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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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2
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Spencer SA, Adipa FE, Baker T, Crawford AM, Dark P, Dula D, Gordon SB, Hamilton DO, Huluka DK, Khalid K, Lakoh S, Limbani F, Rylance J, Sawe HR, Simiyu I, Waweru-Siika W, Worrall E, Morton B. A health systems approach to critical care delivery in low-resource settings: a narrative review. Intensive Care Med 2023; 49:772-784. [PMID: 37428213 PMCID: PMC10354139 DOI: 10.1007/s00134-023-07136-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023]
Abstract
There is a high burden of critical illness in low-income countries (LICs), adding pressure to already strained health systems. Over the next decade, the need for critical care is expected to grow due to ageing populations with increasing medical complexity; limited access to primary care; climate change; natural disasters; and conflict. In 2019, the 72nd World Health Assembly emphasised that an essential part of universal health coverage is improved access to effective emergency and critical care and to "ensure the timely and effective delivery of life-saving health care services to those in need". In this narrative review, we examine critical care capacity building in LICs from a health systems perspective. We conducted a systematic literature search, using the World Heath Organisation (WHO) health systems framework to structure findings within six core components or "building blocks": (1) service delivery; (2) health workforce; (3) health information systems; (4) access to essential medicines and equipment; (5) financing; and (6) leadership and governance. We provide recommendations using this framework, derived from the literature identified in our review. These recommendations are useful for policy makers, health service researchers and healthcare workers to inform critical care capacity building in low-resource settings.
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Affiliation(s)
- Stephen A Spencer
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Tim Baker
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Queen Marys University of London, London, UK
- Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Paul Dark
- Humanitarian and Conflict Response Institute, University of Manchester, Manchester, UK
| | - Dingase Dula
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Stephen B Gordon
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - David Oliver Hamilton
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | | | - Karima Khalid
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Felix Limbani
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Jamie Rylance
- Health Care Readiness Unit, World Health Organisation, Geneva, Switzerland
| | - Hendry R Sawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ibrahim Simiyu
- Liverpool School of Tropical Medicine, Liverpool, UK
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Eve Worrall
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ben Morton
- Liverpool School of Tropical Medicine, Liverpool, UK.
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
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Abstract
This White Paper has been formally accepted for support by the International Federation for Emergency Medicine (IFEM) and by the World Federation of Intensive and Critical Care (WFICC), put forth by a multi-specialty group of intensivists and emergency medicine providers from low- and low-middle-income countries (LMICs) and high-income countries (HiCs) with the aim of 1) defining the current state of caring for the critically ill in low-resource settings (LRS) within LMICs and 2) highlighting policy options and recommendations for improving the system-level delivery of early critical care services in LRS. LMICs have a high burden of critical illness and worse patient outcomes than HICs, hence, the focus of this White Paper is on the care of critically ill patients in the early stages of presentation in LMIC settings. In such settings, the provision of early critical care is challenged by a fragmented health system, costs, a health care workforce with limited training, and competing healthcare priorities. Early critical care services are defined as the early interventions that support vital organ function during the initial care provided to the critically ill patient—these interventions can be performed at any point of patient contact and can be delivered across diverse settings in the healthcare system and do not necessitate specialty personnel. Currently, a single “best” care delivery model likely does not exist in LMICs given the heterogeneity in local context; therefore, objective comparisons of quality, efficiency, and cost-effectiveness between varying models are difficult to establish. While limited, there is data to suggest that caring for the critically ill may be cost effective in LMICs, contrary to a widely held belief. Drawing from locally available resources and context, strengthening early critical care services in LRS will require a multi-faceted approach, including three core pillars: education, research, and policy. Education initiatives for physicians, nurses, and allied health staff that focus on protocolized emergency response training can bridge the workforce gap in the short-term; however, each country’s current human resources must be evaluated to decide on the duration of training, who should be trained, and using what curriculum. Understanding the burden of critical Illness, best practices for resuscitation, and appropriate quality metrics for different early critical care services implementation models in LMICs are reliant upon strengthening the regional research capacity, therefore, standard documentation systems should be implemented to allow for registry use and quality improvement. Policy efforts at a local, national and international level to strengthen early critical care services should focus on funding the building blocks of early critical care services systems and promoting the right to access early critical care regardless of the patient’s geographic or financial barriers. Additionally, national and local policies describing ethical dilemmas involving the withdrawal of life-sustaining care should be developed with broad stakeholder representation based on local cultural beliefs as well as the optimization of limited resources.
