Health Care In Low-income Countries Research Articles

On Utilizing Artificial Intelligence to Impact Healthcare in Low-Income Countries

Artificial intelligence (AI) is impacting the society with incredible innovations across the globe, as evidenced by recent media coverage. Integrating AI into healthcare holds promise for improving outcomes in low-income nations. Addressing the reliability, validity, and fairness of algorithms is essential to reduce bias. Global organizations such as the United Nations Educational, Scientific and Cultural Organization (UNESCO), the World Health Organization (WHO), and the European Union promote ethical AI use, guiding its application in healthcare. Philanthropic investment in research is crucial to help develop guidelines that consider the unique needs of marginalized populations. Collaboration between governments, international bodies, researchers, and industry leaders is vital to ensure responsible AI adoption. By prioritizing the welfare of all populations, we can harness AI’s potential to enhance healthcare in low-income countries while mitigating risks.

Equipping undergraduate medical and nursing students with elderly health care assessment skills at Makerere University, College of Health Sciences, Uganda

BackgroundElderly health care training and aging science remain the least prioritized discipline of medical education in many African countries. With scant scientific evidence on elderly health care in low-income countries, coupled with limited exposure to elderly health care training, this project aimed to equip undergraduate health professional students with elderly health care assessment skills and research through an online course and a clinical placement.MethodsStudents (3rd year) underwent online elderly health care training through the Alison courses published by the Advanced Learning Academy in Ireland. The students were then subjected to an online exam with a pass mark of 80%. Students were also trained on standard elderly health care assessment tools through a one-day session. For practical skills on data collection, each student assessed 15 elderly patients at the Mulago National Referral Hospital Assessment Centre. All tools once filled in were assessed for completion. A one-day reflection session was held with students, faculty and the project leads to share findings from the various tools used to assess elderly individuals. The students shared their experiences and provided feedback on the online training as well as the hardships they may have experienced while administering the tools. A certificate of participation was provided to the students at the end of the project.ResultsAll the students (10) gained knowledge on elderly assessment skills, the impact of aging on various body systems, and how to manage common occurrences among elderly individuals. The average score in the post-exam was 82% (standard deviation ± 2.01). All students (10) reported having had this as their first training on the assessment of functionality among elderly individuals.ConclusionsThe students gained knowledge of elderly health assessments as well as the impact of aging on various body systems. They also gained insight into how to care for the elderly holistically with an added understanding of how to manage spinal and traumatic brain injuries.

Empowering the LMIC hinterlands with compatible technologies for neonatal care – the resilience of a research group

Background: High neonatal mortality rate (NMR) in low- and middle-income countries (LMIC) might not be resolved until rural healthcare facilities are empowered with sustainable frugal technologies and procedures. Needed technologies may not rely on cutting-edge systems of the high-income countries (HIC), which require much funding and well-established public infrastructure to thrive. Rather, tailored non-conventional designs that are compatible with the deficiencies at low-income settings must take center stage. Study design: A multistage strategy was designed to identify and resolve the technology and knowledge gaps responsible for high NMR and rural community deficiencies militating against neonatal interventions within the primary healthcare settings in Nigeria. Methods: We concluded many scientific investigations and developed interventions over 25 years period to resolve the various factors militating against neonatal survival in Nigeria. Unconventional ideas relying on solar powered systems and easily available local materials were developed, trialed, and commissioned at various times across 31 tertiary hospitals spanning all regions of Nigeria. Stand-alone studies or solutions-creation, amidst discouraging situations, were individually completed, peer-reviewed, and journal-published. The full package of technologies was finally assembled to launch a community empowerment strategy – the Neonatal Rescue Scheme – to generate integrated proof of concept. Finding: The number of early neonatal deaths and overall NMR drastically reduced at participating centers. Conclusions: This Rescue-Scheme strategy could revolutionize neonatal healthcare in low-income countries and drastically reduce Nigeria’s corporate NMR if properly adopted. Clinical evidence: Recent studies of the Scheme and various combinations of its neonatal technologies have demonstrated significant clinical evidence of NMR-reduction, e.g., overall NMR fell from 90/’00 to 4/’00 as published by Amina-center Minna Nigeria 2023; early mortality fell from 81% to 0% - University of Abuja Teaching Hospital Nigeria 2017, etc.

