Background
Asthma education, a key component of long-term asthma management, is challenging in resource-limited settings with shortages of clinical staff. Task-shifting educational roles to lay (non-clinical) staff is a potential solution. We conducted a randomised controlled trial of an enhanced a...sthma care intervention for children in Malawi, which included reallocation of asthma education tasks to lay-educators. In this qualitative sub-study, we explored the experiences of asthmatic children, their families and lay-educators, to assess the acceptability, facilitators and barriers, and perceived value of the task-shifting asthma education intervention.
Methods
We conducted six focus group discussions, including 15 children and 28 carers, and individual interviews with four lay-educators and a senior nurse. Translated transcripts were coded independently by three researchers and key themes identified.
Results
Prior to the intervention, participants reported challenges in asthma care including the busy and sometimes hostile clinical environment, lack of access to information and the erratic supply of medication. The education sessions were well received: participants reported greater understanding of asthma and their treatment and confidence to manage symptoms. The lay-educators appreciated pre-intervention training, written guidelines, and access to clinical support. Low education levels among carers presented challenges, requiring an open, non-critical and individualised approach.
Discussion
Asthma education can be successfully delivered by lay-educators with adequate training, supervision and support, with benefits to the patients, their families and the community. Wider implementation could help address human resource shortages and support progress towards Universal Health Coverage.
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Investigación original / Original research
Panam Salud Publica. 2016;39(1):38–43.
WHO Information Leaflet COVID-19: Considerations on tuberculosis (TB) care
BACKGROUND: Growing political attention to antimicrobial resistance (AMR) offers a rare opportunity for achieving meaningful action. Many governments have developed national AMR action plans, but most have not yet implemented policy interventions to reduce antimicrobial overuse. A systematic evidenc...e map can support governments in making evidence-informed decisions about implementing programs to reduce AMR, by identifying, describing, and assessing the full range of evaluated government policy options to reduce antimicrobial use in humans.
METHODS AND FINDINGS: Seven databases were searched from inception to January 28, 2019, (MEDLINE, CINAHL, EMBASE, PAIS Index, Cochrane Central Register of Controlled Trials, Web of Science, and PubMed). We identified studies that (1) clearly described a government policy intervention aimed at reducing human antimicrobial use, and (2) applied a quantitative design to measure the impact. We found 69 unique evaluations of government policy interventions carried out across 4 of the 6 WHO regions. These evaluations included randomized controlled trials (n = 4), non-randomized controlled trials (n = 3), controlled before-and-after designs (n = 7), interrupted time series designs (n = 25), uncontrolled before-and-after designs (n = 18), descriptive designs (n = 10), and cohort designs (n = 2). From these we identified 17 unique policy options for governments to reduce the human use of antimicrobials. Many studies evaluated public awareness campaigns (n = 17) and antimicrobial guidelines (n = 13); however, others offered different policy options such as professional regulation, restricted reimbursement, pay for performance, and prescription requirements. Identifying these policies can inform the development of future policies and evaluations in different contexts and health systems. Limitations of our study include the possible omission of unpublished initiatives, and that policies not evaluated with respect to antimicrobial use have not been captured in this review.
CONCLUSIONS: To our knowledge this is the first study to provide policy makers with synthesized evidence on specific government policy interventions addressing AMR. In the future, governments should ensure that AMR policy interventions are evaluated using rigorous study designs and that study results are published.
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Objective: To review the effectiveness of antibiotic stewardship interventions in hospitals in low- and middle-income countries.
30 January 2020
This document outlines the standard operating procedures for detection and response to case/s of suspected novel coronavirus disease (2019-nCoV) in South Africa. The content of this document should inform provincial preparedness plans.
BACKGROUND. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The burden of asthma in children is increasing in low- and middle-income countries and remains under-recognised and poorly managed.
OBJE...CTIVES. To quantify the burden of asthma in the South African (SA) population and identify the risk factors associated with disease severity in the local context.
METHODS. The SA Childhood Asthma Working Group (SACAWG) convened in January 2017 with task groups, each headed by a section leader, constituting the editorial committee on assessment of asthma epidemiology, diagnosis, control, treatments, novel treatments and self-management plans. The epidemiology task group reviewed the available scientific literature and assigned evidence according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system.
CONCLUSIONS. Asthma in children remains a common condition, which has shown an increasing prevalence in urban and rural populations of SA. Of concern is that almost half of children in urban communities experience severe asthma symptoms, and many asthmatics lack a formal diagnosis and thus access to treatment. Exposure to tobacco smoke and living in highly polluted areas increase the severity of wheezing in young children.
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Background Unrest in Chile over inequalities has underscored the need to improve public hospitals. Nursing has been overlooked as a solution to quality and access concerns, and nurse staffing is poor by international standards. Using Chile’s new diagnosis-related groups system and surveys of nurse...s and patients, we provide information to policy makers on feasibility, net costs, and estimated improved outcomes associated with increasing nursing resources in public hospitals.
