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Birabwa C, Banke-Thomas A, Semaan A, van Olmen J, Kananura RM, Arinaitwe ES, Waiswa P, Beňová L. The quality of routine data for measuring facility-based maternal mortality in public and private health facilities in Kampala City, Uganda. Popul Health Metr 2024; 22:22. [PMID: 39180044 PMCID: PMC11342531 DOI: 10.1186/s12963-024-00343-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 08/15/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Routine health facility data are an important source of health information in resource-limited settings. Regular quality assessments are necessary to improve the reliability of routine data for different purposes, including estimating facility-based maternal mortality. This study aimed to assess the quality of routine data on deliveries, livebirths and maternal deaths in Kampala City, Uganda. METHODS We reviewed routine health facility data from the district health information system (DHIS2) for 2016 to 2021. This time period included an upgrade of DHIS2, resulting in two datasets (2016-2019 and 2020-2021) that were managed separately. We analysed data for all facilities that reported at least one delivery in any of the six years, and for a subset of facilities designated to provide emergency obstetric care (EmOC). We adapted the World Health Organization data quality review framework to assess completeness and internal consistency of the three data elements, using 2019 and 2021 as reference years. Primary data were collected to verify reporting accuracy in four purposively selected EmOC facilities. Data were disaggregated by facility level and ownership. RESULTS We included 255 facilities from 2016 to 2019 and 247 from 2020 to 2021; of which 30% were EmOC facilities. The overall completeness of data for deliveries and livebirths ranged between 53% and 55%, while it was < 2% for maternal deaths (98% of monthly values were zero). Among EmOC facilities, completeness was higher for deliveries and livebirths at 80%; and was < 6% for maternal deaths. For the whole sample, the prevalence of outliers for all three data elements was < 2%. Inconsistencies over time were mostly observed for maternal deaths, with the highest difference of 96% occurring in 2021. CONCLUSIONS Routine data from childbirth facilities in Kampala were generally suboptimal, but the quality was better in EmOC facilities. Given likely underreporting of maternal deaths, further efforts to verify and count all facility-related maternal deaths are essential to accurately estimate facility-based maternal mortality. Data reliability could be enhanced by improving reporting practices in EmOC facilities and streamlining reporting processes in private-for-profit facilities. Further qualitative studies should identify critical points where data are compromised, and data quality assessments should consider service delivery standards.
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Affiliation(s)
- Catherine Birabwa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.
| | - Aduragbemi Banke-Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Rornald Muhumuza Kananura
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | | | - Peter Waiswa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Global Public Health, Karolinska Institute, Stockholm, Sweden
- Busoga Health Forum, Jinja, Uganda
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Muralidharan V, Schamroth J, Youssef A, Celi LA, Daneshjou R. Applied artificial intelligence for global child health: Addressing biases and barriers. PLOS DIGITAL HEALTH 2024; 3:e0000583. [PMID: 39172772 PMCID: PMC11340888 DOI: 10.1371/journal.pdig.0000583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Given the potential benefits of artificial intelligence and machine learning (AI/ML) within healthcare, it is critical to consider how these technologies can be deployed in pediatric research and practice. Currently, healthcare AI/ML has not yet adapted to the specific technical considerations related to pediatric data nor adequately addressed the specific vulnerabilities of children and young people (CYP) in relation to AI. While the greatest burden of disease in CYP is firmly concentrated in lower and middle-income countries (LMICs), existing applied pediatric AI/ML efforts are concentrated in a small number of high-income countries (HICs). In LMICs, use-cases remain primarily in the proof-of-concept stage. This narrative review identifies a number of intersecting challenges that pose barriers to effective AI/ML for CYP globally and explores the shifts needed to make progress across multiple domains. Child-specific technical considerations throughout the AI/ML lifecycle have been largely overlooked thus far, yet these can be critical to model effectiveness. Governance concerns are paramount, with suitable national and international frameworks and guidance required to enable the safe and responsible deployment of advanced technologies impacting the care of CYP and using their data. An ambitious vision for child health demands that the potential benefits of AI/Ml are realized universally through greater international collaboration, capacity building, strong oversight, and ultimately diffusing the AI/ML locus of power to empower researchers and clinicians globally. In order that AI/ML systems that do not exacerbate inequalities in pediatric care, teams researching and developing these technologies in LMICs must ensure that AI/ML research is inclusive of the needs and concerns of CYP and their caregivers. A broad, interdisciplinary, and human-centered approach to AI/ML is essential for developing tools for healthcare workers delivering care, such that the creation and deployment of ML is grounded in local systems, cultures, and clinical practice. Decisions to invest in developing and testing pediatric AI/ML in resource-constrained settings must always be part of a broader evaluation of the overall needs of a healthcare system, considering the critical building blocks underpinning effective, sustainable, and cost-efficient healthcare delivery for CYP.
