ABSTRACT
More than 500 million people worldwide live with cardiovascular disease (CVD). Health systems today face fundamental challenges in delivering optimal care due to ageing populations, healthcare workforce constraints, financing, availability and affordability of CVD medicine, and service del...ivery.
Digital health technologies can help address these challenges. They may be a tool
to reach Sustainable Development Goal 3.4 and reduce premature mortality from
non-communicable diseases (NCDs) by a third by 2030. Yet, a range of fundamental barriers prevents implementation and access to such technologies. Health system governance, health provider, patient and technological factors can prevent or distort their implementation.
World Heart Federation (WHF) roadmaps aim to identify essential roadblocks on the pathway to effective prevention, detection, and treatment of CVD. Further, they aim to provide actionable solutions and implementation frameworks for local adaptation. This WHF Roadmap for digital health in cardiology identifies barriers to implementing digital health technologies for CVD and provides recommendations for overcoming them.
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Delivery of comprehensive arrhythmia care requires the simultaneous presence of many resources. These include complex hospital infrastructure, expensive implantable equipment, and expert personnel. In many low- and middle-income countries (LMICs), at least 1 of these components is often missing, res...ulting in a gap between the demand for arrhythmia care and the capacity to supply care. In addition to this treatment gap, there exists a training gap, as many clinicians in LMICs have limited access to formal training in cardiac electrophysiology. Given the progressive increase in the burden of cardiovascular diseases in LMICs, these patient care and clinical training gaps will widen unless further actions are taken to build capacity. Several strategies for building arrhythmia care capacity in LMICs have been described. Medical missions can provide donations of both equipment and clinical expertise but are only intermittently present and therefore are not optimized to provide the longitudinal support needed to create self-sustaining infrastructure. Use of donated or reprocessed equipment (eg, cardiac implantable electronic devices) can reduce procedural costs but does not address the need for infrastructure, including diagnostics and expert personnel. Collaborative efforts involving multiple stakeholders (eg, professional organizations, government agencies, hospitals, and educational institutions) have the potential to provide longitudinal support of both patient care and clinician education in LMICs.
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Background: Community Health Workers (CHWs) have a positive impact on the provision of community-based
primary health care through screening, treatment, referral, psychosocial support, and accompaniment. With a
broad scope of work, CHW programs must balance the breadth and depth of tasks to mainta...in CHW motivation for
high-quality care delivery. Few studies have described the CHW perspective on intrinsic and extrinsic motivation to
enhance their programmatic activities.
Methods: We utilized an exploratory qualitative study design with CHWs employed in the household model in Neno
District, Malawi, to explore their perspectives on intrinsic and extrinsic motivators and dissatisfiers in their work. Data
was collected in 8 focus group discussions with 90 CHWs in October 2018 and March–April 2019 in seven purposively
selected catchment areas. All interviews were audiotaped, transcribed verbatim, coded, and analyzed using Dedoose.
Results: Themes of complex intrinsic and extrinsic factors were generated from the perspectives of the CHWs in
the focus group discussions. Study results indicate that enabling factors are primarily intrinsic factors such as positive
patient outcomes, community respect, and recognition by the formal health care system but can lead to the chal-
lenge of increased scope and workload. Extrinsic factors can provide challenges, including an increased scope and
workload from original expectations, lack of resources to utilize in their work, and rugged geography. However, a posi-
tive work environment through supportive relationships between CHWs and supervisors enables the CHWs.
Conclusion: This study demonstrated enabling factors and challenges for CHW performance from their perspec-
tive within the dual-factor theory. We can mitigate challenges through focused efforts to limit geographical distance,
manage workload, and strengthen CHW support to reinforce their recognition and trust. Such programmatic empha-
sis can focus on enhancing motivational factors found in this study to improve the CHWs’ experience in their role. The
engagement of CHWs, the communities, and the formal health care system is critical to improving the care provided
to the patients and communities, along with building supportive systems to recognize the work done by CHWs for
the primary health care systems.
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The "Cystic Fibrosis Fact Sheet" by the National Heart, Lung, and Blood Institute provides an overview of cystic fibrosis (CF), a chronic and often fatal genetic disorder affecting the respiratory and digestive systems. The document outlines the causes, genetic inheritance patterns, and symptoms of ...CF, which include thick mucus buildup, respiratory issues, and digestive problems. It also discusses diagnostic methods, such as the sweat test and genetic testing, and highlights current treatment approaches focused on symptom management, including chest therapy, medications, and potential gene therapy. The fact sheet emphasizes patient and family education to improve quality of life and support coping strategies.
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The article "Economic Burden of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Literature Review" examines the financial impact associated with moderate-to-very severe COPD. The review analyzes studies published between 2006 and 2016 that discuss healthcare resource utilization (HRU), di...rect costs, and indirect costs related to COPD, with a focus on Europe and North America. It highlights that direct costs, including hospitalizations and medical treatments, increase with the severity of COPD and the frequency of exacerbations. Multivariate analyses identify key factors driving these costs, such as comorbidities and prior treatment history. The findings underscore the significant economic burden of COPD on healthcare systems and emphasize the need for improved management strategies to reduce costs and optimize patient care.