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English Analysis on World about Agriculture, Climate Change and Environment, Drought, Flood and more; published on 27 Oct 2021 by GCA
This article looks at the Baseline Standards developed by the International Society for Paediatric
Oncology (SIOP) for paediatric oncology nursing care in low- and middle-income countries. The
Baseline Standards lay the foundation for effective care and address barriers such as inadequate
staffin...g levels, lack of support, limited access to nurse education and unsafe nursing environments.
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BackgroundClimate change is one of the great challenges of our time. The consequences of climate change on exposed biological subjects, as well as on vulnerable societies, are a concern for the entire scientific community. Rising temperatures, heat waves, floods, tornadoes, hurricanes, droughts, fir...es, loss of forest, and glaciers, along with disappearance of rivers and desertification, can directly and indirectly cause human pathologies that are physical and mental.
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WHO‘s Global Strategy to Accelerate the Elimination of Cervical Cancer, launched today, outlines three key steps: vaccination, screening and treatment. Successful implementation of all three could reduce more than 40% of new cases of the disease and 5 million related deaths by 2050.
Esta guía rápida sobre la adaptación de los programas de resistencia a los antimicrobianos (TAP, por su sigla en inglés) se ha elaborado para ayudar los países a iniciar y ejecutar proyectos para enfrentar la propagación de la resistencia a los antimicrobianos en sus territorios. La resistenci...a a los antimicrobianos es un problema complejo, con muchos factores que afectan su aparición y propagación, por lo que resulta difícil abordarlo. La guía rápida del proceso de TAP está diseñada para ayudar a los grupos de trabajo de TAP a nivel nacional a aplicar un enfoque de estudio del comportamiento para formular intervenciones apropiadas y factibles a fin de comenzar a combatir la resistencia a los antimicrobianos en sus contextos. La guía proporciona un panorama general de la resistencia a los antimicrobianos y el proceso de TAP, y conduce a los usuarios a lo largo de cinco etapas para evaluar la factibilidad, adquirir una comprensión referencial de los problemas, priorizar los temas que han de tratarse, formular estrategias y ejecutar y evaluar las intervenciones. La guía viene acompañada del Conjunto de Herramientas de TAP. Ejercicios, herramientas y plantillas para facilitar su plan de intervenciones a medida contra la resistencia a los antimicrobianos, que contiene ejercicios y recursos para facilitar cada etapa de formulación del proyecto.
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23 décembre 2020 Ce document résume les recommandations de l'OMS concernant l'utilisation rationnelle des équipements de protection individuelle (EPI) dans les établissements de soins de santé et les stratégies temporaires en cas de pénurie aiguë d'approvisionnement. Ce document contient ég...alement 2 sections en annexe qui décrivent les recommandations actualisées d'utilisation des EPI pour les travailleurs de la santé en fonction du scénario de transmission, du milieu et de l'activité dans le contexte de COVID-19 (annexe 1), et des considérations actualisées pour la décontamination ou le retraitement des EPI (annexe 2). Ce guide est destiné aux autorités de santé publique, aux organisations et aux personnes de référence impliquées dans les décisions concernant la distribution, la gestion et l'utilisation des EPI par les travailleurs de la santé.
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Results from studies evaluating the effectiveness of focused psychosocial support interventions in children exposed to traumatic events in humanitarian settings in low-income and middle-income countries have been inconsistent, showing varying results by setting and subgroup (eg, age or gender). We a...imed to assess the effectiveness of these interventions, and to explore which children are likely to benefit most.
Lancet Glob Health 2018; 6: e390–400
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The evolving epidemic of type 2 diabetes mellitus has challenged health-care professionals. It stands among the leading causes of mortality in the present world. It warrants new and versatile approaches to improve mortality and the associated huge quality-adjusted life years lost to it once diagnose...d. A possible venue to lower the incidence is to assess the safety and efficacy of various diabetes prevention strategies. Diet and exercise have a well-developed role in the prevention of weight gain and, ultimately, diabetes mellitus type II in high-risk individuals. However, high-risk individuals can also benefit from adjunct pharmacotherapy. In light of this information, we decided to conduct a systematic review of randomized controlled trials. This article summarizes the evidence in the literature on the pharmacological prevention of diabetes in high-risk individuals.
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NEUROLOGY ATLAS presents for the first time, the most
comprehensive collection and compilation of information on
neurological resources across 109 countries. The results confirm
that the available resources including services for neurological
disorders are markedly insufficient; in addition, the...re are large
inequities across regions and income groups of countries.
Urgent action is required to enhance the resources available
to address the increasing burden of neurological disorders.
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Buruli ulcer (BU), a neglected tropical disease (NTD), is an infection of the skin and subcutaneous tissue caused by Mycobacterium ulcerans. The disease has been documented in many South American, Asian, and Western Pacific countries and is widespread throughout much of Africa, especially in West... and Central Africa.
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