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Affiliation(s)
- Vijaytha Muralidharan
- Department of Dermatology, Stanford University, Stanford, California, United States of America
| | - Joel Schamroth
- Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Alaa Youssef
- Stanford Center for Artificial Intelligence in Medicine and Imaging, Department of Radiology, Stanford University, Stanford, California, United States of America
| | - Leo A. Celi
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Roxana Daneshjou
- Department of Dermatology, Stanford University, Stanford, California, United States of America
- Department of Biomedical Data Science, Stanford University, Stanford, California, United States of America
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Ares-Blanco S, Guisado-Clavero M, Lygidakis C, Fernández-García M, Petek D, Vinker S, Li D, Stadval A, Solves JJM, Del Rio LR, Larrondo IG, Fitzgerald L, Adler L, Assenova R, Bakola M, Bayen S, Brutskaya-Stempkovskaya E, Busneag IC, Divjak AĆ, Peña MD, Domeyer PR, Gjorgjievski D, Gómez-Johansson M, Hanževački M, Hoffmann K, Iлькoв O, Ivanna S, Jandrić-Kočić M, Karathanos VT, Kirkovski A, Knežević S, Korkmaz BÇ, Kostić M, Krztoń-Królewiecka A, Heleno B, Nessler K, Lingner H, Murauskienė L, Neves AL, López NP, Perjés Á, Petrazzuoli F, Petricek G, Sattler M, Saurek-Aleksandrovska N, Seifert B, Serafini A, Sentker T, Tiili P, Torzsa P, Valtonen K, Vaes B, van Pottebergh G, Gómez-Bravo R, Astier-Peña MP. Exploring the accessibility of primary health care data in Europe's COVID-19 response: developing key indicators for managing future pandemics (Eurodata study). BMC PRIMARY CARE 2024; 25:221. [PMID: 38902681 PMCID: PMC11188206 DOI: 10.1186/s12875-024-02413-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/29/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Primary Health Care (PHC) plays a crucial role in managing the COVID-19 pandemic, with only 8% of cases requiring hospitalization. However, PHC COVID-19 data often goes unnoticed on European government dashboards and in media discussions. This project aims to examine official information on PHC patient care during the COVID-19 pandemic in Europe, with specific objectives: (1) Describe PHC's clinical pathways for acute COVID-19 cases, including long-term care facilities, (2) Describe PHC COVID-19 pandemic indicators, (3) Develop COVID-19 PHC activity indicators, (4) Explain PHC's role in vaccination strategies, and (5) Create a PHC contingency plan for future pandemics. METHODS A mixed-method study will employ two online questionnaires to gather retrospective PHC data on COVID-19 management and PHC involvement in vaccination strategies. Validation will occur through focus group discussions with medical and public health (PH) experts. A two-wave Delphi survey will establish a European PHC indicators dashboard for future pandemics. Additionally, a coordinated health system action plan involving PHC, secondary care, and PH will be devised to address future pandemic scenarios. ANALYSIS Quantitative data will be analysed using STATA v16.0 for descriptive and multivariate analyses. Qualitative data will be collected through peer-reviewed questionnaires and content analysis of focus group discussions. A Delphi survey and multiple focus groups will be employed to achieve consensus on PHC indicators and a common European health system response plan for future pandemics. The Eurodata research group involving researchers from 28 European countries support the development. DISCUSSION While PHC manages most COVID-19 acute cases, data remains limited in many European countries. This study collects data from numerous countries, offering a comprehensive perspective on PHC's role during the pandemic in Europe. It pioneers the development of a PHC dashboard and health system plan for pandemics in Europe. These results may prove invaluable in future pandemics. However, data may have biases due to key informants' involvement and may not fully represent all European GP practices. PHC has a significant role in the management of the COVID-19 pandemic, as most of the cases are mild or moderate and only 8% needed hospitalization. However, PHC COVID-19 activity data is invisible on governments' daily dashboards in Europe, often overlooked in media and public debates.