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Jiang LG, Greenwald PW, Alfonzo MJ, Torres-Lavoro J, Garg M, Munir Akrabi A, Sylvanus E, Suleman S, Sundararajan R. An International Virtual Classroom: The Emergency Department Experience at Weill Cornell Medicine and Weill Bugando Medical Center in Tanzania. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:690-697. [PMID: 34593591 PMCID: PMC8514026 DOI: 10.9745/ghsp-d-21-00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 07/20/2021] [Indexed: 11/15/2022]
Abstract
Emergency medicine (EM) is rapidly being recognized as a specialty around the globe. This has particular promise for low- and middle-income countries (LMICs) that experience the largest burden of disease for emergency conditions. Specialty education and training in EM remain essentially an apprenticeship model. Finding the required expertise to educate graduate learners can be challenging in regions where there are low densities of specialty providers.We describe an initiative to implement a sustainable, bidirectional partnership between the Emergency Medicine Departments of Weill Cornell Medicine (WCM) in New York, NY, USA, and Bugando Medical Center (BMC) in Mwanza, Tanzania. We used synchronous and asynchronous telecommunication technology to enhance an ongoing emergency medicine education collaboration.The Internet infrastructure for this collaboration was created by bolstering 4G services available in Mwanza, Tanzania. By maximizing the 4G signal, sufficient bandwidth could be created to allow for live 2-way audio/video communication. Using synchronous and asynchronous applications such as Zoom and WhatsApp, providers at WCM and BMC can attend real-time didactic lectures, participate in discussion forums on clinical topics, and collaborate on the development of clinical protocols. Proof of concept exercises demonstrated that this system can be used for real-time mentoring in EKG interpretation and ultrasound technique, for example. This system was also used to share information and develop operations flows during the COVID-19 pandemic. The use of telecommunication technology and e-learning in a format that promotes long-term, sustainable interaction is practical and innovative, provides benefit to all partners, and should be considered as a mechanism by which global partnerships can assist with training in emergency medicine in LMICs.
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Affiliation(s)
- Lynn G Jiang
- Department of Emergency Medicine, New York-Presbyterian Weill Cornell Medical Center, New York, NY.
| | - Peter W Greenwald
- Department of Emergency Medicine, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Michael J Alfonzo
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Jane Torres-Lavoro
- Department of Emergency Medicine, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Manish Garg
- Department of Emergency Medicine, New York-Presbyterian Weill Cornell Medical Center, New York, NY
| | - Ally Munir Akrabi
- Department of Emergency Medicine, Weill Bugando Medical Center, Mwanza, Tanzania
| | - Erasto Sylvanus
- Department of Emergency Medicine, Weill Bugando Medical Center, Mwanza, Tanzania
| | - Shahzmah Suleman
- Department of Emergency Medicine, Weill Bugando Medical Center, Mwanza, Tanzania
| | - Radhika Sundararajan
- Department of Emergency Medicine, New York-Presbyterian Weill Cornell Medical Center, New York, NY.,Center for Global Health, Weill Cornell Medicine, New York, NY
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Papali A, Diaz JV, Carter EJ, Ferreira JC, Fowler R, Gebremariam TH, Gordon SB, Lee BW, Murthy S, Riviello ED, West TE, Adhikari NK. Academic careers in global pulmonary and critical care medicine. J Glob Health 2021; 10:010313. [PMID: 32257140 PMCID: PMC7100859 DOI: 10.7189/jogh.10.010313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Alfred Papali
- Division of Pulmonary & Critical Care Medicine, Atrium Health, Charlotte, North Carolina, USA.,Division of Pulmonary & Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | | | - E Jane Carter
- Department of Medicine, Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Juliana C Ferreira
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brasil
| | - Rob Fowler
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Stephen B Gordon
- The Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Liverpool School of Tropical Medicine, Liverpool, UK
| | - Burton W Lee
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Srinivas Murthy
- Department of Paediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elisabeth D Riviello
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - T Eoin West
