Low-resource Healthcare Research Articles

The Impact of Laparoscopic Treatment on Fertility Outcomes in Patients with Severe Endometriosis

Background: Endometriosis, a prevalent gynecological disorder affecting women of reproductive age, is a significant cause of infertility, especially in severe cases involving extensive adhesions, endometriomas, and deep infiltrating lesions. In Bangladesh, the delay in diagnosis and limited access to advanced treatments, including laparoscopic surgery, poses challenges to improving fertility outcomes for women with severe endometriosis. Objective: This study aimed to assess the impact of laparoscopic treatment on fertility outcomes in patients with severe endometriosis, particularly in a resource-limited healthcare setting in Bangladesh. Methods: This retrospective cohort study included 78 women with severe endometriosis from tertiary hospitals in Dhaka and Khulna, Bangladesh. All participants had previously experienced unsuccessful in vitro fertilization (IVF) attempts and subsequently underwent laparoscopic surgery between 2015 and 2024. Data collection involved reviewing primary and secondary data from these tertiary hospitals, including medical records and operative reports, and was supplemented by follow-up interviews for comprehensive analysis. Variables such as patient age, infertility duration, previous IVF cycles, operative findings, and postoperative fertility outcomes were analyzed using SPSS, with statistical significance set at P < .05. Results: The mean age of patients was 34.3 years, and the average duration of infertility was 52.9 months. Post-laparoscopic surgery, 42.3% (33/78) of women successfully delivered, with 7% achieving spontaneous conception. Younger age, fewer prior IVF cycles, and a normal uterine appearance on transvaginal ultrasound were significantly associated with improved fertility outcomes. Salpingectomy was more common among those who delivered (70%), though the removal of ovarian endometriomas did not significantly impact fertility success. Conclusion: Laparoscopic treatment significantly improves fertility outcomes in Bangladeshi women with severe endometriosis, even in a resource-limited setting. Age, normal ovarian function, and uterine appearance were key factors influencing reproductive success. These findings underscore the importance of timely surgical intervention for endometriosis-related infertility, highlighting the need for improved access to laparoscopic surgery in low-resource healthcare systems.

Exploring Empathic Communication Among Community Health Workers: Applying the ENACT Tool in Two South African Sites.

Introduction. Effective empathic communication between health care providers and patients is an essential part of health care. In resource-poor contexts, evidence is needed to understand the quality and content of health care communication within real-life clinical engagements. We used the existing Enhancing Assessment of Common Therapeutic Factors (ENACT) tool to measure empathic communication skills among a group of community health workers (CHWs) receiving a novel quality improvement intervention called Nyamekela4Care in South Africa. Methods. In two resource-limited sites in the Western Cape, South Africa, we audio-recorded CHWs, with consent, in routine client consultations at baseline and postintervention. All sessions were in Afrikaans. We used the adapted ENACT tool to rate recordings at both timepoints, assessing 11 items including communication skills, emotional engagement, process and interaction. We used ANOVA to assess preimplementation and postimplementation differences in empathic communication, and analyzed coders' feedback on the coding process itself. Results. We analyzed n = 66 recordings from 11 CHWs, observing positive directionality overall, with most skills improving over time. Despite near-significant improvements in communication delivery (p = .083), self-confidence/groundedness (p = .029) significantly changed but in the opposite direction. Large effect sizes were observed in verbal communication, responsiveness to client, and identifying external resources, with no significant difference between timepoints. ENACT was feasible to apply to audio recordings; inter-coder reliability was suboptimal despite coder training and ongoing monitoring and support. Discussion. Quality improvement interventions may improve empathic skills in diverse contexts, and our results demonstrate how empathic skills could be more routinely assessed in low-resource health care settings.

