scholarly journals The burden of non-TB lung disease presenting to TB clinics in The Gambia: preliminary data in the Xpert® MTB/Rif era

2019 ◽  
Vol 9 (4) ◽  
pp. 166-168
Author(s):  
S. Jayasooriya ◽  
A. Jobe ◽  
S. Badjie ◽  
O. Owolabi ◽  
A. Rachow ◽  
...  
Keyword(s):  
Health Service ◽  
The Gambia ◽  
Middle Income ◽  
Health Service Provision ◽  
Middle Income Countries ◽  
History Of ◽  
Negative Sputum ◽  
Lost To Follow Up ◽  
Hiv 1

In some low and middle-income countries, 10–20% of patients presenting with a persistent cough have tuberculosis (TB). Once TB is excluded, health service provision for alternative diagnoses is limited. We prospectively studied patients with two Xpert-negative sputum results presenting to a TB clinic in The Gambia. Of 239 patients, 108 did not have TB; 65/102 (6 were lost to follow-up) had alternative diagnoses, 24.6% of which were non-respiratory; 37/102 had no diagnosis, 27.0% of whom were HIV-1-positive; 37.8% had a history of TB and 24.3% smoked. We highlight the need for general health service integration with TB platforms and exploration of non-TB patients with chronic respiratory symptoms.

scholarly journals Cost of maternal health services in low and middle-income countries: protocol for a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e027822 ◽  
Author(s):  
Aduragbemi Banke-Thomas ◽  
Ibukun-Oluwa Omolade Abejirinde ◽  
Oluwasola Banke-Thomas ◽  
Adamu Maikano ◽  
Charles Anawo Ameh
Keyword(s):  
Systematic Review ◽  
Maternal Health ◽  
Health Service ◽  
Health Services ◽  
Maternal Health Services ◽  
Maternal Health Service ◽  
Economic Evaluations ◽  
Middle Income ◽  
Health Service Provision ◽  
Middle Income Countries

IntroductionThere is substantial evidence that maternal health services across the continuum of care are effective in reducing morbidities and mortalities associated with pregnancy and childbirth. There is also consensus regarding the need to invest in the delivery of these services towards the global goal of achieving Universal Health Coverage in low/middle-income countries (LMICs). However, there is limited evidence on the costs of providing these services. This protocol describes the methods and analytical framework to be used in conducting a systematic review of costs of providing maternal health services in LMICs.MethodsAfrican Journal Online, CINAHL Plus, EconLit, Embase, Global Health Archive, Popline, PubMed and Scopus as well as grey literature databases will be searched for relevant articles which report primary cost data for maternal health service in LMICs published from January 2000 to June 2019. This search will be conducted without implementing any language restrictions. Two reviewers will independently search, screen and select articles that meet the inclusion criteria, with disagreements resolved by discussions with a third reviewer. Quality assessment of included articles will be conducted based on cost-focused criteria included in globally recommended checklists for economic evaluations. For comparability, where feasible, cost will be converted to international dollar equivalents using purchasing power parity conversion factors. Costs associated with providing each maternal health services will be systematically compared, using a subgroup analysis. Sensitivity analysis will also be conducted. Where heterogeneity is observed, a narrative synthesis will be used. Population contextual and intervention design characteristics that help achieve cost savings and improve efficiency of maternal health service provision in LMICs will be identified.Ethics and disseminationEthical approval is not required for this review. The plan for dissemination is to publish review findings in a peer-reviewed journal and present findings at high-level conferences that engage the most pertinent stakeholders.PROSPERO registration numberCRD42018114124

scholarly journals Challenges Affecting Health Referral Systems in Low-And Middle-Income Countries: A Systematic Literature Review

2021 ◽  
Vol 6 (3) ◽  
pp. 33-44
Author(s):  
Mildred Nakayuki ◽  
Annabella Basaza ◽  
Hasifah Namatovu
Keyword(s):  
Health Service ◽  
Service Provision ◽  
Inclusion Criteria ◽  
Middle Income ◽  
Health Service Provision ◽  
Middle Income Countries ◽  
Emergency Units ◽  
Impaired Health ◽  
Referral Systems ◽  
Low And Middle Income

Aims: Low and middle-income countries are still facing challenges of dysfunctional referral systems which have impaired health service provision. This review aimed at investigating these challenges to understand their nature, cause, and the impacts they have on health service provision. Methods: Database search was made in Google scholar, ACM Library, PubMed health, and BMC public health, and a total of 123 papers were generated. Only 14 fitted the inclusion criteria. Inclusion criteria included studies that were both quantitative and qualitative addressing challenges facing referral systems or health referral systems, studies describing the barriers to effective referral systems, and studies describing factors that affect referral systems. The review only included studies conducted in LMICs and included literature between January 2010 and February 2021. Findings: Results revealed that human resource and financial constraints, non-compliance, and communication are the key challenges affecting referral systems in LMICs. Recommendation: Countries that are facing these challenges need to overhaul the system and improve end-to-end communication between hospitals, improve capacity specifically in referral and emergency units, and sensitizing patients on the adherence to emergency protocols.

