Disease In Low-income Countries Research Articles

Toward a New Field of Global Engineering

The Engineer’s role in addressing global poverty challenges has often been confined to village and community-scale interventions, product design and development, or large-scale infrastructure design and construction. Yet despite fifty years of these approaches, over half the world’s population still lives on less than $5.50 a day, the global burden of disease in low-income countries is overwhelmingly attributable to environmental health contaminants, and climate change is already negatively affecting people in developing countries. The conventional community, product or infrastructure focuses of development engineering is insufficient to address these global drivers that perpetuate poverty. The emerging field of Global Engineering can work to identify and address these structural issues. Global Engineering should be concerned with the unequal and unjust distribution of access to basic services such as water, sanitation, energy, food, transportation and shelter, and place an emphasis on identifying the drivers, determinants and solutions favoring equitable access. Technology development and validation, data collection and impact evaluation can contribute to evidence-based influence on policies and practice. Global Engineering envisions a world in which everyone has safe water, sanitation, energy, food, shelter and infrastructure, and can live in health, dignity, and prosperity.

Best Buy in Public Health or Luxury Expense?: The Cost-effectiveness of a Pediatric Operating Room in Uganda From the Societal Perspective.

To determine the cost-effectiveness of building and maintaining a dedicated pediatric operating room (OR) in Uganda from the societal perspective. Despite the heavy burden of pediatric surgical disease in low-income countries, definitive treatment is limited as surgical infrastructure is inadequate to meet the need, leading to preventable morbidity and mortality in children. In this economic model, we used a decision tree template to compare the intervention of a dedicated pediatric OR in Uganda for a year versus the absence of a pediatric OR. Costs were included from the government, charity, and patient perspectives. OR and ward case-log informed epidemiological and patient outcomes data, and measured cost per disability adjusted life year averted and cost per life saved. The incremental cost-effectiveness ratio (ICER) was calculated between the intervention and counterfactual scenario. Costs are reported in 2015 US$ and inflated by 5.5%. In Uganda, the implementation of a dedicated pediatric OR has an ICER of $37.25 per disability adjusted life year averted or $3321 per life saved, compared with no existing operating room. The ICER is well below multiple cost-effectiveness thresholds including one times the country's gross domestic product per capita ($694). The ICER remained robust under 1-way and probabilistic sensitivity analyses. Our model ICER suggests that the construction and maintenance of a dedicated pediatric operating room in sub-Saharan Africa is very-cost effective if hospital space and personnel pre-exist to staff the facility. This supports infrastructure implementation for surgery in sub-Saharan Africa as a worthwhile investment.

1-hydroxy-5, 7-dimethoxy-2 naphthalene-carboxaldehyde inhibitors as novel antimycobacterial agents targeting H-InMyoFib cells and targeting enzymes involved in fatty acid biosynthesis of bacilli

Background: Gastrointestinal tuberculosis (Gastrointestinal TB) is a rapidly common infectious disease in low income countries due to poor life style that poses diagnostic challenge, as the broad spectrum features of the disease which may lead to diagnostic interruptions and complications. Early diagnosis and initiation of antituberculous therapy without drug-resistance is essential to prevent morbidity and mortality. 1-hydroxy-5, 7-dimethoxy-2 naphthalene-carboxaldehyde (HDNC) is a bioactive compound derived from Aegle marmelos (Rutaceae, ‘Bael’). It is a naturally occurring flavonoid having anticancer and wound healing properties. Methods & Materials: The present study demonstrated that HDNC had ant-mycobacterial effects on tubercle bacilli ATCC25618, multi-drug and extensively drugresistant clinical isolates with minimum inhibitory concentrations of 147 and 312 μM, respectively. Bacilli mainly affect the GIT, causing a strong local inflammatory response that is critical to the pathogenesis of tuberculosis. Results: We investigated the effects of HDNC on interferon (IFN)-γ-stimulated human GIT fibroblast H-InMyoFib cells. HDNC suppressed the release of tumor necrosis factor (TNF)-α and interleukin (IL)-12. A nontoxic dose of HDNC reduced mRNA expression of TNF-α, IL-1β, IL-6, IL-12, and matrix metalloproteinase-1 in IFN-γ-stimulated cells. HDNC inhibited IFN-γ-mediated stimulation of extracellular signal regulated kinase and p38 mitogen-activated protein kinase and showed high affinity binding to these kinases (binding constants: 3.95 × 104 M−1 and 6.8 × 103 M−1, respectively).HDNC inhibit targeting enzymes involved in fatty acid biosynthesis, such as enoyl-ACP-reductase, b-ketoacyl-ACP reductase and b-hydroxyacyl-ACP dehydratase of bacilli. A mouse in vivo study of lipopolysaccharide-induced GIT inflammation revealed that a nontoxic dose of HDNC reduced the levels of IL-1β, IL-6, IL-12, and INF-γ in GIT tissue. Conclusion: Gastrointestinal TB is generally managed with medical therapy with antituberculous drugs These data provide the first evidence that HDNC could be developed as a potent antituberculosis drug and represents as a strong candidate for the b-hydroxyacyl-ACP dehydratase enzyme of Bacilli.

