Hospital Infrastructure Research Articles

The Role of Air Transport Infrastructure Towards Breaking Seasonality in Emerging Tourism Destinations: A Qualitative Study of Akureyri, North Iceland

This paper examines the impact of air infrastructure development on emerging insular destinations by focusing on Akureyri, located in North Iceland. It examines the intricate relationship between airport infrastructure capacity expansion, the building of human capacity, hospitality infrastructure growth, and seasonality challenges. Through extensive qualitative interviews and literature reviews from stakeholders, policymakers, and academics, the research synthesises how an airport expansion offers democratisation of tourism mobilities and connectedness with the outside world for remotely located communities in the region. The analysis found that despite the stakeholders’ increased awareness of the complexities in accommodating year-round tourism, there is a readiness to increase the tourism enterprise flows. Nevertheless, the study shows a high deficit in hospitality infrastructure along with regional investment imbalances, revealing the lack of a comprehensive capacity building strategy. Ultimately, the authors advocate for an ‘extended capacity’ approach to tackle the challenges presented in the process of overcoming seasonality issues. The paper stresses the need for developed human skill capacity and diversified services and products alongside infrastructure capacity upgrades. The gained insights are gathered in two figures. The first identifies and maps the contextual landscape encompassing North Iceland’s tourism industry and its stakeholders, while the other showcases the complexity of the process the destination undergoes for breaking seasonality, while exposing the interconnections of potential outcomes, stakeholders’ needs, and the existing and in process capacities.

Adaptive Architecture and Infection Prevention in Hospitals

In healthcare facility design, especially in hospitals, infection control is paramount due to the vulnerability of patients to nosocomial or healthcare-associated infections (HAIs). Despite advancements in medical practices and infection control measures, HAIs remain a significant challenge to patient safety and public health, particularly within hospital settings. Integrating adaptive architecture principles into hospital design and infrastructure presents a promising approach to addressing this issue. This paper examines the intersection of adaptive architecture and infection prevention in hospitals, with a focus on designing and constructing healthcare facilities to effectively curb the spread of infections. By incorporating adaptive architecture, hospitals can create environments that are responsive to the dynamic needs of patients, staff, and infection control protocols. Design elements such as flexible room layouts, easily adaptable ventilation systems, and antimicrobial surfaces can help minimize the risk of HAIs by reducing pathogen transmission and promoting cleanliness. Additionally, strategic placement of hand hygiene stations, isolation rooms, and patient flow pathways can optimize infection control practices and enhance patient safety. Strategically locating hand hygiene stations, isolation rooms, and patient flow pathways optimizes infection control practices and improves patient safety. By combining innovative design strategies and advanced technology, hospitals can better combat HAIs, fostering safer environments for patients and healthcare staff. This paper investigates how the collaboration of adaptive architecture and infection prevention can yield more robust and efficient healthcare facilities in the fight against HAIs. Keywords - HAIs, Adaptive Architecture, Infection, adaptable ventilation, flexible layouts, antimicrobial surfaces.

Implementation of a 3-phase grid-coupled solar electricity and back-up system at Mulanje Mission Hospital, Malawi.

In this report we describe the implementation of a new electricity supply system at Mulanje Mission Hospital, Malawi, which integrates the use of grid electricity, solar-generated electricity and battery back-up. To realize the system, suppliers from several countries had to be used and external expertise and funding were vital. The completed system provides reliable and good quality electricity to all departments in the hospital, prioritizing essential equipment when needed. Implementation of the system has reduced cost of electricity bills by 60%, ended black-outs and extended longevity of electrical equipment. We describe our approach, the materials used and results with challenges and recommendations to governments, donors interested in hospital infrastructure and other health facilities operating in similar circumstances. Others in similar settings can benefit from the experiences documented.