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Affiliation(s)
- Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- SemFYC representative in EGPRN (European General Practitioner Research Network), Madrid, Spain
| | - Marina Guisado-Clavero
- Investigation Support Multidisciplinary Unit for Primary Health Care and Community North Area of Madrid, Madrid, Spain
| | - Charilaos Lygidakis
- World Organization of Family Doctors (WONCA) Chief Executive Officer, Brussels, Belgium
| | - María Fernández-García
- Las Cortes Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- semFYC Vice-Chair, Madrid, Spain
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- EGPRN, Brussels, Belgium
| | - Shlomo Vinker
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University and WONCA Europe President, Tel Aviv, Israel
| | - Donald Li
- World Organization of Family Doctors (WONCA) Past president, Brussels, Belgium
| | - Anna Stadval
- World Organization of Family Doctors (WONCA) President, Brussels, Belgium
| | | | - Lourdes Ramos Del Rio
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Ileana Gefaell Larrondo
- Fundación de Investigación e Innovación Biosanitaria de Atención Primaria (FIIBAP), Madrid, Spain
- Red de Investigación de Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Barcelona, Spain
| | - Louise Fitzgerald
- Member of Irish College of General Practice (MICGP), Member of Royal College of Physician (MRCSI), Dublin, Ireland
| | - Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Radost Assenova
- Department Urology and General Practice, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Maria Bakola
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Science, University of Ioannina, Ioannina, Greece
| | - Sabine Bayen
- Department of General Practice, University of Lille, Lille, France
| | | | - Iliana-Carmen Busneag
- Spiru Haret" University, Occupational Health Expert, Practicing family doctor, Bucharest, Romania
| | - Asja Ćosić Divjak
- Health Centre Zagreb West and Department of Family Medicine, University of Zagreb, Zagreb, Croatia
| | - Maryher Delphin Peña
- Department of Geriatric Medicine, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | | | | | | | - Miroslav Hanževački
- Health Centre Zagreb West and Department of Family Medicine, University of Zagreb, Zagreb, Croatia
| | - Kathryn Hoffmann
- General Practice and Primary Care, Med. University of Vienna, Vienna, Austria
| | - Oкcaнa Iлькoв
- Department of Family Medicine and Outpatient Care, Medical Faculty 2, Uzhhorod National University, Uzhhorod, Ukraine
| | - Shushman Ivanna
- Department of Family Medicine and Outpatient Care, Medical Faculty 2, Uzhhorod National University, Uzhhorod, Ukraine
| | | | - Vasilis Trifon Karathanos
- Medical Department, Medical Education Unit, Laboratory of Hygiene and Epidemiology, Faculty of Health Sciences, University of Ioannina- Greece. GHS, Larnaca, Cyprus
| | - Aleksandar Kirkovski
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | | | | | - Milena Kostić
- Dr Đorđe Kovačević Health Center, Lazarevac, Belgrade, Serbia
| | | | - Bruno Heleno
- Comprehensive Health Research Center, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- USF das Conchas, Regional Health Administration Lisbon and Tagus Valley, Lisbon, Portugal
| | - Katarzyna Nessler
- Department of Family Medicine, UJCM at Uniwersytet Jagielloński - Collegium Medicum, Krakow, Poland
| | - Heidrun Lingner
- Hannover Medical School, Center for Public Health and Healthcare, Hannover, OE, Germany
| | - Liubovė Murauskienė
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnus, Lithuania
| | - Ana Luisa Neves
- Imperial College London, London, UK
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Naldy Parodi López
- Närhälsan Kungshöjd Health Centre, Gothenburg, Sweden
- Department of Clinical Pharmacology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ábel Perjés
- Department of Family Medicine at the University of Semmelweis, Budapest, Hungary
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Goranka Petricek
- Health Centre Zagreb West and Department of Family Medicine, University of Zagreb, Zagreb, Croatia
| | | | | | - Bohumil Seifert
