scholarly journals Using Dynamic Features for Automatic Cervical Precancer Detection

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 716
Author(s):  
Roser Viñals ◽  
Pierre Vassilakos ◽  
Mohammad Saeed Rad ◽  
Manuela Undurraga ◽  
Patrick Petignat ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Visual Inspection ◽  
Resource Constraints ◽  
Health Workers ◽  
Low Cost ◽  
Health Concern ◽  
Dynamic Features ◽  
Middle Income ◽  
Middle Income Countries ◽  
Cervical Precancer

Cervical cancer remains a major public health concern in developing countries due to financial and human resource constraints. Visual inspection with acetic acid (VIA) of the cervix was widely promoted and routinely used as a low-cost primary screening test in low- and middle-income countries. It can be performed by a variety of health workers and the result is immediate. VIA provides a transient whitening effect which appears and disappears differently in precancerous and cancerous lesions, as compared to benign conditions. Colposcopes are often used during VIA to magnify the view of the cervix and allow clinicians to visually assess it. However, this assessment is generally subjective and unreliable even for experienced clinicians. Computer-aided techniques may improve the accuracy of VIA diagnosis and be an important determinant in the promotion of cervical cancer screening. This work proposes a smartphone-based solution that automatically detects cervical precancer from the dynamic features extracted from videos taken during VIA. The proposed solution achieves a sensitivity and specificity of 0.9 and 0.87 respectively, and could be a solution for screening in countries that suffer from the lack of expensive tools such as colposcopes and well-trained clinicians.

scholarly journals Cervical Precancer Treatment in Low- and Middle-Income Countries: A Technology Overview

2017 ◽  
Vol 3 (4) ◽  
pp. 400-408 ◽  
Author(s):  
Mauricio Maza ◽  
Celina M. Schocken ◽  
Katherine L. Bergman ◽  
Thomas C. Randall ◽  
Miriam L. Cremer
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Precancerous Lesions ◽  
Low Cost ◽  
Treatment Modalities ◽  
Middle Income ◽  
Novel Technologies ◽  
Middle Income Countries ◽  
Cervical Precancer ◽  
Low And Middle Income

Cervical cancer is the fourth leading cause of cancer-related death in women worldwide, with 90% of cases occurring in low- and middle-income countries (LMICs). There has been a global effort to increase access to affordable screening in these settings; however, a corresponding increase in availability of effective and inexpensive treatment modalities for ablating or excising precancerous lesions is also needed to decrease mortality. This article reviews the current landscape of available and developing technologies for treatment of cervical precancer in LMICs. At present, the standard treatment of most precancerous lesions in LMICs is gas-based cryotherapy. This low-cost, effective technology is an expedient treatment in many areas; however, obtaining and transporting gas is often difficult, and unwieldy gas tanks are not conducive to mobile health campaigns. There are several promising ablative technologies in development that are gasless or require less gas than conventional cryotherapy. Although further evaluation of the efficacy and cost-effectiveness is needed, several of these technologies are safe and can now be implemented in LMICs. Nonsurgical therapies, such as therapeutic vaccines, antivirals, and topical applications, are also promising, but most remain in early-stage trials. The establishment of evidence-based standardized protocols for available treatments and the development and introduction of novel technologies are necessary steps in overcoming barriers to treatment in LMICs and decreasing the global burden of cervical cancer. Guidance from WHO on emerging treatment technologies is also needed.

Compulsory Licenses: A Tool to Improve Global Access to the HPV Vaccine?

2009 ◽  
Vol 35 (2-3) ◽  
pp. 323-350 ◽  
Author(s):  
Peter Maybarduk ◽  
Sarah Rimmington
Keyword(s):  
Cervical Cancer ◽  
Low Cost ◽  
Hpv Vaccines ◽  
Generic Competition ◽  
Middle Income ◽  
Compulsory Licensing ◽  
Middle Income Countries ◽  
Health Agencies ◽  
Pricing Power ◽  
Voluntary Basis

AbstractCervical cancer disproportionately affects women in lower- and middle-income countries. But the new vaccines developed to prevent infection with some strains of the human papillomavirus (HPV) that cause cervical cancer are priced beyond the reach of most women and health agencies in these regions, due in part to the monopoly pricing power of brand-name companies that hold the patents on the vaccines. Compulsory licenses, which authorize generic competition with patented products, could expand access to HPV vaccines under certain circumstances. If high-quality biogeneric HPV vaccines can be produced at low cost and be broadly and efficiently registered, and if Merck and GSK are unwilling to grant licenses on a voluntary basis, compulsory licensing could play a pivotal role in ensuring vaccinations against HPV are available to all, around the world, regardless of ability to pay.

