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Rekhtman D, Bermudez F, Vervoort D, Kaze L, Patton-Bolman C, Swain J. A Global Systematic Review of Open Heart Valvular Surgery in Resource-Limited Settings. Ann Thorac Surg 2024; 117:652-660. [PMID: 37898373 DOI: 10.1016/j.athoracsur.2023.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/24/2023] [Accepted: 10/09/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Many obstacles challenge the establishment and expansion of cardiac surgery in low- and middle-income countries, despite the unmet cardiac surgical needs. One challenge has been providing adequate follow-up care to monitor anticoagulation, manage morbidity, and prevent mortality. This systematic review describes outcomes after valvular cardiac surgery and focuses on strategies for prolonged follow-up care in resource-constrained settings. METHODS Studies published between 2012 and 2022 were collected from Embase and the Cochrane Library. Article inclusion criteria were adolescent and adult patients, open heart valvular surgery, and analysis of at least 1 postoperative outcome at least 30 days postoperatively. Studies that focused on pediatric patients, pregnant patients, transcatheter procedures, in-hospital outcomes, and nonvalvular surgical procedures were excluded. Descriptive statistics were assessed, and articles were summarized after abstract screening, full-text review, and data extraction. RESULTS Sixty-seven relevant publications were identified after screening. The most commonly studied regions were Asia (46%), Africa (36%), and Latin America (9%). Rheumatic heart disease was the most commonly studied valvular disease (70%). Reported outcomes included mortality, surgical reintervention, and thrombotic events. Follow-up duration ranged from 30 days to 144 months; 11 studies reported a follow-up length of 12 months. CONCLUSIONS Addressing the unmet cardiac care needs requires a multifaceted approach that leverages telemedicine technology, enhances medical infrastructure, and aligns advocacy efforts. Learning from the cost-effective establishment of cardiac surgery in low- and middle-income countries, we can apply past innovations to foster sustainable cardiac surgical capacity.
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Affiliation(s)
- David Rekhtman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | | | - Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Leslie Kaze
- Graduate School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom; Team Heart, Inc, Kigali, Rwanda
| | | | - JaBaris Swain
- Team Heart, Inc, Kigali, Rwanda; Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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2
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Argaw S, Genetu A, Vervoort D, Agwar FD. The state of cardiac surgery in Ethiopia. JTCVS OPEN 2023; 14:261-269. [PMID: 37425461 PMCID: PMC10328795 DOI: 10.1016/j.xjon.2023.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 07/11/2023]
Abstract
Objectives Six billion people globally do not have access to cardiac surgical care. In this study, we aimed to describe state of cardiac surgery in Ethiopia. Methods Data on status of local cardiac surgery collected from surgeons and cardiac centers. Medical travel agents were interviewed about number of cardiac patients who were assisted to travel abroad for surgery. Historical data and number of patients treated by non-governmental organizations were collected via interviews and by accessing existing databases. Results Patients access cardiac care via 3 avenues: mission-based, abroad referral, and care at local centers. Traditionally, the first 2 have been the main mode of access; however, since 2017, an entirely local team has begun performing heart surgery in the country. Currently, surgical cardiac care is provided at 4 local centers: a charity organization, a tertiary public hospital, and 2 for-profit centers. Procedures at the charity center are provided for free, whereas in others, patients mostly pay out of pocket. There are only 5 cardiac surgeons for 120 million people. More than 15,000 patients are on waitlist for surgery, mainly because of lack of consumables and limited numbers of centers and workforce. Conclusions There is a change in the trend from non-governmental mission- and referral-based care toward care in local centers in Ethiopia. The local cardiac surgery workforce is growing but still insufficient. The number of procedures is limited with long wait lists due to limited workforce, infrastructure, and resources. All stakeholders should work on training more workforce, providing consumables, and creating feasible financing schemes.
