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Zhang J, Liu L, Xiang P, Fang Q, Nie X, Ma H, Hu J, Xiong R, Wang Y, Lu H. AI co-pilot bronchoscope robot. Nat Commun 2024; 15:241. [PMID: 38172095 PMCID: PMC10764930 DOI: 10.1038/s41467-023-44385-7] [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: 06/13/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
The unequal distribution of medical resources and scarcity of experienced practitioners confine access to bronchoscopy primarily to well-equipped hospitals in developed regions, contributing to the unavailability of bronchoscopic services in underdeveloped areas. Here, we present an artificial intelligence (AI) co-pilot bronchoscope robot that empowers novice doctors to conduct lung examinations as safely and adeptly as experienced colleagues. The system features a user-friendly, plug-and-play catheter, devised for robot-assisted steering, facilitating access to bronchi beyond the fifth generation in average adult patients. Drawing upon historical bronchoscopic videos and expert imitation, our AI-human shared control algorithm enables novice doctors to achieve safe steering in the lung, mitigating misoperations. Both in vitro and in vivo results underscore that our system equips novice doctors with the skills to perform lung examinations as expertly as seasoned practitioners. This study offers innovative strategies to address the pressing issue of medical resource disparities through AI assistance.
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Affiliation(s)
- Jingyu Zhang
- State Key Laboratory of Industrial Control and Technology, Zhejiang University, 310027, Hangzhou, China
- Institute of Cyber-Systems and Control, Department of Control Science and Engineering, Zhejiang University, 310027, Hangzhou, China
| | - Lilu Liu
- State Key Laboratory of Industrial Control and Technology, Zhejiang University, 310027, Hangzhou, China
- Institute of Cyber-Systems and Control, Department of Control Science and Engineering, Zhejiang University, 310027, Hangzhou, China
| | - Pingyu Xiang
- State Key Laboratory of Industrial Control and Technology, Zhejiang University, 310027, Hangzhou, China
- Institute of Cyber-Systems and Control, Department of Control Science and Engineering, Zhejiang University, 310027, Hangzhou, China
| | - Qin Fang
- State Key Laboratory of Industrial Control and Technology, Zhejiang University, 310027, Hangzhou, China
- Institute of Cyber-Systems and Control, Department of Control Science and Engineering, Zhejiang University, 310027, Hangzhou, China
| | - Xiuping Nie
- State Key Laboratory of Industrial Control and Technology, Zhejiang University, 310027, Hangzhou, China
- Institute of Cyber-Systems and Control, Department of Control Science and Engineering, Zhejiang University, 310027, Hangzhou, China
| | - Honghai Ma
- Department of Thoracic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, China
| | - Jian Hu
- Department of Thoracic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 310009, Hangzhou, China
| | - Rong Xiong
- State Key Laboratory of Industrial Control and Technology, Zhejiang University, 310027, Hangzhou, China.
- Institute of Cyber-Systems and Control, Department of Control Science and Engineering, Zhejiang University, 310027, Hangzhou, China.
| | - Yue Wang
- State Key Laboratory of Industrial Control and Technology, Zhejiang University, 310027, Hangzhou, China.
- Institute of Cyber-Systems and Control, Department of Control Science and Engineering, Zhejiang University, 310027, Hangzhou, China.
| | - Haojian Lu
- State Key Laboratory of Industrial Control and Technology, Zhejiang University, 310027, Hangzhou, China.
- Institute of Cyber-Systems and Control, Department of Control Science and Engineering, Zhejiang University, 310027, Hangzhou, China.
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2
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Jackson P, Muyanja SZ, Siddharthan T. Health Equity and Respiratory Diseases in Low- and Middle-Income Countries. Clin Chest Med 2023; 44:623-634. [PMID: 37517840 DOI: 10.1016/j.ccm.2023.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Over 80% of the morbidity and mortality related to acute and chronic respiratory diseases occur in low- and middle-income countries (LMICs), a reflection of vast disparities in care for these conditions. Over the next decade, the prevalence of respiratory diseases is expected to increase, as population growth in LMICs exceeds high-income countries (HICs). Pediatric morbidity and mortality from lower respiratory tract infections and asthma occur almost exclusively in LMICs, contributing to a greater loss of quality adjusted life years from these conditions when compared with HICs.
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Affiliation(s)
- Peter Jackson
- Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, 1200 East Broad Street, Box 980050, Richmond, VA 23298, USA
| | | | - Trishul Siddharthan
- Division of Pulmonary and Critical Care Medicine, University of Miami, 1951 Northwest 7th Avenue, Miami, FL 33136, USA.
