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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Severe cases of COVID-19 are associated with rehabilitation needs related to the consequences of ventilatory support, and prolonged immobilization and bed rest. These may include: − Impaired lung function; − Physical deconditioning and muscle weakness; − Delirium and other cognitive impairment...s; − Impaired swallow and communication; and − Mental health disorders and psychosocial support needs. − Rehabilitation needs may be amplified by underlying health conditions and decrements in health associated with ageing, − Rehabilitation professionals play an important role in facilitating early discharge, which is especially critical in the context of hospital bed shortages. − Rehabilitation needs of people with severe COVID-19 exist during the acute, sub-acute and long-term phases of care; rehabilitation professionals should be positioned in ICUs, hospital wards, stepdown facilities and in the community. − Particularly in the acute phase, rehabilitation interventions for patients with severe COVID-19 requiring ventilatory support generally require a particular skill-set acquired through specialist training.
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Этот документ представляет собой обновление
рекомендаций «Уход на дому за пациентами с легкой
формой заболевания COVID‑19 и тактика ведения
контактных лиц», опубл...кованных 17 марта 2020 г. Он
дополнен рекомендациями касательно организации ухода
на дому безопасным и надлежащим образом за
пациентами с заболеванием, вызванным новым
коронавирусом 2019 г. (COVID-19), а также
санитарно-эпидемиологических мер в отношении
контактных лиц. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts
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Cardiovascular disease (CVD) is the leading cause of global deaths, with the majority occurring in low- and middle-income countries (LMIC). The primary and secondary prevention of CVD is suboptimal throughout the world, but the evidence-practice gaps are much more pronounced in LMIC. Barriers at the... patient, health-care provider, and health system level prevent the implementation of optimal primary and secondary prevention. Identification of the particular barriers that exist in resource-constrained settings is necessary to inform effective strategies to reduce the identified evidence-practice gaps. Furthermore, targeting modifiable factors that contribute most significantly to the global burden of CVD, including tobacco use, hypertension, and secondary prevention for CVD will lead to the biggest gains in mortality reduction. We review a select number of novel, resource-efficient strategies to reduce premature mortality from CVD, including: (1) effective measures for tobacco control; (2) implementation of simplified screening and management algorithms for those with or at risk of CVD, (3) increasing the availability and affordability of simplified and cost-effective treatment regimens including combination CVD preventive drug therapy, and (4) simplified delivery of health care through task-sharing (non-physician health workers) and optimizing self-management (treatment supporters). Developing and deploying systems of care that address barriers related to the above, will lead to substantial reductions in CVD and related mortality.
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Cardiovascular diseases, principally ischemic heart disease (IHD), are the most important cause of death and disability in the majority of low- and lower-middle-income countries (LLMICs). In these countries, IHD mortality rates are significantly greater in individuals of a low socioeconomic status (...SES).
Three important focus areas for decreasing IHD mortality among those of low SES in LLMICs are (1) acute coronary care; (2) cardiac rehabilitation and secondary prevention; and (3) primary prevention. Greater mortality in low SES patients with acute coronary syndrome is due to lack of awareness of symptoms in patients and primary care physicians, delay in reaching healthcare facilities, non-availability of thrombolysis and coronary revascularization, and the non-affordability of expensive medicines (statins, dual anti-platelets, renin-angiotensin system blockers). Facilities for rapid diagnosis and accessible and affordable long-term care at secondary and tertiary care hospitals for IHD care are needed. A strong focus on the social determinants of health (low education, poverty, working and living conditions), greater healthcare financing, and efficient primary care is required. The quality of primary prevention needs to be improved with initiatives to eliminate tobacco and trans-fats and to reduce the consumption of alcohol, refined carbohydrates, and salt along with the promotion of healthy foods and physical activity. Efficient primary care with a focus on management of blood pressure, lipids and diabetes is needed. Task sharing with community health workers, electronic decision support systems, and use of fixed-dose combinations of blood pressure-lowering drugs and statins can substantially reduce risk factors and potentially lead to large reductions in IHD. Finally, training of physicians, nurses, and health workers in IHD prevention should be strengthened.
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In 2020, the COVID-19 pandemic impacted the world beyond imagination. To date, it has infected more than 135 million people, killed over 2.9 million people, and is projected to plunge up to 115 million people into extreme poverty.1 As countries have gone into lockdown, gender-based violence has incr...eased, unemployment has soared, and access to health care for the poorest and most vulnerable has been cut. COVID-19 has made people less likely to seek health care because they are afraid of getting infected with the virus. Fear and uncertainty surrounding COVID-19 have also increased stigma and discrimination. As frontline workers without enough access to personal protective equipment (PPE) risk their lives to treat patients, the virus pushes already fragile health systems to the brink.