- Charles University, First Faculty of Medicine, Institute of General Practice, Prague, Czech Republic
| | - Alicia Serafini
- Azienda Unità Sanitaria Locale di Modena, Laboratorio EduCare, University of Modena and Reggio Emilia, Modena, Italy
| | - Theresa Sentker
- Center for Public Health and Healthcare, Hannover Medical School, Hannover, Germany
| | - Paula Tiili
- Communicable Diseases and Infection Control Unit, City of Vantaa, Vantaa and University of Helsinki, Helsinki, Finland
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Kirsi Valtonen
- Communicable Diseases and Infection Control Unit, City of Vantaa, Vantaa and University of Helsinki, Helsinki, Finland
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Gijs van Pottebergh
- Academisch Centrum voor Huisartsgeneeskunde KU Leuven Kapucijnenvoer, Leuven, Belgium
| | - Raquel Gómez-Bravo
- CHNP, Rehaklinik, Ettelbruck, Luxembourg.
- Department of Behavioural and Cognitive Sciences, Research Group Self-Regulation and Health, Institute for Health and Behaviour, Faculty of Humanities, Education, and Social Sciences, Luxembourg University, WONCA SIGFV Executive, SSLMG Executive, Luxembourg, Luxembourg.
| | - Maria Pilar Astier-Peña
- Universitas Health Centre, Public Health Service of Aragon, Zaragoza, Spain
- Chair of Patient Safety Working Group of Semfyc (Spanish Society for Family and Community Medicine) and and SECA (Spanish Society for Healthcare Quality) Board Member, Madrid, Spain
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Molenaar J, Beňová L, Christou A, Lange IL, van Olmen J. Travelling numbers and broken loops: A qualitative systematic review on collecting and reporting maternal and neonatal health data in low-and lower-middle income countries. SSM Popul Health 2024; 26:101668. [PMID: 38645668 PMCID: PMC11031824 DOI: 10.1016/j.ssmph.2024.101668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/27/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
Data and indicator estimates are considered vital to document persisting challenges in maternal and newborn health and track progress towards global goals. However, prioritization of standardised, comparable quantitative data can preclude the collection of locally relevant information and pose overwhelming burdens in low-resource settings, with negative effects on the provision of quality of care. A growing body of qualitative studies aims to provide a place-based understanding of the complex processes and human experiences behind the generation and use of maternal and neonatal health data. We conducted a qualitative systematic review exploring how national or international requirements to collect and report data on maternal and neonatal health indicators are perceived and experienced at the sub-national and country level in low-income and lower-middle income countries. We systematically searched six electronic databases for qualitative and mixed-methods studies published between January 2000 and March 2023. Following screening of 4084 records by four reviewers, 47 publications were included in the review. Data were analysed thematically and synthesised from a Complex Adaptive Systems (CAS) theoretical perspective. Our findings show maternal and neonatal health data and indicators are not fixed, neutral entities, but rather outcomes of complex processes. Their collection and uptake is influenced by a multitude of system hardware elements (human resources, relevancy and adequacy of tools, infrastructure, and interoperability) and software elements (incentive systems, supervision and feedback, power and social relations, and accountability). When these components are aligned and sufficiently supportive, data and indicators can be used for positive system adaptivity through performance evaluation, prioritization, learning, and advocacy. Yet shortcomings and broken loops between system components can lead to unforeseen emergent behaviors such as blame, fear, and data manipulation. This review highlights the importance of measurement approaches that prioritize local relevance and feasibility, necessitating participatory approaches to define context-specific measurement objectives and strategies.
