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Low resource setting

Kiran T Thakur, Alexandra Boubour, Deanna Saylor, Mitashee Das, David R Bearden, Gretchen L Birbeck
: Neurological conditions associated with HIV remain major contributors to morbidity and mortality and are increasingly recognized in the aging population on long-standing combination antiretroviral therapy (cART). Importantly, growing evidence shows that the CNS may serve as a reservoir for viral replication, which has major implications for HIV eradication strategies. Though there has been major progress in the last decade in our understanding of the pathogenesis, burden, and impact of neurological conditions associated with HIV infection, significant scientific gaps remain...
March 15, 2018: AIDS
Fauzia A Khan, Alan F Merry
The safety of anesthesia characteristic of high-income countries today is not matched in low-resource settings with poor infrastructure, shortages of anesthesia providers, essential drugs, equipment, and supplies. Health care is delivered through complex systems. Achieving sustainable widespread improvement globally will require an understanding of how to influence such systems. Health outcomes depend not only on a country's income, but also on how resources are allocated, and both vary substantially, between and within countries...
April 2018: Anesthesia and Analgesia
C Roger Goucke, Pongparadee Chaudakshetrin
Approximately 80% of the world's population lives in countries with little or no access to pain management. These countries also have 74% of the world's deaths from cancer and human immunodeficiency virus. Appropriate use of oral opioids can control 80%-90% of cancer pain. However, only 6.7% of the world's medical opioids are available in these low-resource countries. With the Lancet Commission on Global Surgery calling for a significant expansion of surgical services, postoperative pain management will need to be an increasing focus of our attention...
April 2018: Anesthesia and Analgesia
Michael Schriver, Vincent Kalumire Cubaka, Peter Vedsted, Innocent Besigye, Per Kallestrup
BACKGROUND: External supervision of primary health care facilities to monitor and improve services is common in low-income countries. Currently there are no tools to measure the quality of support in external supervision in these countries. AIM: To develop a provider-reported instrument to assess the support delivered through external supervision in Rwanda and other countries. METHODS: "External supervision: Provider Evaluation of Supervisor Support" (ExPRESS) was developed in 18 steps, primarily in Rwanda...
2018: Global Health Action
Nandita Perumal, Diego G Bassani, Daniel E Roth
The term "stunting" has become pervasive in international nutrition and child health research, program, and policy circles. Although originally intended as a population-level statistical indicator of children's social and economic deprivation, the conventional anthropometric definition of stunting (height-for-age z scores <-2 SD) is now widely used to define chronic malnutrition. Epidemiologists often portray it as a disease, making inferences about the causes of growth faltering based on comparisons between stunted (i...
March 1, 2018: Journal of Nutrition
E A R Engku Nur Syafirah, A B Nurul Najian, Phiaw Chong Foo, Mohammad Ridhuan Mohd Ali, Maizan Mohamed, Chan Yean Yean
Cholera, caused by Vibrio cholerae is a foodborne disease that frequently reported in food and water related outbreak. Rapid diagnosis of cholera infection is important to avoid potential spread of disease. Among available diagnostic platforms, loop-mediated isothermal amplification (LAMP) is regarded as a potential diagnostic tool due to its rapidity, high sensitivity and specificity and independent of sophisticated thermalcycler. However, the current LAMP often requires multiple pipetting steps, hence is susceptible to cross contamination...
March 12, 2018: Acta Tropica
Qian-Wen Deng, Xiang-Dong Luo, Ya-Ling Chen, Yi Zhou, Fan-Tao Zhang, Biao-Lin Hu, Jian-Kun Xie
BACKGROUND: Low phosphorus availability is a major factor restricting rice growth. Dongxiang wild rice (Oryza rufipogon Griff.) has many useful genes lacking in cultivated rice, including stress resistance to phosphorus deficiency, cold, salt and drought, which is considered to be a precious germplasm resource for rice breeding. However, the molecular mechanism of regulation of phosphorus deficiency tolerance is not clear. RESULTS: In this study, cDNA libraries were constructed from the leaf and root tissues of phosphorus stressed and untreated Dongxiang wild rice seedlings, and transcriptome sequencing was performed with the goal of elucidating the molecular mechanisms involved in phosphorus stress response...
March 15, 2018: Biological Research
Minerva Kyei-Onanjiri, Mary Carolan-Olah, John Koku Awoonor-Williams, Terence V McCann
BACKGROUND: Maternal morbidity and mortality is most prevalent in resource-poor settings such as sub-Saharan Africa and southern Asia. In sub-Saharan Africa, Ghana is one of the countries still facing particular challenges in reducing its maternal morbidity and mortality. Access to emergency obstetric care (EmOC) interventions has been identified as a means of improving maternal health outcomes. Assessing the range of interventions provided in health facilities is, therefore, important in determining capacity to treat obstetric emergencies...