A story to tell or not, a glimpse of emergency setting in the low economic country: experience sharing and Review

Delivering efficient emergency health care in low-income countries presents significant challenges due to various factors, including limited resources, inadequate infrastructure, and socio-economic barriers. This article explores the complexities associated with emergency care delivery in resource-limited settings. Issues such as pre-hospital care, triage, waiting times, out-of-pocket expenditures, and the implementation of international protocols with limited resources. The lack of access to well-equipped ambulances, trained personnel, and basic first aid knowledge contributes to the difficulties faced in pre-hospital care. Non-functional triage systems, direct access to emergency rooms, and financial constraints further hinder timely and effective patient care. The implementation of international protocols in settings with limited resources poses additional challenges for healthcare providers and patients.

Catastrophic health expenditure and household impoverishment in Togo.

The main way of financing healthcare in low-income countries continues to be out-of-pocket payments. Despite the efforts of national authorities and international partners to protect households from impoverishment arising from seeking healthcare, the risk of incurring catastrophic healthcare expenses remains very high for households in developing countries. This study aims to analyse catastrophic health expenditures and their effects on household impoverishment in Togo. Data were obtained from the CWIQ survey, a nationally representative survey conducted in 2015 among 2400 households.We calculated the incidence and the intensity of catastrophic health expenditures in Togo through various thresholds and then estimated the effects of these expenditures on the level of households' impoverishment by determining poverty levels using consumption expenditure before and after making payments for healthcare. The results indicate that the incidence of catastrophic expenditure varies between 6% and 57% depending on the thresholds used. Households at risk of catastrophic expenditure spend between 19% and 64% of their spending on healthcare. Based on total expenditure and above 20%, the richest households are more prone to catastrophic health expenditures. The findings also show that the incidence of impoverishment caused by health expenditure payments is 8.2% in relative terms and 4.52% in absolute terms. In Togo, 4.52% of households are impoverished by catastrophic health expenditures. This impoverishment effect is greater for male-headed households. Health system reforms aiming at accessibility to quality care and the development of pre-payment mechanisms will promote the earlier use of healthcare services and thus reduce the higher healthcare costs generated by later attendance at them.

Adoption of electronic health record systems to enhance the quality of healthcare in low-income countries: a systematic review

BackgroundElectronic health record (EHR) systems are mentioned in several studies as tools for improving healthcare quality in developed and developing nations. However, there is a research gap in presenting the...

Caesarean childbirth and associated factors during Covid-19 pandemic at public hospitals in the Sidama region, Southern Ethiopia

BackgroundThe increasing number of caesarean births worldwide concerns pregnant women, obstetric service providers, and the country's economy. Unnecessary caesarean childbirth increases childbirth complications and the cost of health care in low-income countries, including Ethiopia.ObjectiveThis study aims to assess caesarean birth and associated factors at the Sidama region public hospitals, Southern Ethiopia, 2020.MethodsAn institution-based cross-sectional study was conducted among 484 women who gave birth at public hospitals in the Sidama region. A multi-stage sampling technique was employed. The data were collected from 1st to 30th of July 2020 by face-to-face interviews using a semi-structured questionnaire (see Table S1: see supplementary materials associated with this article on line), and the wealth index was analysed by principal component analysis. Backward logistic regression used an adjusted odds ratio and a 95% confidence interval to assess the strength and association between the caesarean section and its associated factors. A P-value of < 0.05 was used to declare statistical significance.ResultCaesarean childbirth in this study was 34.3%. In this study, partograph monitoring (AOR = 2.23, CI = 1.13, 4.38), previous caesarean birth (AOR = 3.21, CI = 1.28,8.17), having genital cutting/mutilation (AOR = 2.51, CI = 1.14,5.53), intermittent cardiotocography monitoring during childbirth (AOR = 2.3, CI = 1.14, 4.49), absence of companionship during delivery (AOR = 4.97, CI = 2.37, 10.43) and is not remembering the last normal menstrual period (AOR = 3.12, CI = 1.40,6.94) had increased the odds of caesarean birth.ConclusionStudies show that the prevalence of caesarean has alarmingly increased in both developed and developing countries. However, the magnitude of caesarean section differs from country to country and in rural and urban areas; the magnitude of caesarean section in this study is much higher than the WHO recommends threshold. The local health bureau and obstetric care providers should pay attention to the caesarean section and need intervention in partograph plotting, companionship, cardiotocography, and female genital mutilation.

