Global Health Innovation is an electronic, peer-reviewed open access journal published bi-annually by the University of Cape Town Libraries. The journal has the mission of advancing and disseminating interdisciplinary knowledge on all aspects of social and technological innovation for improved health and healthcare, with an emphasis on research addressing developing settings and with a developmental focus. The journal is the product of a partnership between Northwestern University, the University of Lagos, the University of Ibadan, and the University of Cape Town, and its development has been supported by a grant from the NIH-Fogarty International Center (D43TW009374).
Global Health Innovation is an open access journal, and the authors (copyright owners) should be properly acknowledged when works are cited.
Potential of ultraviolet germicidal irradiation for infection prevention and control of SARS-CoV-2 in South Africa
The response to the challenges arising during the COVID-19 pandemic has seen the rapid implementation of innovative technological solutions which have been built on established knowledge and resources. This has been reflected in infection, prevention and control practices (IPC) to minimise the transmission of the disease. In this article, we review ultraviolet germicidal irradiation (UVGI) as such a technology. We illustrate the way it has traditionally been used in airborne and surface disinfection strategies, and how it has, more recently, been adapted. UVGI has been widely used as an environmental IPC measure against tuberculosis in South Africa, though challenges have been experienced in the implementation of the technology in public healthcare facilities. This has resulted in the development of a knowledge and infrastructure base. We posit that, given the established UVGI resources in South Africa, the technology may be a viable environmental IPC solution for the COVID-19 period and beyond.
Copyright (c) 2020 Faatiema Salie, Trust Saidi
Nurturing next-generation biomedical engineers in Africa: The impact of Innovators’ Summer Schools
The mission of healthcare systems in Africa to deliver compassionate and effective care has been constrained by growing populations, increasing burden of disease, political conflict and limited resources. The impacts of these constraints can be substantially alleviated, and the healthcare services strengthened, through the creation and adoption of affordable, accessible and appropriate biomedical engineering systems and technologies. There is an urgent need for building capacities in biomedical engineering, innovation and entrepreneurship in African countries. The African Biomedical Engineering Consortium has been organising a series of Innovators’ Summer Schools to meet this need by empowering students and researchers with entrepreneurial and innovative skills, and facilitating the design and development of robust, appropriate, and commercially viable medical systems and devices. In this paper, we analyse and discuss the impact of six of these schools held between 2012 and 2017. We used a questionnaire-based survey to collect responses from students who had attended the summer schools. The results of this study demonstrate that the teaching-learning model adopted in the ABEC summer schools was largely effective in promoting biomedical engineering skills, career choices, professional networks and partnerships amongst young African engineers and life scientists who attended the summer schools.
Copyright (c) 2020 Daniel Atwine, Yvonne Wanjiku Karanja, Arti Ahluwalia, Carmelo De Maria, Dawit Assefa, Victor Konde, Edwin Khundi, Philippa Ngaju Makobore, Mainen Moshi, Martin Nzomo, Muhammad Ali Rushdi, Robert Tamale Ssekitoleko, June Madete
Collaboration for preliminary design of a mobile health solution for ambulance dispatch in Rwanda
Copyright (c) 2020 Ashley Rosenberg, Rob Rickard, Fraterne Zephyrin Uwinshuti, Gabin Mbanjumucyo, Menelas Nkeshimana, Jean Marie Uwitonze, Ignace Kabagema, Theophile Dushime, Sudha Jayaraman
Emergency remote teaching for design thinking in health innovation
Copyright (c) 2020 Nailah Conrad, Jaydon Farao
Mechanisms of childhood injury: A novel approach to the terminology
Copyright (c) 2020 Caroline Zabiegaj-Zwick, Andrew Brown, Marie-Louise Loos, Stewart Cleeve, Marko Nikoloski, Arjan Bastiaan Van As
Digital health communication in South Africa during COVID-19
On 11 March 2020, the World Health Organisation (WHO) declared a global pandemic as the world experienced the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to 144 countries (World Health Organisation, 2020a). The disease resulting from the virus – coronavirus disease 2019 (COVID-19) – had already overloaded the health systems of many nations. In South Africa, which confirmed its first positive COVID-19 case on 5 March, the pandemic has resulted in extreme measures to prevent its spread, including a national lockdown and various restrictions on movement. It has also resulted in one of the most widespread health communication campaigns since the HIV epidemic during the 2000s. Terms such as “social distancing” and “flattening the curve” have become part of our communal vocabulary due to the extent of health messaging. The communication on practical preventative solutions, such as hand- washing and alternative greeting practices (Prem et al., 2020), has also been shared widely in an easy-to- understand manner. The WHO specifically emphasises the accurate and timely communication of essential health information as imperative to curbing the spread of the virus, and how important such communication is to shifting behaviours and perceptions (WHO, 2020b). In addition, accurate and authoritative information, which inspires trust, is important in combatting the spread of the virus. This has meant innovation in digital health communication.