COVID-19 hand hygiene practices and its barriers among health care workers in a low-resource setting: a cross-sectional study in Nigeria

Abstract Background Poor hand hygiene (HH) among health care workers (HCWs) in low-resource healthcare settings has continued to increase the spread of infectious diseases, including COVID-19. The present study aimed to assess the knowledge, attitude, adherence, and barriers to HH practices among HCWs during the COVID-19 pandemic in Nigeria. Methods The study was an online cross-sectional survey using a tailored questionnaire distributed through chain referral sampling among southern Nigerian HCWs during the first wave of the COVID-19 pandemic (February to August 2020). The primary outcomes were knowledge, attitude, adherence to HH guidelines, and the barriers limiting compliance with the guidelines. Data were analysed using percentage, frequency, mean, standard deviation, one-way ANOVA, and multiple linear regression. The study timeline was from 15 April to 31 July 2020. Results Four hundred and fifty-four HCWs (236 males and 218 females) participated in the study. The participants had a moderate knowledge of standard HH protocol (mean ± SD) 62.45 ± 10.82%, positive attitude 84.34 ± 11.32%, and high adherence to the standard guidelines 81.21 ± 9.49%. There was no significant difference in knowledge, attitude, and adherence across the healthcare professions. Increasing age (β = 0.186, p < 0.003) and knowledge (β = 0.229, p < 0.001), and decreasing negligence (β = − 0.178, p = 0.004), and forgetfulness (β = − 0.159, p = 0.012) were the significant predictors of effective HH practices. Conclusion Nigerian HCWs had moderate knowledge, a positive attitude, and adhered to the standard HH practices during the COVID-19 pandemic. However, the major barriers were institutional-based factors such as the inadequate supply of HH items, competing job demands, emergencies, increased workload, and personal characteristics such as age, poor knowledge, negligence, and forgetfulness. We recommend that hospital management provide their staff with adequate HH materials and continued infectious disease training.

Early surgical outcomes of children with mechanical intestinal obstruction at Moi teaching and referral hospital, Kenya

Background: Intestinal obstruction constitutes the largest proportion of abdominal surgical emergencies in the paediatric and adult patients in Sub-Saharan Africa, including Kenya. It is associated with high postoperative surgical complication and mortality rate in low resource healthcare systems. Methods: A prospective mixed methods study with consecutive sampling procedure was carried out from September 2021 to June 2023. Pediatric patients from birth to 14 years, with mechanical intestinal obstruction were included in the study. Categorical data was analyzed in frequencies and percentages and continuous data was analyzed using measures of central tendency and measures of dispersion. Bivariate and multivariate associations between the dependent and independent variables were assessed with a p value of less than 0.05 being statistically significant. Results: The final study population was 318 participants. Majority of participants were male with neonates comprising almost one third of participants. Classical symptoms were present in a majority of patients at initial presentation. Intussusception (34.6%) was the leading acquired aetiology of paediatric mechanical intestinal obstruction. Operative surgical management was in 94.6% of participants. Surgical complications were present in 61.1% of participants. The commonest surgical complication was surgical site infection in 16.9%. Overall mortality rate was 10.2% with 23.3% among neonates and 4.9% in older children. Referral status was statistically associated with mortality (p<0.001). Intestinal atresia had the highest case-specific mortality rate. Age, presence of comorbidity were factors associated to postoperative complications and mortality (p<0.05). Conclusions: The overall mortality rate was 10.2%. A higher mortality was seen among neonates compared to older children.

Effect of continuous workshop training of the helping babies breathe program on the retention of midwives' knowledge and skills: A clinical trial study

AimTo investigate the impact of ongoing workshop training of the "Helping Babies Breathe" program on the durability of midwives' knowledge and skills. BackgroundImplementing the Helping Babies Breathe (HBB) program is crucial as a simple protocol for neonatal resuscitation in low-resource healthcare settings to decrease the rate of asphyxia and perinatal mortality by the initial healthcare providers. In addition to training in this program, it is also essential to guarantee the retention of the acquired knowledge and skills. DesignA quasi-experimental clinical trial study with a single-group, pre-test-and-post-test design. MethodsThis study was conducted throughout the year 2022, with a sample size of 61 midwives selected through a census sampling from those working in the delivery and operating rooms of X Hospital in x City. The midwives participated in 3-hour workshops. This study was performed in two stages: intervention and follow-up. The evaluation Instruments included the HBB educational package, which consisted of a questionnaire and 3 Objective Structured Clinical Exams. During the intervention phase, the HBB program training was conducted through a series of workshops held at four different time points over a span of six months. In the follow-up stage, the learners were not provided with any further training. The evaluation was done immediately after the initial training workshop of the HBB program, at the end of the final workshop in the sixth month and at the end of the follow-up period. ResultsThe mean knowledge score of the baseline, at six months and at twelve months after the initial workshop were documented as (17 SD1.2), (17.79 SD 0.4) and (17.73 SD 0.5), respectively. There was a statistically significant difference in the mean knowledge scores between the baseline and the six and twelve months (P<0.05), but no statistically significant difference was observed between six and twelve months (P>0.05).The mean skill scores showed a significant improvement and were maintained after six months compared with the initial assessment (P<0.05); however, there was a significant decrease in skill score twelve months later, in comparison to both the initial assessment and the first six months (P<0.05). ConclusionsHealthcare workers can maintain their knowledge and skills by participating in ongoing training workshops. However, without continuous training, their skills may diminish. Therefore, it is essential to implement training programs that emphasize regular practice and repetition to ensure knowledge and skills retention. Registration numberThe present research was a part of the research work with the ethics ID IR.IRSHUMS.REC.1400.019.