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Updated 22 august 2016. This document aims to provide interim guidance on the case definition of GBS and strategies to manage the syndrome, in the context of Zika virus and its potential association with GBS. This document is intended to inform the development of local clinical protocols and health ...policies related to the care of patients with GBS
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MedPPE emphasizes the role and timing of health workers jobs and offers specific information to prevent the spread of COVID-19. The guidelines are aimed at all personnel working in health facilities, including security guards, administrative and cleaning personnel, transfer assistants, nurses, biome...dical and imaging technicians, surgeons, and physicians, among others.
MedPPE provides guidance for the use of PPE according to workers’ function, the level of care they provide, and the multiple environments of primary health care and hospitals. The tool also clarifies the type of PPE needed when performing aerosol-generating procedures and other activities related to the care of patients infected or suspected of being infected with COVID-19.
However, use of PPE alone is not enough to protect against COVID-19. Hand hygiene and proper PPE dressing and undressing procedures must also be followed, along with the proper disposal and management of waste.
MedPPE is available in Spanish, English, Portuguese and French for iOS and Android devices.
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Chronic kidney disease (CKD) is an important contributor to mortality from noncommunicable diseases. No decrease has been seen for CKD mortality contrary to many other important non-communicable diseases (e.g., cardiovascular disease). The prevalence of CKD and kidney failure are increasing all over... the world – and thereby also the need for dialysis. Unfortunately, the prevalence increases most rapidly in lowand middle-income countries. Globally, there are great inequities in access and quality of management of kidney failure. Many low- and middle-income countries cannot meet the increased need for dialysis. If the patients receive dialysis, it might only be for a limited period due to the out-of-pocket expenses. There are global disparities in CKD mortality reflecting the disparities in access to care. Lack of access to dialysis is an important cause of the increased CKD mortality in low- and middle-income countries.
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Tobacco use is the leading preventable cause of death worldwide and is a major risk factor for cardiovascular disease (CVD). Both prevention of smoking initiation among youth and smoking cessation among established smokers are key for reducing smoking prevalence and the associated negative health co...nsequences. Proven tobacco cessation treatment includes pharmacotherapy and behavioral support, which are most effective when provided together. First-line medications (varenicline, bupropion, and nicotine replacement) are effective and safe for patients with CVD. Clinicians who care for patients with CVD should give as high a priority to treating tobacco use as to managing other CVD risk factors. Broader tobacco control efforts to raise tobacco taxes, adopt smoke-free laws, conduct mass media campaigns, and restrict tobacco marketing enhance clinicians' actions working with individual smokers.
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The whole book has 50.3 MB!!!!
To download chapter by chapter:
http://www.uib.no/cih/en/resources/neurology-in-africa
Africa is a vast continent and neurological disorders are a common cause of disability and death. This practical neurology textbook is specifically written for Sub-Saharan Africa.... The aim of this book is for students to gain an understanding of neurology, learn the necessary clinical skills and obtain sufficient knowledge to care for patients presenting with neurological disorders. Diagnosis in neurology is based on accurate history and physical examination and this book emphasizes these principles
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In December 2019 a novel coronavirus (2019-nCoV) was identified as the causative agent of a severe acute respiratory illness among people exposed in a seafood market in Wuhan, China; • Human-to-human transmission has been documented, including in healthcare workers, and aerosol-generating procedur...es (AGP)† may play a role in the spread of the disease; • There are uncertainties in the natural history of the 2019-nCoV, including source(s), transmissibility mechanisms, viral shedding, and persistence of the virus in the environment and on fomites; • As of 6 February 2020, the following precautions are recommended for the care of patients with suspected or confirmed cases of 2019-nCoV: o For any suspected or confirmed cases of 2019-nCoV: standard + contact + droplet precautions o For any suspected or confirmed cases of 2019-nCoV and AGP: standard + contact + airborne precautions • The use of personal protective equipment (PPE) by healthcare workers requires an evaluation of the risk related to healthcare-related activities;
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The "Primary Healthcare Standard Treatment Guidelines and Essential Medicines List" by the South African National Department of Health provides evidence-based guidelines for diagnosing and managing common medical conditions at the primary healthcare level. This document includes treatment protocols ...for various health issues, such as infections, chronic diseases, maternal and child health, mental health, and emergency care. It aims to standardize care, promote rational medicine use, and ensure equitable access to essential medications across South Africa. The guidelines emphasize prevention, accurate diagnosis, and efficient treatment strategies to improve patient outcomes.
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The coronavirus outbreak that began in 2019 (COVID-19) threatens to reverse years of hard-won gains in preventing and treating HIV. Fragile health systems are further stressed as health workers navigate an increased client load and demands at work while also being concerned for their own health and ...that of their families. Health facilities have been redesigned to care for patients with COVID-19, posing challenges to other services. Governments and civil society organizations have redirected scarce resources and shifted programming priorities to respond to the pandemic. Several countries have reported intermittent declines in HIV testing and diagnosis, antenatal care visits, collection of antiretroviral medicines (ARVs) by people living with HIV, and attendance at clinic appointments. Community-based education and support programmes have had to rapidly adapt to restrictions on movement and public gatherings. Children, adolescents, and women have experienced multiple deprivations due to the adverse impact of the pandemic.