345 Analysis of the Caribbean Neurosurgery Workforce: Scope of Practice, Challenges and Ways Forward

INTRODUCTION: There are close to 45 neurosurgeons for 16 million people in the Caribbean Community (CARICOM) region. The aim of our study is to understand the current scope of practice for neurosurgical providers in the Caribbean, as very sparse information has been published. METHODS: This study surveyed neurosurgeons within Caribbean and CARICOM countries online using qualitative and quantitative methods via Qualtrics. RESULTS: Of 38 countries within the Caribbean, 26 (68%) were surveyed of which 18 (69%) replied. In total 61 neurosurgeons were identified, with a majority of general neurosurgeons (56%). Remarkably, the majority of countries failed to meet the threshold workforce density for safe health care - either expressed by FTE neurosurgeons or neurosurgical centers. Most neurosurgical practices denied receiving or sending medical referrals. If otherwise, most referrals took longer than 8 hours without significant difference regarding the destination. Lastly, challenges confronting neurosurgical advancement were found in: technology and equipment (40%), trained personnel (31%), hospital or medical center infrastructure (14%), neurosurgical education and training (44%). CONCLUSIONS: To our knowledge, this is the first comprehensive qualitative and quantitative study exploring the current status of the Caribbean neurosurgery workforce, the challenges and the potential ways forward. Arming the local providers with improved resources and support would only serve to add value to the region thus making excellent patient care the standard for a region in need of just that.

An Efficient Secure Sharing of Electronic Health Records Using IoT-Based Hyperledger Blockchain

Electronic Health Record (EHR) systems are a valuable and effective tool for exchanging medical information about patients between hospitals and other significant healthcare sector stakeholders in order to improve patient diagnosis and treatment around the world. Nevertheless, the majority of the hospital infrastructures that are now in place lack the proper security, trusted access control, and management of privacy and confidentiality concerns that the current EHR systems are supposed to provide. Goal. For various EHR systems, this research proposes a Blockchain-enabled Hyperledger Fabric Architecture as a solution to this delicate issue. The three steps of the suggested system are the secure upload phase, the secure download phase, and authentication. Patient registration, login, and verification make up the authentication step. The administrator grants authorization to read, edit, delete, or revoke the files following user details verification. In the secure upload phase, feature extraction is carried out first, and then a hashed access policy is created from the extracted feature. Next, the hash value is stored in an IoT-based Hyperledger blockchain. The uploaded EHR files are additionally encrypted before being stored on the cloud server. In the secure download step, the physician uses a hashed access policy to send the request to the cloud and decrypts the corresponding files. The experimental findings demonstrate that the system outperformed cutting-edge techniques. The proposed Modified Key Policy Attribute-Based Encryption performs better for the remaining 10 to 25 mb file sizes. This IoT framework compares MKP-ABE with certain efficiency indicators, such as encryption, decryption period, protection level analysis and encrypted memory use, resource use on decryption, upload time, and transfer time, which are present in the KP-ABE, the ECC, RSA, and AES. Here, the IoT device suggested requires 4008 ms for data encryption and 4138 ms for the data decryption.

The Benefits and Barriers of Providing Non-Pharmacological Pain Relief to Women in Labour during COVID-19: A Qualitative Study of Midwives in South Africa

Pregnancy is an exceptional event in a woman’s life. As a result of the intense pain associated with childbirth, women require encouragement and support during this crucial phase. Midwives play a crucial role in the maternal care paradigm, managing labour pain alongside ensuring the mother and baby’s safety during the labour process. This study explored midwives’ perspectives concerning the utilisation and barriers of non-pharmacological labour pain reduction methods during COVID-19 in Matjhabeng Municipality hospitals in South Africa’s Free State Province. Ten midwives participated in a semi-structured interview wherein the audio was recorded and transcribed verbatim. The data were analysed using Tesch’s approach for open-coding data analysis. Midwives’ experiences with non-pharmacological therapeutic options for relieving labour pain were varied. They used mobilisation techniques, warm bathing, deep breathing exercises, back massaging, and psychological support. Midwives affirmed that non-pharmacological labour pain interventions were poorly implemented because of staff shortages, heavy workload, and COVID-19 regulations at the time. In efforts to address the obstacles in managing labour pain and alleviate the pain of women during labour, midwives recommended the provision of education and advocacy, the employment of additional midwives and auxiliary staff, and improvement in hospital infrastructure. Due to staff shortages, heavy workloads, and COVID-19 restrictions that limit birth companions, non-pharmacological pain reduction methods are not properly implemented. Health education; employing additional midwives, professional doulas, and students; and improving health infrastructure are midwives’ concerns. Prioritising midwife training in non-pharmacological labour pain management is crucial for delivering the best possible care during childbirth.

