Setting up a pragmatic clinical trial in a low-resource setting: A qualitative assessment of GoLBeT, a trial of podoconiosis management in Northern Ethiopia

Background Clinical trials are often perceived as being expensive, difficult and beyond the capacity of healthcare workers in low-resource settings. However, in order to improve healthcare coverage, the World Health Organization (WHO) World Health Report 2013 stated that all countries need to become generators as well as recipients of data. This study is a methodological examination of the steps and processes involved in setting up the Gojjam Lymphoedema Best Practice Trial (GoLBeT; ISRCTN67805210), a highly pragmatic clinical trial conducted in northern Ethiopia. Challenges to the trial and strategies used to deal with them were explored, together with the reasons for delays. Methodology and principal findings Qualitative research methods were used to analyse emails and reports from the period between trial inception and recruitment. This analysis was complemented by interviews with key informants from the trial operational team. The Global Health Research Process Map was used as a framework against which to compare the steps involved in setting up the trial. A mini-group discussion was conducted with the trial operational team after study completion for reflection and further recommendations. This study showed that the key areas of difficulty in setting up and planning this trial were: the study design, that is, deciding on the study endpoint, where and how best to measure it, and assuring statistical power; recruitment and appropriate training of staff; planning for data quality; and gaining regulatory approvals. Collaboration, for example with statisticians, the trial steering committee, the study monitors, and members of the local community was essential to successfully setting up the trial. Conclusions and significance Lessons learnt from this trial might guide others planning pragmatic trials in settings where research is not common, allowing them to anticipate possible challenges and address them through trial design, planning and operational delivery. We also hope that this example might encourage similar pragmatic studies to be undertaken. Such studies are rarely undertaken or locally led, but are an accessible and efficient way to drive improved outcomes in public health.

Capacity-Building and Continuing Professional Development in Healthcare and Rehabilitation in Low- and Middle-Income Countries - A Scoping Review Protocol

Background: A recent world health report suggests that there is a growing rehabilitation human resource crisis. This review focuses on capacity-building needed to meet present and future rehabilitation challenges in low- and middle-income countries (LMICs). Capacity building is the process by which individuals and organizations obtain, improve, and retain the skills, knowledge, tools, equipment, and other resources needed to do their jobs competently. The objectives of this review are; 1) to determine how capacity-building has been defined, implemented, and evaluated in LMICs; and 2) to provide an overview of the effectiveness of capacity-building initiatives.Methods: In the first of seven stages, we will refine and delimit the research. Then, we will identify relevant studies by searching five biomedical databases, two rehabilitation databases, three regional databases, and three databases of grey literature. Two independent reviewers will then select the studies using a priori selection criteria. We will exclude incomplete records, records published prior to 2000 for databases and 2010 for grey literature, and records written in languages other than English or Spanish. We will also exclude records focusing on entry-to-practice programs in academic settings. For Objective 1, using qualitative analysis software we will extract and analyze text from included records which defines or explains capacity building. For Objective 2, using an online file sharing platform, one reviewer will extract data describing the effectiveness of capacity building interventions and a second reviewer will verify accuracy, with disagreements resolved by consensus. The results will be collated using tables and charts. After synthesizing the results, we will discuss the practicality and applicability of findings with partners from Honduras and Colombia. We will use several formats and venues including presentations and publications in English and Spanish to present our results.Discussion: To our knowledge, this will be the first attempt to systematically identify knowledge of capacity-building and rehabilitation in LMICs. This scoping review results will offer unique insights concerning the breadth and depth of literature in the area. It is anticipated that results from this scoping review will guide efforts in future capacity-building efforts in rehabilitation in LMICsReview Registration: Busch AJ, Deprez D, Bidonde J, Ramírez PA, Araque EP. Capacity building and continuing professional development in healthcare and rehabilitation in low and middle income countries - A scoping review. 2021. doi:10.17605/OSF.IO/7VGXU.