Ultrasonographic assessment of ophthalmic diseases in low-income countries.

We undertook a study between December 2016 and February 2017 on 1637 of 2101 patients with clearly documented findings. These underwent ocular B-scan ultrasonography (USG). Their ages were in the range of 10 days to 92 years; among these patients, 921 (56.26%) were male and 224 (13.68%) were children. Among the adults, 669 (40.86%) patients had anterior segment and 636 (38.85%) had posterior segment pathology. In addition, there were 108 (6.59%) with orbital pathology. Our experience is that USG is an effective, quick, low-cost and non-invasive diagnostic tool for the diagnosis of various ocular and orbital conditions in high patient volume centres (including children and adults) especially where resources are limited.

Critical care of tropical disease in low income countries: Report from the Task Force on Tropical Diseases by the World Federation of Societies of Intensive and Critical Care Medicine

Tropical disease results in a great burden of critical illness. The same life-saving and supportive therapies to maintain vital organ functions that comprise critical care are required by these patients as for all other diseases. In low income countries, the little available data points towards high mortality rates and big challenges in the provision of critical care. Improving critical care in low income countries requires a focus on hospital design, training, triage, monitoring & treatment modifications, the basic principles of critical care, hygiene and the involvement of multi-disciplinary teams. As a large proportion of critical illness from tropical disease is in low income countries, the impact and reductions in mortality rates of improved critical care in such settings could be substantial.

Severe neonatal chlamydial conjunctivitis with unilateral corneal perforation after unattended home delivery in rural Ethiopia

<em>Background</em>. Neonatal chlamydial conjunctivitis is an easily preventable, though still highly prevalent infectious disease in low-income countries and if left untreated it is associated with major local and systemic complications that threat new-borns’ health. <br /><em>Case presentation.</em> We present two cases of severe neonatal chlamydial conjunctivitis with unilateral corneal involvement in new-born children, after unattended home deliveries in rural Ethiopia. Despite antibiotic treatment, in one case, surgical corneal repair was necessary in order to avoid excessive scarring and subsequent unilateral blindness of the child. <br /><em>Conclusions</em>. As the presence of an ophthalmologist in sub-Saharan Africa is very rare, many children in the same condition may become blind due to lack of trained surgeons. For these reasons, screening programmes for sexually transmitted infections in pregnant women with suspect vaginal discharge should be implemented by local authorities; as well as local prophylaxis with tetracyclin eye-ointment being made available in rural communities.

Management of Para-aortic Lymph Node Disease in Patients With Cervical Cancer: What Is the Best Approach?

Cervical cancer remains a prevalent and deadly disease in low-income countries, especially among young and otherwise healthy women. Multimodality treatment has led to a significant improvement in outcomes for patients with locally advanced disease, and this is mainly because of the incorporation of platinum-based chemoradiotherapy in current treatment protocols. However, locally advanced tumors are associated with a greater risk for para-aortic lymph node (PALN) involvement, which is an important adverse prognostic factor. Most staging techniques have low accuracy for detection of disease in this area, which could lead to understaging and undertreatment. Meanwhile, patients with PALN disease are underrepresented in trials addressing the treatment of advanced cervical cancer and a few studies have been directed at this population. The aim of this review is to analyze the current data regarding staging and treatment of cervical cancer with PALN disease to determine which strategy is best when managing these patients.