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Affiliation(s)
- Jil Molenaar
- Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000, Antwerp, Belgium
- University of Antwerp, Doornstraat 331, 2610, Wilrijk, Belgium
| | - Lenka Beňová
- Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Aliki Christou
- Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Isabelle L. Lange
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
- Center for Global Health, Technical University of Munich (TUM), Munich, Germany
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Taylor A, Liwewe T, Todd J, Kankhwali C, Mwale A, Kiwuwa-Muyingo S. Insights into COVID-19 data collection and management in Malawi: exploring processes, perceptions, and data discrepancies. Wellcome Open Res 2024; 9:217. [PMID: 39114492 PMCID: PMC11303952 DOI: 10.12688/wellcomeopenres.21131.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 08/10/2024] Open
Abstract
Background The completion of case-based surveillance forms was vital for case identification during COVID-19 surveillance in Malawi. Despite significant efforts, the resulting national data suffered from gaps and inconsistencies which affected its optimal usability. The objectives of this study were to investigate the processes of collecting and reporting COVID-19 data, to explore health workers' perceptions and understanding of the collection tools and processes, and to identify factors contributing to data quality. Methods A total of 75 healthcare professionals directly involved in COVID-19 data collection from the Malawi Ministry of Health in Lilongwe and Blantyre participated in Focus Group Discussions and In-Depth Interviews. We collected participants' views on the effectiveness of surveillance forms in collecting the intended data, as well as on the data collection processes and training needs. We used MAXQDA for thematic and document analysis. Results Form design significantly influenced data quality and, together with challenges in applying case definitions, formed 44% of all issues raised. Concerns regarding processes used in data collection and training gaps comprised 49% of all the issues raised. Language issues (2%) and privacy, ethical, and cultural considerations (4%), although mentioned less frequently, offered compelling evidence for further review. Conclusions Our study highlights the integral connection between data quality and the design and utilization of data collection forms. While the forms were deemed to contain the most relevant fields, deficiencies in format, order of fields, and the absence of an addendum with guidelines, resulted in large gaps and errors. Form design needs to be reviewed so that it appropriately fits into the overall processes and systems that capture surveillance data. This study is the first of its kind in Malawi, offering an in-depth view of the perceptions and experiences of health professionals involved in disease surveillance on the tools and processes they use.
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Affiliation(s)
- Amelia Taylor
- Malawi University of Business and Applied Sciences, Blantyre, Malawi
| | | | - Jim Todd
- The London School of Hygiene and Tropical Medicine, London, UK
| | | | - Anne Mwale
- The Public Health Institute of Malawi, Lilongwe, Malawi
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Umer F, Adnan S, Lal A. Research and application of artificial intelligence in dentistry from lower-middle income countries - a scoping review. BMC Oral Health 2024; 24:220. [PMID: 38347508 PMCID: PMC10860267 DOI: 10.1186/s12903-024-03970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/02/2024] [Indexed: 02/15/2024] Open
Abstract
Artificial intelligence (AI) has been integrated into dentistry for improvement of current dental practice. While many studies have explored the utilization of AI in various fields, the potential of AI in dentistry, particularly in low-middle income countries (LMICs) remains understudied. This scoping review aimed to study the existing literature on the applications of artificial intelligence in dentistry in low-middle income countries. A comprehensive search strategy was applied utilizing three major databases: PubMed, Scopus, and EBSCO Dentistry & Oral Sciences Source. The search strategy included keywords related to AI, Dentistry, and LMICs. The initial search yielded a total of 1587, out of which 25 articles were included in this review. Our findings demonstrated that limited studies have been carried out in LMICs in terms of AI and dentistry. Most of the studies were related to Orthodontics. In addition gaps in literature were noted such as cost utility and patient experience were not mentioned in the included studies.