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Neill Kj Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Correia JC, Lopes A, Nhabali A, Madrigal V, Errasti CR, Brady E, Hadjiconstantinou M, Perolini MC. Implementation and evaluation of a specialized diabetes clinic in Guinea-Bissau: lessons learnt from the field. Pan Afr Med J 2021; 37:126. [PMID: 33425159 PMCID: PMC7755353 DOI: 10.11604/pamj.2020.37.126.26127] [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: 09/17/2020] [Accepted: 09/26/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction diabetes care in Guinea-Bissau (GB) is characterized by a lack of properly trained healthcare professionals (HCPs) and guidelines for diagnosis, treatment and follow up of patients. To address these issues, this project was launched with the objective to train HCPs in the management of diabetic patients and establish a specialized diabetes clinic in the Hospital Nacional Simão Mendes, a public tertiary care hospital in Bissau, capital of GB. This project is led by the Geneva University Hospitals (HUG) in collaboration with the Swiss Association for the Aid to Diabetic People in Guinea-Bissau, with the support of the International Solidairty Office (SSI) of the State of Geneva, and AIDA (Ayuda, Intercambio y Desarrollo). Methods specialists from the HUG in collaboration with local experts in GB developed and delivered a culturally and contextually adapted training course pertaining to diabetes care to HCPs in this hospital. Pre and post training tests were conducted to assess differences in knowledge and practices. Following the training program, a diabetes clinic was set up and an audit was conducted to assess its performance. Results a total of 24 HCP attended the training program and exhibited statistically significant improvements in their knowledge pertaining to diabetes care (mean difference between pre and post-test = 14.53, SD 11.60, t=-4.8, p < 0.001). The diabetes clinic was established and provided consultations 2 days per week. A total of 63 patients consulted at this clinic, of which 49 had type two diabetes treated with oral antidiabetic drugs and 14 were type 1 diabetics treated with insulin. Patients had blood glucose measurements and received therapeutic, dietary and physical activity counselling. Several barriers leading to occasional interruptions of service were encountered, including a political instability in the country and strikes of healthcare staff demanding better wages and working conditions. Conclusion: this study delineates the feasibility of setting up a diabetes consultation clinic in GB despite important barriers. To ensure successful running of such consultation clinics, continued buy-in and support from stakeholders should be ensured. Diabetes training should be incorporated in pre-and post-graduate training curriculums of all HCP to help shape a better workforce.
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Affiliation(s)
- Jorge César Correia
- Unit of Patient Education, Division of Endocrinology, Diabetology, Nutrition and Patient Education, WHO Collaborating Center, Department of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Adalgisa Lopes
- Association Suisse d´Aide aux Personnes Diabétiques en Guiné-Bissau, Geneva, Switzerland
| | - Adramane Nhabali
- Department of Internal Medicine, Hospital Nacional Simão Mendes, Bissau, Guinea-Bissau
| | - Victor Madrigal
- Aida Ayuda Intercambio y Desarrollo (AIDA), Bissau, Guinea-Bissau
| | | | - Emer Brady
- Leicester Diabetes Centre, University Hospitals of Leicester, NHS Trust, UK
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Talib Z. Postgraduate Medical Education in Sub-Saharan Africa: A Scoping Review Spanning 26 Years and Lessons Learned. J Grad Med Educ 2019; 11:34-46. [PMID: 31428258 PMCID: PMC6697307 DOI: 10.4300/jgme-d-19-00170] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/30/2019] [Accepted: 06/04/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Investments in training physician specialists through postgraduate medical education (PGME) are critical for Sub-Saharan Africa, given the increasing burden of non-communicable diseases. OBJECTIVES The objectives of this scoping review were to (1) understand the breadth of publications on PGME from Sub-Saharan Africa, and (2) conduct a thematic analysis of lessons learned by specific training programs. METHODS We conducted a literature search of 7 databases for PGME literature published between January 1991 and December 2016. Two reviewers independently reviewed titles and abstracts for inclusion. Full-text articles were then reviewed, and bibliometric data were extracted to create a profile of PGME-related publications. Two authors coded the manuscripts to identify articles written about specific PGME programs. These were analyzed for lessons learned. RESULTS We identified 813 publications that reported on postgraduate medical education in Sub-Saharan Africa. Most articles were published between 2005 and 2016. Nations leading in publication were South Africa and Nigeria, followed by Ethiopia, Uganda, Kenya, Ghana, and Malawi. The largest number of articles related to general surgery training, followed by family medicine, emergency medicine, and anesthesiology. Thematic analysis revealed advantages of training programs for health facilities, challenges related to teaching, resourcing, and standardizing of training, and lessons learned related to international partnerships, faculty engagement, and research support for trainees. CONCLUSIONS PGME in Sub-Saharan Africa has evolved over the past 26 years. Future growth will require strategic support to scale programs, support new specialties, trainees, and teachers, and leverage best practice models to sustain PGME programs.