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3
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Karmali DN, Argento AC, Kirenga B, Batra H, Lee HJ, MacRosty CR, Lerner GR, Siddharthan T, Worodria W, Jackson P. A Longitudinal Study of Multimodal Bronchoscopy Training in Uganda. ATS Sch 2023; 4:152-163. [PMID: 37538081 PMCID: PMC10394594 DOI: 10.34197/ats-scholar.2022-0080oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/22/2022] [Indexed: 08/05/2023] Open
Abstract
Background Flexible bronchoscopy is an essential tool in diagnosing and managing pulmonary diseases. However, there is limited capacity for bronchoscopy in low and middle income countries (LMICs). In 2019, a pilot program for flexible bronchoscopy training was launched for local physicians in Kampala, Uganda. We then conducted a follow up multimodal bronchoscopy course after 2 years. Objective The aim of this study is to assess a longitudinal multimodal bronchoscopy training in an LMIC setting. Methods A multimodal follow up curriculum was developed with pulmonologists from Uganda and the United States. The training was delivered to Ugandan providers who attended previous bronchoscopy training and new participants. The training included a prepared curriculum consisting of lectures, simulations, and deliberate practice-based proctoring. A 12-question multiple-choice exam was administered at the beginning and end of the course, assessing knowledge. Procedural competency was measured using a validated assessment tool called the BSTAT (Bronchoscopic Skills and Tasks Assessment Tool). Results were analyzed to evaluate the retention of knowledge among those who took part in previous training and the efficacy of the follow-up curriculum for participants without previous training. Results Among the participants who attended didactic training in 2022 (11), mean exam scores were improved after training, from 43.9 (standard deviation [SD], 11.3) to 59.8 (SD, 16.1) (mean difference [MD], +15.9; SD, 13.9; P = 0.008), but were lower compared with post didactic scores in 2019: 90.8 (SD, 6.1; MD, -31; P < 0.0001). Participants who completed BSTAT assessments (8) had mean scores similar in 2019 and 2022, at 72.1 and 75.2, respectively (MD, 3.1; P = 0.38). Conclusion This study provides an example of how a longitudinal multimodal bronchoscopy curriculum can improve competency and proficiency for local physicians in an LMIC.
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Affiliation(s)
- Dipan N. Karmali
- Division of Pulmonary and Critical Care, University of Miami Health System, Miami, Florida
| | - A. Christine Argento
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland
| | - Bruce Kirenga
- College of Health Sciences and
- Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Hitesh Batra
- Division of Pulmonary and Critical Care, University of Alabama Birmingham, Birmingham, Alabama
| | - Hans J. Lee
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland
| | - Christina R. MacRosty
- Division of Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and
| | - Guil R. Lerner
- Division of Pulmonary and Critical Care, University of Miami Health System, Miami, Florida
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care, University of Miami Health System, Miami, Florida
| | - William Worodria
- College of Health Sciences and
- Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Peter Jackson
- Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, Virginia
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4
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Magwenzi P, Rusakaniko S, Sibanda EN, Gumbo FZ. Challenges in the diagnosis of asthma in children, what are the solutions? A scoping review of 3 countries in sub Saharan Africa. Respir Res 2022; 23:254. [PMID: 36123720 PMCID: PMC9487077 DOI: 10.1186/s12931-022-02170-y] [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: 09/10/2021] [Accepted: 09/09/2022] [Indexed: 08/29/2023] Open
Abstract
Background Asthma is the commonest chronic respiratory tract disease in children. In low-income countries, challenges exist in asthma diagnosis. In surveys done in children, the prevalence of ‘asthma’ defined by symptoms is high compared to ‘doctor diagnosed asthma’. The questions answered by this review are (i) What challenges have been experienced in the diagnosis of asthma in children? (ii) What solutions will address these challenges? Methods The Arksey and O’Malley’s framework for scoping reviews was used for the study methodology, while the PRISMA-ScR checklist guided the reporting process. Electronic databases: PubMed Central, EMBASE and Google Scholar were searched. Primary quantitative and qualitative studies and reviews from 2010 to 2021, from Nigeria, South Africa and Uganda written in English or translated to English, which answered the study questions were included. The author, title, country, study type, methods, purpose, findings and references were captured onto a predefined data collection table. The ‘Preview, Question, Read, Summarise’ system was used and a narrative report was used to summarise the findings. Results A total of 28 studies were included. The causes of under-diagnosis of asthma include lack of community knowledge and perception of asthma, poor accessibility to health care, strained health systems, lack of diagnostic tests including spirometry, low levels of knowledge among health-care workers and lack of or non-implementation of asthma guidelines. Strategies to improve asthma diagnosis will include community and school based education programmes, revision of asthma diagnostic terms, guideline development and implementation and health systems strengthening. Conclusion This scoping review provides research evidence for policy makers and health-workers involved in the care of asthmatic children on challenges faced in asthma diagnosis and strategies to improve asthma diagnosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02170-y.