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Affiliation(s)
- Fahad Umer
- Department of Surgery, Section of Dentistry, The Aga Khan University, Karachi, Pakistan
| | - Samira Adnan
- Department of Operative Dentistry, Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Abhishek Lal
- Department of Medicine, Section of Gastroenterology, The Aga Khan University, Karachi, Pakistan.
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Zenebe GA, Alemu W, Yehualashet D, Nakachew M. Improving data use in decision-making and utilization of maternal healthcare services through a data-informed platform for health approaches in districts of the Gedeo Zone, southern Ethiopia, 2023: a cluster-randomized control trial. FRONTIERS IN HEALTH SERVICES 2023; 3:1125399. [PMID: 37670893 PMCID: PMC10475933 DOI: 10.3389/frhs.2023.1125399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 08/07/2023] [Indexed: 09/07/2023]
Abstract
Background In low-resource countries such as Ethiopia, the utilization of local data for planning and decision-making health systems was frequently constrained. In addition, despite several government initiatives, maternal health services were not completely utilized. On the other hand, efforts to effectively utilize the local data available to improve the utilization level of maternal healthcare services were insufficient, necessitating the need for a different approach. Objective This implementation study aims to test and validate the effectiveness of a data-informed platform for health (DIPH) strategies on data use for decision-making and utilization of maternal health services in districts of the Gedeo Zone, southern Ethiopia. Methods A two-arm parallel group, type II hybrid, cluster-randomized control trial design has been implemented to conduct the study between 1 September 2022 and 29 February 2024. Six woredas/districts have been assigned to the intervention arm and the other six to the control arm. Baseline and end-line data have been collected from 120 eligible health management staff (from both intervention arm and control arm). In the intervention arm, district health management staff have been given specialized training and continuous technical assistance as a package called the DIPH strategy by embedding it with the district's current decision-making platform such as Performance Review Team meetings. The DIPH strategy has mainly focused on five-step approaches such as situational assessment, stakeholder engagement, defining/setting priorities, planning, and follow-up. Health management staff in the control arm have performed their regular daily activities. The χ2 and t-tests have been used to check the effect of the intervention. In addition, difference-in-differences estimates have been calculated because the change may inherently occur over time. A P-value of <0.05 and a 95% confidence interval have been used to declare the significance of the intervention. Discussion The findings of this study were supposed to give insights into implementation strategies that improve data use in decision-making and utilization of maternal healthcare services at the woreda level and uncover contextual factors that boost the response of these strategies.
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Affiliation(s)
- Getachew Assefa Zenebe
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Wagaye Alemu
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Daniel Yehualashet
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Mequanint Nakachew
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
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Chockalingam M, Srivastava A, C Gandhi DB, Solomon JM, Kamalakannan S, Rajeswaran J, Dhamija RK, Someshwar HP, Surya N. Digitalization of Neurorehabilitation in LMICs: Experiences from the Indian Federation of Neurorehabilitation. Neurol India 2023; 71:783-784. [PMID: 37635520 DOI: 10.4103/0028-3886.383873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Manigandan Chockalingam
- Department of Occupational Therapy, School of Health Sciences, University of Galway, University Road, Galway, Ireland
| | - Abhishek Srivastava
- Centre for Physical Medicine & Rehabilitation, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharastra, India
| | - Dorcas B C Gandhi
- Department of Neurology and College of Physiotherapy, Christian Medical College & Hospital, Ludhiana, Punjab, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sureshkumar Kamalakannan
- Department of Social Work, School of Health and Life Sciences, Education and Community Well-Being, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Jamuna Rajeswaran
- Department of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India
| | - Rajinder K Dhamija
- Institute of Human Behaviour and Allied Sciences (IHBAS), New Delhi, India
| | - Hitav Pankaj Someshwar
- Early Intervention Center, TNMC and BYL Nair Ch. Hospital, Bhaudaji Road, Matunga, Mumbai, Maharastra, India
| | - Nirmal Surya
- Department of Neurology, Bombay Hospital and Medical Research, Mumbai, Maharastra, India