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Losonczy LI, Barnes SL, Liu S, Williams SR, McCurdy MT, Lemos V, Chandler J, Colas LN, Augustin ME, Papali A. Critical care capacity in Haiti: A nationwide cross-sectional survey. PLoS One 2019; 14:e0218141. [PMID: 31194795 PMCID: PMC6565360 DOI: 10.1371/journal.pone.0218141] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/26/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Critical illness affects health systems globally, but low- and middle-income countries (LMICs) bear a disproportionate burden. Due to a paucity of data, the capacity to care for critically ill patients in LMICs is largely unknown. Haiti has the lowest health indices in the Western Hemisphere. In this study, we report results of the first known nationwide survey of critical care capacity in Haiti. DESIGN Nationwide, cross-sectional survey of Haitian hospitals in 2017-2018. SETTING Haiti. SUBJECTS All Haitian health facilities with at least six hospital beds. INTERVENTIONS Electronic- and paper-based survey. RESULTS Of 51 health facilities identified, 39 (76.5%) from all ten Haitian administrative departments completed the survey, reporting 124 reported ICU beds nationally. Of facilities without an ICU, 20 (83.3%) care for critically ill patients in the emergency department. There is capacity to ventilate 62 patients nationally within ICUs and six patients outside of the ICU. One-third of facilities with ICUs report formal critical care training for their physicians. Only five facilities met criteria for a Level 1 ICU as defined by the World Federation of Societies of Intensive and Critical Care Medicine. Self-identified barriers to providing more effective critical care services include lack of physical space for critically ill patients, lack of equipment, and few formally trained physicians and nurses. CONCLUSIONS Despite a high demand for critical care services in Haiti, current capacity remains insufficient to meet need. A significant amount of critical care in Haiti is provided outside of the ICU, highlighting the important overlap between emergency and critical care medicine in LMICs. Many ICUs in Haiti lack basic components for critical care delivery. Streamlining critical care services through protocol development, education, and training may improve important clinical outcomes.
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Affiliation(s)
- Lia I. Losonczy
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Emergency Medicine, George Washington University, Washington, District of Columbia, United States of America
| | - Sean L. Barnes
- Department of Decision, Operations & Information Technologies, Robert H. Smith School of Business, University of Maryland, College Park, Maryland, United States of America
| | - Shiping Liu
- Department of Mathematics, University of Maryland, College Park, Maryland, United States of America
| | - Sarah R. Williams
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Michael T. McCurdy
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Vivienne Lemos
- Taddle Creek Family Health Team, Toronto, Ontario, Canada
| | | | - L. Nathalie Colas
- Department of Internal Medicine, St. Luke Hospital, Port-au-Prince, Haiti
| | - Marc E. Augustin
- Department of Internal Medicine, St. Luke Hospital, Port-au-Prince, Haiti
| | - Alfred Papali
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Division of Pulmonary & Critical Care Medicine, Atrium Health, Charlotte, North Carolina, United States of America
- Division of Pulmonary & Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- * E-mail:
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9
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Abstract
Caring for critically ill patients is challenging in resource-limited settings, where the burden of disease and mortality from potentially treatable illnesses is higher than in resource-rich areas. Barriers to delivering quality critical care in these settings include lack of epidemiologic data and context-specific evidence for medical decision-making, deficiencies in health systems organization and resources, and institutional obstacles to implementation of life-saving interventions. Potential solutions include the development of common definitions for intensive care unit (ICU), intensivist, and intensive care to create a universal ICU organization framework; development of educational programs for capacity building of health care professionals working in resource-limited settings; global prioritization of epidemiologic and clinical research in resource-limited settings to conduct timely and ethical studies in response to emerging threats; adaptation of international guidelines to promote implementation of evidence-based care; and strengthening of health systems that integrates these interventions. This manuscript reviews the field of global critical care, barriers to safe high-quality care, and potential solutions to existing challenges. We also suggest a roadmap for improving the treatment of critically ill patients in resource-limited settings.