Psychological safety and team learning during a problem-solving game for staff at a South African hospital
South Africa’s National Health Insurance (NHI) program promises to be the vehicle of universal health coverage for the country by 2030. In public healthcare organizations, which are already challenged by under-resourcing and staff shortages, the demands of NHI place a heavy burden on the healthcare workers tasked with managing the associated system changes and delivering services to program specifications. As teams are the units tasked with driving organizational adaptivity and performance in the healthcare sector globally, effective teams are critical for successful NHI implementation. We explore a cost-effective intervention for promoting teamwork in the public healthcare system. A problem-solving game called the marshmallow challenge was used as an experimental intervention at an NHI pilot site, a provincial district hospital, where staff were already familiar with the impending challenges of change management. A qualitative post-game survey was administered to gather data on the experiences of 100 participating hospital staff. Groups also engaged in a post-game reflective discussion. We examine the individuals’ experiences of the game in order to establish how interventions of this kind can empower healthcare workers to practice effective teamwork and team learning and how a psychologically safe environment can be cultivated.
Copyright (c) 2020 Earle John du Plooy, Hamieda Parker
Design and evaluation of a low-cost sphygmomanometer to monitor women with pre-eclampsia in low-resource settings
We developed and pilot tested a sphygmomanometer designed to monitor pregnant women in low-resource settings. Blood pressure was assessed in 138 subjects, including healthy adults (n=85), pregnant women (n=42), and women at-risk for pre-eclampsia (n=11) using the novel sphygmomanometer, manual auscultation, and the GE Dinamap Procare 400. Accuracy of the device was evaluated by comparing measurements of the test device and the Dinamap in healthy volunteers and pregnant women in Texas and in women at risk for pre-eclampsia in Malawi. Measurements from the test device in pregnant and healthy volunteer populations differed from those collected using the auscultatory method by 0.2 mmHg (95% CI: -18.8 to 19.2, systolic) and -2.8 mmHg (95% CI: -21.0 to 15.4, diastolic). In women at risk for pre-eclampsia, measurements with the test device differed from those of the Dinamap on average by 2.9 mmHg (95% CI: -29.3 to 35.1, systolic) and -5.4 mmHg (95% CI: -45.8 to 34.9, diastolic). Compared against the auscultatory method, measurements with the Dinamap differed on average by 0.0 mmHg (95% CI: -31.8 to 31.9, systolic) and -3.7 mmHg (95% CI: -28.6 to 21.3, diastolic). Accuracy was reduced when patients were moving or not seated during measurement. When testing the device against British Hypertension Society standards, the device achieved a grade of A/A in pregnant persons. This sphygmomanometer has the potential to provide low-resource hospitals with an affordable, accurate option for regular blood pressure monitoring. However, algorithm improvements are needed to reduce sensitivity to subject motion and posture.