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Affiliation(s)
- P Magwenzi
- Child and Adolescent Health Unit, Faculty of Medical Sciences, University of Zimbabwe, P O Box A178, Avondale, Harare, Zimbabwe.
| | - S Rusakaniko
- Family Medicine, Global and Public Health Unit, Faculty of Medical Sciences, University of Zimbabwe, P O Box A178, Avondale, Harare, Zimbabwe
| | - E N Sibanda
- Asthma, Allergy and Immune Dysfunction Clinic, 113, Kwame Nkrumah Avenue, Harare, Zimbabwe
| | - F Z Gumbo
- Child and Adolescent Health Unit, Faculty of Medical Sciences, University of Zimbabwe, P O Box A178, Avondale, Harare, Zimbabwe
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Surgical Capacity Building in Low- and Middle-Income Countries: Lessons for Thoracic Surgery. Thorac Surg Clin 2022; 32:269-278. [PMID: 35961735 DOI: 10.1016/j.thorsurg.2022.02.003] [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: 11/20/2022]
Abstract
There is great need for intentional investment in capacity building for thoracic surgical conditions. This article provides a brief overview of thoracic surgical capacity building for low- and middle-income countries using the Lancet framework of infrastructure, workforce, financing, and information management. The authors highlight the needs, opportunities, and challenges that are relevant for the thoracic surgical community, as it aims to increase care for patients with these conditions globally.
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Desalu OO, Ojuawo OB, Aladesanmi AO, Adeoti AO, Opeyemi CM, Oloyede T, Afolayan OJ, Fawibe AE. Etiology and Clinical Patterns of Chronic Cough in the Chest Clinic of a Tertiary Hospital in Nigeria. Int J Gen Med 2022; 15:5285-5296. [PMID: 35655657 PMCID: PMC9153995 DOI: 10.2147/ijgm.s363326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/28/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Olufemi O Desalu
- Department of Medicine University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
- Correspondence: Olufemi O Desalu, Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria, Tel +2348187143391, Email
| | - Olutobi B Ojuawo
- Department of Medicine University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Adeniyi O Aladesanmi
- Department of Medicine University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Adekunle O Adeoti
- Department of Medicine, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
| | - Christopher M Opeyemi
- Department of Medicine University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Taofeek Oloyede
- Department of Medicine, Federal Medical Centre, Katsina, Katsina State, Nigeria
| | - Oluwafemi J Afolayan
- Department of Medicine, Goulburn Valley Health, Shepparton, Victoria State, Australia
| | - Ademola E Fawibe
- Department of Medicine University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
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Zeng LH, Hussain M, Syed SK, Saadullah M, Jamil Q, Alqahtani AM, Alqahtani T, Akram N, Khan IA, Parveen S, Fayyaz T, Fatima M, Shaukat S, Shabbir N, Fatima M, Kanwal A, Barkat MQ, Wu X. Revamping of Chronic Respiratory Diseases in Low- and Middle-Income Countries. Front Public Health 2022; 9:757089. [PMID: 35265582 PMCID: PMC8899038 DOI: 10.3389/fpubh.2021.757089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/29/2021] [Indexed: 01/09/2023] Open
Abstract
Low- and middle-income countries (LMICs) endure an asymmetrically high burden of worldwide disease and death caused by chronic respiratory diseases (CRDs), i.e., asthma, emphysema, bronchiectasis, and post-tuberculosis lung disease (PTLD). CRDs are firmly related with indigence, infectious diseases, and other non-communicable diseases (NCDs) and add to complex multi-disease with great impact on the lives and livelihood of those affected. The pertinence of CRDs to health and demographic wellbeing is relied upon to increment in the long time ahead, as expectations of life rise and the contending dangers of right on time youth mortality and irresistible infections level. The WHO has distinguished the counteraction and control of NCDs as an earnest improvement issue and crucial for the sustainable development goals (SDSs) by 2030. In this review, we center on CRDs in LMICs. We examine the early life roots of CRDs, challenges in their avoidance, identification and administration in LMICs, and the pathways to resolve for accomplish valid widespread wellbeing inclusion.