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The document provides practical guidance for individuals with COPD, covering topics such as medication management, oxygen therapy, mucus control, physical exercise, smoking cessation, nutrition, associated conditions, and how to prevent and manage exacerbations. It emphasizes the importance of patie...nt education, adherence to treatment plans, and collaboration with healthcare providers to improve quality of life and disease outcomes.
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The document outlines the 2019 update to the South African guideline for managing chronic obstructive pulmonary disease (COPD). It emphasizes the importance of early diagnosis, prevention through smoking cessation, use of bronchodilators as primary pharmacotherapy, and a comprehensive approach to pa...tient care including pulmonary rehabilitation and the management of comorbidities. The guideline also covers recommendations for handling acute exacerbations, surgical interventions, and long-term treatment options.
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Chronic obstructive pulmonary disease (COPD) is a complex disease that requires differential diagnosis and proper classification to identify appropriate therapy. Nonpharmacologic therapy and preventative measures should be utilized to prevent worsening of disease, symptoms, and complications. The Gl...obal Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines classify a patient’s COPD and provide recommendations for first-line treatment. The 2021 update included information regarding the use of e-cigarettes as nicotine replacement, triple therapy, and how the SARS-CoV-2 virus impacted patients with COPD. This article will focus on the diagnosis, classification, and treatment of COPD, as well as recently updated information regarding the use of e-cigarettes and the impact of COVID-19.
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Background
Asthma education, a key component of long-term asthma management, is challenging in resource-limited settings with shortages of clinical staff. Task-shifting educational roles to lay (non-clinical) staff is a potential solution. We conducted a randomised controlled trial of an enhanced a...sthma care intervention for children in Malawi, which included reallocation of asthma education tasks to lay-educators. In this qualitative sub-study, we explored the experiences of asthmatic children, their families and lay-educators, to assess the acceptability, facilitators and barriers, and perceived value of the task-shifting asthma education intervention.
Methods
We conducted six focus group discussions, including 15 children and 28 carers, and individual interviews with four lay-educators and a senior nurse. Translated transcripts were coded independently by three researchers and key themes identified.
Results
Prior to the intervention, participants reported challenges in asthma care including the busy and sometimes hostile clinical environment, lack of access to information and the erratic supply of medication. The education sessions were well received: participants reported greater understanding of asthma and their treatment and confidence to manage symptoms. The lay-educators appreciated pre-intervention training, written guidelines, and access to clinical support. Low education levels among carers presented challenges, requiring an open, non-critical and individualised approach.
Discussion
Asthma education can be successfully delivered by lay-educators with adequate training, supervision and support, with benefits to the patients, their families and the community. Wider implementation could help address human resource shortages and support progress towards Universal Health Coverage.
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The2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group was coordinated and supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Healt...h. It is designed to improve patient care and support informed decision making about asthma management in the clinical setting. This update addresses six priority topic areas as determined by the state of the science at the time of a needs assessment, and input from multiple stakeholders:
• Fractional Exhaled Nitric Oxide Testing
• Indoor Allergen Mitigation
• Intermittent Inhaled Corticosteroids
• Long-Acting Muscarinic Antagonists
• Immunotherapy in the Treatment of Allergic Asthma
• Bronchial Thermoplasty
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Asthma is the most common chronic condition in children worldwide. It affects daytime activities, sleep and school attendance and causes anxiety to parents, families and other carers. The quality of asthma diagnosis and management globally still needs substantial improvement. From infancy to the tee...nage years, there are age-specific challenges, including both underdiagnosis and overdiagnosis with stigma-related barriers to treatment in some cultures and in adolescents. The Paediatric Asthma Project Plan has been initiated to strengthen diagnosis and management of asthma. This encompasses a vision for the next 10–15 years, building on the knowledge and experience from previous educational projects. It will take into account the educational needs of patients, carers and healthcare professionals as well as the accessibility and affordability of medication, particularly in low and middle-income countries where the prevalence of asthma is rising more rapidly. This overview presents a first step for those involved in the diagnosis and management of childhood asthma to strengthen care for children globally.
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In 2009, WHO’s Second International Conference on Buruli Ulcer Control and Research resolved to strengthen the capacity of national laboratories to confirm cases of the disease, but advised that “efforts are still needed to develop simple diagnostic tools usable in the field as well as disabilit...y prevention methods”.