Catastrophic Morbidly Adherent Posterior Placenta: Case Reports, Literature Review Current Through at Long Time Since Cases Registration

There are analyzed the difficulties and accuracy of diagnosis, in conjunction to the moment technical opportunities at long interval after registration (2009, 2012) in two cases of posterior Morbidly Adherent Placenta/Placenta Accreta Spectrum (MAP/PAS), with deep myometrial invasion (grade 3B) and uterine serosa perforation (grade 3E), a contemporary serious disease generating severe maternal coagulation disorders, multiple organ failure and hemorrhagic shock up to death, after total hemostasis hysterectomy. Undiagnosed or suspicious second trimester posterior MAP/PAS, in low-lying placenta, morbid obesity (BMI>40), in an intact uterus, or in a scar uterus post cesarean delivery (CD) were followed by maternal death. In countries with low-to-middle income/ resources, and few centers of excellence, medical staff surgical qualities, and well trained interdisciplinary team must meet patients’ and their families trust and cooperation, and timely available life-saving resources for complex therapies in critical care cases, and hospital infrastructure to benefit from actual expanded knowledge and guidelines.

Are international guideline recommendations for the management of placenta accreta spectrum applicable in low- and middle-income countries?

The aim of this study was to explore how obstetricians-gynecologists in low- and middle-income countries (LMICs) can apply current international clinical practice guidelines (CPGs) for the management of placenta accreta spectrum (PAS) in limited resource settings. This was an observational, survey-based study. Clinicians with expertise in managing patients with PAS in LMICs were contacted for their evaluation of the recommendations included in four PAS clinical practice guidelines. Out of the 158 clinicians contacted, we obtained responses from 65 (41.1%), representing 27 middle income countries (MICs). The results of this survey suggest that the care of PAS patients in middle income countries is very different from what is recommended by international CPGs. Participants in the survey identified that their practice was limited by insufficient availability of hospital infrastructure, low resources of local health systems and lack of trained multidisciplinary teams (MDTs) and this did not enable them to follow CPG recommendations. Two-thirds of the participants surveyed describe the absence of centers of excellence in their country. In over half of the referral hospitals with expertise in managing PAS, there are no MDTs. One-third of patients with intraoperative findings of PAS are managed by the team initially performing the surgery (without additional assistance). The care of patients with PAS in middle income countries frequently deviates from established CPG recommendations largely due to limitations in local resources and infrastructure. New practical guidelines and training programs designed for low resource settings are needed.

The influence of COVID-19 on the health sector

Healthcare, as a fundamental component of human well-being, plays a pivotal role in shaping overall quality of life. This research investigates the extensive ramifications of the COVID-19 epidemic on the healthcare sector, encompassing the challenges and opportunities that have emerged in its wake. This study investigates the implications for hospital infrastructure through a comprehensive analysis of pertinent literature. The findings reveal significant deficiencies in essential resources such as ventilators and personal protective equipment (PPE). The evident manifestation of the psychological burden experienced by healthcare personnel highlights the imperative of allocating additional resources to support them. The advent of the pandemic has given rise to telemedicine and other digital alternatives, leading to a significant transformation in the field of healthcare delivery. Lockdowns, mask mandates, and other public health interventions are crucial in mitigating the transmission of the pathogen. Despite facing significant challenges, the ongoing pandemic has accelerated advancements in the field of medicine. This study contributes to the existing body of knowledge regarding effective strategies for addressing future pandemics and underscores the imperative of establishing a healthcare system that is adaptable and responsive. In the era following the COVID-19 pandemic, it is imperative to proactively tackle challenges and explore untapped opportunities in the healthcare sector by continuous research and assertive endeavors.

ASSESSMENT OF INDIVIDUALS’ SATISFACTION WITH THE QUALITY OF FAMILY HEALTH INSURANCE SERVICES IN DONG NAI PROVINCE, VIETNAM

Based on fundamental theoretical framework, hypothetical research models, and primary data via direct surveys of 250 individuals who use family health insurance services in Dong Nai Province, we propose a research model consisting of 6 influencing factors with 28 observed variables. The study uses quantitative methodology of Cronbach's Alpha test, exploratory factor analysis, multiple regression analysis, and robustness test, to determine the factors influencing individuals' satisfaction with family health insurance services. The research results reveal five significant factors influencing individuals’ satisfaction with the quality of family health insurance services in the study area, ranked in order of importance: (1) administrative procedures; (2) hospital infrastructure; (3) hospital service capacity; (4) convenience of family health insurance; (5) medical staff empathy. Based on these findings, the study proposes several managerial implications to enhance overall satisfaction with the quality of family health insurance services in Dong Nai Province.