GANGGUAN PERNAPASAN PADA PEKERJA DAN PENGUKURAN KADAR DEBU DI TEMPAT PEMBUATAN BATU BATA DI KECAMATAN TENAYAN RAYA

Pembuatan batu bata merupakan salah satu industri sektor informal yang banyak ditekuni oleh masyarakat Indonesia. Tidak ada data yang pasti tentang pekerjaan di sektor informal baik tentang jumlah pekerjaan, resiko yang dihadapi kejadian ganguaan pernapasan maupun kecelakaan kerja. Namun tidak berarti tidak ada bahaya yang dihadapi para perajin batu bata. Laporan organisasi kesehatan dunia (WHO) dalam World Health Report 2000 menyebutkan, lima penyakit paru utama merupakan 17,4% dari seluruh kematian di dunia, masing-masing terdiri dari infeksi paru 7,2% PPOK (Penyakit Paru Obstruktif Kronis) 4,8% tuberculosis 3,0% kanker paru/trakea/bronkus 2,1% dan asma 0,3%. Tujuan penelitian ini adalah untuk mengetahui gangguan pernapasan pada pekerja di tempat pembuatan batu bata serta pengukuran kadar debu di tempat pembuatan batu bata di Kecamatan Tenayan Raya Kota Pekanbaru. Penelitian ini merupakan penelitian deskriptif dengan desain observasional. Penelitian dilakukan pada bulan Juli 2020. Lokasi penelitian di lakukan di Kecamatan Tenayan Raya. Jumlah sampel sebanyak 70 pekerja, penggumpulan data menggunakan kuesioner dan pengukuran kadar debu menggunakan Light House Meter. Analisis data menggunakan analisis univariat. Hasil penelitian menunjukkan jumlah pekerja yang mengalami gangguan pernapasan sebanyak 61 pekerja (87.1%), tidak menggunakan alat pelindung diri (masker) sebanyak 58 pekerja (82.9%), kadar debu di tempat pembuatan batu bata melebihi nilai ambang batas yang dipersyaratkan.

Comparison of European Clinical Guidelines on the Management of Alcohol Use Disorders

<b><i>Background:</i></b> Alcohol is a leading cause of morbidity and mortality in the European region, and tackling the harmful use of alcohol is a public health priority. Most countries in the region have national strategies for treating alcohol use disorders (AUD), but there is significant between-country variation. <b><i>Objectives:</i></b> This study aimed to compare clinical guidelines for the management of AUD from countries of the European region and to determine whether countries’ relative wealth or quality of their health systems had affected the guidelines. <b><i>Methods:</i></b> A survey was conducted of 24 countries. The survey encompassed how AUD clinical guidelines were researched, the range and expertise of contributors, which topics of AUD treatment were included, the definition of a “standard drink” used, and the publishing, funding, endorsement, and dissemination of the guideline. <b><i>Results:</i></b> Twenty-one of the 24 countries surveyed had a clinical guideline for AUD. All guidelines were underpinned by a literature review, and psychiatrists were the professional group most commonly involved in producing them. Most of the guidelines covered typical cornerstones of AUD care such as treatment of alcohol dependence, pharmacotherapy for relapse prevention, and detoxification. Definitions of a “standard drink” ranged from 8 to 20 grams of ethanol. Governments or governmental bodies were the main publishers and funders of guidelines, and the vast majority of guidelines were freely available online. There were no statistically significant effects of GDP, GDP per capita, or World Health Organization’s World Health Report rankings on whether countries were more likely to have an AUD clinical guideline, to have performed a systematic literature review, or to have involved service users in producing their guideline. <b><i>Conclusions:</i></b> The results of this survey reflect widespread good practice in producing AUD clinical guidelines across European countries. Regional research collaborations could offer significant time and cost savings in producing the evidence base from which guidelines are then written.

World Health Report on Vision: Aging Implications for Global Vision and Eye Health

In 2019, the World Health Organization World Report on Vision estimated that that 2.2 billion people have a vision impairment, of which almost half could have been prevented or is yet to be addressed. As the global population ages and the prevalence of visual impairment increases, inequities in eye care and the downstream health and aging consequences of vision loss will become magnified. This session will: (1) provide key information regarding the burden of eye disease and visual impairment among older adults worldwide; (2) outline a framework created to conceptualize the aging and long-term health implications of vision loss, and (3) discuss the global public health challenges to eye care and to maximizing health for older adults with visual impairments.

FISCAL SNAGS AND THE FAMILY CAREGIVERS OF SCHIZOPHRENICS

The prevalence of schizophrenia in India is about 3/1000 individuals (Gururaj Girish & Isaac, 2005). The World Health Report, 2001 states the prevalence of schizophrenia is approximately 24 million people across the globe, which is a shocking revelation. The instances about mental health concerns are increasing day by day. The breakdown in family due to several life changing issues especially recently with COVID-19 (Corona Virus Disease) pandemic has changed almost everything in a person’s life. In such circumstances managing and balancing a sound mental health is like an adventure. Family has a crucial role to play in it and a strong family bondage is a bonus to it. Nonetheless, every coin has two sides especially when the dilemma is long lasting like that of schizophrenia, it cripples down the family. OBJECTIVE: To study economic problems faced by the family caregivers of schizophrenics. METHOD: A descriptive study was conducted to examine the fiscal snags by the family caregivers of patients and schizophrenia. 200 family caregivers were selected by applying stratified systematic sampling method from the Hospitals for Mental Health operated by Department of Health, Government of Gujarat and a criterion of minimum facility of 100 beds was applied thereto. A structured interview tool was designed for the purpose of present study by referring the Burden Assessment Scale of Thara et.al (1998) and the Zarit Burden Interview. RESULTS: Most of the respondents strongly agree that their financial conditions are not adequate to look after the care receivers 33 (n=66). Most of the respondent worried for the future financial need of the care receivers 36.5 (n=73). Most of the respondents strongly agree the statement that they have never received any form of financial support from other family members is treating the care receiver 33.5 (n=67).