Developing the OpenFlexure Microscope towards medical use: technical and social challenges of developing globally accessible hardware for healthcare.

The OpenFlexure Microscope is an accessible, three-dimensional-printed robotic microscope, with sufficient image quality to resolve diagnostic features including parasites and cancerous cells. As access to lab-grade microscopes is a major challenge in global healthcare, the OpenFlexure Microscope has been developed to be manufactured, maintained and used in remote environments, supporting point-of-care diagnosis. The steps taken in transforming the hardware and software from an academic prototype towards an accepted medical device include addressing technical and social challenges, and are key for any innovation targeting improved effectiveness in low-resource healthcare. This article is part of the Theo Murphy meeting issue 'Open, reproducible hardware for microscopy'.

Implementing the Serious Illness Care Program in Safety Net Health Systems: A Qualitative Study

ContextInterventions to improve the quality of care for people affected by serious illness commonly fail to reach patients from marginalized and underserved communities, which include those characterized by racialized or indigenous identity, sexual and gender minority status, and rural living. Interventions to improve care through serious illness conversations have demonstrated benefit, but little is known about their implementation in health systems that predominantly serve these patient groups. ObjectivesThe study aimed to understand factors influencing implementation of a serious illness communication-focused intervention—the Serious Illness Care Program in health systems who primarily provide care to marginalized and underserved communities. MethodsQualitative interviews (16) and focus groups (3) were conducted with 19 interdisciplinary team members from six geographically diverse U.S. healthcare systems. Using a template analysis approach, investigators coded data inductively and deductively to identify themes. ResultsThree themes emerged: patient factors, intervention elements, and health system contextual factors. Participants highlighted mission-driven efforts, creativity, interprofessional practice, and trainees as enablers of success. They identified weaknesses in the intervention's communication tool—the Serious Illness Conversation Guide as barriers to implementation of conversations. Resource constraints, socio-economic vulnerability, and mistrust in the health system were seen as additional barriers. ConclusionsHealth systems that provide care to underserved and marginalized communities face unique challenges implementing the Serious Illness Care Program. They also possess assets, some unique to these settings, that support program adoption. Findings suggest that implementation of similar programs in low-resource healthcare settings may help address unmet needs among marginalized populations.

BT-Net: An end-to-end multi-task architecture for brain tumor classification, segmentation, and localization from MRI images

Brain tumors are severe medical conditions that can prove fatal if not detected and treated early. Radiologists often use MRI and CT scan imaging to diagnose brain tumors early. However, a shortage of skilled radiologists to analyze medical images can be problematic in low-resource healthcare settings. To overcome this issue, deep learning-based automatic analysis of medical images can be an effective tool for assistive diagnosis. Conventional methods generally focus on developing specialized algorithms to address a single aspect, such as segmentation, classification, or localization of brain tumors. In this work, a novel multi-task network was proposed, modified from the conventional VGG16, along with a U-Net variant concatenation, that can simultaneously achieve segmentation, classification, and localization using the same architecture. We trained the classification branch using the Brain Tumor MRI Dataset, and the segmentation branch using a “Brain Tumor Segmentation dataset. The integration of our method’s output can aid in simultaneous classification, segmentation, and localization of four types of brain tumors in MRI scans. The proposed multi-task framework achieved 97% accuracy in classification and a dice similarity score of 0.86 for segmentation. In addition, the method shows higher computational efficiency compared to existing methods. Our method can be a promising tool for assistive diagnosis in low-resource healthcare settings where skilled radiologists are scarce.

Assessment of Patient Safety in a Low-Resource Health Care System: Proposal for a Multimethod Study.