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Affiliation(s)
- Ling-Hui Zeng
- Department of Pharmacology, Zhejiang University City College, Hangzhou, China
| | - Musaddique Hussain
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Shahzada Khurram Syed
- Department of Basic Medical Sciences, School of Health Sciences, University of Management and Technology Lahore, Lahore, Pakistan
| | - Malik Saadullah
- Department of Pharmaceutical Chemistry, Government College University, Faisalabad, Pakistan
| | - Qurratulain Jamil
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Ali M. Alqahtani
- Department of Pharmacology, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Taha Alqahtani
- Department of Pharmacology, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Nadia Akram
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Imran Ahmad Khan
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Sajida Parveen
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Tehreem Fayyaz
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Mobeen Fatima
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Saira Shaukat
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Najia Shabbir
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Mehwish Fatima
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Aisha Kanwal
- Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | | | - Ximei Wu
- Department of Pharmacology, Zhejiang University City College, Hangzhou, China
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8
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Meghji J, Mortimer K, Agusti A, Allwood BW, Asher I, Bateman ED, Bissell K, Bolton CE, Bush A, Celli B, Chiang CY, Cruz AA, Dinh-Xuan AT, El Sony A, Fong KM, Fujiwara PI, Gaga M, Garcia-Marcos L, Halpin DMG, Hurst JR, Jayasooriya S, Kumar A, Lopez-Varela MV, Masekela R, Mbatchou Ngahane BH, Montes de Oca M, Pearce N, Reddel HK, Salvi S, Singh SJ, Varghese C, Vogelmeier CF, Walker P, Zar HJ, Marks GB. Improving lung health in low-income and middle-income countries: from challenges to solutions. Lancet 2021; 397:928-940. [PMID: 33631128 DOI: 10.1016/s0140-6736(21)00458-x] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 01/19/2023]
Abstract
Low-income and middle-income countries (LMICs) bear a disproportionately high burden of the global morbidity and mortality caused by chronic respiratory diseases (CRDs), including asthma, chronic obstructive pulmonary disease, bronchiectasis, and post-tuberculosis lung disease. CRDs are strongly associated with poverty, infectious diseases, and other non-communicable diseases (NCDs), and contribute to complex multi-morbidity, with major consequences for the lives and livelihoods of those affected. The relevance of CRDs to health and socioeconomic wellbeing is expected to increase in the decades ahead, as life expectancies rise and the competing risks of early childhood mortality and infectious diseases plateau. As such, the World Health Organization has identified the prevention and control of NCDs as an urgent development issue and essential to the achievement of the Sustainable Development Goals by 2030. In this Review, we focus on CRDs in LMICs. We discuss the early life origins of CRDs; challenges in their prevention, diagnosis, and management in LMICs; and pathways to solutions to achieve true universal health coverage.
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Affiliation(s)
- Jamilah Meghji
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Global Initiative for Asthma (GINA), Fontana, WI, USA; Global Initiative for COPD (GOLD), Fontana, WI, USA; British Thoracic Society Global Health Group, London, UK; Global Asthma Network (GAN), Auckland, New Zealand; Pan African Thoracic Society, Durban, South Africa; International Union Against Tuberculosis and Lung Diseases, Paris, France.
| | - Alvar Agusti
- Global Initiative for COPD (GOLD), Fontana, WI, USA; British Thoracic Society Global Health Group, London, UK; Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain
| | - Brian W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Innes Asher
- Global Asthma Network (GAN), Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Eric D Bateman
- Global Initiative for Asthma (GINA), Fontana, WI, USA; Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Karen Bissell
- Global Asthma Network (GAN), Auckland, New Zealand; School of Population Health, University of Auckland, Auckland, New Zealand
| | - Charlotte E Bolton
- British Thoracic Society Global Health Group, London, UK; NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham UK
| | - Andrew Bush
- British Thoracic Society Global Health Group, London, UK; Imperial College and Royal Brompton Hospital, London, UK
| | - Bartolome Celli
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Harvard Medical School, Boston, MA, USA
| | - Chen-Yuan Chiang
- International Union Against Tuberculosis and Lung Diseases, Paris, France; Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Alvaro A Cruz
- Global Initiative for Asthma (GINA), Fontana, WI, USA; Department of Internal Medicine, Federal University of Bahia, Salvador, Brazil
| | - Anh-Tuan Dinh-Xuan
- Cochin Hospital, Université de Paris, Paris, France; European Respiratory Society, Lausanne, Switzerland
| | - Asma El Sony
- Global Asthma Network (GAN), Auckland, New Zealand; International Union Against Tuberculosis and Lung Diseases, Paris, France; Epidemiological Laboratory (EPI Lab) for Public Health and Research, Khartoum, Sudan
| | - Kwun M Fong
- The University of Queensland Thoracic Research Centre and The Prince Charles Hospital, Queensland, QLD, Australia; Asian Pacific Society of Respirology, Tokyo, Japan
| | - Paula I Fujiwara
- International Union Against Tuberculosis and Lung Diseases, Paris, France
| | - Mina Gaga