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Online learning for clinical management staff of respiratory diphtheria in Cox's Bazar, Bangladesh.
In December 2017, the WHO Health Emergencies Programme launched an online learning for clinical staff on respiratory diphtheria through the OpenWHO.org platform. The 4-hour course targets clinicians ...caring for patients during outbreaks in vulnerable settings, such as in Cox's Bazar. It is also applicable to clinicians working in settings that share similar challenges, due to limitations of: laboratory capacity, availability of treatment facilities, number of trained staff, medications, medical supplies, and supportive care.
With the OpenWHO App, users can now view course content on a mobile device, with or without internet connection, once it has been downloaded: an important feature needed in vulnerable settings. Material is now being translated into Bahasa Indonesia and Arabic.
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The present guidelines incorporate all these changes, leading to a substantial reconfiguration of therapeutic choices for both disease forms.
HAT is a serious, life-threatening disease and the efficacy of fexinidazole depends on swallowing the medicine after an appropriate intake of food as well as... on completing the full 10-day treatment schedule. Therefore, the recommendations regarding fexinidazole administration are considered key elements that must be carefully followed. When the conditions listed in these guidelines are not met for any individual patient, the alternative available treatments should be prescribed.
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Antimicrobial resistance has become a serious public health threat for effective treatment of an ever increasing range of infections caused by bacteria, parasites, viruses and fungi. When infections can no longer be treated by first-line antibiotics, other antibiotics must be used, which are both mo...re expensive and more toxic. Treatment and hospitalization is prolonged, and patients undergoing operations and other medical procedures are more vulnerable to infections. All this imposes a huge burden on health care systems and on the economy of countries. This is a major challenge to the health system in Mauritius which provides health care free of user cost to the whole population.
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his manual is for people who have had no formal training in counselling but wish to learn the necessary components to establishing an effective counselling relationship. It will be useful for anyone who is involved in counselling people with a mental health problem.
h...is manual aims at providing counsellors with information about the basic skills required in counselling in a practical and simple to understand format. It is meant to accompany the Healthy Activity Program (HAP) and Counselling for Alcohol Problems (CAP) manuals for counselling patients with depression and harmful/dependent drinking in primary care settings.
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The Covid-19 pandemic has so far infected more than 30 million people in the world, having major impact on global health with collateral damage. In Mozambique, a public state of emergency was declared at the end of March 2020. This has limited people's movements and reduced public services, leading ...to a decrease in the number of people accessing health care facilities. An implementation research project, The Alert Community for a Prepared Hospital, has been promoting access to maternal and child health care, in Natikiri, Nampula, for the last four years. Nampula has the second highest incidence of Covid-19. The purpose of this study is to assess the impact of Covid-19 pandemic Government restrictions on access to maternal and child healthcare services. We compared health centres in Nampula city with healthcare centres in our research catchment area. We wanted to see if our previous research interventions have led to a more resilient response from the community.
METHODS: Mixed-methods research, descriptive, cross-sectional, retrospective, using a review of patient visit documentation. We compared maternal and child health care unit statistical indicators from March-May 2019 to the same time-period in 2020. We tested for significant changes in access to maternal and child health services, using KrushKall Wallis, One-way Anova and mean and standard deviation tests. We compared interviews with health professionals, traditional birth attendants and patients in the two areas. We gathered data from a comparable city health centre and the main city referral hospital. The Marrere health centre and Marrere General Hospital were the two Alert Community for a Prepared Hospital intervention sites.
RESULTS: Comparing 2019 quantitative maternal health services access indicators with those from 2020, showed decreases in most important indicators: family planning visits and elective C-sections dropped 28%; first antenatal visit occurring in the first trimester dropped 26%; hospital deliveries dropped a statistically significant 4% (p = 0.046), while home deliveries rose 74%; children vaccinated down 20%.
CONCLUSION: Our results demonstrated the negative collateral effects of Covid-19 pandemic Government restrictions, on access to maternal and child healthcare services, and highlighted the need to improve the health information system in Mozambique.
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Social inequalities are perpetuating unhealthy living and working conditions and behaviours. These causes are commonly called ‘the social determinants of health’. Achieving greater equity in health will demand that the health sector assumes a greater leadership role in addressing social inequali...ties. This requires equipping health and care workers to better understand how the social determinants of health impact patients and communities. Education of the health workforce is thus a key step to advancing action. Integration of the social determinants of health into education and training will prepare the workforce to adjust clinical practice, define appropriate public health programmes and leverage cross-sector policies and mechanisms.
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