March 15, 2018: BMC Health Services Research
Jennifer Carns, Kondwani Kawaza, M K Quinn, Yinsen Miao, Rudy Guerra, Elizabeth Molyneux, Maria Oden, Rebecca Richards-Kortum
BACKGROUND: Neonatal hypothermia is widely associated with increased risks of morbidity and mortality, but remains a pervasive global problem. No studies have examined the impact of hypothermia on outcomes for preterm infants treated with CPAP for respiratory distress syndrome (RDS). METHODS: This retrospective analysis assessed the impact of hypothermia on outcomes of 65 neonates diagnosed with RDS and treated with either nasal oxygen (N = 17) or CPAP (N = 48) in a low-resource setting...
2018: PloS One
Qiang Lu, Guanghui Liu, Chuanli Xiao, Chuanzhen Hu, Shiwu Zhang, Ronald X Xu, Kaiqin Chu, Qianming Xu, Zachary J Smith
In this paper we report the development of a cost-effective, modular, open source, and fully automated slide-scanning microscope, composed entirely of easily available off-the-shelf parts, and capable of bright field and fluorescence modes. The automated X-Y stage is composed of two low-cost micrometer stages coupled to stepper motors operated in open-loop mode. The microscope is composed of a low-cost CMOS sensor and low-cost board lenses placed in a 4f configuration. The system has approximately 1 micron resolution, limited by the f/# of available board lenses...
2018: PloS One
Sara Whetstone, Meg Autry
An unprecedented number of medical students and residents express the desire to participate in global health work during their training and beyond. Preparing learners for work in underserved settings makes it more likely that they will continue to work in areas of need. Training programs that focus on global health have been criticized as there is ample work to be done in the US, and often global health work becomes learner-centric, which is difficult to maintain and potentially burdensome and harmful to the host site...
March 1, 2018: AMA Journal of Ethics
Ramadhani Kigume, Stephen Maluka, Peter Kamuzora
While decentralisation of health systems has been on the policy agenda in low-income and middle-income countries since the 1970s, many studies have focused on understanding who has more decision-making powers but less attention is paid to understand what those powers encompass. Using the decision space approach, this study aimed to understand the amount of decision-making space transferred from the central government to institutions at the periphery in the decentralised health system in Tanzania. The findings of this study indicated that the decentralisation process in Tanzania has provided authorities with a range of decision-making space...
March 15, 2018: International Journal of Health Planning and Management
Eiman Zargaran, Richard Spence, Lauren Adolph, Andrew Nicol, Nadine Schuurman, Pradeep Navsaria, Damon Ramsey, S Morad Hameed
Importance: Collection and analysis of up-to-date and accurate injury surveillance data are a key step in the maturation of trauma systems. Trauma registries have proven to be difficult to establish in low- and middle-income countries owing to the burden of trauma volume, cost, and complexity. Objective: To determine whether an electronic trauma health record (eTHR) used by physicians can serve as simultaneous clinical documentation and data acquisition tools. Design, Setting, and Participants: This 2-part quality improvement study included (1) preimplementation and postimplementation eTHR study with assessments of satisfaction by 41 trauma physicians, time to completion, and quality of data collected comparing paper and electronic charting; and (2) prospective ecologic study describing the burden of trauma seen at a Level I trauma center, using real-time data collected by the eTHR on consecutive patients during a 12-month study period...
March 14, 2018: JAMA Surgery
Sanghoon Kim, Michael Crose, Will J Eldridge, Brian Cox, William J Brown, Adam Wax
Optical coherence tomography (OCT) is a widely used biomedical imaging tool, primarily in ophthalmology to diagnose and stage retinal diseases. In order to increase access for a wider range of applications and in low resource settings, we developed a portable, low-cost OCT system that has comparable imaging performance to commercially available systems. Here, we present the system design and characterization and compare the system performance to other commercially available OCT systems. In addition, future cost reductions and potential additional applications of the low-cost OCT system are discussed...