Patterns of infections, aetiological agents and antimicrobial resistance at a tertiary care hospital in northern Tanzania.

To determine the causative agents of infections and their antimicrobial susceptibility at a tertiary care hospital in Moshi, Tanzania, to guide optimal treatment. A total of 590 specimens (stool (56), sputum (122), blood (126) and wound swabs (286)) were collected from 575 patients admitted in the medical and surgical departments. The bacterial species were determined by conventional methods, and disc diffusion was used to determine the antimicrobial susceptibility pattern of the bacterial isolates. A total of 249 (42.2%) specimens were culture-positive yielding a total of 377 isolates. A wide range of bacteria was isolated, the most predominant being Gram-negative bacteria: Proteus spp. (n = 48, 12.7%), Escherichia coli (n = 44, 11.7%), Pseudomonas spp. (n = 40, 10.6%) and Klebsiella spp (n = 38, 10.1%). Wound infections were characterised by multiple isolates (n = 293, 77.7%), with the most frequent being Proteus spp. (n = 44, 15%), Pseudomonas (n = 37, 12.6%), Staphylococcus (n = 29, 9.9%) and Klebsiella spp. (n = 28, 9.6%). All Staphylococcus aureus tested were resistant to penicillin (n = 22, 100%) and susceptible to vancomycin. Significant resistance to cephalosporins such as cefazolin (n = 62, 72.9%), ceftriaxone (n = 44, 51.8%) and ceftazidime (n = 40, 37.4%) was observed in Gram-negative bacteria, as well as resistance to cefoxitin (n = 6, 27.3%) in S. aureus. The study has revealed a wide range of causative agents, with an alarming rate of resistance to the commonly used antimicrobial agents. Furthermore, the bacterial spectrum differs from those often observed in high-income countries. This highlights the imperative of regular generation of data on aetiological agents and their antimicrobial susceptibility patterns especially in infectious disease endemic settings. The key steps would be to ensure the diagnostic capacity at a sufficient number of sites and implement structures to routinely exchange, compare, analyse and report data. Sentinel sites (hospitals) across the country (and region) should report on a representative subset of bacterial species and their susceptibility to drugs at least annually. A central organising body should collate the data and report to relevant national and international stakeholders.

A neglected infection in literature: Childhood musculoskeletal tuberculosis - A bibliometric analysis of the most influential papers.

Pediatric tuberculosis (TB) is known to have a wide range of presentations, and if left untreated, primary TB may lead to bone and joint involvement. The literature on this topic is very scarce, and no comprehensive systematic review or meta-analysis of the current knowledge is available to date. The aim of this study is to identify and analyze the literature with highest impact based on citation rate analysis. All databases of the Thomson and Reuters "Web of Knowledge" were used to conduct our search of the 100 most cited articles on this topic published between 1950 and 2014. The included articles were analyzed in terms of citation rate, age, study type, area of research, level of evidence (LOE), and more. All 100 articles were published between 1967 and 2011 in 51 different journals. The average citation rate was 74.26, all articles were on average 23.1 years, and most studies were originated from India (n = 22), followed by the USA (n = 21). The majority of publications were review articles (42%), described clinical course (n = 48), and assigned an LOE IV (44%). TB infection is a high burden disease in low-income countries but widely studied in a fi rst world setup. This research gap between the geographic distribution of disease burden and origin of publications could initiate possibilities for high-burden countries to share their opinion. Their experience is of a high level of importance and relevance which furthermore is necessary to create a more accurate picture of pediatric musculoskeletal TB burden in literature.