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Lavoie MCC, Blanco N, Mwango LK, Nichols BE, Whittington A, Lindsay B, Adebayo O, Mujansi M, Tembo K, Hachaambwa L, Mumba D, Musonda B, Claassen CW. Addressing the Need for a Preexposure Prophylaxis Monitoring and Evaluation Implementation Guide: Experience From Zambia. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200396. [PMID: 37116937 PMCID: PMC10141438 DOI: 10.9745/ghsp-d-22-00396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/23/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND The HIV care continuum comprises well-defined steps and indicators. In contrast, indicators along the preexposure prophylaxis (PrEP) cascade are still in the early stages of implementation. Monitoring and evaluation (M&E) of PrEP services is critical to optimizing PrEP uptake and adherence during periods of HIV risk. We provide an overview of global indicators for PrEP, describe the development process and outcomes of Zambia's 2022 National Pre-Exposure Prophylaxis (PrEP) Program Monitoring & Evaluation Implementation Guide, and discuss the guide's implications for other countries in sub-Saharan Africa. NATIONAL M&E GUIDE DEVELOPMENT PROCESS During the scale-up of PrEP, the Zambia Ministry of Health (MOH) and the National HIV/AIDS/STI/TB Council recognized the need for a national unified monitoring system to guide the effective implementation of PrEP services. Stakeholders from the MOH, civil society, professional organizations, funding agencies, and implementing partners developed the National Pre-Exposure Prophylaxis (PrEP) Program Monitoring & Evaluation Implementation Guide. This guide is aligned with the existing global indicators from the World Health Organization and the U.S. President's Emergency Plan for AIDS Relief and adapted to the country's needs, context, and health information systems. Zambia's experience in developing the guide has highlighted the importance of strengthening client-level monitoring systems for HIV prevention, ensuring flexibility of the PrEP monitoring system to accommodate PrEP delivery modalities and differentiated service delivery models, and training health workers to enhance PrEP services and deliver care PrEP services along the continuum to prevent HIV acquisition effectively. CONCLUSIONS Using a collaborative and consensus-based approach, Zambia developed its first national PrEP M&E implementation guide to provide standardized guidelines for optimizing the delivery, monitoring, and evaluation of PrEP service delivery. Zambia's experience can inform other countries in sub-Saharan Africa as they develop national M&E implementation approaches for PrEP.
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Affiliation(s)
- Marie-Claude C Lavoie
- Division of Global Health Sciences, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Natalie Blanco
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Linah K Mwango
- Center for International Health Education and Biosecurity-Zambia, Lusaka, Zambia
| | - Brooke E Nichols
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Anna Whittington
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Brianna Lindsay
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Morley Mujansi
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | - Kalima Tembo
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | - Lottie Hachaambwa
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for International Health Education and Biosecurity-Zambia, Lusaka, Zambia
| | - Daliso Mumba
- National HIV/AIDS/STI/TB Council, Lusaka, Zambia
| | | | - Cassidy W Claassen
- Division of Global Health Sciences, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
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Agweyu A, Hill K, Diaz T, Jackson D, Hailu BG, Muzigaba M. Regular measurement is essential but insufficient to improve quality of healthcare. BMJ 2023; 380:e073412. [PMID: 36914202 PMCID: PMC9999465 DOI: 10.1136/bmj-2022-073412] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Ambrose Agweyu and colleagues argue that large scale improvements in quality of healthcare require strong change management as well as health information systems that can provide continuous and rapid feedback
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Affiliation(s)
- Ambrose Agweyu
- Department of Epidemiology and Demography KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Theresa Diaz
- Department of Maternal Newborn, Child, and Adolescent Health, and Ageing, World Health Organization, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Debra Jackson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, University of the Western Cape, Bellville, South Africa
- Data and Analytics Section, Unicef, New York, USA
| | - Binyam G Hailu
- World Health Organization Country Office, Free Town, Sierra Leone
| | - Moise Muzigaba
- Department of Maternal Newborn, Child, and Adolescent Health, and Ageing, World Health Organization, Avenue Appia 20, 1202 Geneva, Switzerland
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Artificial intelligence for strengthening healthcare systems in low- and middle-income countries: a systematic scoping review. NPJ Digit Med 2022; 5:162. [PMID: 36307479 PMCID: PMC9614192 DOI: 10.1038/s41746-022-00700-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/29/2022] [Indexed: 02/08/2023] Open