scholarly journals Use of Paclitaxel to Successfully Treat Children, Adolescents, and Young Adults with Kaposi Sarcoma in Southwestern Tanzania

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 275
Author(s):  
Hamidu Adinani ◽  
Liane Campbell ◽  
Nader Kim El-Mallawany ◽  
Jeremy Slone ◽  
Parth Mehta ◽  
...  
Keyword(s):  
Young Adults ◽  
Treatment Failure ◽  
Kaposi Sarcoma ◽  
Adolescents And Young Adults ◽  
Term Survival ◽  
Middle Income ◽  
Middle Income Countries ◽  
Special Circumstances ◽  
Lost To Follow Up

Treating Kaposi sarcoma (KS) in children, adolescents, and young adults (AYA) remains a challenge in low- and middle-income countries (LMIC) where chemotherapy options and availability are limited. We describe a retrospective cohort review of pediatric patients with KS treated with paclitaxel in Mbeya, Tanzania, between 1 March 2011 and 31 December 2019. Paclitaxel was given to patients who had KS relapse, a contraindication to bleomycin, vincristine, and doxorubicin (ABV), special circumstances in which a clinician determined that paclitaxel was preferable to ABV, or experienced treatment failure, defined as persistent KS symptoms at the completion of treatment. All patients also received multidisciplinary palliative care. Seventeen patients aged 5.1–21.3 years received paclitaxel, of whom 47.1% (8/17) had treatment failure, 29.4% (5/17) received paclitaxel as initial treatment, and 23.5% (4/17) had relapsed. All HIV positive patients (16/17) were given anti-retroviral therapy (ART) and 87.5% (14/16) achieved viral load <1000 cp/mL. At censure, 82.3% (14/17) of patients were alive—71.4% (10/14) achieved complete clinical remission and 28.6% (4/14) achieved a partial response. The median follow up was 37.3 months (range 8.0–83.5, IQR 19.7–41.6), and no patients were lost to follow up. In this cohort, high rates of long-term survival and favorable outcomes were possible with paclitaxel treatment.

scholarly journals Prevalence of MDR organism (MDRO) carriage in children and their household members in Siem Reap Province, Cambodia

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
Shweta R Singh ◽  
Bunsoth Mao ◽  
Konstantin Evdokimov ◽  
Pisey Tan ◽  
Phana Leab ◽  
...  
Keyword(s):  
Final Analysis ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Middle Income ◽  
E Coli ◽  
Middle Income Countries ◽  
Siem Reap ◽  
High Prevalence ◽  
Significant Public Health ◽  
History Of

Abstract Background The rising incidence of infections caused by MDR organisms (MDROs) poses a significant public health threat. However, little has been reported regarding community MDRO carriage in low- and middle-income countries. Methods We conducted a cross-sectional study in Siem Reap, Cambodia comparing hospital-associated households, in which an index child (age: 2–14 years) had been hospitalized for at least 48 h in the preceding 2–4 weeks, with matched community households on the same street, in which no other child had a recent history of hospitalization. Participants were interviewed using a survey questionnaire and tested for carriage of MRSA, ESBL-producing Enterobacterales (ESBL-E) and carbapenemase-producing Enterobacterales (CPE) by culture followed by antibiotic susceptibility testing. We used logistic regression analysis to analyse associations between collected variables and MDRO carriage. Results Forty-two pairs of households including 376 participants with 376 nasal swabs and 290 stool specimens were included in final analysis. MRSA was isolated from 26 specimens (6.9%). ESBL-producing Escherichia coli was detected in 269 specimens (92.8%) whereas ESBL-producing Klebsiella pneumoniae was isolated from 128 specimens (44.1%), of which 123 (42.4%) were co-colonized with ESBL-producing E. coli. Six (2.1%) specimens tested positive for CPE (4 E. coli and 2 K. pneumoniae). The prevalence ratios for MRSA, ESBL-producing E. coli and ESBL-producing K. pneumoniae carriage did not differ significantly in hospital-associated households and hospitalized children compared with their counterparts. Conclusions The high prevalence of ESBL-E across both household types suggests that MDRO reservoirs are common in the community. Ongoing genomic analyses will help to understand the epidemiology and course of MDRO spread.