scholarly journals Human Papilloma Virus self-sampling performance in low- and middle-income countries

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ashwini Kamath Mulki ◽  
Mellissa Withers
Keyword(s):  
Cervical Cancer ◽  
Health Workers ◽  
Sub Saharan Africa ◽  
Screening Methods ◽  
Middle Income ◽  
Middle Income Countries ◽  
Novel Approach ◽  
Very High ◽  
Low And Middle Income

Abstract Background Screening for HPV has led to significant reductions in cervical cancer deaths in high-income countries. However, the same results have not been achieved in low- and middle-income countries (LMICs). HPV self-sampling is a novel approach that could improve screening rates. Methods This study’s objective is to summarize the recent literature on HPV self-sampling in LMICs, focusing on sensitivity/specificity, and feasibility/acceptability of self-sampling compared to traditional screening methods. We conducted a PubMed search for articles published in English within the last 10 years on self-sampling in LMICs. Results Fifty eligible articles from 26 countries were included, 19 of which came from sub-Saharan Africa and 18 from Latin America/Caribbean. Seven studies examined sensitivity, with five reporting rates higher than 91%. Six reported on specificity, which was also very high at 86–97.8%. Six studies examined self-sampling concordance with provider-collected sampling, with concordance rates ranging from 87 to 97.5%. A total of 38 studies examined the feasibility/acceptability of HPV self-sampling. Participation rates were very high in all studies, even when self-sampling was done at participants’ homes (over 89% participation). Overall, participants reported that HPV self-sampling was easy to perform (75–97%, 18 studies), painless (60–90%, nine studies), and preferred over provider-collected sampling (57–100%, 14 studies). Eight studies reported follow-up rates for participants who completed self-sampling; however, these rates varied widely-from 13.7 to 90%. The major benefits of self-sampling include convenience of screening from home, less embarrassment, and less travel. Improved education and awareness of self-sampling, combined with support from community health workers, could reduce perceptions of self-sampling being inferior to provider-collected sampling. Improving follow-up of abnormal results and improving linkages to treatment are also essential. Conclusion Our literature review highlights HPV self-sampling is a well-performing test that shows promise in terms of expanding screening efforts for the prevention of cervical cancer-related deaths in LMICs.

scholarly journals Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: A Systematic Review of Current Implementations and Gaps in Research (Preprint)

2020 ◽  
Author(s):  
Andrea H. Rossman ◽  
Hadley W. Reid ◽  
Michelle M. Pieters ◽  
Ceclia Mizelle ◽  
Megan von Isenberg ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Health Workers ◽  
Digital Health ◽  
Meta Analysis ◽  
Cancer Control ◽  
Risk Of Bias ◽  
Middle Income ◽  
High Burden ◽  
Middle Income Countries ◽  
Study Designs

BACKGROUND Eight-five percent of deaths due to cervical cancer occur in low- and middle-income countries (LMICs). In recent years, many digital health strategies have been implemented in LMICs to ameliorate patient-, provider-, and health system level challenges in cervical cancer control. Yet, there are limited efforts to systematically review the effectiveness and current landscape of digital health strategies for cervical cancer control in LMICs. OBJECTIVE We aimed to conduct a systematic review of digital health strategies for cervical cancer control in LMICs to assess their effectiveness, describe the range of strategies used, and summarize challenges to their implementation. METHODS A systematic search was conducted to identify publications describing digital health strategies for cervical cancer control in LMICs from five academic databases and Google Scholar. Titles and abstracts were screened and full texts were reviewed for eligibility. A structured data extraction template was used to summarize information from included studies. The risk of bias and data reporting guidelines for mobile health were assessed for each study. A meta-analysis of effectiveness was planned along with a narrative review of digital health strategies, implementation challenges, and opportunities for future research. RESULTS In the 24 included studies, digital health strategies for cervical cancer control focused predominantly on cervical image capture, remote expert review, training health workers, and, less frequently, patient education. Most included studies were implemented in sub-Saharan Africa, with fewer studies in other LMIC regions such as Asia or South America. One study had low risk of bias, and three studies had a moderate risk of bias while the remaining 20 studies had a high risk of bias. Due to insufficient studies with robust study designs, matched outcomes or interventions, a meta-analysis of effectiveness was not possible. Existing strategies used digital health for improving women’s knowledge and awareness about cervical cancer, increasing access to cervical cancer services, improving training of health workers and availability of data, and ensuring continuity of care. Key challenges in implementing digital health strategies for cervical cancer control were related to the high burden of training, technology-specific issues, infrastructure challenges, challenges with technology reach and inequitable access to technology among target users. CONCLUSIONS The current evidence on the effectiveness of digital health strategies for cervical cancer control is limited and, in most cases, is associated with a high risk of bias. Further studies are recommended to expand the investigation of digital health strategies for cervical cancer using robust study designs, explore other LMIC settings with high burden of cervical cancer (e.g., South America), and test a greater diversity of digital strategies. CLINICALTRIAL The review protocol is registered with the PROSPERO database for prospectively registered systematic reviews (Protocol # CRD42017071560).

