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 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 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 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 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 Developing a Complex Understanding of Physical Activity in Cardiometabolic Disease from Low-to-Middle-Income Countries—A Qualitative Systematic Review with Meta-Synthesis

2021 ◽  
Vol 18 (22) ◽  
pp. 11977
Author(s):  
Martin Heine ◽  
Marelise Badenhorst ◽  
Chanel van Zyl ◽  
Gabriela Lima de Melo Ghisi ◽  
Abraham Samuel Babu ◽  
...  
Keyword(s):  
Physical Activity ◽  
Physical Activity Behaviour ◽  
Local Context ◽  
Cardiometabolic Disease ◽  
Middle Income ◽  
Low Resource Settings ◽  
Low Resource ◽  
Middle Income Countries ◽  
Review Team ◽  
Activity Behaviour

Physical activity behaviour is complex, particularly in low-resource settings, while existing behavioural models of physical activity behaviour are often linear and deterministic. The objective of this review was to (i) synthesise the wide scope of factors that affect physical activity and thereby (ii) underpin the complexity of physical activity in low-resource settings through a qualitative meta-synthesis of studies conducted among patients with cardiometabolic disease living in low-to-middle income countries (LMIC). A total of 41 studies were included from 1200 unique citations (up to 15 March 2021). Using a hybrid form of content analysis, unique factors (n = 208) that inform physical activity were identified, and, through qualitative meta-synthesis, these codes were aggregated into categories (n = 61) and synthesised findings (n = 26). An additional five findings were added through deliberation within the review team. Collectively, the 31 synthesised findings highlight the complexity of physical activity behaviour, and the connectedness between person, social context, healthcare system, and built and natural environment. Existing behavioural and ecological models are inadequate in fully understanding physical activity participation in patients with cardiometabolic disease living in LMIC. Future research, building on complexity science and systems thinking, is needed to identify key mechanisms of action applicable to the local context.

scholarly journals Challenges to peer support in low- and middle-income countries during COVID-19

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Richard Mpango ◽  
Jasmine Kalha ◽  
Donat Shamba ◽  
Mary Ramesh ◽  
Fileuka Ngakongwa ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Peer Support ◽  
Global Mental Health ◽  
Health Conditions ◽  
Middle Income ◽  
Low Resource Settings ◽  
Mental Health Conditions ◽  
Middle Income Countries

Abstract Background A recent editorial urged those working in global mental health to “change the conversation” on coronavirus disease (Covid-19) by putting more focus on the needs of people with severe mental health conditions. UPSIDES (Using Peer Support In Developing Empowering mental health Services) is a six-country consortium carrying out implementation research on peer support for people with severe mental health conditions in high- (Germany, Israel), lower middle- (India) and low-income (Tanzania, Uganda) settings. This commentary briefly outlines some of the key challenges faced by UPSIDES sites in low- and middle-income countries as a result of Covid-19, sharing early lessons that may also apply to other services seeking to address the needs of people with severe mental health conditions in similar contexts. Challenges and lessons learned The key take-away from experiences in India, Tanzania and Uganda is that inequalities in terms of access to mobile technologies, as well as to secure employment and benefits, put peer support workers in particularly vulnerable situations precisely when they and their peers are also at their most isolated. Establishing more resilient peer support services requires attention to the already precarious situation of people with severe mental health conditions in low-resource settings, even before a crisis like Covid-19 occurs. While it is essential to maintain contact with peer support workers and peers to whatever extent is possible remotely, alternatives to face-to-face delivery of psychosocial interventions are not always straightforward to implement and can make it more difficult to observe individuals’ reactions, talk about emotional issues and offer appropriate support. Conclusions In environments where mental health care was already heavily medicalized and mostly limited to medications issued by psychiatric institutions, Covid-19 threatens burgeoning efforts to pursue a more holistic and person-centered model of care for people with severe mental health conditions. As countries emerge from lockdown, those working in global mental health will need to redouble their efforts not only to make up for lost time and help individuals cope with the added stressors of Covid-19 in their communities, but also to regain lost ground in mental health care reform and in broader conversations about mental health in low-resource settings.

scholarly journals How to implement new diagnostic products in low-resource settings: an end-to-end framework

2018 ◽  
Vol 3 (6) ◽  
pp. e000914 ◽  
Author(s):  
Melissa Latigo Mugambi ◽  
Trevor Peter ◽  
Samuel F Martins ◽  
Cristina Giachetti
Keyword(s):  
Best Practices ◽  
Product Development ◽  
Healthcare Systems ◽  
Regulatory Requirements ◽  
Middle Income ◽  
Low Resource Settings ◽  
Middle Income Countries ◽  
In Vitro Diagnostic ◽  
Phase Gate

Diagnostics developers often face challenges introducing in-vitro diagnostic (IVD) products to low- and middle-income countries (LMICs) because of difficulty in accessing robust market data, navigating policy and regulatory requirements and implementing and supporting products in healthcare systems with limited infrastructure. Best practices recommend the use of a phase-gate model with defined activities and milestones by phase to successfully move a product from concept to commercialisation. While activities for commercialisation of products in high-income countries (HICs) are well understood, the activities required for introduction of IVDs in LMICs are not. In this paper, we identify the key activities needed for IVD product development and implementation and map them to the various phases of the model, paying particular attention to those activities that might be conducted differently in LMICs.

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