PE) in pregnant women. While enthusiasm on the usefulness of several of these markers in predicting PE is evolving, essentially all work so far has focused on the needs of high-resource settings and high-income countries, resulting primarily in multi-parameter laboratory assays based on proteomic and metabolomics analysis techniques. These highly complex methods, however, require laboratory capabilities that are rarely available or affordable in low-resource settings (LRS). The importance of quantifying maternal and perinatal risks and identifying which pregnancies can be safely prolonged is also much greater in LRS, where intensive care facilities that can rapidly respond to PE-related health threats for women and infants are limited. For these reasons, simple, low cost, sensitive, and specific point-of-care (POC) tests are needed that can be performed by antenatal health care providers in LRS and that can facilitate decisions about detection and management of PE. Our study aims to provide a comprehensive systematic review of current and emerging blood and urine biomarkers for PE, not only on the basis of their clinical performance, but also of their suitability to be used in LRS-compatible test formats, such as lateral flow and other variants of POC rapid assays.

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Assessment of Local Supply Chains and Stock Management Practices for Trauma Care Resources in Ghana: A Comparative Small Sample Cross-Sectional Study

10.21203/rs.3.rs-19987/v4 ◽

2021 ◽

Author(s):

Godfred Boakye ◽

Adam Gyedu ◽

Melissa Stewart ◽

Peter Donkor ◽

Charles Mock ◽

...

Keyword(s):

Supply Chain ◽

Resource Availability ◽

Trauma Care ◽

Management Practices ◽

Low Cost ◽

The United States ◽

Small Sample ◽

Stock Management ◽

Low Resource ◽

High Resource

Abstract Background: Injuries are a major public health problem globally. With sound planning and organization, essential trauma care can be reliably provided with relatively low-cost equipment and supplies. However, availability of these resources requires an effective and efficient supply chain and good stock management practices. Therefore, this study aimed to assess trauma care resource-related supply management structures and processes at health facilities in Ghana. By doing so, the findings may allow us to identify specific structures and processes that could be improved to facilitate higher quality and more timely care. Methods: Ten hospitals were purposively selected using results from a previously performed national trauma care capacity assessment of hospitals of all levels in Ghana. Five hospitals with low resource availability and 5 hospitals with high resource availability were assessed using the United States Agency for International Development (USAID) Logistics Indicators Assessment Tool and stock ledger review. Data were described and stock management practices were correlated with resource availability. Results: There were differences in stock management practices between low and high resource availability hospitals, including frequency of reporting and audit, number of stock-outs on day of assessment (median 9 vs 2 stock-outs, range 3 – 57 vs 0 – 9 stock-outs, respectively; p=0.05), duration of stock-outs (median 171 vs 8 days, range 51 – 1,268 vs 0 – 182 days, respectively; p=0.02), and fewer of up-to-date stock cards (24 vs 31 up-to-date stock cards, respectively; p=0.07). Stock-outs were common even among low-cost, essential resources (e.g., nasal cannulas and oxygen masks, endotracheal tubes, syringes, sutures, sterile gloves). Increased adherence to stock management guidelines and higher percentage of up-to-date stock cards were correlated with higher trauma resource availability scores. However, the variance in trauma resource availability scores was poorly explained by these individual factors or when analyzed in a multivariate regression model (r2=0.72; p value for each covariate between 0.17 – 0.34). Conclusions: Good supply chain and stock management practices are correlated with high trauma care resource availability. The findings from this study demonstrate several opportunities to improve stock management practices, particularly at low resource availability hospitals.

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Assessment of local supply chains and stock management practices for trauma care resources in Ghana: a comparative small sample cross-sectional study

BMC Health Services Research ◽

10.1186/s12913-021-06063-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Godfred Boakye ◽

Adam Gyedu ◽

Melissa Stewart ◽

Peter Donkor ◽

Charles Mock ◽

...

Keyword(s):

Supply Chain ◽

Resource Availability ◽

Trauma Care ◽

Management Practices ◽

Low Cost ◽

The United States ◽

Small Sample ◽

Stock Management ◽

Low Resource ◽

High Resource

Abstract Background Injuries are a major public health problem globally. With sound planning and organization, essential trauma care can be reliably provided with relatively low-cost equipment and supplies. However, availability of these resources requires an effective and efficient supply chain and good stock management practices. Therefore, this study aimed to assess trauma care resource-related supply management structures and processes at health facilities in Ghana. By doing so, the findings may allow us to identify specific structures and processes that could be improved to facilitate higher quality and more timely care. Methods Ten hospitals were purposively selected using results from a previously performed national trauma care capacity assessment of hospitals of all levels in Ghana. Five hospitals with low resource availability and 5 hospitals with high resource availability were assessed using the United States Agency for International Development (USAID) Logistics Indicators Assessment Tool and stock ledger review. Data were described and stock management practices were correlated with resource availability. Results There were differences in stock management practices between low and high resource availability hospitals, including frequency of reporting and audit, number of stock-outs on day of assessment (median 9 vs 2 stock-outs, range 3–57 vs 0–9 stock-outs, respectively; p = 0.05), duration of stock-outs (median 171 vs 8 days, range 51–1268 vs 0–182 days, respectively; p = 0.02), and fewer of up-to-date stock cards (24 vs 31 up-to-date stock cards, respectively; p = 0.07). Stock-outs were common even among low-cost, essential resources (e.g., nasal cannulas and oxygen masks, endotracheal tubes, syringes, sutures, sterile gloves). Increased adherence to stock management guidelines and higher percentage of up-to-date stock cards were correlated with higher trauma resource availability scores. However, the variance in trauma resource availability scores was poorly explained by these individual factors or when analyzed in a multivariate regression model (r2 = 0.72; p value for each covariate between 0.17–0.34). Conclusions Good supply chain and stock management practices are correlated with high trauma care resource availability. The findings from this study demonstrate several opportunities to improve stock management practices, particularly at low resource availability hospitals.