- Athens Chest Hospital Sotiria, Athens, Greece; World Health Organization, Geneva, Switzerland
| | - Luis Garcia-Marcos
- Global Asthma Network (GAN), Auckland, New Zealand; Paediatric Pulmonology and Allergy Units, Arrixaca Children's University Hospital, University of Murcia, Murcia, Spain; BioHealth Research Institute of Murcia, Murcia, Spain; ARADyAL network, Madrid, Spain
| | - David M G Halpin
- Global Initiative for COPD (GOLD), Fontana, WI, USA; University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - John R Hurst
- British Thoracic Society Global Health Group, London, UK; UCL Respiratory, University College London, London, UK
| | - Shamanthi Jayasooriya
- British Thoracic Society Global Health Group, London, UK; Academic Unit of Primary Care, University of Sheffield, Sheffield, UK
| | - Ajay Kumar
- International Union Against Tuberculosis and Lung Diseases, Paris, France
| | - Maria V Lopez-Varela
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Pulmonary Department, Universidad de la Republica, Montevideo, Uruguay
| | - Refiloe Masekela
- Pan African Thoracic Society, Durban, South Africa; College of Health Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Bertrand H Mbatchou Ngahane
- Pan African Thoracic Society, Durban, South Africa; International Union Against Tuberculosis and Lung Diseases, Paris, France; Douala General Hospital, Douala, Cameroon
| | - Maria Montes de Oca
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Pulmonary Department, Universidad Central de Venezuela, Caracas, Venezuela
| | - Neil Pearce
- Global Asthma Network (GAN), Auckland, New Zealand; London School of Hygiene & Tropical Medicine, London, UK
| | - Helen K Reddel
- Global Initiative for Asthma (GINA), Fontana, WI, USA; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Sundeep Salvi
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Pulmocare Research and Education Foundation, Pune, India
| | - Sally J Singh
- British Thoracic Society Global Health Group, London, UK; Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Cherian Varghese
- Department of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Claus F Vogelmeier
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, Marburg, Germany; German Center for Lung Research (DZL), Giessen, Germany
| | - Paul Walker
- British Thoracic Society Global Health Group, London, UK; Department of Respiratory Medicine, Liverpool Teaching Hospitals, Liverpool, UK
| | - Heather J Zar
- Pan African Thoracic Society, Durban, South Africa; Department of Paediatrics & Child Health, Red Cross Childrens Hospital, Cape Town, South Africa; SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Guy B Marks
- Global Asthma Network (GAN), Auckland, New Zealand; International Union Against Tuberculosis and Lung Diseases, Paris, France; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; UNSW Medicine, Sydney, NSW, Australia
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9
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Plum C, Stolbrink M, Zurba L, Bissell K, Ozoh BO, Mortimer K. Availability of diagnostic services and essential medicines for non-communicable respiratory diseases in African countries. Int J Tuberc Lung Dis 2021; 25:120-125. [PMID: 33656423 PMCID: PMC7987206 DOI: 10.5588/ijtld.20.0762] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND: The global burden of disease due to asthma and chronic obstructive pulmonary disease (COPD) is substantial and particularly great in low- and middle-income countries, including many African countries. Management is affected by availability of diagnostic tests and essential medicines. The study aimed to explore the availability of spirometry services and essential medicines for asthma and COPD in African countries.METHOD: Questionnaires were delivered to healthcare workers at the annual meeting of the Pan African Thoracic Society Methods in Epidemiology and Clinical Research (PATS MECOR) and International Multidisciplinary Programme to Address Lung Health and TB in Africa (IMPALA). Data were analysed using simple descriptive statistics.RESULTS: A total of 37 questionnaires representing 13 African countries were returned. Spirometry availability was 73.0%. The most common reasons for non-availability were lack of knowledge of the utility of the test. Within the study sample, 33.3% faced sporadic availability due to maintenance issues. Essential medicines availability ranged from 37.8% for inhaled corticosteroid-long-acting beta-agonist inhalers to 100% for prednisolone 5 mg tablets, mainly due to supply chain problems.CONCLUSION: There is varied availability of spirometry and WHO essential medicines for COPD and asthma in African countries. Strategies are needed to improve access to basic effective care for people with non-communicable lung disease in Africa.
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Affiliation(s)
- C Plum
- Liverpool School of Tropical Medicine, Liverpool
| | - M Stolbrink
- Institute of Infection, Veterinary and Ecological Sciences, Liverpool, UK
| | - L Zurba
- Education for Health Africa, Durban, South Africa
| | - K Bissell
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - B O Ozoh
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool
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10
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Jackson P, Siddharthan T, Argento AC, Sachdeva A, Yarmus L, Gupte A, Katagira W, Kirenga B, Worodria W, Lee HJ. Pilot Project to Assess the Potential Cost-Benefit of a Bronchoscopy Program for the Diagnosis of TB in Uganda. Chest 2020; 159:1970-1973. [PMID: 33171159 DOI: 10.1016/j.chest.2020.10.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/21/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Peter Jackson
- Division of Pulmonary and Critical Care, Department of Medicine, Virginia Commonwealth University, Richmond, VA.