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Affiliation(s)
- Salem Argaw
- Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Abraham Genetu
- Department of Surgery, School of Medicine, College of Health Sciences, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dominique Vervoort
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
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Ntaganda E, Ssebuufu R, Bacon DR, Daniel TM. Teaching Thoracic Surgery in a Low-Resource Setting:: Creation of a Simulation Curriculum in Rwanda. Thorac Surg Clin 2022; 32:279-287. [PMID: 35961736 DOI: 10.1016/j.thorsurg.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Surgical education and global health partnerships have evolved over the years. There is growing recognition of the importance of in-country training of surgeons and surgeon specialists in low-resource settings to support the local health care system. There are numerous ways in which high-income partners can support local training programs. The Human Resources for Health program was initiated in 2012 to advance in-country training of health care professionals in Rwanda. As there was a limited in-country operative experience for teaching general thoracic surgery, simulation models were developed, influenced by a prior course developed for American cardiothoracic trainees. Local Rwandan faculty were engaged. Adaptations from the American version included constructing models from inexpensive materials to make the simulation more feasible in the Rwanda setting.
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Affiliation(s)
- Edmond Ntaganda
- Consultant Pediatric Surgeon, Centre Hospitalier Universitaire de Kigali (CHUK), KN 4th Avenue, Kigali City, P.O. Box 655, Kigali, Rwanda; Loma Linda University School of Medicine, San Bernando, California, USA
| | - Robinson Ssebuufu
- Uganda Medical and Dental Practitioners Council (UMDPC), P.O. Box 1594, Kampala, Uganda
| | - Daniel R Bacon
- Department of Surgery, The Ohio State University School of Medicine, Columbus, OH, USA
| | - Thomas M Daniel
- Department of Surgery, University of Virginia School of Medicine, P.O. Box 800709, Charlottesville, VA 22908, USA.
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Taslakian EN, Garber K, Shekherdimian S. Diaspora engagement: a scoping review of diaspora involvement with strengthening health systems of their origin country. Glob Health Action 2022; 15:2009165. [PMID: 34904934 PMCID: PMC8676662 DOI: 10.1080/16549716.2021.2009165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Diaspora communities are a growing source of external aid and resources to address unmet needs of health systems of their homelands. Although numerous articles have been published, these endeavors as a whole have not been systematically assessed. OBJECTIVE Examine the available literature to assess activities through which diasporas engage with the health system in their origin country and what barriers they face in their interventions. METHODS This is a scoping review from 1990-2018 using the PRISMA-Scr framework to examine both peer-reviewed and gray literature on (1) specific activities through which diasporas contribute to the health system in their origin country; (2) major health needs diasporas have tried to address; and (3) barriers faced by diaspora healthcare efforts. RESULTS The initial search identified 119 articles, of which 45 were eligible after excluding non-relevant studies. These were case studies of diaspora contributions to health systems in their origin country (13), interviews (13), literature reviews (9), general articles on the topic (4), and correspondences or presentations (6). The healthcare needs diasporas have sought to address include health workforce emigration ('brain drain') (10), capacity building for research and training (10), inadequate infrastructure (5), and finances (4). Specific activities included short-term missions (11), establishing partnerships (9), emigration back to country of origin (8), specific research and training programs (8), and financial remittances (5). Specific barriers identified were most commonly financial need within the origin country (8), lack of sustainability (6), communication issues (6), lack of intention to return to the origin country (5), infrastructure (4), and political concerns (3). CONCLUSION Further research on how to expand the scope of and reduce barriers to diaspora engagement is needed to optimize the effectiveness of diaspora contributions to their origin countries. Metrics and standards should be developed for assessing impact of diaspora engagement and interventions.