In 2013, WHO and the Foundation for Innovative New Diagnostics convened a meeting of Buruli ulcer experts in Geneva, Switzerland (9) at which two priority unmet needs in diagnosis were identified:
a diagnostic test for early detection of Buruli ulcer in symptomatic patients with sufficient positive predictive value to put patients on appropriate treatment; and
a screening test at the primary health care or community level for symptomatic patients with ulcer
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Dracunculiasis, also known as Guinea-worm disease is a parasitic disease caused by the nematode Dracunculus medinensis. The infection is transmitted to humans by drinking water contaminated with the small crustacean copepods (Cyclops) which contain the larvae of D. medinensis. Humans are the princip...al definitive host and Cyclops being the intermediate host. The disease is endemic to the rural and poorer areas of the world and is most common in African countries like Chad, South Sudan, Ethiopia, and Mali. Efforts are underway towards global eradication of this disease. Due to its rarity in developed countries, this activity describes the interprofessional team's role in the assessment and treatment of patients with this condition.
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Online learning for clinical management staff of respiratory diphtheria in Cox's Bazar, Bangladesh.
In December 2017, the WHO Health Emergencies Programme launched an online learning for clinical staff on respiratory diphtheria through the OpenWHO.org platform. The 4-hour course targets clinicians ...caring for patients during outbreaks in vulnerable settings, such as in Cox's Bazar. It is also applicable to clinicians working in settings that share similar challenges, due to limitations of: laboratory capacity, availability of treatment facilities, number of trained staff, medications, medical supplies, and supportive care.
With the OpenWHO App, users can now view course content on a mobile device, with or without internet connection, once it has been downloaded: an important feature needed in vulnerable settings. Material is now being translated into Bahasa Indonesia and Arabic.
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The document titled "Prevención y control del cólera" (Cholera Prevention and Control) provides essential guidance on preventing and managing cholera, a disease characterized by severe watery diarrhea and vomiting. Without prompt treatment, cholera can lead to death due to dehydration within hours.... The disease is primarily transmitted through the ingestion of food or water contaminated with the feces of an infected person.
To protect against cholera and other diarrheal diseases, the document emphasizes the importance of drinking safe water, such as bottled water with intact seals, boiled water, or water treated with chlorine products. Frequent handwashing with safe water and soap is recommended, and in the absence of soap, hands can be cleaned using ash or sand followed by rinsing with safe water. Proper sanitation practices, such as using latrines or burying feces and avoiding defecation near water sources, are crucial. The document also highlights safe food practices, including thoroughly cooking food (especially seafood), consuming it while hot, keeping it covered, and peeling fruits and vegetables. Ensuring the safe cleaning of kitchens and areas where the family bathes or washes clothes is also advised.
In case of diarrheal illness, the document stresses the immediate use of oral rehydration solution (ORS) to prevent dehydration and the importance of seeking medical attention as quickly as possible. Patients should continue ORS intake both at home and during transit to a health facility. These preventative measures and prompt treatment strategies are vital for reducing cholera transmission and mortality.
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Since late August 2022, cases of severe acute watery diarrhoea have been increasingly reported across Syria, concentrated
particularly along the Euphrates river. These were later confirmed to be cholera cases.3 Cholera is a disease caused by
bacteria that can be found in faeces, and spreads throug...h people consuming contaminated water or food. It causes severe
watery diarrhoea and vomiting which lead to dehydration. If treated immediately, less than 1% of cases result in patients
dying. However, if timely treatment is not available, cholera can lead to death within hours in 25 to 50% of cases. The
situation is critical in Syria as the local population is facing a severe water crisis due to drought, falling groundwater levels,
reduced flow in the Euphrates River, and reduced functionality of Alouk water station. REACH has been monitoring
developments in Northeast Syria through regular data collection cycles, remote sensing data, and rapid needs assessments
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The website for the COPD Foundation in South Africa provides information and resources dedicated to raising awareness, improving education, and supporting individuals affected by Chronic Obstructive Pulmonary Disease (COPD). Managed by the C.A.R.E.S. Group (COPD Advocacy, Research, Education, Suppor...t), the site aims to advocate for better COPD management and care. It includes guidance for patients, caregivers, and healthcare professionals, along with updates on research, events, and programs to enhance COPD treatment and support throughout South Africa.
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The document "COPD 101: Understanding the Basics" from the COPD Foundation provides foundational knowledge about chronic obstructive pulmonary disease (COPD). It explains what COPD is, common symptoms, risk factors, diagnosis methods, and treatment options, including medications and lifestyle change...s. The guide emphasizes early diagnosis and management to help patients live healthier lives and prevent disease progression.
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The document "COPD 101: Understanding the Basics" from the COPD Foundation provides foundational knowledge about chronic obstructive pulmonary disease (COPD). It explains what COPD is, common symptoms, risk factors, diagnosis methods, and treatment options, including medications and lifestyle change...s. The guide emphasizes early diagnosis and management to help patients live healthier lives and prevent disease progression.
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Asthma is the most common chronic illness of childhood. The prevalence is rising and the mortality and morbidity from asthma are unacceptably high in South Africa. This article emphasizes the importance to make a correct diagnosis based, most importantly, on the clinical history and supported by inv...estigations. Further, the appropriate drug and device must be chosen to achieve good asthma control. It explains that patients must be followed up regularly and their asthma control must be assessed so that the treatment can then be adjusted according to the level of control. Additionally, Asthma education and adherence are important components of management of the condition.
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