Impact of Free Maternal Care Policy on Maternal and Child Health Indicators in Ghana

Background: Maternal and child mortality remain major global public health challenges. Majority of the world’s maternal mortality occur in low–income countries including Ghana, where financial barriers make maternal healthcare inaccessible to many womenduring obstetric emergencies, resulting in avoidable maternal deaths. Ghana implemented a free maternal care policy nation-wide in 2008 .to provide pregnant women antenatal, delivery and postnatal care in public, and accredited private healthcare facilities. This work assesses the impact of the policy on selected Maternal and Child Health (MCH) indicators in Ghana.Methods: Literature on financial barriers to maternal healthcare in Low Income Countries (LICs) was reviewed. WHO databases were searched for MCH indicators for Ghana from 2000-2011, aggregated and trends analysed. Additional data was obtained from Maamobi Polyclinic, Koforidua Regional Hospital (KRH), and the Korle Bu Teaching Hospitals (KBTH). These were statistically analysed for trends to assess the policy’s impact on these indicators.Results: Over four years of implementation, average antenatal coverage increased by 2%, skilled birth attendance 11%; contraceptive prevalence unchanged and unmet need for contraception rose marginally. Under-5 mortality declined by 22%. KBTH recorded increased antenatal (ANC) attendance and decreased annual deliveries that were non-significant. Maternal Mortality Rate (MMR) increased by 89/100,000LB; Caesarean section (C/S) rate rose by 5.5%, fresh still birth (FSB) rate increased and Neonatal intensive careunit (NICU) admissions surged 21%. KRH recorded significant increases in deliveries by 2114; C/S rate by 3% while MMR reduced by 0.56% (562/100,000LB). However, the FSB proportion increased by 13%, ANC attendance reduced by 567, annual deliveries rose by300, C/S rate and FSB increased by 3% and 11% respectively per year at the Maamobi Polyclinic.Conclusion: Encouraging trends were observed in the MCH indicators attributable to the policy. Increasing FSB rates indicate inadequate care quality especially intra-partum monitoring possibly due to over-stretched staff and facilities from rising patient loads.

Rwandan primary healthcare providers' perception of their capability in the diagnostic practice.

BackgroundSkill-mix imbalance is a global concern for primary healthcare in low-income countries. In Rwanda, primary healthcare facilities (health centres, HCs) are predominantly led by nurses. They have to diagnose a multitude of health complaints. Whether they feel capable of undertaking this responsibility has yet to be explored.AimThis study explored how healthcare providers (HPs) at Rwandan HCs perceived their capability in the diagnostic practice.SettingRural and urban HCs in Muhanga district, Rwanda.MethodQualitative, semi-structured interviews with nurses and clinical officers, and observations of consultations were made. Findings were analysed thematically.ResultsRwandan HPs were confident in their competences to perform diagnostic procedures although nurses felt that the responsibilities lay beyond their professional training. Clinical officers believed that their professional training prepared them to function competently and autonomously in the diagnostic practice, although all HPs experienced a high dependency on medical history taking, physical examination and laboratory tests for reaching a diagnosis. Resource constraints (time, rooms and laboratory tests) were seen as a barrier to perform diagnostic tasks optimally, and HPs experienced in-service training and supervision as insufficient. They increased their diagnostic competences through work experience, self-learning and supportive peer collaboration.ConclusionClinical officers perceived themselves as capable in the diagnostic practice. Nurses may compensate for insufficient school training through in-service learning opportunities and feel capable in the diagnostic practice. Formative mentorship schemes and tailored education may prove valuable, but further research on how to improve HPs’ diagnostic capability in Rwanda’s primary healthcare sector is needed.