scholarly journals Violence against health workforce in Bangladesh: a call for action

2018 ◽  
Vol 5 (5) ◽  
pp. 2151 ◽  
Author(s):  
Md Mahbub Hossain ◽  
Abida Sultana ◽  
Tanmoy Shaha ◽  
Md Zillur Rahman ◽  
Md Mohibur Hossain Nirob ◽  
...  
Keyword(s):  
Health Workforce ◽  
Workplace Violence ◽  
Health Workers ◽  
Health Service Delivery ◽  
Health Concern ◽  
Physical Assault ◽  
Middle Income ◽  
Racial Harassment ◽  
Middle Income Countries ◽  
Life Threatening

Violence against health workforce has become a public health concern affecting the lives of the health professionals and the overall health service delivery to a greater extent. Common forms of workplace violence faced by healthcare professionals include verbal abuse, physical assault, bullying, sexual harassment and racial harassment. The scenario is more severe in low and middle-income countries where physicians, nurses and other health workers get exposure to such horrifying experiences in their day-to-day activities and Bangladesh is no exception in this regard. Experiencing different kind of conflicts at workplace has become a common news resulting life threatening injuries of the victims and leaving non-healing scars in the minds of those who has been serving to heal the wounds of others.

scholarly journals The role of community health workers in cervical cancer screening in low-income and middle-income countries: a systematic scoping review of the literature

2019 ◽  
Vol 4 (3) ◽  
pp. e001452 ◽  
Author(s):  
James O’Donovan ◽  
Charles O’Donovan ◽  
Shobhana Nagraj
Keyword(s):  
Cervical Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Scoping Review ◽  
Health Workers ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Cost

IntroductionCommunity-based screening for cervical cancer and task sharing to community health workers (CHWs) have been suggested as a potential way to increase screening coverage in low- and middle-income countries (LMICs). The aims of the scoping review were to understand the following: (i) where and how CHWs are currently deployed in screening in LMIC settings; (ii) the methods used to train and support CHWs in screening, and (iii) The evidence on the cost-effectiveness of using CHWs to assist in screening.MethodsA scoping literature search of 11 major databases and the grey literature was performed between 1978 and 2018. We included comprehensive search terms for ‘CHWs’ and ‘Cervical Cancer’, and used the World Bank criteria to define LMICs.ResultsOf the 420 articles screened, 15 met the inclusion criteria for review. Studies were located in Africa (n=5), Asia (n=5), and South and Central America (n=5). CHWs played a role in community education and raising awareness (n=14), conducting or assisting in cervical screening (n=5), or follow-up (n=1). 11 studies described CHW training activities. Only one study provided a formal cost analysis.ConclusionThe roles of CHWs in cervical cancer screening in LMICs have largely to date focused on education, outreach, and awareness programmes. Community-based approaches to cervical cancer screening are feasible, although the sociocultural context plays an important role in the acceptability of these interventions. Further in-depth contextually grounded studies exploring the acceptability of such interventions are required, as well as studies exploring the cost-effectiveness of involving CHWs in cervical cancer screening activities.

scholarly journals A comparative analysis of cervical cancer prevention between Nigeria and Nordic countries that have experienced a decline in cervical cancer incidence

2020 ◽  
Author(s):  
Helen I Anyasi ◽  
Anna M Foss
Keyword(s):  
Cervical Cancer ◽  
Health Workers ◽  
Grey Literature ◽  
Monitoring And Evaluation ◽  
Cervical Cancer Prevention ◽  
Nordic Countries ◽  
Cochrane Library ◽  
Middle Income ◽  
Middle Income Countries ◽  
Demand Creation