General hospital preparedness in facing flood disasters

Hospitals had a very important function in disaster management, especially in providing health services to reduce the suffering of disaster victims in the form of deceases and injuries. Hospital preparedness in facing disasters was contained in the Hospital Disaster Plan which was prepared based on the Safe Hospital Framework [1], and the Hospital Safety Index[2]. The purpose of this study was to analyze the preparedness of Aceh Tamiang General Hospital in facing flood disasters from 4 (four) aspects or evaluation modules namely, Hazard Affecting, Structural Safety, Non-Structural Safety, Emergency and Disaster Management, specifically analyzing the aspect of “Emergency and Disaster Management” according to the research focus namely, hospital policies, human resources preparedness and hospital infrastructure readiness in facing flood disasters. The research methodology was qualitative with a phenomenological design by 7 (seven) informants. The results of the study showed that the policies of the hospital leadership had been good, with the existence of a Leadership Decree concerning the Formation of a Hospital Disaster Management Team, since 2019 ago. However, there were still hospital personnel who did not know about the organizational structures, goals and functions as team members. Many hospital health workers could not go to work because their homes and access to the hospital were flooded. Besides that, hospital infrastructure, especially motorized vehicles such as ambulances and other operational vehicles, could not operate due to flood conditions that reached up to 1 meter. Therefore it was suggested that the socialization of the Disaster Management Team and Disaster Management Simulation should be carried out periodically, for example, twice a year. It should be suggested that the hospital proposed procuring an ambulance with certain specifications and a rescue boat, so that it could break through the floods that occur almost every year.

Application of Complex Neutrosophic Graphs in Hospital Infrastructure Design

Complex neutrosophic graphs are created by combining complex neutrosophic sets with graph theory ideas. This provides a flexible framework for tackling complex problem-solving circumstances. Various processes, such as union, join, and composition, are thoroughly investigated to improve the administration of complicated neutrosophic graphs. This research also looks into the area of complicated neutrosophic graph homeomorphisms, investigating the transformations and mappings that occur inside these structures. This investigation advances our knowledge of the intrinsic features and linkages found in complicated neutrosophic graphs. Finally, our methodology’s practical usefulness is demonstrated by its use in the design of hospital infrastructure. We illustrate the effectiveness of complicated neutrosophic graphs in addressing difficult design concerns and optimizing infrastructure solutions for practical deployment in this real-world scenario.

IoT Based Air Quality Monitoring and Controlling System for Hospital

This project introduces an IoT based Air Quality Monitoring and Controlling System tailored for hospital environments. Utilizing a variety of sensors, including those for particulate matter, carbon dioxide, and volatile organic compounds, the system ensures continuous real-time monitoring of indoor air quality. NodeMCU facilitates wireless communication, enabling the transmission of data to a central server or cloud platform. Hospital staff can remotely monitor air quality conditions, receiving threshold alerts in the event of pollutant levels surpassing predefined limits. The system integrates a controlling mechanism, allowing for the activation of ventilation systems or air purifiers based on the collected data. Energy efficiency is prioritized through intelligent control of air quality devices. Historical data analysis enables administrators to identify patterns and improve overall air quality management. The system seamlessly integrates with existing hospital infrastructure and is designed for scalability, ensuring adaptability to evolving needs. Overall, this IoT-based solution offers a smart and automated approach to maintaining a healthy indoor environment in hospital settings.

A phenomenological study of the experiences of nurses working in integrated nursing care wards in Korea