The high prevalence of adverse events (AEs) globally in health care delivery has led to the establishment of many guidelines to enhance patient safety. However, patient safety is a relatively nascent concept in low- and middle-income countries (LMICs) where health systems are already overburdened and underresourced. This is why it is imperative to study the nuances of patient safety from a local perspective to advocate for the judicious use of scarce public health resources. This study aims to assess the status of patient safety in a health care system within a low-resource setting, using a multipronged, multimethod approach of standardized methodologies adapted to the local setting. We propose purposive sampling to include a representative mix of public and private, rural and urban, and tertiary and secondary care hospitals, preferably those ascribed to the same hospital quality standards. Six different approaches will be considered at these hospitals including (1) focus group discussions on the status quo of patient safety, (2) Hospital Survey on Patient Safety Culture, (3) Hospital Consumer Assessment of Healthcare Providers and Systems, (4) estimation of incidence of AEs identified by patients, (5) estimation of incidence of AEs via medical record review, and (6) assessment against the World Health Organization's Patient Safety Friendly Hospital Framework via thorough reviews of existing hospital protocols and in-person surveys of the facility. The abovementioned studies collectively are expected to yield significant quantifiable information on patient safety conditions in a wide range of hospitals operating within LMICs. A multidimensional approach is imperative to holistically assess the patient safety situation, especially in LMICs. Our low-budget, non-resource-intensive research proposal can serve as a benchmark to conduct similar studies in other health care settings within LMICs. PRR1-10.2196/50532.

Abstract 6087: Cytomics-on-chip and AI-driven predictive analysis platform for early detection of epithelial cancers

Abstract Cancer is the 2nd leading cause of death (over 605,000 people) in the US, at an expense of over $200B, with 1 in 3 people projected to have cancer during their lifetime per CDC. Despite the significant impact of early detection and screening on prognosis, only some cancers are diagnosed at an early stage. Carcinomas, comprising &amp;gt;80% of cancer incidence, allow ease in cytology sample access chairside, due to the lesions’ epithelial presentation. This presents a unique opportunity for early detection and screening in epithelial cancers. In low-resource healthcare settings, from clinical examination to the long, tedious and expensive diagnostic journey for cancers &amp; pre-cancerous lesions, can lead to missed, delayed or over diagnosis scenarios. This affects treatment initiation and potentially outcome. To facilitate early intervention, there is compelling need to develop accurate and effective minimally invasive screening platforms. Recent advances in the -omics disciplines, microfluidics and AI tools are starting to reveal promising signatures of early disease detection, with potential to drastically improve screening and diagnostic systems. We are developing a novel application of the cytomics-on-chip platform, for enabling chairside, quantitative screening of suspicious epithelial lesions. The biosensor module involves 1. a single use, cytomics platform employing a cartridge with cellular array and high specificity biomarker reagents, that allows single cell molecular imaging to be completed in a portable analyzer. 2. a microfluidics module that allows cytomorphometric measurements to be completed. 3. The results generated are utilized to train machine learning algorithms to detect cyto-signatures and provide an intuitive result that may be utilized by health care practitioners in clinical-decision making. The first cell-based point-of-care oncology tool has recently been validated with high accuracy (99.3%), sensitivity and specificity, in a multi-site prospective clinical study. Here we demonstrate a pilot study towards development of a smart single cell cytomics-on-chip platform for prompt cytomorphometric and biomarker characterization towards diagnosis of urothelial, anal and cervical cancers, and dysplasia lesions, utilizing brush/pap and fresh urine samples. This has potential for continuous quantitative indexing, for disease categorization. As cancers become more pervasive, improved early detection/screening methods that are accurate, cost effective, easy to implement during routine clinical practice, and providing minimal discomfort to the patient, are urgently needed, improving confidence in clinicians’ decisions. Citation Format: Kritika Srinivasan Rajsri, Michael P. McRae, Nicolaos J. Christodoulides, Khaled Algashaamy, Monica T. Garcia-Buitrago, Fei Chen, Fang-Ming Deng, Jennifer S. Smith, John T. McDevitt. Cytomics-on-chip and AI-driven predictive analysis platform for early detection of epithelial cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6087.