Is Autonomy a Universal Value of Human Existence? Scope of Autonomy in Medical Practice: A Comparative Study between Western Medical Ethics and Islamic Medical Ethics

The practice of contemporary medicine has been tremendously influenced by western ideas and it is assumed by many that autonomy is a universal value of human existence. In the World Health Report 2000, the World Health Organization (WHO) considered autonomy a “universal” value of human life against which every health system in the world should be judged. Further in Western bioethics, patient autonomy and self -determination prevails in all sectors of social and personal life, a concept unacceptable to some cultures. In principle, there are challenges to the universal validity of autonomy, individualism and secularism, as most non-Western cultures are proud of their communal relations and spiritualistic ethos and, thereby imposing Western beliefs and practices as aforementioned can have deleterious consequences. Religion lies at the heart of most cultures which influences the practice patterns of medical professionals in both visible and unconscious ways. However, religion is mostly viewed by scientists as mystical and without scientific proof. Herein lies the dilemma, whether medical professionals should respect the cultural and religious beliefs of their patients? In this paper we aim to discuss some of the limitations of patient's autonomy by comparing the process of reasoning in western medical ethics and Islamic medical ethics, in order to examine the possibility and desirability of arriving at a single, unitary and universally acceptable notion of medical ethics. We propose a more flexible viewpoint that accommodates different cultural and religious values in interpreting autonomy and applying it in an increasingly multilingual and multicultural, contemporaneous society in order to provide the highest level of care possible.

Midwifery crisis in Africa: the introduction of the human resources information systems

Background Each year, 2.7 million newborns die during their first day of life: a number that equals the entire population of Namibia. In the “Year of Nursing and Midwives”, this article highlights the importance of skilled birth attendants: researchers estimate a 56% of maternal, fetal and neonatal deaths reduction in case of midwife assisted delivery. Methods Authors propose an integrative review involving a mapping exercise of the literature. The search included peer reviewed research and discursive literature on variables to assess the capacity of HRH. Results Research shows that steps to recognize and support this working relationship require multipronged approaches to address imminent training, resource and infrastructure deficits, as well as broader health system strengthening. Central Africa Republic, Côte d'Ivoire, Democratic Republic of Congo, Ethiopia, Liberia, Madagascar, Rwanda, Sierra Leone, Uganda and Tanzania all experience a midwife density per 1000 population lower than 1. Improved service provision may be associated with development of supervision systems like the introduction of a human resources information system to help mobilise domestic resources. This review also looks at the level and the relative importance of each revenue. Conclusions Given issues such as shortages and poor retention of human resources for maternal and newborn health service delivery in low resources settings, international organizations should focus on strengthening capacity of midwives at community and facility level as a realistic measure to at least halve maternal and perinatal mortality. Information systems may contribute to the development of national and local policies in the country, which address the human resources needs of the health care system to meet regional and national demands. References World Health Organization. The World Health Report 2006-working together for health. UNFPA, ICM, WHO. The State of the World-s Midwifery (SoWMy) 2014. Key messages Information systems may contribute to the development of national and local policies in the country. international organizations should focus on strengthening capacity of midwives at community and facility level.

PSYCHOLOGICAL PROBLEMS OF FAMILY CAREGIVERS OF PATIENTS WITH SCHIZOPHRENIA

Approximately 24 million people worldwide experiencing schizophrenia (The World Health Report, 2001). Several people with mental disorder have to rely on support of family and friends to help them in their day-to-day happenings. In that era, caregivers are at risk for physical and mental health dilemma.1 Caring for a person with any mental illness often creates physical, emotional dilemma among the family caregivers more than they think. That is why it is also essential to rationalize that issue too. Family care givers of patients with any mental illness have different perspectives and coping strategies about the situation that may lead to feeling of sadness, loneliness, helplessness, hopeless at a variance among the care givers. OBJECTIVES: • To study levels of psychological problems faced by the family caregivers of patients with schizophrenia. • To study association between demographic variables and levels of psychological problems of family caregivers with schizophrenia. METHOD: A descriptive study was carried out to examine the psychological problems faced by family caregivers of patients with schizophrenia. 200 family caregivers were selected by applying stratified systematic sampling method from the government hospitals of mental health of Gujarat state with a criterion of minimum facility of 100 beds. A self-structured interview schedule was designed for study purpose by referring the Burden Assessment Tool of Thara et.al (1998) and Zarit Burden Interview. RESULT: Majority of the respondents (51%) feel anxious, depressed and frustrated due to caregiving responsibility. Majority of the respondents (52.5%) believed that care giving responsibility is mentally tiring for the family caregivers. Majority of the respondents (40.5%) agree with the statement that their contacts with family & friends have lessened due to the illness of care receiver.