Copyright (c) 2020 Laura Causey, Sam Meja, Edward Cleo Kommwa, Phylos Bonongwe, Ronald Mataya, Ha Nguyen, Hector Mendez Figueroa, Erica Skerrett, Tyler Young, Kelley Maynard, Z Maria Oden, Rebecca Richards-Kortum
Human-centered design for medical devices and diagnostics in global health
So much lifesaving medical technology exists in the world, yet so little of it benefits communities with low resources. Purchase price is only one barrier. The World Health Organization found nearly three quarters of devices provided by industrialized countries are not used when they reach low resource communities. Most medical devices and diagnostics fail to operate effectively in environments with power fluctuations, high temperatures, high humidity, dust, insect infiltration, poor availability of spare parts, high-cost consumables, and low staff-to-patient ratio. To provide robust, well-designed products for low-resource environments, devices need to be developed to address the needs of the local clinics, hospitals, and communities. Human-Centered Design (HCD) is a set of tools, processes, and mindsets that can help a team uncover the essential needs of diverse stakeholders involved in the success of medical technology for global health. This paper provides an overview of the HCD techniques we have found most useful in developing medical technology for global health applications. To illustrate the HCD techniques and their benefits, we present a case study of Design that Matters’ Firefly phototherapy. The device is now treating newborn jaundice in low-resource hospitals in over 20 low and middle-income countries.
Copyright (c) 2020 Mark James Fisher, Elizabeth Johansen
A novel collection cup for tuberculosis sputum in South Africa: engineering design and user testing considerations
Low-cost, targeted engineering interventions can revolutionize health care, particularly in low-income environments. We outline a process for user testing of novel sputum collection cup models for PCR-based based tuberculosis assays in Cape Town, South Africa. Providing a sputum sample is difficult for many patients, and the quality of the sample affects downstream test performance. Observational data was collected from six representative sites including outpatient clinics, hospitals, and processing laboratories, and interviews were performed with individuals involved with sputum collection (n=10), processing (n=10), and transportation (n=3). Participants compared “rocket” and “squeeze” prototypes to the current cup by answering standardized questions and ranking the usability and perceived safety of the models. Sputum collectors found the current model significantly easier to use (p-value: 0.0091) and safer (p-value: 0.0044) than the “squeeze” model. Sputum processors found the “squeeze” model more difficult to use than both the current jar (p-value: 0.0091) and the “rocket” model (p-value: 0.0012). They additionally perceived the “squeeze” model to be less safe than the “rocket” prototype (p-value: 0.0007). These results were incorporated into a remodelled sputum collection cup that contains a stable, upright base, maximum and minimum markers, and a tight seal to meet the needs of primary users.
Copyright (c) 2018 Matthew D Doerfler, Katie N Truitt, Mark J Fisher, Grant Theron, Sally M McFall
A review of mHealth interventions for diabetes in pregnancy
Gestational diabetes mellitus (GDM) has high morbidity and risk for mortality when mismanaged. This is particularly relevant in low- and middle-income countries (LMIC), where GDM related complications occur at a higher rate, with worse outcomes, due to a lack of healthcare resources. Mobile health (mHealth) presents an opportunity to improve the management of GDM in LMIC. We conducted a meta-analysis, which found that using mHealth as an intervention for GDM caused a statistically significant decrease of 0.38 mmol/L (95% CI -0.52 mmol/L to -0.23 mmol/L) in overall blood glucose levels during pregnancy compared to the control group. There was a significantly higher probability of vaginal deliveries in the intervention group than the control group (risk ratio (RR) = 1.18, 95% CI 1.03 to 1.36). It was less likely for new-borns from the intervention group to be diagnosed with hypoglycaemia than new-borns from the control group (RR = 0.67, 95% CI 0.48 to 0.93). This review found evidence for mHealth offering improvements in biological, maternal, perinatal, cognitive and economic outcomes by aiding in the management of GDM. This could be particularly important to LMIC where the lack of resources and high healthcare-related costs contribute to the mismanagement of GDM.