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Affiliation(s)
- Editt N. Taslakian
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - Kent Garber
- Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Shant Shekherdimian
- Division of Pediatric Surgery, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA,CONTACT Shant Shekherdimian Division of Pediatric Surgery, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Wallen TJ, Fults M, Fariha NJ, Le M, Blenden R, Soto R. Failure to Rescue in Humanitarian Congenital Cardiac Surgery. Ann Thorac Surg 2019; 109:1475-1479. [PMID: 31610169 DOI: 10.1016/j.athoracsur.2019.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 08/17/2019] [Accepted: 09/06/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cardiac surgeons have a significant history of participating in humanitarian work; however, the outcomes in this arena are not well delineated. We sought to define and describe failure to rescue (FTR) in this setting by analyzing the outcomes of the International Children's Heart Foundation. METHODS From 2008 to 2017, 3009 patients underwent operations during the course of an International Children's Heart Foundation mission. Of these, 1165 patients had at least one complication. These patients were divided into those who ultimately died (FTR group, n = 107) and those who survived (survivor group, n = 1058). Clinical presentation and outcomes were compared. RESULTS The overall FTR rate was 10%. Patients in the FTR group were significantly younger, weighed less, and were shorter. Children who required a preoperative admission to the intensive care unit were more likely to be in the FTR group. Intraoperative data demonstrated significantly longer cardiopulmonary bypass time among FTR patients, with similar use of intraoperative blood product. Postoperatively, patients in the FTR group had more reintubations than survivors. Cardiopulmonary bypass and intensive care unit times were shown to be significant predictors of FTR. There was a trend between program volume and FTR rate. Program volume appeared to be correlated with FTR. CONCLUSIONS Failure to rescue occurs at a rate of 10% in the humanitarian congenital cardiac surgery setting. The FTR patients were younger, required more intubations, and had significantly more diagnoses of transposition of the great arteries. Longer cardiopulmonary bypass time and intensive care unit admission were associated with increased risk of FTR.
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Affiliation(s)
- Tyler J Wallen
- University of Florida Health System, Gainesville, Florida.
| | - Marci Fults
- Atlantic Health System, Goryeb Children's Hospital, Morristown, New Jersey
| | - Nwaukoni J Fariha
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Marilyn Le
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Randa Blenden
- International Children's Heart Foundation, Memphis, Tennessee
| | - Rodrigo Soto
- International Children's Heart Foundation, Memphis, Tennessee
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Contextual Challenges to Safe Surgery in a Resource-limited Setting: A Multicenter, Multiprofessional Qualitative Study. Ann Surg 2019; 267:461-467. [PMID: 28257319 DOI: 10.1097/sla.0000000000002193] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Safe surgery should be available to all patients, no matter the setting. The purpose of this study was to explore the contextual-specific challenges to safe surgical care encountered by surgeons and surgical teams in many in low- and middle-income countries (LMICs), and to understand the ways in which surgical teams overcome them. BACKGROUND Optimal surgical performance is highly complex and requires providers to integrate and communicate information regarding the patient, task, team, and environment to coordinate team-based care that is timely, effective, and safe. Resource limitations common to many LMICs present unique challenges to surgeons operating in these environments, but have never been formally described. METHODS Using a grounded theory approach, we interviewed 34 experienced providers (surgeons, anesthetists, and nurses) at the 4 tertiary referral centers in Rwanda, to understand the challenges to safe surgical care and strategies to overcome them. Interview transcripts were coded line-by-line and iteratively analyzed for emerging themes until thematic saturation was reached. RESULTS Rwandan-described challenges related to 4 domains: physical resources, human resources, overall systems support, and communication/language. The majority of these challenges arose from significant variability in either the quantity or quality of these domains. Surgical providers exhibited examples of resilient strategies to anticipate, monitor, respond to, and learn from these challenges. CONCLUSIONS Resource variability rather than lack of resources underlies many contextual challenges to safe surgical care in a LMIC setting. Understanding these challenges and resilient strategies to overcome them is critical for both LMIC surgical providers and surgeons from HICs working in similar settings.
