Archives of Disease in Childhood 2021;106:238-240.
For the primary health worker in a low/middle-income country (LMIC) setting, delivering quality primary care is challenging. This is often complicated by clinical guidance that is out of date, inconsistent and informed by evidence from high-income countries that ignores LMIC resource constraints and... burden of disease. The Knowledge Translation Unit (KTU) of the University of Cape Town Lung Institute has developed, implemented and evaluated a health systems intervention in South Africa, and localised it to Botswana, Nigeria, Ethiopia and Brazil, that simplifies and standardises the care delivered by primary health workers while strengthening the system in which they work. At the core of this intervention, called Practical Approach to Care Kit (PACK), is a clinical decision support tool, the PACK guide. This paper describes the development of the guide over an 18-year period and explains the design features that have addressed what the patient, the clinician and the health system need from clinical guidance, and have made it, in the words of a South African primary care nurse, ‘A tool for every day for every patient’. It describes the lessons learnt during the development process that the KTU now applies to further development, maintenance and in-country localisation of the guide: develop clinical decision support in context first, involve local stakeholders in all stages, leverage others’ evidence databases to remain up to date and ensure content development, updating and localisation articulate with implementation.
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The global increase of healthcare-associated infections (HAI) presents a growing concern in healthcare worldwide. According to the European Centre for Disease Prevention and Control (ECDC), the annual number of HAI exceeds 2.6million and produces the highest estimated amou...nt of disability-adjust-ed-life-years, surpassing all other reported communicable diseases in the European Union and European Economic Area. Multi-drug-resistant Gram-negative (MDR-GN) bacteria have become increasingly common as a cause for HAI, such as central line-as-sociated bloodstream infections, wound or surgical site infections and catheter-associated urinary tract infections
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This manual is to assist health care providers and laboratory scientists to diagnose mycobacterium ulcerans disease (Buruli ulcer). The manual aims to achieve a better understanding of the clinical presentation and its diagnosis. The methods described are tailored to various levels of care and avail...able resources to improve the diagnosis and surveillance of the disease.
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The second edition of the joint WHO, WIPO and WTO
publication “Promoting Access to Medical Technologies
and Innovation: Intersections between public health,
intellectual property and trade” (the Trilateral Study),*
published in 2020, included a special insert mappi...ng the
challenges posed by the COVID-19 pandemic in relation
to the integrated health, trade and IP policy framework set
out in the study. The Trilateral Study and the special insert
were designed to serve as background reference for policy-
makers in the widest sense – lawmakers, government
officials, delegates to international organizations, non-
governmental organizations (NGOs) and researchers
who seek a comprehensive presentation of the full range
of issues, including institutions and legal concepts with
which they may be unfamiliar. It is also designed to serve
as a factual resource for the three organizations’ technical
cooperation activities.
This update revises the information contained in that
insert in the light of more recent developments as of
30 August 2021. Further updates will be made to reflect
subsequent developments.
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Curr Opin Pharmacol . 2022 Apr;63:102203.doi: 10.1016/j.coph.2022.102203. Epub 2022 Feb 11.
The COVID-19 pandemic has widespread economic and social effects on Latin America (LA) and the Caribbean (CA). This region, which has a high prevalence of chronic diseases, has been one of the most affected... during the pandemic. Multiple symptoms and comorbidities are related to distinct COVID-19 outcomes. However, there has been no explanation as to why different patients present with different arrays of clinical presentations. Studies report that similar to comorbidities, each country in LA and the CA has its own particular health issues.
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Over 1 million women in Burkina Faso caught between conflict and COVID-19
More than a million women and girls in Burkina Faso are facing increased sexual violence, hunger and water shortage as a result of the coronavirus pandemic on top of the existing conflict, said Oxfam today.
In its report “...Women in Burkina Faso’s crisis: survivors and heroines”, Oxfam reveals that women and girls are exposed to unprecedented risks including daily harassment and aggression, especially in the fields and at water points.