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Schluger NW, Sherman CB, Binegdie A, Gebremariam T, Kebede D, Worku A, Carter EJ, Brändli O. Creating a specialist physician workforce in low-resource settings: reflections and lessons learnt from the East African Training Initiative. BMJ Glob Health 2018; 3:e001041. [PMID: 30245867 PMCID: PMC6144898 DOI: 10.1136/bmjgh-2018-001041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/09/2018] [Accepted: 08/24/2018] [Indexed: 01/21/2023] Open
Abstract
Many African countries have extremely low ratios of physicians to population, and there are very, very few specialists. This leaves most patients without access to specialised care, and importantly also leaves many countries with insufficient expertise to properly evaluate the burden of illness and the needs of the population overall. The challenges to training a specialised physician workforce in resource-limited settings are many, and they go far beyond the (relatively simple) task of transmission of clinical skills. We initiated a capacity-building programme to train pulmonary physicians in Ethiopia, a country of 105 million persons with a high burden of lung disease that had no prior existing training programme in pulmonary medicine. Using volunteer faculty from the USA and Europe, we have provided high-quality training and established a cohort of pulmonary specialists there. We have identified several components of training that go beyond clinical skills development but which we feel are crucial to sustainability. These components include the delineation of viable career pathways that allow professional growth for subspecialist physicians and that support the permanent establishment of a local faculty; the development of important non-clinical skills, including leadership and pedagogical techniques; training in clinical research methodologies; and the development of mechanisms to amplify the impact of a still relatively small number of specialised physicians to address the needs of the population generally. Our programme, the East African Training Initiative, has successfully addressed many of these challenges and we hope that it can be replicated elsewhere.
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Affiliation(s)
- Neil W Schluger
- Departments of Medicine, Epidemiology and Environmental Health Science, Columbia University Vagelos College of Physicians and Surgeons and Mailman School of Public Health, New York City, New York, USA
| | - Charles B Sherman
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Amsalu Binegdie
- Department of Medicine, Addis Ababa University School of Medicine/Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Tewedros Gebremariam
- Department of Medicine, Addis Ababa University School of Medicine/Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Dawit Kebede
- Department of Medicine, Addis Ababa University School of Medicine/Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Aschalew Worku
- Department of Medicine, Addis Ababa University School of Medicine/Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - E Jane Carter
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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11
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An assessment of critical care capacity in the Gambia. J Crit Care 2018; 47:245-253. [PMID: 30059869 DOI: 10.1016/j.jcrc.2018.07.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/30/2018] [Accepted: 07/20/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Critical illnesses are a major cause of morbidity and mortality in The Gambia, yet national data on critical care capacity is lacking. MATERIALS AND METHODS We surveyed eight of the eleven government-owned health facilities providing secondary and tertiary care in The Gambia's public health sector. At each hospital, a designated respondent completed a questionnaire reporting information on the presence of an intensive care unit, the number of critical care beds where available, monitoring equipment, and the ability to provide basic critical care services at their respective hospitals. RESULTS The response rate was 88% (7/8 hospitals). Only one hospital had a dedicated intensive care unit with eight ICU beds, resulting in an estimated 0.4 ICU beds/100,000 population in the country. All hospitals reported treating more than 50 critically ill patients a month, with trauma, obstetric emergencies, hypertensive emergencies and stroke accounting for the leading causes of admission respectively. The country lacks any trained specialists and resources to diagnose and treat critically ill patients. CONCLUSIONS The Gambia has a very low ICU bed capacity and lacks the human resources and equipment necessary to diagnose and treat the large number of critically ill patients admitted to public hospitals in the country.