Zen and the art of experiments: A note on preventive healthcare and the 2019 nobel prize in economics

Abstract I discuss Banerjee, Duflo and Kremer’s work on preventive healthcare in low-income countries. Their research in this field has changed the way that governments view cost-recovery for key preventive services, ranging from deworming to insecticide-treated bed-nets. Equally, their contributions also help us understand why markets likely under-produce preventive goods and how traditional economic thinking on externalities and subsidies may have to be reevaluated in the light of new experimental findings. Throughout, their research in this field typifies a deep commitment to learning from the setting that they are working in, as well as an unyielding dedication to improving the lives of the poor.

Challenges to achieving appropriate and equitable access to Caesarean section: ethnographic insights from rural Pakistan.

Access to Caesarean section (C-section) remains inadequate for some groups of women while others have worryingly high rates. Understanding differential receipt demands exploration of the socio-cultural, and political economic, characteristics of the health systems that produce them. This extensive institutional ethnography investigated under- and over-receipt of C-section in two rural districts in Pakistan - Jhelum and Layyah. Data were collected between November and July 2013 using semi-structured interviews from a randomly selected sample of 11 physicians, 38 community midwives, 18 Lady Health Visitors and nurses and 15 Traditional Birth Attendants. In addition, 78 mothers, 35 husbands and 23 older women were interviewed. The understandings of birth by C-section held by women and their family members were heavily shaped by gendered constructions of womanhood, patient-provider power differentials and financial constraints. They considered C-section an expensive and risky procedure, which often lacked medical justification, and was instead driven by profit motive. Physicians saw C-section as symbolizing obstetric skill and status and a source of legitimate income. Physician views and practices were also shaped by the wider health care system characterized by private practice, competition between providers and a lack of regulation and supervision. These multi-layered factors have resulted in both unnecessary intervention, and missed opportunities for appropriate C-sections. The data indicate a need for synergistic action at patient, provider and system levels. Recommendations include: improving physician communication with patients and family so that the need for C-section is better understood as a life-saving procedure, challenging negative attitudes and promoting informed decision-making by mothers and their families, holding physicians accountable for their practice and introducing price caps and regulations to limit financial incentives associated with C-sections. The current push for privatization of health care in low-income countries also needs scrutiny given its potential to encourage unnecessary intervention.

Improving long-lasting insecticidal nets use in Kayange community of north-western Burundi: a pilot study exploring the use of quality improvement methodologies in low-resource community settings

Quality improvement (QI) approaches have demonstrated a lot of promise in improving clinical care processes, both in high-resource and low-resource settings. However, most examples of QI initiatives in healthcare in...

Detection of Crimean-Congo Haemorrhagic Fever cases in a severe undifferentiated febrile illness outbreak in the Federal Republic of Sudan: A retrospective epidemiological and diagnostic cohort study.

BackgroundUndifferentiated febrile illness (UFI) is one of the most common reasons for people seeking healthcare in low-income countries. While illness and death due to specific infections such as malaria are often well-quantified, others are frequently uncounted and their impact underappreciated. A number of high consequence infectious diseases, including Ebola virus, are endemic or epidemic in the Federal Republic of Sudan which has experienced at least 12 UFI outbreaks, frequently associated with haemorrhage and high case fatality rates (CFR), since 2012. One of these occurred in Darfur in 2015/2016 with 594 cases and 108 deaths (CFR 18.2%). The aetiology of these outbreaks remains unknown.Methodology/Principal findingsWe report a retrospective cohort study of the 2015/2016 Darfur outbreak, using a subset of 65 of 263 outbreak samples received by the National Public Health Laboratory which met selection criteria of sufficient sample volume and epidemiological data. Clinical features included fever (95.8%), bleeding (95.7%), headache (51.6%) and arthralgia (42.2%). No epidemiological patterns indicative of person-to-person transmission or health-worker cases were reported. Samples were tested at the Public Health England Rare and Imported Pathogens Laboratory using a bespoke panel of likely pathogens including haemorrhagic fever viruses, arboviruses and Rickettsia, Leptospira and Borrelia spp. Seven (11%) were positive for Crimean-Congo haemorrhagic fever virus (CCHFV) by real-time reverse transcription PCR. The remaining samples tested negative on all assays.Conclusions/SignificanceCCHFV is an important cause of fever and haemorrhage in Darfur, but not the sole major source of UFI outbreaks in Sudan. Prospective studies are needed to explore other aetiologies, including novel pathogens. The presence of CCHFV has critical infection, prevention and control as well as clinical implications for future response. Our study reinforces the need to boost surveillance, lab and investigative capacity to underpin effective response, and for local and international health security.