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Cardiac surgery for adult CHD in Nigeria: a too-familiar tale. Cardiol Young 2019; 29:16-18. [PMID: 30378515 DOI: 10.1017/s104795111800166x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Swain JD, Sinnott C, Breakey S, Hasson Charles R, Mody G, Nyirimanzi N, Patton-Bolman C, Come P, Ganza G, Rusingiza E, Ruhamya N, Mucumbitsi J, Borges J, Zammert M, Muehlschlegel JD, Oakes R, Leavitt B, Bolman RM. Ten-year clinical experience of humanitarian cardiothoracic surgery in Rwanda: Building a platform for ultimate sustainability in a resource-limited setting. J Thorac Cardiovasc Surg 2018; 155:2541-2550. [DOI: 10.1016/j.jtcvs.2017.11.106] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/28/2017] [Accepted: 11/14/2017] [Indexed: 10/17/2022]
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Wallen TJ, Arnaoutakis GJ, Blenden R, Soto R. Programmatic Changes to Reduce Mortality and Morbidity in Humanitarian Congenital Cardiac Surgery. World J Pediatr Congenit Heart Surg 2018; 9:47-53. [DOI: 10.1177/2150135117737686] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: This report documents the outcomes of cardiac surgical mission trips organized by the International Children's Heart Foundation (ICHF), a nongovernmental organization that provides congenital heart surgery services to the developing world, and discusses factors associated with a reduction of mortality and morbidity in this setting. Methods: A retrospective review of a prospectively maintained database was conducted to identify any patient who underwent surgical intervention during the course of an ICHF mission trip. Results: From 2008 to 2016, a total of 223 trips were made to 23 countries and 3,783 operations were performed. Over 40 unique types of operations were performed with repairs of atrial septal defects (ASDs; n = 479), ventricular septal defects (VSDs; n = 760), teratology of Fallot (n = 473), and ligation of patient ductus arteriosus (PDA; n = 242), comprising the majority of cases. Several organizational policy changes were instituted in 2015. These include the requirement of the host site to have a fully functional blood bank and access to medical subspecialties, the ICHF providing 24-hour intensivist coverage, and not performing surgery on patients weighing less than 10 kg until local capacity has been developed. The overall mortality rate fell to 2.3% from 8.1% after the implementation of these policies. The mortality for ASD repair, VSD repair, PDA ligation, and the repair of tetralogy of Fallot fell from 1.2% to 0%, 1.8% to 0%, 0% to 0%, and 5.6% to 5.1%, respectively. The reoperation rate fell from 11% to 3% and reoperation for a bleeding indication fell from 6% to 2%. Conclusions: Programmatic-level changes have been associated with reduced rates of mortality and morbidity in humanitarian congenital cardiac surgery.
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Affiliation(s)
- Tyler J. Wallen
- Department of Surgery, Mercy Catholic Medical Center, Philadelphia, PA, USA
| | | | - Randa Blenden
- The International Children’s Heart Foundation, Memphis, TN, USA
| | - Rodrigo Soto
- The International Children’s Heart Foundation, Memphis, TN, USA
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Barasa FA, Vedanthan R, Pastakia SD, Crowe SJ, Aruasa W, Sugut WK, White R, Ogola ES, Bloomfield GS, Velazquez EJ. Approaches to Sustainable Capacity Building for Cardiovascular Disease Care in Kenya. Cardiol Clin 2016; 35:145-152. [PMID: 27886785 DOI: 10.1016/j.ccl.2016.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cardiovascular diseases are approaching epidemic levels in Kenya and other low- and middle-income countries without accompanying effective preventive and therapeutic strategies. This is happening in the background of residual and emerging infections and other diseases of poverty, and increasing physical injuries from traffic accidents and noncommunicable diseases. Investments to create a skilled workforce and health care infrastructure are needed. Improving diagnostic capacity, access to high-quality medications, health care, appropriate legislation, and proper coordination are key components to ensuring the reversal of the epidemic and a healthy citizenry. Strong partnerships with the developed countries also crucial.
