scholarly journals Establishing a Comprehensive Ethics-Based Checklist for Surgical Camp Activities at AMPATH-Kenya

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Diane B. Choi, BS ◽  
Kyle L. Carpenter, MD ◽  
Connie H. Keung, MD
Keyword(s):  
Experimental Design ◽  
Surgical Care ◽  
Standards Of Care ◽  
Government Agencies ◽  
Anesthesia Care ◽  
Short Term ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World ◽  
Training And Research

Background and Hypothesis: Global health has made strides in controlling and reducing harm from infectious diseases such as Polio and HIV/AIDS but this focus has not been mirrored in surgical and anesthesia care, especially in many low and middle-income countries (LMICs). In 2010, an estimated 16.9 million lives were lost from conditions that required surgical care and 5 billion people in LMICs lack safe and affordable surgical and anesthesia. Organization of surgical camps can bring skilled physicians to temporarily meet the unmet surgical needs in underserved areas. However, currently there are no government agencies or accrediting bodies existing to assess the scope/impact of short-term surgical camp care or establish standards of care for such services.   Experimental Design or Project Methods: The AMPATH mission of “start with healthcare and then do more to empower communities, educate tomorrow’s medical experts and research breakthroughs that will truly change the health of the world” was incorporated into the ethical checklist proposed. The four principles – beneficence, non-maleficence, autonomy, and justice were used as guidance for the checklist.   Results: The checklist can be organized into three main areas: Care, Empowerment & Training, and Research (Figure 1).

Remote Digital Preoperative Assessments for Cleft Lip and Palate May Improve Clinical and Economic Impact in Global Plastic Surgery

2017 ◽  
Vol 54 (5) ◽  
pp. 535-539 ◽  
Author(s):  
Christopher Hughes ◽  
Jacob Campbell ◽  
Swagoto Mukhopadhyay ◽  
Susan Mccormack ◽  
Richard Silverman ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Plastic Surgery ◽  
Cleft Lip ◽  
Digital Video ◽  
Cleft Lip And Palate ◽  
Surgical Care ◽  
Short Term ◽  
Middle Income ◽  
Alveolar Cleft ◽  
Middle Income Countries

Objective Reconstructive surgical care can play a vital role in the resource-poor settings of low- and middle-income countries. Telemedicine platforms can improve the efficiency and effectiveness of surgical care. The purpose of this study is to determine whether remote digital video evaluations are reliable in the context of a short-term plastic surgical intervention. Setting The setting for this study was a district hospital located in Latacunga, Ecuador. Patients Participants were 27 consecutive patients who presented for operative repair of cleft lip and palate. Main Outcome Measures We calculated kappa coefficients for reliability between in-person and remote digital video assessments for the classification of cleft lip and palate between two separate craniofacial surgeons. We hypothesized that the technology would be a reliable method of preoperative assessment for cleft disease. Results Of the 27 (81.4%) participants, 22 received operative treatment for their cleft disorder. Mean age was 11.1 ± 8.3 years. Patients presented with a spectrum of disorders, including cleft lip (24 of 27, 88.9%), cleft palate (19 of 27, 70.4%), and alveolar cleft (19 of 27, 70.4%). We found a 95.7% agreement between observers for cleft lip with substantial reliability (κ = .78, P .01). There was an 82.6% agreement between observers for cleft palate, with a moderate interrater reliability (κ = .55, P = .01). We found only a 47.8% agreement between observers for alveolar cleft with a nonsignificant, weak kappa agreement (κ = .06, P .74). Conclusions Remote digital assessments are a reliable way to preoperatively diagnose cleft lip and palate in the context of short-term plastic surgical interventions in low- and middle-income countries. Future work will evaluate the potential for real-time, telemedicine assessments to reduce cost and improve clinical effectiveness in global plastic surgery.

scholarly journals Climate drivers of plague epidemiology in British India, 1898–1949

2020 ◽  
Vol 287 (1928) ◽  
pp. 20200538
Author(s):  
Warren S. D. Tennant ◽  
Mike J. Tildesley ◽  
Simon E. F. Spencer ◽  
Matt J. Keeling
Keyword(s):  
Predictive Models ◽  
Control Measures ◽  
Climate Data ◽  
British India ◽  
Middle Income ◽  
Middle Income Countries ◽  
Complex Interactions ◽  
The World ◽  
Spatio Temporal