Paradoxes in Eye Health Care in Low-Income Countries and Design Strategies for Mobile Health Technology to Overcome them

INTRODUCTION: Low income countries bear 90% of the burden of avoidable blindness. In particular, glaucoma is one of the major causes of visual impairment. Early detection is critical to avoid irreversible blindness due to this underdiagnosed disease. Mobile and connected technologies yield potentia

Beneath the Surface: Crude and Sensitive Quality of Care Measures for Maternal and Neonatal Healthcare in Rural Uganda

Background: Efforts to improve access to healthcare in low-income countries will not achieve the maternal and child health (MCH) Sustainable Development Goals unless there is a concomitant improvement in the quality of care (QoC) provided. This study measures infrastructure and QoC indicators in rural Ugandan health facilities. Valid and sensitive measures of the quality of current clinical practices in resource-limited settings are critical for effectively intervening to reduce adverse maternal and neonatal outcomes. Methods: Facility-based assessments of infrastructure and clinical quality during labor and delivery were conducted in six primary care health facilities in the greater Masaka area, Uganda in 2017. Data were collected using direct observation of clinical encounters and facility checklists. Direct observation comprised the entire delivery process, from initial client assessment to discharge, and included emergency management (e.g. postpartum hemorrhage, neonatal resuscitation). Health providers were assessed on their adherence to best practice standards of care. Findings: The quality of facility infrastructure was relatively high in facilities, with little variation in availability of equipment and supplies. However, heterogeneity in adherence to best clinical practices was noted across procedure type and facility. Adherence to crude measures of clinical quality were relatively high but more sensitive measures of the same clinical practice were found to be much lower. Interpretation: Crude QoC indicators are insufficient to validly measure MCH clinical quality, and more sensitive measures of input and process quality of clinical care, with an emphasis on the timing of these processes, are needed to develop effective MCH interventions. Funding Statement: The study was funded by LifeNet International Declaration of Interests: The authors report a grant from LifeNet International during the conduct of the study. Three of the authors of this publication (JK, LA, SW) were paid employees of LifeNet International, the funder, at the time this study was carried out and assisted with study design, data collection and manuscript preparation. However, no LifeNet author had access to aggregate study data during data collection, nor was any LifeNet employee involved with data analysis or in the initial presentation of study results. Ethics Approval Statement: Ethical approval was obtained from the Uganda National Council of Science and Technology (UNCST), The AIDS Support Organization (TASO) in Uganda, and the Duke University Campus institutional review board.

High-quality health systems in the Sustainable Development Goals era: time for a revolution.

High-quality health systems in the Sustainable Development Goals era: time for a revolution.

Dynamic Clinical Algorithms: Digital Technology Can Transform Health Care Decision-Making.

.Most health care in low-income countries is delivered at a primary care level by health workers who lack quality training and supervision, often distant from more experienced support. Lack of knowledge and poor communication result in a poor quality of care and inefficient delivery of health services. Although bringing great benefits in sectors such as finance and telecommunication in recent years, the Digital Revolution has lightly and inconsistently affected the health sector. These advances offer an opportunity to dramatically transform health care by increasing the availability and timeliness of information to augment clinical decision-making, based on improved access to patient histories, current information on disease epidemiology, and improved incorporation of data from point-of-care and centralized diagnostic testing. A comprehensive approach is needed to more effectively incorporate current digital technologies into health systems, bringing external and patient-derived data into the clinical decision-making process in real time, irrespective of health worker training or location. Such dynamic clinical algorithms could provide a more effective framework within which to design and integrate new digital health technologies and deliver improved patient care by primary care health workers.