Copyright (c) 2019 Jason Leslie Collier, Jill Fortuin Abrahams
ADHD Screening Tool: Investigating the effectiveness of a tablet-based game with machine learning
This study investigated the ability of a low-cost, mobile device-based game incorporating machine learning to screen participants between ages six and twelve years for attention-deficit/hyperactivity disorder inattentive subtype (ADHDI). Relevant information from literature was incorporated into the game in light of the DSM-V diagnostic criteria. The game has seven back-to-back segments with unique layouts and a visual theme.The ADHD Screening Tool presents a novel patient-testing interface with a cloud-based machine learning classifier (MLC) integrated with a consensus algorithm. The game was tested with 39 clinically diagnosed participants (ADHDIand non-ADHD). Out of nine classifiers tested, the locally-deep support vector machine gave the best results: using leave-one-out cross-validation, this MLC classified data from five game segments for 38 participants with sensitivity of 92.9% and specificity of 82.9%. By making use of the consensus algorithm, the 39th participant was correctly classified according to the clinical diagnosis. The MLC and consensus algorithm were able to classify 39 participants with a sensitivity of 100% and specificity of 87.5%. To overcome participant class imbalance, the synthetic minority oversampling technique (SMOTE) was implemented on game segment data. The SMOTE two-class LDSVM yielded sensitivity of 90.7% and specificity of 94.4%. The study used an internet-connected, commercially available tablet.
Copyright (c) 2019 Romano Swarts, Pieter Rousseau Fourie, Dawie van den Heever
C-THAN: A new research center for the development of point-of-care technology for HIV/AIDS
TheCenter for Innovation in Point-of-Care Technologies for HIV/AIDS at Northwestern University (C-THAN) is a partner in the Point-of-Care Technologies Research Network (POCTRN) of the National Institutes of Biomedical Imaging and Bioengineering. POCTRN’s mission is to drivethe development of appropriate point-of-care (POC) diagnostic technologies through collaboration that merges scientific and technological capabilities with clinical need. C-THAN develops POC technologies for improved management of HIV/AIDS in low- and middle-income countries with a focus on sub-Saharan Africa. C-THAN incorporates clinical and user needs with technology expertise and resources to address commercialization and implementation barriers through: 1) assessment of unmet clinical needs in POC testing for HIV/AIDS and its comorbidities; 2) collaborations with physicians, researchers and engineers; 3) development of technical, clinical, industrial and regulatory partnerships; 4) clinical testing of prototype devices; and 5) creation of training opportunities for technology developers, evaluators, and other stakeholders. Technologies supported include tests for detection and monitoring of HIV/AIDS and its common comorbidities including tuberculosis, non-tuberculous mycobacteria, viral hepatitis and HIV-related malignancies. CTHAN relies on collaborations established by Northwestern University in Nigeria, South Africa, Mali and Tanzania, to have impact on the prevention and clinical management of HIV/AIDS.
Copyright (c) 2019 Sally McFall, Mamoudou Maiga, Matthew Glucksberg, Kara Palamountain, Chad Achenbach, Robert Murphy
Use of sodium dodecyl sulfate to improve tuberculosis sputum smear microscopy
Sputum smear microscopy (SSM), the most widely available tool for tuberculosis (TB) detection, has limited performance in paucibacillary patients and requires highly experienced technicians. The objective of this study was to determine whether the addition of sodium dodecyl sulfate (SDS), a detergent that thins sputum, at 4% and 10%, improves the detection of acid-fast bacilli (AFB), the clarity of slides, and the biosafety of the technique. Thirty participants with presumptive TB were enrolled. Three independent, blinded technicians examined the slides. Regular sputum concentrated AFB smear and sputum culture were used as standard control methods. Sputum culture was also performed before and after 10% SDS addition for safety analysis. We found that neither SSM with SDS 4% nor SSM with SDS 10% improved the test’s performance. However, slides with 4% and 10% SDS, compared with slides prepared without SDS, had significantly better clarity scores. The 10% SDS-prepared sputum samples were all culture negative. While adding SDS detergent does not improve the performance of SSM slides, it does improve the clarity and biosafety. Where experienced technicians are scarce, especially in low resource settings, use of SDS may enhance the ease of slide reading in sputum smear microscopy.