BackgroundThis study aimed to understand the experiences of nurses working in the integrated nursing care service, a relatively recent addition to the Korean hospital infrastructure, to suggest ways in which to address their grievances and needs and improve their job satisfaction, thereby reducing turnover.MethodsThis study adopted a qualitative approach to explore subjects’ vivid experiences. Data were collected through in-depth interviews with 17 nurses with over one year of experience working in integrated nursing care wards. The main question asked was “Can you describe your experiences in the integrated nursing care ward?” All interviews were recorded, transcribed, and analyzed using Colaizzi’s method for phenomenological research.ResultsSix theme clusters were derived from the analysis: “distorted perceptions of the integrated nursing care ward,” “challenges owing to distorted perceptions of the integrated nursing care ward,” “loneliness and fighting alone,” “being ridiculed,” “practicing textbook holistic care,” and “the satisfaction felt only in the integrated nursing care ward.” For the overarching theme, we identified “Satisfaction in providing holistic care despite the challenges.”ConclusionsWhile working in the integrated nursing care ward, nurses practiced holistic nursing care, which in turn built their self-esteem. However, they experienced greater levels of stress as a result of misinformation. Therefore, dissemination of accurate information is necessary to correct public misunderstandings of the integrated nursing care wards. Further, adequate compensation and support systems are needed to relieve the stress nurses felt because of such misunderstandings. Additionally, nurses should be motivated to continue to provide quality care for the patients and take pride in their work. Future research should explore the physical and mental concerns of nurses working in integrated care wards.

Perspectives on Communication Technology Use for Alleviating the Impact of COVID-19 on Hospitalized Patients' Well-Being and Transitions in Care.

The COVID-19 pandemic created many challenges for in-patient care including patient isolation and limitations on hospital visitation. Although communication technology, such as video calling or texting, can reduce social isolation, there are challenges for implementation, particularly for older adults. This study used a mixed methodology to understand the challenges faced by in-patients and to explore the perspectives of patients, family members, and health care providers (HCPs) regarding the use of communication technology. Surveys and focus groups were used. Patients who had access to communication technology perceived the COVID-19 pandemic to have more adverse impact on their well-beings but less on hospitalization outcomes, compared to those without. Most HCPs perceived that technology could improve programs offered, connectedness of patients to others, and access to transitions of care supports. Focus groups highlighted challenges with technology infrastructure in hospitals. Our study findings may assist efforts in appropriately adopting communication technology to improve the quality of in-patient and transition care.

Trade Openness and Life Expectancy: Evidence from Nigeria

The health sector in Nigeria is at risk following barriers to international trade, as trade across Nigeria and the rest of the world may not be sufficiently promoting health indicators in particular life expectancy. This paper examined the impact of trade openness on life expectancy in Nigeria from 1986 to 2023. This paper utilized the autoregressive distributed lag model (ARDL) on trade openness, foreign direct investment, hospital infrastructure, electricity consumption and government health expenditure. From the result, it was showed that trade openness had a negative impact on life expectancy, while the three lagged value of foreign direct investment had a positive impact on infant mortality. As a way of policy implementation, the Government should create mechanisms to control the extent to which the economy is opened to the external world. This is because illicit and substandard health goods could be brough tinto the country which could have adverse and negative effect on the health come in the long run in Nigeria.

A Survey on Environmental Sustainability Among Anesthesiologists: An Opportunity for Changing Behaviors.

Introduction Environmental sustainability (ES) is a current issue related to natural resource scarcity, pollution and climate change. Although operating rooms (ORs) comprise a small proportion of the entire hospital infrastructure, they significantly impact the environment. Anesthesiologists are ideally positioned to assume leadership, mitigating this negative impact regarding OR waste in the environment. We created a Green Team, comprising multidisciplinary professionals from different areas of a tertiary Portuguese medical center, and conducted a survey that was sent to all the institution's anesthesiologists to assess the current state of ES. Results From the sample of 133 participants, 101 responses were obtained. Concerning knowledge and training on ES, a significant portion of the respondents (66.7%) seem to attribute "great importance" to the subject. As to the greatest barrier to waste separation in the OR, several respondents highlighted the issues of "inadequate information/education/training" (62.6%) and "lack of support from hospital/OR in-chief/administration" (26.3%). Finally, among seven methods to raise awareness of ES, "training during residency" was the top choice for these professionals, with 52.5% of the votes. Discussion Most anesthesiologists who responded to the survey recognize the utmost importance of ES and have perceived the environmental impact of their anesthetic practices in the OR. Overall, this tendency is consistent with other international studies. Moreover, most of those surveyed separate waste at home and want to extend this practice -in a more structured approach- to their workplace, with an effective separation of anesthetic and general waste in the OR. Conclusion Professionals perceive barriers to performing green practices, whether the lack of environmental education and awareness, the absence of recycling containers or waste separation bags, or the lack of protocols and guidelines implementing these circuits. With the publication of this work, we aim to encourage other institutions to implement ES projects in their hospitals and ORs.