Technological solutions for an effective health surveillance system for road traffic crashes in Burkina Faso

ABSTRACT Background: In the early 2000s, electronic surveillance systems began to be developed to collect and transmit data on infectious diseases in low-income countries (LICs) in real-time using mobile technologies. Such surveillance systems, however, are still very rare in Africa. Among the non-infectious epidemics to be surveilled are road traffic injuries, which constitute major health events and are the fifth leading cause of mortality in Africa. This situation also prevails in Burkina Faso, whose capital city, Ouagadougou, is much afflicted by this burden. There is no surveillance system, but there have been occasional surveys, and media reports of fatal crashes are numerous and increasing in frequency. Objective: The objective of this article is to present the methodology and implementation of, and quality of results produced by, a prototype of a road traffic crash and trauma surveillance system in the city of Ouagadougou. Methods: A surveillance system was deployed in partnership with the National Police over a six-month period, from February to July 2015, across the entire city of Ouagadougou. Data were collected by all seven units of the city’s National Police road crash intervention service. They were equipped with geotracers that geolocalized the crash sites and sent their positions by SMS (short message service) to a surveillance platform developed using the open-source tool Ushahidi. Descriptive statistical analyses and spatial analyses (kernel density) were subsequently performed on the data collected. Results: The process of data collection by police officers functioned well. Researchers were able to validate the data collection on road crashes by comparing the number of entries in the platform against the number of reports completed by the crash intervention teams. In total, 873 crash scenes were recorded over 3 months. The system was accessible on the Internet for open consultation of the map of crash sites. Crash-concentration analyses were produced that identified ‘hot spots’ in the city. Nearly 80% of crashes involved two-wheeled vehicles. Crashes were more numerous at night and during rush hours. They occurred primarily at intersections with traffic lights. With regard to health impacts, half of the injured were under the age of 29 years, and 6 persons were killed. Conclusions: This pilot study demonstrated the feasibility of developing simple surveillance systems, based on mHealth, in LICs.

Deletion of toxin-antitoxin systems in the evolution of Shigella sonnei as a host-adapted pathogen.

Pathogenic Shigella spp. are the leading cause of bacterial dysentery, with Shigella flexneri and Shigella sonnei accounting for around 90% of cases worldwide. Although S. flexneri causes most disease in low-income countries (following ingestion of contaminated food and/or water), S. sonnei predominates in wealthy countries and is mainly spread from person to person. Although both species contain a large virulence plasmid, pINV, that is essential for the organism to cause disease, little is known about its maintenance. Here, using a counterselectable marker within the virulence-encoding region of pINV, we show that the S. sonnei plasmid is less stable than that of S. flexneri, especially at environmental temperatures. GmvAT, a toxin-antitoxin system, is responsible for the difference in stability and is present in pINV from S. flexneri but absent in S. sonnei pINV. GmvT is an acetyltransferase toxin that inhibits protein translation. Loss of GmvAT and a second toxin-antitoxin system, CcdAB, from pINV reduces S. sonnei plasmid stability outside the host, reflecting the host-adapted lifestyle and person-to-person transmission of this species and differences in its epidemiology.

Access to essential medicines to treat chronic respiratory disease in low-income countries.

Chronic respiratory diseases (CRDs) affect hundreds of millions of people. The United Nations 2011 meeting on non-communicable diseases (NCDs) marked a turning point in addressing this burden. The targets established following this meeting incorporated specific measures to address the availability and affordability of essential medicines. These are aligned with the sustainable development goals (SDGs) and the push for universal health coverage. However, essential medicines for CRDs remain unaffordable and unavailable to many. For asthma, the availability of medicines was respectively 30.1% and 43.1% in the public and private sectors. The maximum annual costs of treatment were US$102.10 for beclometasone, US$82.99 for salbutamol and US$1501.79 for budesonide, representing respectively 40%, 15% and 209% of per capita income in Malawi, Burkina Faso and Guinea. Multiple factors contribute to poor availability and affordability. Experience from human immunodeficiency virus/acquired immune-deficiency syndrome shows that medicines and care can be delivered in low-income countries and among the NCDs. A unique example of an effective mechanism for providing access to affordable essential CRD medicines is the Asthma Drug Facility. Working on the six health system building blocks proposed by the World Health Organization can help countries address not only problems regarding access to medicines, but also those hampering adequate care. Improving medicine supply systems, training, national guidelines, financing, research, data utilisation and models of care at the primary health care level will help. A CRD target (e.g., 50% reduction in asthma hospitalisations) as well as the use of asthma as a measure for health system effectiveness and CRDs as a tracer for SDGs would help focus global, national and local leadership.

