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 This is often complicated by clinical guidance that is out of date, inconsistent and informed by evidence from high-income countries that ignores LMIC resource constraints and...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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Trop. Med. Infect. Dis. 2018, 3, 72;
The study identified some key determinants of untimely and incomplete childhood vaccinations in the context of Bangladesh. The findings will contribute to the improvement of age-specific vaccination and support policy makers in taking the necessary control ...strategies with respect to delayed and early vaccination in Bangladesh.
https://doi.org/10.3390/tropicalmed3030072
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This guide includes information relevant for tuberculosis (TB) program and laboratory managers, as well as Ministry of Health officials across disease programs interested in establishing integrated solutions for specimen referral. Though TB-focused in name, it offers integration-oriented assessment,... design, and monitoring guidance related to improving coordination and efficiency, and is relevant for other programs as well. Country case studies include viral load and early infant diagnosis (EID) in Uganda and EID in Ethiopia.
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We systematically reviewed Medline as well as the references of published review articles for relevant studies of adherence to multidrug treatment of both drug-susceptible and drug-resistant TB through February 3, 2018. We included randomized controlled trials (RCTs) as well as prospective and retro...spective cohort studies (CSs) with an internal or external control group that evaluated any adherence intervention and conducted a meta-analysis of their impact on TB treatment outcomes. Our search identified 7,729 articles, of which 129 met the inclusion criteria for quantitative analysis. Seven adherence categories were identified, including DOT offered by different providers and at various locations, reminders and tracers, incentives and enablers, patient education, digital technologies (short message services [SMSs] via mobile phones and video-observed therapy [VOT]), staff education, and combinations of these interventions.
https://doi.org/10.1371/journal.pmed.1002595
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As the global community aims to fulfill its commitments to the UN Sustainable Development Goals, and the achievement of universal health coverage, dozens of countries have committed to the expansion of community health workers (CHWs) as the front line of their healthcare systems [1, 2]. Robust resea...rch demonstrates CHWs improve access to care, reduce maternal, newborn, and child mortality, improve clinical outcomes for chronic diseases, and prevent disease outbreaks [3].
To support the operationalization of quality CHW program design and implementation, USAID, UNICEF, the Community Health Impact Coalition, and Initiatives Inc. have updated and adapted the Community Health Worker Assessment and Improvement Matrix (CHW AIM) Program Functionality Matrix [12]. This tool can be used to identify design and implementation gaps in both small- and national-scale CHW programs, and close gaps in policy and practice.
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Current and expected problems such as ageing, increased prevalence of chronic conditions and multi-morbidity, increased emphasison healthy lifestyle and prevention, and substitution for care from hospitals by care provided in the community encourage countries worldwide to develop new models of prima...ry care delivery. Owing to the fact that many tasks do not necessarily require the knowledge and skills of a doctor, interest in using nurses to expand the capacity of the primary care workforce is increasing. Substitution of nurses for doctors is one strategy used to improve access, efficiency, and quality of care. This is the first update of the Cochrane review published in 2005.
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Journal of Palliative Medicine Volume 21, Number 10, 2018
DOI: 10.1089/jpm.2018.0248ad
Epidemic meningitis is a major public health challenge in the African 'meningitis belt', an area that extends from Senegal to Ethiopia with an estimated total population of 500 million. Since 2002, the World Health Organization (WHO), in collaboration with its collaborating centres for meningitis, h...as progressively supported countries in implementing a strategy of ES for meningitis. The strategy is the recommended standard for all countries of the Belt and it is now actively being implemented at different levels in all countries.
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Levels and Inequities
DHS Further Analysis Reports No. 110
This study shows large variations in maternal health indicators across high-priority counties in Kenya. Nairobi exceeds the national average on all maternal health indicators in this study, while other highpriority counties consist...ently are disadvantaged compared with Kenya as a whole in most maternal health indicators. Kisumu exceeds the national average in use of antenatal care, delivery in a health facility, and postnatal care, but not other indicators. Nakuru has fewer women with fertility risk and fewer women who report that the distance they must travel to reach a health facility is a problem.
This study identifies a number of inequities in maternal health indicators across socio-demographic characteristics in the high-priority counties—most in the distribution of delivery care and least in antenatal care. Inequities are also observed in fertility risk and postnatal care.
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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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Background document to the 2018 joint statement by WHO, UNFPA, UNICEF, ICM, ICN, FIGO and IPA: definition of skilled health personnel providing care during childbirth
WHO has issued a new recommendation on the length of bladder catheterization following surgical repair of a simple obstetric urinary fistula. Currently the length of catheterization is not standard and ranges from 5 to 42 days. The new guidance recommends a 7–10 day period of bladder catheterizati...on to allow complete healing. Longer periods of catheterization can be inconvenient for the woman, her family and care providers as it is associated with more discomfort and inconvenience. It also increases the risk of infection and erosion related to catheterization; requires more intensive nursing care and costs more per patient.
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Epidemics of infectious diseases are occurring more often, and spreading faster and further than ever, in many different regions of the world. The background factors of this threat are biological, environmental and lifestyle changes, among others. A potentially fatal combination of newly-discovered ...diseases, and the re-emergence of many long-established ones, demands urgent responses in all countries. Planning and preparation for epidemic prevention and control are essential. The purpose of this “Managing epidemics” manual is to provide expert guidance on those responses.
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Introductión
Capítulo A.9
Edición: Matías Irarrázaval & Andres Martin
Traducción: Fernanda Prieto-Tagle & José Montejo