Knowledge, Attitude, and Practice of Patient Referral among Patent and Proprietary Medicine Vendors in Obio-Akpor, Rivers State.

With the limited number of trained health care providers in Nigeria, PPMVs are inevitable, especially in rural areas for the supply of drugs, and integration through appropriate referral practices is quintessential. This study assessed the knowledge, attitude, and practice of patient referral among PPMVs in a setting with limited hospital infrastructure. This cross-sectional descriptive survey was conducted in Obio-Akpor, Rivers State using a structured questionnaire that measured the participants' socio-demographic characteristics as well as knowledge, attitude, and practice of patient referral. Descriptive and inferential analyses were conducted with SPSS version 25 and a p-value <0.05 was considered significant. Most of the respondents reported moderate knowledge, attitude, and practice (62.4%, 73.4%, and 58% respectively) of patient referral. Multivariate analysis showed statistically significant inverse relationships between years of experience and odds of their knowledge, attitude, and practice of referral. PPMVs with 3 years of experience reported significantly higher odds of adequate knowledge (AOR = 178.96; 95%CI: 60.15 - 532.49; p-value <0.005), attitude (AOR = 7.38;95%CI: (3.78 - 14.40; P-value <0.005) and practice (AOR = 131.56; 95%CI: 53.50 - 323.51; p-value <0.005) than those with above 10 years of experience after controlling for the effects of other variables. The most frequently reported barrier to referral was fear of losing clients while most referrals were for laboratory investigations. Most PPMVs reported moderate knowledge, attitude, and practice of patient referral. PPMVs were aware of the benefits of referrals but concerned about losing their clients to formal healthcare facilities.

Addressing Inequality in the COVID-19 Pandemic in Africa: A Snapshot from Clinical Symptoms to Vaccine Distribution

On 30 January 2020, WHO declared COVID-19 a public health emergency of global concern. COVID-19 became pandemic on 11 March 2020, and spread unprecedently. No country was prepared to face its impact. Major fears started to be expressed for Africa, where dramatic consequences were expected, due to the weakness of health systems. In this review, we related major concerns, at that time but still present, regarding the limited resources in terms of qualified physicians and researchers, as well as the scarce funds to purchase essential medical equipment and improve hospital infrastructures. The difficulties to provide proper care became an undeniable mark of inequality, highlighting the need to empower local capacity and raise preparedness against infection outbreaks. The transmissibility of genetic variants affecting African nations, the immunopathology underlying comorbidities, sequelae, and pre-existing conditions, often related to changes in iron metabolism and enhancing COVID-19 severity, were described. The obstacles in adopting standardized prevention measures were highlighted, along with testing capacity biases and inequity of healthcare access and vaccine distribution. By providing a better understanding of the COVID-19 pandemic in Africa, we draw attention to the need for collaborative efforts to leverage the quality of healthcare and research in this continent.

Adaptation and validation of the Children’s Surgical Assessment Tool for Rwandan district hospitals

ABSTRACT Background/Aims Paediatric surgical care is a critical component of child health and basic universal health coverage and therefore should be included in comprehensive evaluations of surgical capacity. This study adapted and validated the Children’s Surgical Assessment Tool (CSAT), a tool developed for district and tertiary hospitals in Nigeria to evaluate hospital infrastructure, workforce, service delivery, financing, and training capacity for paediatric surgery, for use in district hospitals in Rwanda. Methods We used a three-round modified Delphi process to adapt the CSAT to the Rwandan context. An expert panel of surgeons, anaesthesiologists, paediatricians, and health systems strengthening experts were invited to participate based on their experience with paediatric surgical or anaesthetic care at district hospitals or with health systems strengthening in the Rwandan context. We used the Content Validity Index to validate the final tool. Results The adapted tool had a final score of 0.84 on the Content Validity Index, indicating a high level of agreement among the expert panel. The final tool comprised 171 items across five domains: facility characteristics, service delivery, workforce, financing, and training/research. Conclusion The adapted CSAT is appropriate for use in district hospitals in Rwanda to evaluate the capacity for paediatric surgery. This study provides a framework for adapting and validating a comprehensive paediatric surgical assessment tool to local contexts in LMICs and used in similar settings in sub-Saharan Africa.