March 1, 2018: Biomedical Optics Express
Wendy E Whatney, Neel R Gandhi, Cecilia S Lindestam Arlehamn, Azhar Nizam, Hao Wu, Melanie J Quezada, Angela Campbell, Salim Allana, Mbuyi Madeleine Kabongo, Jeremiah Khayumbi, Benson Muchiri, Joshua Ongalo, Joan Tonui, Loren E Sasser, Tawania J Fergus, Gregory Sadat Ouma, Samuel Gurrion Ouma, Allison A Beck, Mark J Mulligan, Alawode Oladele, Deepak Kaushal, Kevin P Cain, Lance Waller, Henry M Blumberg, John D Altman, Joel D Ernst, Jyothi Rengarajan, Cheryl L Day
Antigen-specific CD4 and CD8 T cells are important components of the immune response to Mycobacterium tuberculosis , yet little information is currently known regarding how the breadth, specificity, phenotype, and function of M. tuberculosis -specific T cells correlate with M. tuberculosis infection outcome in humans. To facilitate evaluation of human M. tuberculosis -specific T cell responses targeting multiple different Ags, we sought to develop a high throughput and reproducible T cell response spectrum assay requiring low blood sample volumes...
March 14, 2018: Journal of Immunology: Official Journal of the American Association of Immunologists
Jennifer L Guthrie, Clare Kong, David Roth, Danielle Jorgensen, Mabel Rodrigues, Patrick Tang, Maichael Thejoe, Kevin Elwood, Victoria J Cook, James Johnston, Jennifer L Gardy
Prospective universal genotyping of tuberculosis (TB) isolates is used by many laboratories to detect clusters of cases and inform contact investigations. Prior to universal genotyping, most TB prevention programs genotyped isolates on request only, relying on requests from public health professionals whose knowledge of a patient's clinical, demographic, and epidemiological characteristics suggested potential transmission. To justify the switch from on-request to universal genotyping - particularly in the public health domain, with its limited resources and competing priorities - it is important to demonstrate the additional benefit provided by a universal genotyping program...
March 14, 2018: Journal of Clinical Microbiology
Etienne Gignoux, Jonathan Polonsky, Iza Ciglenecki, Mathieu Bichet, Matthew Coldiron, Enoch Thuambe Lwiyo, Innocent Akonda, Micaela Serafini, Klaudia Porten
In 2013, a large measles epidemic occurred in the Aketi Health Zone of the Democratic Republic of Congo. We conducted a two-stage, retrospective cluster survey to estimate the attack rate, the case fatality rate, and the measles-specific mortality rate during the epidemic. 1424 households containing 7880 individuals were included. The estimated attack rate was 14.0%, (35.0% among children aged <5 years). The estimated case fatality rate was 4.2% (6.1% among children aged <5 years). Spatial analysis and linear regression showed that younger children, those who did not receive care, and those living farther away from Aketi Hospital early in the epidemic had a higher risk of measles related death...
2018: PloS One
Jecca Rhea Steinberg, Janine S Bruce, Paloma Marin-Nevarez, Kimmy Phan, Sylvia Bereknyei Merrell, Lisa J Chamberlain
OBJECTIVE: School readiness by kindergarten entry is associated with increased high school graduation, decreased juvenile arrest, and better long-term health. Inadequate early childhood learning (ECL) disproportionately affects low-income children. Pediatricians have near-universal access to children younger than 5 years but remain an underused ECL resource. This study examined caregivers' perceptions of ECL, the role of the pediatrician and pediatric office, and the use of community-based ECL resources among diverse, low-income caregivers whose children were not enrolled in preschool...
March 13, 2018: Journal of Developmental and Behavioral Pediatrics: JDBP
George W Pratt, Andy Fan, Bissrat Melakeberhan, Catherine M Klapperich
Proper management of an HIV infection requires that a patient be at least 80-95% adherent to a prescribed drug regimen to avoid poor health outcomes and the development of drug-resistant HIV strains. Clinicians generally monitor adherence habits indirectly through patient self-reporting, pill counting, and electronic drug monitoring. While direct measurement of patient samples like urine for monitoring drug levels is possible, it requires specialized equipment and training that is not readily available in resource-limited settings where the need is greatest...
August 9, 2018: Analytica Chimica Acta
Xavier Tchetnya, Calypse Asangbe Ngwasiri, Tiayah Munge, Leopold Ndemnge Aminde
BACKGROUND: Toxic epidermal necrolysis (TEN) is a rare life threatening dermatological disorder characterized by extensive epidermal detachment and erosion of mucous membranes. It is typically a side effect of some medications. Nevirapine, a nonnucleoside reverse transcriptase inhibitor (NNRTI) is one of the frequently used components of highly active antiretroviral therapy (HAART). Skin rash is its common adverse reaction, usually mild and rarely progressing to TEN. Ophthalmic involvement is common as well but rarely progresses to blindness especially in the pediatric population...
March 13, 2018: BMC Pediatrics
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