Recognition of depression by primary care clinicians in rural Ethiopia

BackgroundDepression is a common health condition affecting up to a third of patients attending primary care, where most of the care for people with depression is provided. Adequate recognition of depression is the critical step in the path to effective care, particularly in low income countries. As part of the Programme for Improving Mental healthcare (PRIME), a project supporting the implementation of integrated mental healthcare in primary care, we evaluated the level of recognition of depression by clinicians working in primary care in rural Ethiopia prior to in service training. We hypothesised that the detection rate of depression will be under 10% and that detection would be affected by gender, education and severity of depression.MethodsCross-sectional survey in eight health centres serving a population of over 160,000 people. A validated version of the 9-item patient health questionnaire (PHQ-9) was administered as an indicator of probable depression. In addition, primary care clinicians completed a clinician encounter form. Participants were consecutive primary care attendees aged 18 years and above.ResultsA total of 1014 participants were assessed. Primary care clinicians diagnosed 13 attendees (1.3%) with depression. The PHQ9 prevalence of depression at a cut-off score of ten was 11.5% (n = 117), of whom 5% (n = 6/117) had received a diagnosis of depression by primary care clinicians. Attendees with higher PHQ scores and suicidality were significantly more likely to receive a diagnosis of depression by clinicians. Women (n = 9/13) and participants with higher educational attainment were more likely to be diagnosed with depression, albeit non-significantly. All cases diagnosed with depression by the clinicians had presented with psychological symptoms.ConclusionAlthough not based on a gold standard diagnosis, over 98% of cases with PHQ-9 depression were undetected. Failure of recognition of depression may pose a serious threat to the scale up of mental healthcare in low income countries. Addressing this threat should be an urgent priority, and requires a better understanding of the nature of depression and its presentation in rural low-income primary care settings.

Developing a measure of mental health service satisfaction for use in low income countries: a mixed methods study

BackgroundService satisfaction is integral to quality of care and measures are therefore considered important indicators of quality. Patient’s responses to their experiences of using services are under-researched in the context of mental healthcare in low income countries. Our aim was to use mixed methods to develop a new measure of satisfaction for use among consumers of the new models of mental healthcare which are currently being scaled-up.MethodsWe used qualitative methods to explore the concept of service satisfaction. On the basis of these findings, we developed a new ‘Mental health service satisfaction scale’ (MHSSS v0.0) by adapting existing measures of service satisfaction. We evaluated psychometric properties of the new measure, among a sample of service users with severe mental disorder (SMD) (n = 200) and caregivers (n = 200). Following expert review, a modified version of the measure was developed (MHSSS v1.0) and psychometric properties were examined with data from a second independent sample (n = 150 service users with SMD and n = 150 caregivers).ResultsFactors identified in analysis of the first quantitative sample coincide with core concepts of service satisfaction as reported in the literature and were reflected in the key themes which emerged from our qualitative study: interpersonal factors, efficacy, communication, technical competency and adequacy of facilities. There was generally consensus among caregivers and service users regarding dimensions of satisfaction. However there was evidence of some differences in prioritization. Revisions made to version 0.0 of the Mental Health Service Satisfaction Scale (MHSSS) led to an improved instrument, with excellent internal consistency, convergent validity and factor loadings indicative of a uni-dimensional construct.ConclusionsOur findings suggest that conceptions of service satisfaction among people accessing a service for SMD are broadly similar with those established in the literature. Our findings indicate that the MHSSS might be a useful candidate for inclusion in the new toolkit of measures needed to facilitate monitoring of service satisfaction which will be crucial to quality improvement.

Collaborative Care Goes Global

Collaborative Care Goes Global