Copyright (c) 2019 Yéya dit Sadio Sarro, Ousmane Kodio, Alisha Kumar, Bassirou Diarra, Bocar Baya, Seydou Diabate, Bourahima Kone, Fanta Sanogo, Mohamed Tolofoudie, Amadou Somboro, Gagni Coulibaly, Boureima Degoga, Mahamadou Kone, Bindongo PP Dembele, Issiaka Camara, Moumine Sanogo, Antime C.G Togo, Nadie Coulibaly, Fatimata Diallo, Etienne Dembele, Brehima Diakite, Seydou Doumbia, Oluwatoyin P Popoola, Souleymane Diallo, Jane Louise Holl, Chad J Achenbach, Robert Leo Murphy, Sally McFall, Mamoudou Maiga
Perceived risks and benefits of nanomedicine: a case study of an anti-tuberculosis drug
Nanotechnologies are novel and have intriguing properties, and yet they have some potential for harm. Using the case study of a nanoparticle anti- tuberculosis drug, this paper analyses the considerations of different stakeholders in assessing the potential risks and benefits of nanomedicine. Interview data from patients, nurses, caregivers and scientists from Gauteng province in South Africa were analysed through the lens of the Social Construction of Technology theoretical framework, which emphasises the importance of understanding the influence of social context on the development, interpretation and use of technologies. The stakeholders displayed varying interpretations of the drug based on their vested interests. To the patients, nurses and caregivers, their challenges in the treatment of tuberculosis influenced what they perceived to be potential risks and benefits of the drug. The scientists considered the functionality of the drug and its potential societal benefits but were also concerned about side effects. The study reveals that the context of stakeholders matters in their assessment of the risks and benefits of nanomedicine. Thus, it is not sufficient to assess a technology focusing only on its technical properties, but it is important to consider how the technology is nested in its broader social, political and cultural environment.
Copyright (c) 2018 Trust Saidi https://creativecommons.org/licenses/by/4.0/
Engaging minibus taxi drivers in the quest for child safer roads
South Africa has double the world average child road fatality rate, with at least 1 300 children killed every year. A leading contributor to this public health challenge is the lack of safe public transport that enables children to reach schools easily. Minibus taxis (MBTs), South Africa’s incarnation of paratransit services, have aimed to fill this gap by providing transport at a reasonably priced fare and a relatively higher frequency, compared with other modes of public transport. However, the informal nature of MBTs means that this form of transport places passengers at a relatively higher risk of road accidents due to the use of unroadworthy vehicles, reckless driving and speeding. This paper provides an overview of the Safe Travel To School (STTS) programme, which was initiated in 2014 with a view to providing a localised intervention that would potentially strengthen the safety of MBTs for scholar transport in South Africa. The programme aims to provide safer travel for child passengers by monitoring driver performance through a tracking device installed in each vehicle and rewarding good driver performance each quarter. A driver recruited into the programme also undergoes health tests and training that covers first aid, defensive driving and road safety training. The literature review that each of these components improves driver performance. A previous evaluation of the programme found that since inception, drivers in the programme have shown better driving performance than general motorists. Thus, the STTS programme potentially provides an implementable practice model for safe scholar transport that is oriented towards a developing country like South Africa.
Copyright (c) 2019 Aliasgher Janmohammed, Ashley Van Niekerk, Ruwayda Samuels, Marcella Naidoo, Sebastian Van As
Low-dose X-ray imaging for paediatric trauma comes of age
Copyright (c) 2019 Arjan Bastiaan Van As, Ebrahim Banderker
The Safer Candle Project: preventing fires from fallen candles
Copyright (c) 2019 Richard Cervantes, Dorothy Schulman, Sebastian Van As, Ashley van Niekerk
Security architecture for a 5G mHealth system
Global health challenges and the proliferation of mobile technologies have been key in the adoption of mHealth for provision of low-cost and equitable healthcare. Evolution of mobile networks to 5G is expected to revolutionise healthcare service delivery due to the stringent performance requirements imposed on 5G. However, because of the open nature of 5G systems, securing patient health information has been identified as a significant barrier to the full adoption of mHealth. In this paper, we propose a security architecture for an mHealth system based on a review of standard principles and guidelines for designing 5G security systems. We present a structured approach for developing and implementing an end-to-end 5G mHealth security system. We propose a security architecture that can be realised using keyless signature infrastructure blockchain, X-tee technology to secure the communication system including hospital and third-party health data networks, physical layer security for securing the wireless interface in access networks, physical unclonable functions, and a trusted execution environment for securing end-user devices. We propose the adoption of network slicing for isolating health systems from other 5G industry verticals. We define system domains that are used to identify security threats and propose mechanisms to mitigate these threats.