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - A Christine Argento
- Division of Pulmonary and Critical Care, School of Medicine, Northwestern University, Chicago, IL
| | - Ashutosh Sachdeva
- Division of Pulmonary and Critical Care, School of Medicine, University of Maryland, Baltimore, MD
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Akshay Gupte
- Division of Infectious Diseases, School of Medicine, Johns Hopkins, Baltimore, MD
| | - Winceslaus Katagira
- Makerere University Makerere University, Kampala, Uganda; Makerere Lung Institute, Makerere University Makerere University, Kampala, Uganda
| | - Bruce Kirenga
- Makerere University Makerere University, Kampala, Uganda; Makerere Lung Institute, Makerere University Makerere University, Kampala, Uganda
| | - William Worodria
- Makerere University Makerere University, Kampala, Uganda; Makerere Lung Institute, Makerere University Makerere University, Kampala, Uganda
| | - Hans J Lee
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD
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A Pilot Program Assessing Bronchoscopy Training and Program Initiation in a Low-income Country. J Bronchology Interv Pulmonol 2020; 28:138-142. [PMID: 33105417 DOI: 10.1097/lbr.0000000000000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/10/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Flexible bronchoscopy is an essential procedure for the evaluation and management of the pulmonary disease. However, this technology and related training is not available in many low-middle income countries (LMICs). We conducted a pilot training program for flexible bronchoscopy in Uganda. METHODS A multimodal curriculum was developed with pulmonologists from Uganda and the United States. The training included an online distance learning management system for video content, simulation, just-in-time training, and deliberate practice via clinical proctoring. Procedural standards and a de novo bronchoscopy suite were concurrently developed. Competency was assessed using the Bronchoscopic Skills and Tasks Assessment Tool written examination and the Ontario Bronchoscopy Assessment Tool. RESULTS We trained 3 pulmonary physicians with no prior experience in flexible bronchoscopy. Three bronchoscopies with bronchoalveolar lavage were performed during the training and an additional 11 cases were performed posttraining. All 3 Ugandan physicians had an increase in their written Bronchoscopic Skills and Tasks Assessment Tool and Ontario Bronchoscopy Assessment Tool in the competent range (P<0.05). All bronchoscopies were successfully completed, adequate samples were obtained, and there were no procedure-related complications. CONCLUSION Bronchoscopy implementation in LMICs is feasible, but requires competency-based training. Further studies are needed to validate this curriculum in LMICs, including the use of this type of curriculum for more complicated bronchoscopic procedures.
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Ramirez AG, Nuradin N, Byiringiro F, Ntakiyiruta G, Giles AE, Riviello R. General Thoracic Surgery in Rwanda: An Assessment of Surgical Volume and of Workforce and Material Resource Deficits. World J Surg 2019; 43:36-43. [PMID: 30132227 PMCID: PMC6318006 DOI: 10.1007/s00268-018-4771-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Benchmarking operative volume and resources is necessary to understand current efforts addressing thoracic surgical need. Our objective was to examine the impact on thoracic surgery volume and patient access in Rwanda following a comprehensive capacity building program, the Human Resources for Health (HRH) Program, and thoracic simulation training. METHODS A retrospective cohort study was conducted of operating room registries between 2011 and 2016 at three Rwandan referral centers: University Teaching Hospital of Kigali, University Teaching Hospital of Butare, and King Faisal Hospital. A facility-based needs assessment of essential surgical and thoracic resources was performed concurrently using modified World Health Organization forms. Baseline patient characteristics at each site were compared using a Pearson Chi-squared test or Kruskal-Wallis test. Comparisons of operative volume were performed using paired parametric statistical methods. RESULTS Of 14,130 observed general surgery procedures, 248 (1.76%) major thoracic cases were identified. The most common indications were infection (45.9%), anatomic abnormalities (34.4%), masses (13.7%), and trauma (6%). The proportion of thoracic cases did not increase during the HRH program (2.07 vs 1.78%, respectively, p = 0.22) or following thoracic simulation training (1.95 2013 vs 1.44% 2015; p = 0.15). Both university hospitals suffer from inadequate thoracic surgery supplies and essential anesthetic equipment. The private hospital performed the highest percentage of major thoracic procedures consistent with greater workforce and thoracic-specific material resources (0.89% CHUK, 0.67% CHUB, and 5.42% KFH; p < 0.01). CONCLUSIONS AND RELEVANCE Lack of specialist providers and material resources limits thoracic surgical volume in Rwanda despite current interventions. A targeted approach addressing barriers described is necessary for sustainable progress in thoracic surgical care.