Peptide-based biosensing approaches for targeting breast cancer-derived exosomes

Exosomes are nanovesicles present in all the biological fluids, making them attractive as non-invasive biomarkers for diseases like cancer, among many others. However, exosomes are complex to separate and detect, requiring comprehensive molecular characterization for their routine use in diagnostics. This study explores the use of peptides as cost-effective and stable alternatives to antibodies for exosome binding. To achieve that, phage display technology was employed to select peptides with high specificity for target molecules in exosomes. Specifically, a selected peptide was evaluated for its ability to selectively bind breast cancer-derived exosomes. Proteomic analysis identified 38 protein candidates targeted by the peptide on exosome membranes. The binding of the peptide to breast cancer-derived exosomes was successfully demonstrated by flow cytometry and magneto-actuated immunoassays. Furthermore, an electrochemical biosensor was also tested for breast cancer-derived exosome detection and quantification. The peptide demonstrated effective binding to exosomes from aggressive cancer cell lines, offering promising results in terms of specificity and recovery. This research shows potential for developing rapid, accessible diagnostic tools for breast cancer, especially in low-resource healthcare settings.

Examining Diagnostic Errors in the Field of Otorhinolaryngology within the Challenging Landscape of Limited-Resource Healthcare.

Diagnostic accuracy is vital in otorhinolaryngology for effective patient care, yet diagnostic mismatches between non-otorhinolaryngology clinicians and ENT specialists can occur. However, studies investigating such mismatches in low-resource healthcare environments are limited. This study aims to analyze diagnostic mismatches in otorhinolaryngology within a low-resource healthcare environment. A publicly available dataset assessing diagnostic outcomes from non-otorhinolaryngology clinicians and ENT specialists was analyzed. The dataset included demographic characteristics, referral diagnoses, and final ENT specialist diagnoses. Descriptive statistics and appropriate statistical tests were employed to assess the prevalence of diagnostic mismatches and associated factors. The analysis comprised 1544 cases. The prevalence of diagnostic mismatches between non-otorhinolaryngology clinicians and ENT specialists was 67.4%. Certain specific ENT diseases demonstrated higher frequencies of diagnostic mismatches. Factors such as mismatch in the diagnosis and compliance of patient were found to influence the occurrence of diagnostic mismatches. This study highlights the presence of diagnostic mismatches in otorhinolaryngology within a low-resource healthcare environment. The prevalence of these mismatches underscores the need for improved diagnostic practices in such settings. Factors contributing to diagnostic mismatches should be further explored to develop strategies for enhancing diagnostic accuracy and reducing diagnostic errors in otorhinolaryngology.

MicroDoc: Developing a guide for managing infections in Zambian rural low-resource health settings

Abstract Lack of access to diagnostic tests and guidelines that are inappropriate for poorly resourced facilities can result in incorrect and excessive prescribing of antimicrobial therapy in rural healthcare settings. On Call Africa (OCA) and Virtual Doctors (VD) are two non-governmental organisations that work in healthcare in Zambia. Volunteers and staff from OCA and VD have collaborated with the Zambian Ministry of Health and local healthcare providers to design a guide to support decisions around management of infections specifically in rural primary healthcare settings in Zambia. Local staff were initially surveyed for their attitudes towards treatment of infections, the content they would like capacity building in, and preferred modes of learning. The team, comprising public health and infectious disease doctors and GPs from Ireland and the UK with experience working in Zambia, have created a guide called MicroDoc which encompasses workshops, PDFs, flowcharts and modules relating to management of infections and antimicrobial prescribing. All the content can be downloaded and accessed offline. The Zambian Standard Treatment Guidelines were consulted for antimicrobial choice, supplemented by NICE and WHO where necessary. Red flags for urgent hospital referral are also incorporated, as well as modules about risks of antimicrobial resistance. Early versions of the guide have been distributed to a range of facilities in Zambia's Southern Province, with promising feedback from healthcare providers. In collaboration with local partners and input from facility staff, MicroDoc will be finalised and rolled out to more health posts and health centres in the region, with a view to eventually expanding to other regions. The OCA team has been conducting clinical audits of prescribing practices in two rural health posts and it is hoped that the MicroDoc guide will contribute to improved antimicrobial stewardship as well as better outcomes for patients. Key messages • Management of infectious presentations is particularly challenging in rural low-resource primary healthcare settings in Sub-Saharan countries such as Zambia. • A team from On Call Africa and Virtual Doctors has created a guide called MicroDoc, in collaboration with Zambian health authorities, to support decision making in managing infections in primary care.