Abstract
In low- and middle-income countries (LMICs), AI has been promoted as a potential means of strengthening healthcare systems by a growing number of publications. We aimed to evaluate the scope and nature of AI technologies in the specific context of LMICs. In this systematic scoping review, we used a broad variety of AI and healthcare search terms. Our literature search included records published between 1st January 2009 and 30th September 2021 from the Scopus, EMBASE, MEDLINE, Global Health and APA PsycInfo databases, and grey literature from a Google Scholar search. We included studies that reported a quantitative and/or qualitative evaluation of a real-world application of AI in an LMIC health context. A total of 10 references evaluating the application of AI in an LMIC were included. Applications varied widely, including: clinical decision support systems, treatment planning and triage assistants and health chatbots. Only half of the papers reported which algorithms and datasets were used in order to train the AI. A number of challenges of using AI tools were reported, including issues with reliability, mixed impacts on workflows, poor user friendliness and lack of adeptness with local contexts. Many barriers exists that prevent the successful development and adoption of well-performing, context-specific AI tools, such as limited data availability, trust and evidence of cost-effectiveness in LMICs. Additional evaluations of the use of AI in healthcare in LMICs are needed in order to identify their effectiveness and reliability in real-world settings and to generate understanding for best practices for future implementations.
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Asefa A, Dossou JP, Hanson C, Hounsou CB, Namazzi G, Meja S, Mkoka DA, Agballa G, Babirye J, Semaan A, Annerstedt KS, Delvaux T, Marchal B, Van Belle S, Pleguezuelo VC, Benova L. Methodological reflections on health system oriented assessment of maternity care in 16 hospitals in sub-Saharan Africa: an embedded case study. Health Policy Plan 2022; 37:1257-1266. [PMID: 36087095 DOI: 10.1093/heapol/czac078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/11/2022] [Accepted: 09/09/2022] [Indexed: 11/15/2022] Open
Abstract
Health Facility Assessments (HFAs) assessing facilities' readiness to provide services are well-established. However, HFA questionnaires are typically quantitative and lack depth to understand systems in which health facilities operate-crucial to designing context-oriented interventions. We report lessons from a multiple embedded case study exploring the experiences of HFA data collectors in implementing a novel HFA tool developed using systems thinking approach. We assessed 16 hospitals in four countries (Benin, Malawi, Tanzania, and Uganda) as part of a quality improvement implementation research. Our tool was organized in 17 sections and included dimensions of hospital governance, leadership, and financing; maternity care standards and procedures; ongoing quality improvement practices; interactions with communities; and mapping of the areas related to maternal care. Data for this study was collected using in-depth interviews with senior experts who conducted the HFA in the countries one to three months after completion of the HFAs. Data were analyzed using the inductive thematic analysis approach. Our HFA faced challenges in logistics (accessing key hospital-based respondents, high turnover of managerial staff, and difficulty accessing information considered sensitive in the context) and methodology (response bias, lack of data quality, and data entry into an electronic platform). Data elements of governance, leadership, and financing were the most affected. Opportunities and strategies adopted aimed at enhancing data collection (building on prior partnerships, understanding local and institutional bureaucracies) and enhancing data richness (identifying respondents with institutional memory, learning from experience, and conducting observations at various times). Moreover, HFA data collectors conducted abstraction of records and interviews in a flexible and adaptive way to enhance data quality. Lessons and new skills learned from our HFA could be used as inputs to respond to the growing need of integrating the systems thinking approach in HFA to improve contextual understanding of operations and structure.
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Affiliation(s)
- Anteneh Asefa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jean-Paul Dossou
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Claudia Hanson
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Gertrude Namazzi
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Samuel Meja
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dickson Ally Mkoka
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Gottfried Agballa
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Josephine Babirye
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Therese Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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