Prevention programs for chronic kidney disease in low-income countries.

Chronic kidney disease (CKD) is an important determinant of the poor health outcome for major noncommunicable diseases that are the leading cause of death worldwide. Early recognition with screening programs of CKD and co-morbid conditions, like hypertension, diabetes, or toxic environments, can potentially slow progression to renal failure, improve quality of life and reduce healthcare cost. Effective multimodal tools are available to prevent CKD by managing its risk factors, and to slow or even halt disease progression to end-stage renal failure (ESRF). They can be adapted even to poor-resource settings of low- and middle-income countries for individual at high risk of CKD. CKD is also linked to acute kidney injury (AKI), that in poorest part of Africa, Asia and Latin America is preventable, treatable and often reversible, if managed adequately and in timely manner as proposed by the program "AKI 0by25" launched by the international Society of Nephrology in 2013. In addition to saving lives, prevention programs will create major heath gains, eventually reducing the current health inequity that arises from unaffordable or unobtainable renal replacement therapies in many part of the developing world if ESRF is not prevented.

The economic burden of childhood pneumococcal diseases in The Gambia.

BackgroundStreptococcus pneumoniae is a common cause of child death. However, the economic burden of pneumococcal disease in low-income countries is poorly described. We aimed to estimate from a societal perspective, the costs incurred by health providers and families of children with pneumococcal diseases.MethodsWe recruited children less than 5 years of age with outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and bacterial meningitis at facilities in rural and urban Gambia. We collected provider costs, out of pocket costs and productivity loss for the families of children. For each disease diagnostic category, costs were collected before, during, and for 1 week after discharge from hospital or outpatient visit.ResultsA total of 340 children were enrolled; 100 outpatient pneumonia, 175 inpatient pneumonia 36 pneumococcal sepsis, and 29 bacterial meningitis cases. The mean provider costs per patient for treating outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and meningitis were US$8, US$64, US$87 and US$124 respectively and the mean out of pocket costs per patient were US$6, US$31, US$44 and US$34 respectively. The economic burden of outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and meningitis increased to US$15, US$109, US$144 and US$170 respectively when family members’ time loss from work was taken into account.ConclusionThe economic burden of pneumococcal disease in The Gambia is substantial, costs to families was approximately one-third to a half of the provider costs, and accounted for up to 30 % of total societal costs. The introduction of pneumococcal conjugate vaccine has the potential to significantly reduce this economic burden in this society.Electronic supplementary materialThe online version of this article (doi:10.1186/s12962-016-0053-4) contains supplementary material, which is available to authorized users.

Descriptive epidemiology and short-term outcomes of heart failure hospitalisation in rural Haiti

ObjectiveThere is increasing attention to cardiovascular diseases in low-income countries. However, little is known about heart failure (HF) in rural areas, where most of the populations in low-income countries live....

The demographics of patients affected by surgical disease in district hospitals in two sub-Saharan African countries: a retrospective descriptive analysis.

BackgroundThere is a growing awareness of the importance of surgical disease within global health. We hypothesised that surgical disease in low income countries predominantly affects young adults and may therefore have a significant economic impact.MethodsWe retrospectively reviewed all surgical admission data from two rural government district hospitals in two different sub-Saharan African countries over a 6-month period. We analysed all surgical admissions with respect to patient demographics (age and gender), diagnosis, and procedure performed.ResultsSurgical admissions accounted for 12.9 and 19.8 % of all hospital admissions in Malawi and Sierra Leone respectively. 18.5 and 6.2 % of all hospital patients required a surgical procedure in Malawi and Sierra Leone respectively, with the low number in Sierra Leone accounted for in that many of the obstetric admissions were referred to a nearby Medicins Sans Frontiers (MSF) hospital for treatment. 17.9 and 10.5 % of surgical admissions were under the age of 16 in Malawi and Sierra Leone respectively, with 16–35 year olds accounting for 57.3 % of surgical admissions in Sierra Leone and 53.5 % in Malawi. Men accounted for 53.7 and 46.0 % of surgical admissions in Sierra Leone and Malawi respectively. An unexpected finding was the high level of patients who absconded from hospital in Sierra Leone after diagnosis but before treatment. This involved 11.8 % of all surgical patients, including 38 % with a bowel obstruction, 39 % with peritonitis and 20 % with ectopic pregnancy.ConclusionsMost people affected by disease requiring surgery are young adults and this may have significant economic implications.