“Feeling Like an Island”: Perceptions of Professional Isolation Among Emergency Nurses

IntroductionProfessional isolation, feelings of being isolated from one’s professional peers and lacking mentoring and opportunities for professional interaction, collaboration, and development, is a challenge for workers across the labor market. The notion of professional isolation is particularly prevalent in low-resource health care settings and is common among emergency nurses. MethodsThis study explored the perceptions of professional isolation among emergency nurses working in a low-resource environment using individual interviews with 13 participants in 5 settings in Lesotho. ResultsThe data were analyzed using qualitative content analysis and revealed an overarching theme of “feeling like an island” containing 3 categories, namely lack of interprofessional collaboration and consultation, skills mismatch, and enforced loneliness. DiscussionThis study suggests that lack of interprofessional collaboration and consultation, skills mismatch, and enforced loneliness have influenced feelings of professional isolation among emergency nurses working in low-resource environments. The findings of this research lend support to the idea that communities of practice may have a potential impact in addressing professional isolation.

Letter to the Editor: Aloe vera Lotion Used as a Potential Alternative Couplant for Sonography, in a Low-Resource Health Care Facility—By Paulinus

Letter to the Editor: <i>Aloe vera</i> Lotion Used as a Potential Alternative Couplant for Sonography, in a Low-Resource Health Care Facility—By Paulinus

Disinfection of Phi6, MS2, and Escherichia coli by Natural Sunlight on Healthcare Critical Surfaces.

Ultraviolet (UV) radiation systems, commonly used to disinfect surfaces, drinking water, and air, stem from historical practice to use sunlight to disinfect household items after contagious illness. Currently, it is still recommended in viral outbreak contexts such as COVID-19, Ebola, and Marburg to expose soft surfaces to sunlight after washing with detergent or disinfecting with chlorine. However, sunlight that reaches the Earth's surface is in the UVA/UVB wavelengths, whereas UV disinfection systems typically rely on biocidal UVC. Our goal was to fill the evidence gap on the efficacy of sunlight disinfection on surface materials common in low-resource healthcare settings by seeding four surfaces (stainless steel, nitrile, tarp, cloth) with three microorganisms (viral surrogate bacteriophages Phi6 and MS2 and Escherichia coli bacteria), with and without soil load, and exposing to three sunlight conditions (full sun, partial sun, cloudy). We conducted 144 tests in triplicate and found: solar radiation averaged 737 W/m2 (SD = 333), 519 W/m2 (SD = 65), and 149 W/m2 (SD = 24) for full sun, partial sun, and cloudy conditions; significantly more surfaces averaged ≥4 log10 reduction value (LRV) for Phi6 than MS2 and E. coli (P < 0.001) after full sun exposure, and no samples achieved ≥4 LRV for partial sun or cloudy conditions. On the basis of our results, we recommend no change to current protocols of disinfecting materials first with a 0.5% chlorine solution then moving to sunlight to dry. Additional field-based research is recommended to understand sunlight disinfection efficacy against pathogenic organisms on healthcare relevant surfaces during actual outbreak contexts.

DEVELOPMENT OF A NOVEL DIABETIC FOOT RISK ASSESSMENT FOR LOW-RESOURCE HEALTHCARE SETTINGS: A CASE STUDY OF LEAN DESIGN

AbstractInterest in applying a “lean” philosophy to design has been slowly growing in recent years, but there are still few broadly applicable methodologies and illustrative cases published in the literature to guide lean design processes. Lean approaches promise cost reduction and increased product value, which could be particularly beneficial in product development for low- and middle-income country markets, where value demands are high. We use the clinical need of efficient diabetic foot risk assessment in lowresource healthcare settings to present an example of lean early-stage design of a medical device. The background of existing medical literature and commercial products is intentionally leveraged throughout the design process to streamline development and minimize the need for independent validation of product strategies and design features. Our approach resulted in an efficient design process that generated a novel, purely mechanical plantar pressure evaluation device that can indicate high risk of diabetic foot ulcer in resource-constrained settings. This case provides a practical example of how design processes can be adapted to be leaner where there are large gains from minimizing design cycle time and cost.