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Affiliation(s)
- Adriana G Ramirez
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, USA.
- University of Virginia Medical Center, P.O. Box 800681, Charlottesville, VA, 22908-0709, USA.
| | - Nebil Nuradin
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Fidele Byiringiro
- Department of Surgery, School of Medicine, University of Rwanda, Kigali, Rwanda
| | | | - Andrew E Giles
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Robert Riviello
- Center for Surgery and Public Health, Women and Brigham Hospital, Harvard University, Boston, MA, USA
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Masekela R, Zurba L, Gray D. Dealing with Access to Spirometry in Africa: A Commentary on Challenges and Solutions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:E62. [PMID: 30591644 PMCID: PMC6339263 DOI: 10.3390/ijerph16010062] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 11/16/2022]
Abstract
Spirometry is an important tool in the surveillance, epidemiology, diagnosis, and management of respiratory disease, yet its accessibility is currently limited in Africa where the burden of respiratory diseases is amongst the highest globally. The reasons for limited access to spirometry in Africa include poor access to training and skilled technicians, limited availability of equipment, consumables, and technical support, and lack of human and financial resources. The Pan African Thoracic Society, working together with regional African thoracic societies and key research initiatives in Africa, have made progress in training and education, but a lot of work is still needed to meet the challenges faced. Accurately defining these challenges of access to high quality spirometry, development of local, standardised, and context-specific training and quality assurance tools; development of appropriate reference standards and innovative approaches to addressing the challenges of access to equipment, consumables and technical support are needed. Training and research collaborations that include regional thoracic societies, health system leaders, the Pan African Thoracic Society and international role players in the field are key to maximising available intellectual and financial resources. Hence ensuring that access to high quality spirometry measures that are used effectively in tackling the burden of respiratory disease in Africa.
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Affiliation(s)
- Refiloe Masekela
- Department of Paediatrics and Child Health, Nelson R Mandela School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban 4013, South Africa.
| | - Lindsay Zurba
- Education for Health Africa, Durban 4302, South Africa.
| | - Diane Gray
- Department of Paediatrics and Child Health and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town 7700, South Africa.
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Adeoti AO, Desalu OO, Fadare JO, Alaofin W, Onyedum CC. Bronchoscopy in Nigerian Clinical Practice: A Survey of Medical Doctors' Perception, Use and Associated Challenges. Ethiop J Health Sci 2018; 27:331-338. [PMID: 29217935 PMCID: PMC5615022 DOI: 10.4314/ejhs.v27i4.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Bronchoscopy is a vital diagnostic and therapeutic procedure in pulmonological practice. The aim of this study was to determine the perception, use and challenges encountered by Nigerian medical doctors involved in this procedure. Materials and Methods A cross-sectional study was conducted among 250 medical doctors recruited from three major tertiary institutions in Nigeria between September 2013 and June 2014. A semi-structured questionnaire was self-administered to adult physicians, paediatricians, and surgeons as well as their trainees to obtain their perception, use and associated challenges in the use of bronchoscopy in clinical practice. Results The majority (91.6%) of the respondents perceived bronchoscopy as a beneficial procedure to respiratory medicine. However, 59.2% of them were not aware of the low mortality rate associated with this procedure. The commonest indications for bronchoscopic use were foreign body aspiration (88.8%) and management of lung tumors (75.6%). Only 21 (8.4%) of the respondents had received formal training in bronchoscopy. Very few procedures (1–5 cases per month) were performed. The respondents identified the lack of formal training in the art of bronchoscopy as the foremost challenge facing its practice in Nigeria. In addition, availability of bronchoscopes, level of awareness, knowledge of the procedure among medical doctors and the cost of the procedure were the challenges faced by the medical doctors. Conclusion There is an urgent need to equip training centers with modern bronchoscopic facilities. In addition,well-structured bronchoscopic training programme is imperative to enhance the trainees' proficiency for the furtherance of bronchoscopic practice.