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12
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Papali A, Schultz MJ, Dünser MW. Recommendations on infrastructure and organization of adult ICUs in resource-limited settings. Intensive Care Med 2017; 44:1133-1137. [PMID: 29159562 DOI: 10.1007/s00134-017-4972-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Alfred Papali
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca Street, 2nd Floor, Baltimore, MD, 21201, USA. .,Institute for Global Health, University of Maryland School of Medicine, Baltimore, USA.
| | - Marcus J Schultz
- Mahidol-Oxford Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Amsterdam, The Netherlands
| | - Martin W Dünser
- Clinic of Anesthesiology and Intensive Care Medicine, Johannes Kepler University, Linz, Austria
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13
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Gebremariam TH, Binegdie AB, Mitiku AS, Ashagrie AW, Gebrehiwot KG, Huluka DK, Sherman CB, Schluger NW. Level of asthma control and risk factors for poor asthma control among clinic patients seen at a Referral Hospital in Addis Ababa, Ethiopia. BMC Res Notes 2017; 10:558. [PMID: 29110731 PMCID: PMC5674820 DOI: 10.1186/s13104-017-2887-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Uncontrolled asthma negatively impacts patients, families, and the community. The level of symptom control among asthmatics in Ethiopia has not been well studied. We investigated the level of asthma control and risk factors for poor asthma control in clinic patients seen in the largest public hospital in Ethiopia. RESULTS In this cross-sectional study, we studied all 182 consecutive subjects with a physician diagnosis of asthma who were seen in chest clinic at Tikur Anbessa Specialized Hospital between July and December 2015. Of the 182 subjects, 68.1% were female. The mean age was 52 ± 12 years and the median duration of asthma was 20 ± 12.7 years. One hundred and seventeen subjects (64.3%) had nighttime awakening due to asthma. Fifty-eight (31%) were not using controller medications and 62 (34.6%) had improper inhaler technique. Only 44 (24.2%) subjects had well-controlled asthma. On multivariate analysis, variables associated with uncontrolled asthma included: use of biomass fuel for cooking, longer duration of asthma (> 30 year), incorrect inhalation technique, and asthma exacerbation in the last 12 months. Most asthmatics attending in the largest public hospital in Ethiopia, had uncontrolled asthma. Several risk factors for poor asthma control were identified. Improved asthma control is possible through directed interventions.
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Affiliation(s)
- Tewodros H. Gebremariam
- College of Heath Sciences, Addis Ababa University, Nifas Silk Lafto Subcity, Jemo 1, P O Box 22787, 1000 Addis Ababa, Ethiopia
| | - Amsalu B. Binegdie
- College of Heath Sciences, Addis Ababa University, Nifas Silk Lafto Subcity, Jemo 1, P O Box 22787, 1000 Addis Ababa, Ethiopia
| | - Abebe S. Mitiku
- College of Heath Sciences, Addis Ababa University, Nifas Silk Lafto Subcity, Jemo 1, P O Box 22787, 1000 Addis Ababa, Ethiopia
| | - Aschalew W. Ashagrie
- College of Heath Sciences, Addis Ababa University, Nifas Silk Lafto Subcity, Jemo 1, P O Box 22787, 1000 Addis Ababa, Ethiopia
| | - Kibrom G. Gebrehiwot
- College of Heath Sciences, Addis Ababa University, Nifas Silk Lafto Subcity, Jemo 1, P O Box 22787, 1000 Addis Ababa, Ethiopia
| | - Dawit K. Huluka
- College of Heath Sciences, Addis Ababa University, Nifas Silk Lafto Subcity, Jemo 1, P O Box 22787, 1000 Addis Ababa, Ethiopia
| | | | - Neil W. Schluger
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University, College of Physicians and Surgeons, New York, NY USA
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The African Pediatric Fellowship Training Program in Pediatric Pulmonology: A Model for Growing African Capacity in Child Lung Health. Ann Am Thorac Soc 2017; 14:500-504. [DOI: 10.1513/annalsats.201612-953ps] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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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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16
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Mbanze I, Moschovis PP, Malhotra A. The American Thoracic Society Global Scholars Program. J Thorac Dis 2016; 8:S586-7. [PMID: 27606102 DOI: 10.21037/jtd.2016.07.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Irina Mbanze
- Division of Cardiology, Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Peter P Moschovis
- Divisions of Pulmonary/Critical Care Medicine and Pediatric Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care & Sleep Medicine, University of California San Diego, La Jolla, CA, USA
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