Plague, caused by Yersinia pestis infection, continues to threaten low- and middle-income countries throughout the world. The complex interactions between rodents and fleas with their respective environments challenge our understanding of human plague epidemiology. Historical long-term datasets of reported plague cases offer a unique opportunity to elucidate the effects of climate on plague outbreaks in detail. Here, we analyse monthly plague deaths and climate data from 25 provinces in British India from 1898 to 1949 to generate insights into the influence of temperature, rainfall and humidity on the occurrence, severity and timing of plague outbreaks. We find that moderate relative humidity levels of between 60% and 80% were strongly associated with outbreaks. Using wavelet analysis, we determine that the nationwide spread of plague was driven by changes in humidity, where, on average, a one-month delay in the onset of rising humidity translated into a one-month delay in the timing of plague outbreaks. This work can inform modern spatio-temporal predictive models for the disease and aid in the development of early-warning strategies for the deployment of prophylactic treatments and other control measures.

scholarly journals Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries

2021 ◽  
Vol 18 (5) ◽  
pp. 2439
Author(s):  
Brendon Stubbs ◽  
Kamran Siddiqi ◽  
Helen Elsey ◽  
Najma Siddiqi ◽  
Ruimin Ma ◽  
...  
Keyword(s):  
Health Survey ◽  
Low Income ◽  
World Health ◽  
Low Income Countries ◽  
Multivariable Logistic Regression Analysis ◽  
World Health Survey ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World ◽  
Low And Middle Income

Tuberculosis (TB) is a leading cause of mortality in low- and middle-income countries (LMICs). TB multimorbidity [TB and ≥1 non-communicable diseases (NCDs)] is common, but studies are sparse. Cross-sectional, community-based data including adults from 21 low-income countries and 27 middle-income countries were utilized from the World Health Survey. Associations between 9 NCDs and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Eight out of 9 NCDs (all except visual impairment) were associated with TB (odds ratio (OR) ranging from 1.38–4.0). Prevalence of self-reported TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and ≥5 NCDs had 2.61 (95% confidence interval (CI) = 2.14–3.22), 4.71 (95%CI = 3.67–6.11), 6.96 (95%CI = 4.95–9.87), 10.59 (95%CI = 7.10–15.80), and 19.89 (95%CI = 11.13–35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs were three times higher than in people without multimorbidity or TB, and a third of the YLDs were attributable to NCDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed.

scholarly journals Barriers to training in laparoscopic surgery in low- and middle-income countries: A systematic review

2021 ◽  
pp. 004947552199818
Author(s):  
Ellen Wilkinson ◽  
Noel Aruparayil ◽  
J Gnanaraj ◽  
Julia Brown ◽  
David Jayne
Keyword(s):  
Laparoscopic Surgery ◽  
Low Cost ◽  
Surgical Care ◽  
Successful Implementation ◽  
Middle Income ◽  
Middle Income Countries ◽  
Technological Advances ◽  
Local Access ◽  
And Training ◽  
Low And Middle Income

Laparoscopic surgery has the potential to improve care in resource-deprived low- and-middle-income countries (LMICs). This study aims to analyse the barriers to training in laparoscopic surgery in LMICs. Medline, Embase, Global Health and Web of Science were searched using ‘LMIC’, ‘Laparoscopy’ and ‘Training’. Two researchers screened results with mutual agreement. Included papers were in English, focused on abdominal laparoscopy and training in LMICs. PRISMA guidelines were followed; 2992 records were screened, and 86 full-text articles reviewed to give 26 key papers. Thematic grouping identified seven key barriers: funding; availability and maintenance of equipment; local access to experienced laparoscopic trainers; stakeholder dynamics; lack of knowledge on effective training curricula; surgical departmental structure and practical opportunities for trainees. In low-resource settings, technological advances may offer low-cost solutions in the successful implementation of laparoscopic training and improve access to surgical care.

scholarly journals Psychological Treatments for the World: Lessons from Low- and Middle-Income Countries

2017 ◽  
Vol 13 (1) ◽  
pp. 149-181 ◽  
Author(s):  
Daisy R. Singla ◽  
Brandon A. Kohrt ◽  
Laura K. Murray ◽  
Arpita Anand ◽  
Bruce F. Chorpita ◽  
...  
Keyword(s):  
Middle Income ◽  
Psychological Treatments ◽  
Middle Income Countries ◽  
The World ◽  
Low And Middle Income
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