Abstract Background A modelling analysis carried out in 2014 suggested that, without cervical cancer screening programmes, the incidence of cervical cancer in Denmark, Finland, Norway and Sweden would have been as high as that in some low- and middle-income countries. We compare programme strategies between Nigeria and these Nordic countries and develop translatable recommendations. Methods A literature review using a systematic approach through Medline, Popline, Global Health, CINAHL PLUS, Cochrane Library, EMBASE, Google Scholar, Africa Wide and WHO databases was conducted. Results Fifteen journal articles and two grey literature reports met our criteria. Six descriptive studies from Nigeria noted that services in Nigeria were mainly provided in urban secondary/tertiary facilities and that uptake was low even where screening was free. Trials in Nigeria and Sweden noted that subsidies and free programmes alone did not improve uptake; a Danish trial demonstrated that reminders and invitations issued by general practitioners improved participation. Conclusion Free screening programmes are important but should also consider incentivisation of treatment when needed and demand creation among health workers. Additionally, effective monitoring and evaluation of programme data are key to improving and maintaining quality. More broadly, we suggest that Nigeria can build success through stakeholder-led implementation of well-defined policies with national consensus to ensure coordination and sustainability.

scholarly journals Scalable Screening and Treatment Response Monitoring for Perinatal Depression in Low- and Middle-Income Countries

2021 ◽  
Vol 18 (13) ◽  
pp. 6693
Author(s):  
Ahmed Waqas ◽  
Abid Malik ◽  
Najia Atif ◽  
Anum Nisar ◽  
Huma Nazir ◽  
...  
Keyword(s):  
Perinatal Depression ◽  
Rating Scale ◽  
Health Workers ◽  
Health Concern ◽  
Response Monitoring ◽  
Local Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Treatment Responses ◽  
Low And Middle Income

Common perinatal mental disorders such as anxiety and depression are a public health concern in low- and middle-income countries. Several tools exist for screening and monitoring treatment responses, which have frequently been tested globally in clinical and research settings. However, these tools are relatively long and not practical for integration into routine data systems in most settings. This study aims to address this gap by considering three short tools: The Community Informant Detection Tool (CIDT) for the identification of women at risk, the 4-item Patient Health Questionnaire (PHQ-4) for screening women at high-risk, and the 4-item Hamilton Depression Rating Scale (HAMD-4) for measuring treatment responses. Studies in rural Pakistan showed that the CIDT offered a valid and reliable key-informant approach for the detection of perinatal depression by utilizing a network of peers and local health workers, yielding a sensitivity of 97.5% and specificity of 82.4%. The PHQ-4 had excellent psychometric properties to screen women with perinatal depression through trained community health workers, with a sensitivity of 93.4% and specificity of 91.70%. The HAMD-4 provided a good model fit and unidimensional construct for assessing intervention responses. These short, reliable, and valid tools are scalable and expected to reduce training, administrative and human resource costs to health systems.

scholarly journals Approaches to motivate physicians and nurses in low- and middle-income countries: a systematic literature review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jaya Gupta ◽  
Mariya C. Patwa ◽  
Angel Khuu ◽  
Andreea A. Creanga
Keyword(s):  
Systematic Review ◽  
Randomized Trial ◽  
Health Worker ◽  
Work Motivation ◽  
Health Workers ◽  
Trial Group ◽  
Middle Income ◽  
Group Design ◽  
Middle Income Countries ◽  
Worker Motivation

AbstractPoor health worker motivation, and the resultant shortages and geographic imbalances of providers, impedes the provision of quality care in low- and middle-income countries (LMICs). This systematic review summarizes the evidence on interventions used to motivate health workers in LMICs. A standardized keyword search strategy was employed across five databases from September 2007 -September 2017. Studies had to meet the following criteria: original study; doctors and/or nurses as target population for intervention(s); work motivation as study outcome; study design with clearly defined comparison group; categorized as either a supervision, compensation, systems support, or lifelong learning intervention; and conducted in a LMIC setting. Two independent reviewers screened 3845 titles and abstracts and, subsequently, reviewed 269 full articles. Seven studies were retained from China (n = 1), Ghana (n = 2), Iran (n = 1), Mozambique (n = 1), and Zambia (n = 2). Study data and risk of bias were extracted using a standardized form. Though work motivation was the primary study outcome, four studies did not provide an outcome definition and five studies did not describe use of a theoretical framework in the ascertainment. Four studies used a randomized trial—group design, one used a non-randomized trial—group design, one used a cross-sectional design, and one used a pretest–posttest design. All three studies that found a significant positive effect on motivational outcomes had a supervision component. Of the three studies that found no effects on motivation, two were primarily compensation interventions and the third was a systems support intervention. One study found a significant negative effect of a compensation intervention on health worker motivation. In conducting this systematic review, we found there is limited evidence on successful interventions to motivate health workers in LMICs. True effects on select categories of health workers may have been obscured given that studies included health workers with a wide range of social and professional characteristics. Robust studies that use validated and culturally appropriate tools to assess worker motivation are greatly needed in the Sustainable Development Goals era.

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.

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