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Affiliation(s)
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Susie J Crowe
- Purdue University College of Pharmacy, West Lafayette, IN, USA
| | | | | | - Russ White
- Tenwek Mission Hospital, Bomet, Kenya; Alpert School of Medicine, Brown University, 2 Dudley Street, PO Box 39, Providence, RI 02905, USA
| | - Elijah S Ogola
- Department of Clinical Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Gerald S Bloomfield
- Department of Medicine, Duke Clinical Research Institute, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Eric J Velazquez
- Department of Medicine, Duke Clinical Research Institute, Duke Global Health Institute, Duke University, Durham, NC, USA
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Giorgi G, Montani F, Fiz-Perez J, Arcangeli G, Mucci N. Expatriates' Multiple Fears, from Terrorism to Working Conditions: Development of a Model. Front Psychol 2016; 7:1571. [PMID: 27790173 PMCID: PMC5062027 DOI: 10.3389/fpsyg.2016.01571] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 09/27/2016] [Indexed: 11/25/2022] Open
Abstract
Companies’ internationalization appears to be fundamental in the current globalized and competitive environment and seems important not only for organizational success, but also for societal development and sustainability. On one hand, global business increases the demand for managers for international assignment. On the other hand, emergent fears, such as terrorism, seem to be developing around the world, enhancing the risk of expatriates’ potential health problems. The purpose of this paper is to examine the relationships between the emergent concept of fear of expatriation with further workplace fears (economic crisis and dangerous working conditions) and with mental health problems. The study uses a quantitative design. Self-reported data were collected from 265 Italian expatriate workers assigned to both Italian and worldwide projects. Structural equation model analyses showed that fear of expatriation mediates the relationship of mental health with fear of economic crisis and with perceived dangerous working conditions. As expected, in addition to fear, worries of expatriation are also related to further fears. Although, the study is based on self-reports and the cross-sectional study design limits the possibility of making causal inferences, the new constructs introduced add to previous research.
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Affiliation(s)
- Gabriele Giorgi
- Department of Psychology, European University of Rome Rome, Italy
| | | | - Javier Fiz-Perez
- Department of Psychology, European University of Rome Rome, Italy
| | - Giulio Arcangeli
- Department of Experimental and Clinical Medicine, University of Florence Florence, Italy
| | - Nicola Mucci
- Department of Experimental and Clinical Medicine, University of Florence Florence, Italy
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Dearani JA, Jacobs JP, Bolman RM, Swain JD, Vricella LA, Weinstein S, Farkas EA, Calhoon JH. Humanitarian Outreach in Cardiothoracic Surgery: From Setup to Sustainability. Ann Thorac Surg 2016; 102:1004-1011. [PMID: 27319988 DOI: 10.1016/j.athoracsur.2016.03.062] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 03/16/2016] [Accepted: 03/18/2016] [Indexed: 10/21/2022]
Abstract
Noncommunicable diseases account for 38 million deaths each year, and approximately 75% of these deaths occur in the developing world. The most common causes include cardiovascular diseases, cancer, respiratory diseases, and diabetes mellitus. Many adults with acquired cardiothoracic disease around the world have limited access to health care. In addition, congenital heart disease is present in approximately 1% of live births and is therefore the most common congenital abnormality. More than one million children in the world are born with congenital heart disease each year, and approximately 90% of these children receive suboptimal care or have no access to care. Furthermore, many children affected by noncongenital cardiac conditions also require prevention, diagnosis, and treatment. Medical and surgical volunteerism can help facilitate improvement in cardiothoracic health care in developing countries. As we move into the future, it is essential for physicians and surgeons to be actively involved in political, economic, and social aspects of society to serve health care interests of the underprivileged around the world. Consequently, in developing countries, a critical need exists to establish an increased number of reputable cardiothoracic programs and to enhance many of the programs that already exist. The optimal strategy is usually based on a long-term educational and technical model of support so that as case volumes increase, quality improves and mortality and morbidity decrease. Humanitarian outreach activities should focus on education and sustainability, and surgical tourism should be limited to those countries that will never have the capability to have free-standing cardiothoracic programs.
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Affiliation(s)
- Joseph A Dearani
- Department of Cardiovascular Surgery, The Mayo Clinic, Rochester, Minnesota.