Copyright (c) 2019 Bessie Malila, Tinashe E.M. Mutsvangwa
Celebrating a year of existence of Global Health Innovation
Novel low-cost soft-tissue mannequins for medical education
Medical simulators are used to help healthcare practitioners learn and refine skills that can only come with sustained experience and practice. However, many training mannequins currently do not simulate the feel of living tissue with sufficient fidelity. This is a drawback when a diagnosis is made through palpation, as in case of the clinical breast exam (CBE), which is in many resource-limited settings the first and only screening method available. Here we describe a novel method for generating medical simulators which are low-cost and more closely resemble living tissue. Using commercially available silicone, a breast model was generated. The apparent stiffness was reduced by introducing voids throughout the interior of the model using the lost-wax method. Finite element modeling (FEM) was used to predict the effects of size and distribution of voids on the apparent stiffness of the prototypes. The prototypes generated through this process were evaluated by physicians trained in the CBE. Our results show that removal of interior volumes produced softer, more pliant and therefore more life-like models when compared to commercially available devices. This was supported by FEM as well as provider assessment of the physical analogues. We conclude that reducing the apparent stiffness by introducing voids produced simulators which better approximated the mechanical properties of live breast tissue and improved the feel of the simulator. This application of FEM offers an effective tool for low-cost and rapid prototyping, reducing cost and increasing availability in low-resource countries. This approach has the potential to improve medical education by offering a new method for modeling not only breast, but any soft tissue.
Copyright (c) 2018 Matthew Glucksberg, Nate P. Davidson, Charles CHwang, John T. Kulesa, Jennifer Saluk
Negative impacts of waste on human health and environment in Nigeria’s urban areas: innovative solutions to the rescue
Copyright (c) 2018 Akinwale Oladotun Coker
The feasibility of fingerstick blood collection for point-of-care HIV-1 viral load monitoring in rural Zambia
Viral load monitoring for HIV treatment is recommended but not feasible in many settings. A point-of-care test using capillary blood would increase access but may require up to 200 μL of blood to achieve a lower limit of detection of 1000 copies/mL. This cross-sectional study evaluated the feasibility of collecting 200 μL of capillary blood as well as blood collection preferences among adults in rural Zambia. Adults seeking HIV counseling and testing at Macha Hospital were recruited in 2015. Capillary blood was collected in four 50 μL tubes. Blood collection was categorized as complete (200 μL collected), partial (all tubes filled but <200 μL obtained due to collection techniques), or incomplete (1-4 tubes attempted; <200 μL obtained due to insufficient blood flow). One fingerstick was required for 90% of the 201 participants. A median blood volume of 196 μL was collected. Complete, partial and incomplete collection was achieved in 34%, 59% and 6% of participants. The majority of participants (95%) preferred fingerstick over venous blood collection. A point-of-care viral load test requiring up to 200 μL of blood is feasible in a rural setting but would require training and supervision to ensure that sufficient blood was collected.
Copyright (c) 2018 Catherine Gayle Sutcliffe, Kara M Palamountain, Sylvia Maunga, Kelly Searle, Philip E. Thuma, William J Moss, Mark J Fisher
Engaged scholarship for health innovation
Copyright (c) 2018 Tinashe Ernest Muzvidzwa Mutsvangwa
Welcome to the inaugural issue of Global Health Innovation
Copyright (c) 2018 Tania Douglas https://creativecommons.org/licenses/by/4.0/
Eh!woza: intersection of art and science to engage youth on tuberculosis
Despite substantial expenditure by national tuberculosis (TB) programmes, significant efforts by advocacy groups, and heavy investment in clinical and biomedical research, TB remains a health emergency disproportionately impacting the poorest and most vulnerable in southern Africa and other endemic regions. Personal experiences of TB are varying and contrasting in these areas where misconception, stigma and taboo are commonplace. An urgent need therefore exists for projects that engage community members as active partners in reducing the impact of TB and other diseases. Eh!woza aims to address this need by fostering collaborative interactions between biomedical TB researchers, a conceptual artist, a non-governmental organization, and young people living in Khayelitsha, a township outside Cape Town. In a series of workshops, the project engages high-school learners with biomedical TB research and provides space, guidance and equipment for participants to produce documentaries about personal experiences of TB. Here, we describe the project’s growth, the results of a formal evaluation which suggest that Eh!woza is responsive to changing dynamics within the study setting, and preliminary findings from anthropological research investigating how knowledge is configured within the project. Finally, we consider prospects for expanding the project and briefly discuss challenges whose resolution could ensure long-term sustainability.