Recognizing global disparities in health and in health transitions in the 21st century: what can nurses do?

PurposeTo examine changes in patterns of health and disease in global context between rich countries (USA, Korea, South Africa) and poor countries (Cambodia, Malawi) by using the framework of epidemiology theory developed by Orman (1971, 2005), and to raise awareness of global health disparities thereby prompting actions to reduce such disparities. Findings1) Life expectancy has increased across all selected countries except South Africa; 2) Korea and the USA have substantially lower mortality rates than other countries; 3) Infant and maternal mortality are still high in the poor countries; 4) The major cause of mortality in the poor countries is still communicable disease with evidence of the onset of non-communicable disease; and 5) The health transition theory provides a description and explanation of the differences in progress in economic development between countries but fails to explain differences in health status within and between countries. ConclusionsLife expectancy and mortality are enormously different among the five selected countries. This excessive health disparity is primarily due to the higher risk of communicable diseases in low-income countries. Social determinants of health are mainly responsible for the health disparities observed within and between countries. Clinical relevanceFuture health care development and global research priorities will not be the same for all countries because the pattern of health transitions in the developing countries is not the same as the developed countries. Actions to reduce global health disparities need to recognize the conditions and social context in which persons live. An effective strategic approach to global health equality should develop a shared system of values, priorities, and delivery infrastructures with the populations who are targeted, aligning delivery within the local social contexts.

An innovative paradigm for surgical education programs in resource-limited settings.

The burden of surgical disease in low-income countries remains significant, in part owing to continued surgical workforce shortages. We describe a successful paradigm to expand Rwandan surgical capacity through the implementation of a surgical education partnership between the National University of Rwanda and the Centre for Global Surgery at the McGill University Health Centre. Key considerations for such a program are highlighted.

The niche reduction approach: an opportunity for optimal control of infectious diseases in low-income countries?

BackgroundDuring the last century, WHO led public health interventions that resulted in spectacular achievements such as the worldwide eradication of smallpox and the elimination of malaria from the Western world. However, besides major successes achieved worldwide in infectious diseases control, most elimination/control programs remain frustrating in many tropical countries where specific biological and socio-economical features prevented implementation of disease control over broad spatial and temporal scales. Emblematic examples include malaria, yellow fever, measles and HIV. There is consequently an urgent need to develop affordable and sustainable disease control strategies that can target the core of infectious diseases transmission in highly endemic areas.DiscussionMeanwhile, although most pathogens appear so difficult to eradicate, it is surprising to realize that human activities are major drivers of the current high rate of extinction among upper organisms through alteration of their ecology and evolution, i.e., their “niche”. During the last decades, the accumulation of ecological and evolutionary studies focused on infectious diseases has shown that the niche of a pathogen holds more dimensions than just the immune system targeted by vaccination and treatment. Indeed, it is situated at various intra- and inter- host levels involved on very different spatial and temporal scales. After developing a precise definition of the niche of a pathogen, we detail how major advances in the field of ecology and evolutionary biology of infectious diseases can enlighten the planning and implementation of infectious diseases control in tropical countries with challenging economic constraints.SummaryWe develop how the approach could translate into applied cases, explore its expected benefits and constraints, and we conclude on the necessity of such approach for pathogen control in low-income countries.

Systematic analysis of funding awarded for mycology research to institutions in the UK, 1997–2010

ObjectivesFungal infections cause significant global morbidity and mortality. We have previously described the UK investments in global infectious disease research, and here our objective is to describe the investments awarded...