scholarly journals Research in pediatric cardiac anesthesia and intensive care in low- and middle- income countries and low resource settings: Challenges and opportunities

2021 ◽  
Vol 14 (3) ◽  
pp. 356
Author(s):  
ParvathiU Iyer ◽  
KrishnaS Iyer
Keyword(s):  
Intensive Care ◽  
Cardiac Anesthesia ◽  
Middle Income ◽  
Low Resource Settings ◽  
Low Resource ◽  
Middle Income Countries ◽  
Challenges And Opportunities ◽  
Low And Middle Income

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.

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 Education, Work, and Motherhood in Low and Middle Income Countries: A Review of Equality Challenges and Opportunities for Women with Disabilities

2018 ◽  
Vol 6 (1) ◽  
pp. 82-93 ◽  
Author(s):  
Belaynesh Tefera ◽  
Marloes L. Van Engen ◽  
Alice Schippers ◽  
Arne H. Eide ◽  
Amber Kersten ◽  
...  
Keyword(s):  
Cultural Practices ◽  
Women With Disabilities ◽  
Middle Income ◽  
Governmental Organization ◽  
Middle Income Countries ◽  
Governmental Organizations ◽  
Non Governmental Organizations ◽  
Challenges And Opportunities ◽  
The Government ◽  
Low And Middle Income

This study looks at the equality challenges and opportunities for women with disabilities in low and middle income countries (LMICs) to participate and succeed in education, employment and motherhood. It is based on a systematic review of the literature from academic and non-governmental organization databases. The search of these databases yielded 24 articles, which were subsequently passed through open, axial, and selective coding. The resulting review found that women with disabilities in LMICs have severe difficulty participating and succeeding in education, employment and motherhood due to a number of interrelated factors: (i) hampered access to education, employment, intimacy and marriage, (ii) stigma and cultural practices resulting in discrimination and prejudice, and (iii) lack of support from family, teachers and institutions—all of which are exacerbated by poverty. Support from families, communities, the government, and non-governmental organizations improves women’s ability to fulfil their social roles (as students, employees and mothers), resulting in a better quality of life. Strategies that create awareness, minimize poverty and facilitate justice may improve the opportunities for women with disabilities in LMICs to participate in education, employment and motherhood, as well as their ability to succeed in these domains.

scholarly journals Partnership models for the establishment of sustainable paediatric cardiac surgical and cardiac intensive care programmes in low- and middle-income countries

2017 ◽  
Vol 27 (S6) ◽  
pp. S55-S60 ◽  
Author(s):  
Patricia Bastero ◽  
Sandra L. Staveski ◽  
Bistra Zheleva ◽  
Emma Scanlan ◽  
Antonio G. Cabrera ◽  
...  
Keyword(s):  
Intensive Care ◽  
Control Systems ◽  
High Performance ◽  
Middle Income ◽  
Middle Income Countries ◽  
International Projects ◽  
Cardiac Intensive Care ◽  
The Caribbean ◽  
Partnership Models ◽  
Low And Middle Income

AbstractThe care of patients with CHD remains a challenge in low- and middle-income countries. Their health systems have not been able to achieve consistently high performance in this field. The large volume of patients, manpower constraints, inconsistencies in the level and type of background training of the teams caring for this patient population, and the inadequate quality control systems are some of the barriers to achieving excellence of care. We describe three different international projects supporting the paediatric cardiac surgical and paediatric cardiac intensive care programmes in Latin America, Asia, and the Caribbean.

Challenges and possibilities of developing cardiac surgery in a peripheral hospital of low- and middle-income countries

Perfusion ◽  
2020 ◽  
Vol 36 (1) ◽  
pp. 38-43
Author(s):  
Kaushal K Tiwari ◽  
Julia Grapsa ◽  
Shankar Laudari ◽  
Michal Pazdernik ◽  
Dominique Vervoort
Keyword(s):  
Cardiac Surgery ◽  
Heart Disease ◽  
Surgical Care ◽  
Capital City ◽  
World Population ◽  
Middle Income ◽  
Middle Income Countries ◽  
Peripheral Hospital ◽  
Challenges And Opportunities ◽  
Low And Middle Income

Objective: Over a million cardiac surgeries are performed every year around the globe. However, approximately 93% of world population living in low- and middle-income countries have no access to cardiac surgery. The incidence of rheumatic and congenital heart disease is high in Nepal, while only 2,500-3,000 cardiac surgeries are performed annually. The aim of our study is to analyze challenges and opportunities of establishing a cardiac surgery program in a peripheral hospital of Nepal. Methods: We analyzed our effort to establish a cardiac surgery program in a peripheral hospital in Nepal. Results: Out of 2,659 consulted and diagnosed patients, we performed 85 open-heart surgeries in 4 years. Mean age of patients was 38.35 ± 14.13 years. The majority of patients were male (62.4% of patients) with 65.9% suffering from rheumatic heart disease. Average intensive care unit stay and hospital stay were 2.32 ± 1.1 and 8.29 ± 2.75 days, respectively. No in-hospital mortality was observed. Conclusion: We conclude that developing cardiac surgical care in a peripheral hospital of a developing country is feasible with support from government, foreign colleagues, local teams, and non-governmental organizations. The availability of a regular cardiac surgery service in the periphery of the country makes such services more accessible for the patients and helps in reducing the long waiting lists and unmanageable workload in the established cardiac centers in the capital city.

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