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Affiliation(s)
| | | | | | - Wemimo Alaofin
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Kibirige D, Kampiire L, Atuhe D, Mwebaze R, Katagira W, Muttamba W, Nantanda R, Worodria W, Kirenga B. Access to affordable medicines and diagnostic tests for asthma and COPD in sub Saharan Africa: the Ugandan perspective. BMC Pulm Med 2017; 17:179. [PMID: 29216852 PMCID: PMC5721472 DOI: 10.1186/s12890-017-0527-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 11/24/2017] [Indexed: 11/25/2022] Open
Abstract
Background Equitable access to affordable medicines and diagnostic tests is an integral component of optimal clinical care of patients with asthma and chronic obstructive pulmonary disease (COPD). In Uganda, we lack contemporary data about the availability, cost and affordability of medicines and diagnostic tests essential in asthma and COPD management. Methods Data on the availability, cost and affordability of 17 medicines and 2 diagnostic tests essential in asthma and COPD management were collected from 22 public hospitals, 23 private and 85 private pharmacies. The percentage of the available medicines and diagnostic tests, the median retail price of the lowest priced generic brand and affordability in terms of the number of days’ wages it would cost the least paid public servant were analysed. Results The availability of inhaled short acting beta agonists (SABA), oral leukotriene receptor antagonists (LTRA), inhaled LABA-ICS combinations and inhaled corticosteroids (ICS) in all the study sites was 75%, 60.8%, 46.9% and 45.4% respectively. None of the study sites had inhaled long acting anti muscarinic agents (LAMA) and inhaled long acting beta agonist (LABA)-LAMA combinations. Spirometry and peak flow-metry as diagnostic tests were available in 24.4% and 6.7% of the study sites respectively. Affordability ranged from 2.2 days’ wages for inhaled salbutamol to 17.1 days’ wages for formoterol/budesonide inhalers and 27.8 days’ wages for spirometry. Conclusion Medicines and diagnostic tests essential in asthma and COPD care are not widely available in Uganda and remain largely unaffordable. Strategies to improve access to affordable asthma and COPD medicines and diagnostic tests should be implemented in Uganda.
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Affiliation(s)
- Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, P.O. BOX 7146, Kampala, Uganda. .,Medical unit, GlaxoSmithKline Pharmaceutical Kenya Limited, Kampala, Uganda.
| | | | - David Atuhe
- Department of Medicine, Case hospital Kampala, Kampala, Uganda
| | - Raymond Mwebaze
- Department of Medicine, St. Francis hospital Nsambya, Kampala, Uganda
| | - Winceslaus Katagira
- Makerere Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Winters Muttamba
- Makerere Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rebecca Nantanda
- Makerere Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - William Worodria
- Division of Pulmonology, Mulago National Referral and Teaching hospital, Kampala, Uganda
| | - Bruce Kirenga
- Makerere Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda.,Division of Pulmonology, Mulago National Referral and Teaching hospital, Kampala, Uganda
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Raising the Profile of Pulmonary Education for Physicians in Low- and Middle-Income Countries. Ann Am Thorac Soc 2017; 13:458-9. [PMID: 27058181 DOI: 10.1513/annalsats.201601-085ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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The East African Training Initiative. A Model Training Program in Pulmonary and Critical Care Medicine for Low-Income Countries. Ann Am Thorac Soc 2017; 13:451-5. [PMID: 26991950 DOI: 10.1513/annalsats.201510-673oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Despite an extensive burden of lung disease in East Africa, there are remarkably few pulmonary physicians in the region and no pulmonary subspecialty training programs. We developed a unique training program for pulmonary medicine in Ethiopia. The East African Training Initiative (EATI) is a 2-year fellowship program at Tikur Anbessa (Black Lion) Specialized Teaching Hospital, the largest public hospital in Ethiopia and the teaching hospital for the Addis Ababa University School of Medicine. The first year is devoted to clinical care and procedural skills. Lectures, conferences, daily inpatient and outpatient rounds, and procedure supervision by visiting faculty provide the clinical knowledge foundation. In the second year, training in clinical research is added to ongoing clinical training. Before graduation, fellows must pass rigorous written and oral examinations and achieve high marks on faculty evaluations. Funding derives from several sources. Ethiopian trainees are paid by the Ethiopian Ministry of Health and the Addis Ababa University School of Medicine. The World Lung Foundation and the Swiss Lung Foundation supply travel and housing costs for visiting faculty, who receive no other stipend. The first two trainees graduated in January 2015, and a second class of three fellows completed training in January 2016. All five presented research abstracts at the annual meetings of the International Union Against Tuberculosis and Lung Disease in 2014 and 2015. The EATI has successfully provided pulmonary medicine training in Ethiopia and has capacity for local leadership. We believe that EATI could be a model for other resource-limited countries.
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Harhay MO, Adeloye D. Barriers to Understanding the Epidemiology of Noncommunicable Lung Disease in Sub-Saharan Africa. Am J Respir Crit Care Med 2016; 194:5-7. [PMID: 27367882 DOI: 10.1164/rccm.201601-0183ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Michael O Harhay
- 1 Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania
| | - Davies Adeloye
- 2 Demography and Social Statistics Covenant University Ota, Nigeria and.,3 Centre for Global Health Research University of Edinburgh Edinburgh, United Kingdom
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