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J Hosp Infect. 2020 Apr 8. pii: S0195-6701(20)30176-6. doi: 10.1016/j.jhin.2020.04.001. [Epub ahead of print]
Little is known about asthma control in the rising number of African children who suffer from this condition. The Achieving Control of Asthma in Children in Africa (ACACIA) study is an observational study collecting evidence about paediatric asthma in urban areas of Ghana, Malawi, Nigeria, South Afr...ica, Uganda and Zimbabwe. The primary objectives are: (1) to identify 3000 children aged between 12 years and 14 years with asthma symptoms; and (2) to assess their asthma control, current treatment, knowledge of and attitudes to asthma and barriers to achieving good control. Secondary objective is to develop interventions addressing identified barriers to good symptom control.
Each centre will undertake screening to identify 500 school children with asthma symptoms using questions from the Global Asthma Network’s questionnaire. Children identified to have asthma symptoms will fill in a digital survey, including: Asthma Control Test, questions on medication usage and adherence, medical care, the Brief-Illness Perception questionnaire and environmental factors. Exhaled nitric oxide testing and prebronchodilator and postbronchodilator spirometry will be performed. A subgroup of children will participate in focus group discussions. Results will be analysed using descriptive statistics and comparative analysis. Informed by these results, we will assess the feasibility of potential interventions, including the adaption of a UK-based theatre performance about asthma attitudes and digital solutions to improve asthma management.
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While epidemiological data for type 1 diabetes (T1D) in low/middle-income countries, and particularly low-income countries (LICs) including Liberia is lacking, prevalence in LICs is thought to be increasing. T1D care in LICs is often impacted by challenges in diagnosis and management. These challeng...es, including misdiagnosis and access to insulin, can affect T1D outcomes and frequency of severe complications. Despite the severe nature of T1D and growing burden in subSaharan Africa, little is currently known about the impact of T1D on patients and caregivers in the region. Methods We conducted a qualitative study consisting of interviews with patients with T1D, caregivers, providers, civil society members and a policy-maker in Liberia to better understand the psychosocial and economic impact of living with T1D, knowledge of T1D and selfmanagement, and barriers and facilitators for accessing T1D care.
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COVID-19 disproportionately affects the poor and vulnerable. Community health workers are poised to play a pivotal role in fighting the pandemic, especially in countries with less resilient health systems. Drawing from practitioner expertise across four WHO regions, this article outlines the targete...d actions needed at different stages of the pandemic to achieve the following goals: (1) PROTECT healthcare workers, (2) INTERRUPT the virus, (3) MAINTAIN existing healthcare services while surging their capacity, and (4) SHIELD the most vulnerable from socioeconomic shocks. While decisive action must be taken now to blunt the impact of the pandemic in countries likely to be hit the hardest, many of the investments in the supply chain, compensation, dedicated supervision, continuous training and performance management necessary for rapid community response in a pandemic are the same as those required to achieve universal healthcare and prevent the next epidemic.
BMJ Global Health2020;5:e002550. doi:10.1136/bmjgh-2020-002550
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There has been no systematic comparison of how the policy response to past infectious disease outbreaks and epidemics was funded. This study aims to collate and analyse funding for the Ebola epidemic and Zika outbreak between 2014 and 2019 in order to understand the shortcomings in funding reporting... and suggest improvements. Methods: Data were collected via a literature review and analysis of financial reporting databases, including both amounts donated and received. Funding information from three financial databases was analysed: Institute of Health Metrics and Evaluation’s Development Assistance for Health database, the Georgetown Infectious Disease Atlas and the United Nations Financial Tracking Service. A systematic literature search strategy was devised and applied to seven databases: MEDLINE, EMBASE, HMIC, Global Health, Scopus, Web of Science and EconLit. Funding information was extracted from articles meeting the eligibility criteria and measures were taken to avoid double counting. Funding was collated, then amounts and purposes were compared within, and between, data sources.
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Tackling Tuberculosis in Under-Served Populations: A Resource for TB Control Boards and their partners
Tokar A, et al. Sex Transm Infect 2019;95:193–200. doi:10.1136/sextrans-2018-053684
Objectives Our study aimed to systematically review the literature and synthesise findings on potential associations of built environment characteristics with type 2 diabetes (T2D) in Asia.
BMJ Open Science 2021;5:e100202. doi:10.1136/
bmjos-2021-100202