ResQvent: A Practical Solution for Addressing the Needs of Mechanical Ventilation in Low Resource and Income Healthcare Settings

ResQvent: A Practical Solution for Addressing the Needs of Mechanical Ventilation in Low Resource and Income Healthcare Settings

Assessment of ventilation in low-resource healthcare settings: Montserrado County, Liberia—2022−2023

Background: Mitigating the risk of nosocomial respiratory disease transmission in the healthcare facilities of low- and middle−income countries (LMICs) poses unique challenges because mechanical ventilation and mixed−mode strategies are often unavailable. Carbon dioxide (CO2) can serve as a proxy for ventilation and, hence, airborne infectious disease transmission risk in naturally ventilated spaces. We assessed the adequacy of ventilation in Liberian hospitals. Methods: We sampled 3 hospitals, both urban and rural, in Montserrado County, Liberia. Moreover, 3 CO2 meters were concurrently utilized to measure CO2 levels at a 1-meter height in every patient-care room in each facility. We recorded temperature, humidity, room dimensions, and number of people in the rooms. From these variables, we calculated absolute ventilation using the ASHRAE equation to determine areas with the highest risk of nosocomial respiratory disease transmission. We also recorded qualitative observations about the sampled spaces. Results: From August 2022 to February 2023, 39 rooms in 3 healthcare facilities were sampled. Initial quantitative findings show that only 8 rooms (21%) met the WHO-recommended ventilation rate of 60 L per second per person. The average ventilation rate per person in the adequately ventilated settings was 86 L per second per patient, compared to 19 liters per second per patient in inadequately ventilated rooms. Additionally, 467 ppm mean CO2 was noted in well-ventilated rooms compared to 895 ppm mean CO2 in inadequately ventilated rooms.Initial qualitative observations showed that facilities with lower CO2 readings tended to be older constructions that likely had been constructed with airborne disease such as tuberculosis in mind. Willingness to open windows was limited by lack of window screens for malaria prevention, and there was a pervasive fallacy that air conditioning was a source of ventilation. Correspondingly, of the 31 inadequately ventilated rooms, 22 (71%) had operating air conditioning units compared with 4 (50%) of the 8 adequately ventilated rooms. Overall, of the 13 rooms without air conditioning, 7 (54%) were more frequently characterized by open windows compared to only 5 of 26 (28%) of rooms that did have air conditioners. Conclusions: Being prepared for the next respiratory disease outbreak and creating more resilient healthcare systems in LMICs requires a frameshift of prevention strategies. Measuring CO2 provides a simple strategy for identifying areas at highest risk for nosocomial respiratory disease transmission, which can be prioritized for low-cost environmental interventions, such as provision of window screens, as part of routine infection prevention and control efforts.Disclosure: None

Barriers to adequate nutrition care for child malnutrition in a low-resource setting: Perspectives of health care providers.

Several studies in developing countries found that more need-based training is required for health care providers (HCPs) in child malnutrition management. An exploratory cross-sectional study was conducted to explore barriers to providing adequate nutrition care as perceived by the healthcare providers (HCPs) in the child malnutrition clinic at a Children's University Hospital in Egypt. Participants were selected using the purposive sampling technique. Five out of seven HCPs in the clinic were included (two male physicians, one female physician, and two female nurses). Qualitative data were collected through in-depth interviews. The interview guide consisted of semi-structured open-ended questions. Quantitative data were the resulting scores from the scoring system used to assess the understandability and actionability of the patient education materials (PEMs) that are available in the clinic. The Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) for the scoring. Statistical analysis: The thematic content analysis technique was employed for qualitative data. The percent score was generated for the PEM actionability and understandability for quantitative data. Most common child malnutrition conditions encountered by HCPs were nutritional deficiencies. Barriers to the delivery of adequate nutrition care to children were physician-centered: limited nutrition education in the medical school, health system-centered: an insufficient number of HCPs, lack of nutritional supplements, lack of patient education materials (PEMs) that suit the characteristics of the served community, lack of updated standard of practice (SOP) and guidelines, inadequate nutrition training of HCPs, and insufficient time for each patient, and caregivers-centered: the low socioeconomic status and false cultural, nutritional beliefs. There are different barriers to adequate nutrition care for child malnutrition in low-resource healthcare settings. Mainly nutritional deficiencies. Most of the barriers were health system-related in the form of insufficient resources (shortage of workforce; concerning the high caseload, nutritional supplements, and PEMs) and inadequate management of resources (lack of skill-based training, lack of updated SOP and guidelines, and lack of properly designed PEMs that facilitate communication with the target caregivers).