| | - Jeffrey P Jacobs
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida
| | | | | | - Luca A Vricella
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Samuel Weinstein
- Children's Hospital at Montefiore, Montefiore Medical Center, New York, New York
| | - Emily A Farkas
- Department of Surgery, Saint Louis University, St. Louis, Missouri
| | - John H Calhoon
- Department of Cardiothoracic Surgery, University of Texas Health Science Center, San Antonio, Texas
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Iwelunmor J, Blackstone S, Veira D, Nwaozuru U, Airhihenbuwa C, Munodawafa D, Kalipeni E, Jutal A, Shelley D, Ogedegebe G. Toward the sustainability of health interventions implemented in sub-Saharan Africa: a systematic review and conceptual framework. Implement Sci 2016; 11:43. [PMID: 27005280 PMCID: PMC4804528 DOI: 10.1186/s13012-016-0392-8] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 02/26/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) is facing a double burden of disease with a rising prevalence of non-communicable diseases (NCDs) while the burden of communicable diseases (CDs) remains high. Despite these challenges, there remains a significant need to understand how or under what conditions health interventions implemented in sub-Saharan Africa are sustained. The purpose of this study was to conduct a systematic review of empirical literature to explore how health interventions implemented in SSA are sustained. METHODS We searched MEDLINE, Biological Abstracts, CINAHL, Embase, PsycInfo, SCIELO, Web of Science, and Google Scholar for available research investigating the sustainability of health interventions implemented in sub-Saharan Africa. We also used narrative synthesis to examine factors whether positive or negative that may influence the sustainability of health interventions in the region. RESULTS The search identified 1819 citations, and following removal of duplicates and our inclusion/exclusion criteria, only 41 papers were eligible for inclusion in the review. Twenty-six countries were represented in this review, with Kenya and Nigeria having the most representation of available studies examining sustainability. Study dates ranged from 1996 to 2015. Of note, majority of these studies (30 %) were published in 2014. The most common framework utilized was the sustainability framework, which was discussed in four of the studies. Nineteen out of 41 studies (46 %) reported sustainability outcomes focused on communicable diseases, with HIV and AIDS represented in majority of the studies, followed by malaria. Only 21 out of 41 studies had clear definitions of sustainability. Community ownership and mobilization were recognized by many of the reviewed studies as crucial facilitators for intervention sustainability, both early on and after intervention implementation, while social and ecological conditions as well as societal upheavals were barriers that influenced the sustainment of interventions in sub-Saharan Africa. CONCLUSION The sustainability of health interventions implemented in sub-Saharan Africa is inevitable given the double burden of diseases, health care worker shortage, weak health systems, and limited resources. We propose a conceptual framework that draws attention to sustainability as a core component of the overall life cycle of interventions implemented in the region.
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Affiliation(s)
- Juliet Iwelunmor
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, IL USA
| | - Sarah Blackstone
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, IL USA
| | - Dorice Veira
- School of Medicine, New York University, New York, NY USA
| | - Ucheoma Nwaozuru
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, IL USA
| | | | - Davison Munodawafa
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Ezekiel Kalipeni
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, IL USA
- Department of Geography, University of Illinois Urbana-Champaign, Champaign, Il USA
| | - Antar Jutal
- West Virginia University, Morgantown, WV USA
| | - Donna Shelley
- School of Medicine, New York University, New York, NY USA
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Building Advanced Surgical Capacity at a Hospital in Port-au-Prince, Haiti. J Craniofac Surg 2015; 26:1042-7. [DOI: 10.1097/scs.0000000000001678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Controlling acute rheumatic fever and rheumatic heart disease in developing countries: are we getting closer? Curr Opin Pediatr 2015; 27:116-23. [PMID: 25490689 DOI: 10.1097/mop.0000000000000164] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To describe new developments (2013-2014) in acute rheumatic fever (ARF) and rheumatic heart disease (RHD) relevant to developing countries. RECENT FINDINGS Improved opportunities for the primary prevention of ARF now exist, because of point-of-care antigen tests for Streptococcus pyogenes, and clinical decision rules which inform management of pharyngitis without requiring culture results. There is optimism that a vaccine, providing protection against many ARF-causing S. pyogenes strains, may be available in coming years. Collaborative approaches to RHD control, including World Heart Federation initiatives and the development of registers, offer promise for better control of this disease. New data on RHD-associated costs provide persuasive arguments for better government-level investment in primary and secondary prevention. There is expanding knowledge of potential biomarkers and immunological profiles which characterize ARF/RHD, and genetic mutations conferring ARF/RHD risk, but as yet no new diagnostic testing strategy is ready for clinical application. SUMMARY Reduction in the disease burden and national costs of ARF and RHD are major priorities. New initiatives in the primary and secondary prevention of ARF/RHD, novel developments in pathogenesis and biomarker research and steady progress in vaccine development, are all causes for optimism for improving control of ARF/RHD, which affect the poorest of the poor.
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