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Resistance Training as a Countermeasure for Key Non-Communicable Diseases in Low-Resource Settings: A Review

Asian Journal of Sports Medicine ◽

10.5812/asjsm.106588 ◽

2020 ◽

Vol In Press (In Press) ◽

Author(s):

Brandon Stuwart Shaw ◽

Ina Shaw

Keyword(s):

Resistance Training ◽

Low Cost ◽

Active Role ◽

Communicable Diseases ◽

Cochrane Library ◽

Health Improvement ◽

Non Communicable Diseases ◽

Low Resource Settings ◽

Low Resource ◽

High Resource

Background: Non-communicable diseases (NCDs) are responsible for 60% of global deaths. Of these NCD-attributable deaths, about 80% are in low- to middle-income countries (LMICs). The role of exercise in major NCDs is evident; however, popular and cost-effective aerobic modes of exercise, such as walking, consistently do not meet minimum intensity guidelines for health improvement. Interestingly, low-cost resistance training (using callisthenics, Pilates, elastic tubing, etc.) has proven equally effective to conventional resistance training using weight machines in improving several health parameters related to NCDs, although their effectiveness in LMICs is not as well documented as in high-income countries (HICs). Objectives: This review aimed to examine low-cost approaches of resistance training to health promotion, NCD risk reduction, and NCD rehabilitation/management to mitigate the epidemic of NCDs in lower-resource settings. Methods: An electronic search was performed on the following databases from inception until December 2019: PubMed/Medline, Sport Discuss, Embase, Science Direct, Current Contents, CISTI Source, Google Scholar, Cochrane Library, Cochrane Database of Systematic Reviews, CINAHL EBM Reviews, and international e-catalogues. Results: Data on resistance training provision cost in low-resource settings indicates that it is not reasonable to use this mode of training in low-resource settings in the same way as it is used in high-resource ones. This review summarized some strategies which can be employed to ensure the delivery of all core resistance training components in low-resource settings. The data suggests that resistance training be adapted for delivery in non-clinical settings in LMICs. Conclusions: Program design variables of resistance training are similar in low- and well-resourced settings. However, only individuals with low-risk will be able to perform exercise without adverse consequences in home-based settings. Health care practitioners in LMICs should take an active role in promoting resistance training when promoting health, reducing NCD risk, and NCD rehabilitation.

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Assessment of Local Supply Chains and Stock Management Practices for Trauma Care Resources in Ghana: A Comparative Small Sample Cross-Sectional Study

10.21203/rs.3.rs-19987/v2 ◽

2020 ◽

Author(s):

Godfred Boakye ◽

Adam Gyedu ◽

Melissa Stewart ◽

Peter Donkor ◽

Charles Mock ◽

...

Keyword(s):

Supply Chain ◽

Resource Availability ◽

Trauma Care ◽

Management Practices ◽

Low Cost ◽

The United States ◽

Small Sample ◽

Stock Management ◽

Low Resource ◽

High Resource

Abstract Background: Injuries are a major public health problem globally. With sound planning and organization, essential trauma care can be reliably provided with relatively low-cost equipment and supplies. However, availability of these resources requires an effective and efficient supply chain and good stock management practices. Therefore, this study aimed to assess trauma care resource-related supply management structures and processes at health facilities in Ghana. By doing so, the findings may allow us to identify specific structures and processes that could be improved to facilitate higher quality and more timely care. Methods: Ten hospitals were purposively selected using results from a previously performed national trauma care capacity assessment of hospitals of all levels in Ghana. Five hospitals with low resource availability and 5 hospitals with high resource availability were assessed using the United States Agency for International Development (USAID) Logistics Indicators Assessment Tool and stock ledger review. Data were described and stock management practices were correlated with resource availability. Results: There were differences in stock management practices between low and high resource availability hospitals, including frequency of reporting and audit, number of stock-outs on day of assessment (median 9 vs 2 stock-outs, range 3 – 57 vs 0 – 9 stock-outs, respectively; p=0.05), duration of stock-outs (median 171 vs 8 days, range 51 – 1,268 vs 0 – 182 days, respectively; p=0.02), and fewer of up-to-date stock cards (24 vs 31 up-to-date stock cards, respectively; p=0.07). Stock-outs were common even among low-cost, essential resources (e.g., nasal cannulas and oxygen masks, endotracheal tubes, syringes, sutures, sterile gloves). Increased adherence to stock management guidelines and higher percentage of up-to-date stock cards were correlated with higher trauma resource availability scores. However, the variance in trauma resource availability scores was poorly explained by these individual factors or when analyzed in a multivariate regression model (r2=0.72; p value for each covariate between 0.17 – 0.34). Conclusions: Good supply chain and stock management practices are correlated with high trauma care resource availability. The findings from this study demonstrate several opportunities to improve stock management practices, particularly at low resource availability hospitals.

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