A Novel Surgical Technique for Large Frontoencephalocele Management: The Mercy Ships Approach

FACE ◽  
2021 ◽  
pp. 273250162097932
Author(s):  
Naikhoba C. O. Munabi ◽  
Eric S. Nagengast ◽  
Gary Parker ◽  
Shaillendra A. Magdum ◽  
Mirjam Hamer ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Intraoperative Complications ◽  
Complication Rates ◽  
The Novel ◽  
Middle Income ◽  
Middle Income Countries ◽  
Lumbar Drain ◽  
Cerebral Herniation ◽  
Long Nose

Background: Large frontoencephaloceles, more common in low and middle-income countries, require complex reconstruction of cerebral herniation, elongated nose, telecanthus, and cephalic frontal bone rotation. Previously described techniques involve multiple osteotomies, often fail to address cephalad brow rotation, and have high complication rates including up to 35% mortality. This study presents a novel, modified, single-staged technique for frontoencephalocele reconstruction performed by Mercy Ships. This technique, which addresses functional and aesthetic concerns with minimal osteotomies, may help improve outcomes in low resources settings. Methods: Retrospective review was performed of patients who underwent frontoencephalocele reconstruction through Mercy Ships using the technique described. Patient data including country, age, gender, associated diagnoses, and prior interventions were reviewed. Intraoperative and post-operative complications were recorded. Results: Eight patients with frontoencephalocele (ages 4-14 years) underwent surgery with the novel technique in 4 countries. Average surgical time was 6.0 ± 0.9 hours. No intraoperative complications occurred. Post-operatively 1 patient experienced lumbar drain dislodgement requiring replacement and a second had early post-operative fall requiring reoperation for hardware replacement. In person follow-up to 2.4 months showed no additional complications. Follow-up via phone at 1 to 2 years post-op revealed all patients who be satisfied with surgical outcomes. Conclusions: Reconstruction of large frontoencephaloceles can be challenging due to the need for functional closure of the defect and craniofacial reconstruction to correct medial hypertelorism, long nose deformity, and cephalad forehead rotation. The novel surgical technique presented in this paper allows for reliable reconstruction of functional and aesthetic needs with simplified incision design, osteotomies, and bandeau manipulation.

scholarly journals Triaging and adaptations of surveillance of cancer services in the COVID pandemic

2020 ◽  
pp. 1-3
Author(s):  
Shirley Lewis ◽  
Lavanya Gurram ◽  
Umesh Velu ◽  
Krishna Sharan
Keyword(s):  
Cancer Patients ◽  
Clinical Examination ◽  
Cancer Care ◽  
Middle Income ◽  
Face To Face ◽  
Middle Income Countries ◽  
Cancer Services ◽  
Low Middle Income Countries

Abstract Introduction: Coronavirus disease (COVID-19) has significantly challenged the access to cancer care and follow-up for a patient with cancer. Methods: Based on published literature and our experiences, it is reasonable to presume that clinical examination and follow-up visits have been significantly curtailed worldwide in order to adhere to the new norms during the pandemic. Although telephonic and telemedicine consultations may help bridge a few gaps, completely dispensing with in-person consultation has its challenges, especially in low middle-income countries. Telephonic consultations could facilitate triaging of ambulatory cancer patients and allocation of face-to-face consultations for high priority patients. Conclusions: We propose a telephonic consultation-based triaging approach for ambulatory cancer patients in order to identify those needing in-hospital consultations.

scholarly journals Modelling the COVID-19 pandemic in context: an international participatory approach

2020 ◽  
Vol 5 (12) ◽  
pp. e003126
Author(s):  
Ricardo Aguas ◽  
Lisa White ◽  
Nathaniel Hupert ◽  
Rima Shretta ◽  
Wirichada Pan-Ngum ◽  
...  
Keyword(s):  
Mathematical Models ◽  
Low Income ◽  
Scientific Evidence ◽  
Participatory Approach ◽  
Middle Income ◽  
Middle Income Countries ◽  
Containment Measures ◽  
History Of ◽  
High Degree ◽  
The Mathematical Model

The SARS-CoV-2 pandemic has had an unprecedented impact on multiple levels of society. Not only has the pandemic completely overwhelmed some health systems but it has also changed how scientific evidence is shared and increased the pace at which such evidence is published and consumed, by scientists, policymakers and the wider public. More significantly, the pandemic has created tremendous challenges for decision-makers, who have had to implement highly disruptive containment measures with very little empirical scientific evidence to support their decision-making process. Given this lack of data, predictive mathematical models have played an increasingly prominent role. In high-income countries, there is a long-standing history of established research groups advising policymakers, whereas a general lack of translational capacity has meant that mathematical models frequently remain inaccessible to policymakers in low-income and middle-income countries. Here, we describe a participatory approach to modelling that aims to circumvent this gap. Our approach involved the creation of an international group of infectious disease modellers and other public health experts, which culminated in the establishment of the COVID-19 Modelling (CoMo) Consortium. Here, we describe how the consortium was formed, the way it functions, the mathematical model used and, crucially, the high degree of engagement fostered between CoMo Consortium members and their respective local policymakers and ministries of health.

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