Copyright (c) 2018 Edward Charles Young, Bianca Masuku, Barbara Toressi, Digby Francis Warner, Anastasia Sideris Koch https://creativecommons.org/licenses/by/4.0/
Supply chain of routine orthopaedic implants in Kampala, Uganda: public-private workarounds arising from poverty and scarcity
We examined how surgical implants were accessed by orthopaedic trauma patients in selected public and private hospitals in Kampala, Uganda. The study employed a series of interviews with professionals highly familiar with this circumstance: orthopaedic surgeons from Mulago National Referral Hospital (MNRH), and staff of the MNRH and Ministry of Health (MOH) procurement departments. We also interviewed patients who had received implants in MNRH. Surgeons were forthcoming in describing how implants were made available to their patients and offered several opinions on implant quality, regulation, and the importance of donations in orthopaedic care. The health care officers corroborated the implant procurement process described by the surgeons. We observed that the procurement process was comprised of three distinct pathways: two pathways through which patients purchased implants either directly or through intermediaries, and one donations pathway that provided Western implants through collaborative partnerships. These pathways have evolved to circumvent the mismatch between the high cost of orthopaedic trauma surgery and the overall poverty of the population. This qualitative study strongly supports expanding the capability of the Uganda National Medical Stores (NMS), the arm of the MOH that stores and distributes medicines and supplies to public hospitals, into a sustainable source of orthopaedic implants, inclusive of improved regulatory oversight and quality control for implants.
Copyright (c) 2018 Zoe Sekyonda, Ashley Reid, Erisa Sabakaki Mwaka, Karim Abdi, Davis Baguma, Jethro Ndyabahika, Conrad Waludde, William Reichert https://creativecommons.org/licenses/by/4.0/
The Kahawa Declaration: a manifesto for the democratization of medical technology
Most medical technology is employed and accepted passively by patients and doctors who have little or no influence in its design or usability. Patients are not involved in the development of medical technology, which is undertaken behind closed doors and whose global impact is hindered by proprietary know-how and by costs. This has so far impeded equitable healthcare as most of the world does not have access to the technology or healthcare coverage. Understanding the relevance of international partnerships for achieving the Sustainable Development Goals, feeling specially committed to the promotion of the Goal on “Good Health and Well-Being”, and convinced about the role that open-source biomedical engineering approaches may play in the future of medical technology, we commit ourselves, through the Kahawa Declaration, to enlighten the transformation of the biomedical engineering field, towards the democratization of medical technology as a key for achieving universal equitable health care. This paper presents the content of the Kahawa Declaration, which was signed in Nairobi in December 2017.
Copyright (c) 2018 Arti Ahluwalia, Carmelo De Maria, Andres Diaz Lantada https://creativecommons.org/licenses/by/4.0/
Promoting global clinical care and research for children with orthopaedic disabilities through motion analysis technology
Human motion analysis is a tool used to understand orthopaedic disabilities in children and to plan and monitor treatment strategies. It enables clinicians to quantitatively describe rehabilitative progress, plan surgeries, and conduct research. While this technology is prevalent in major academic medical centers, access is lacking in many regions throughout the world. This paper presents a novel approach to offer more accessible technology at greatly reduced cost. Current applications are underway in the Philippines, Mexico, and Colombia. Through international partnerships, improvements in clinical care, medical education, and research have been observed.
Copyright (c) 2018 Jacob R Rammer, PhD, Joycie Eulah Abiera, MD, Monica Arroyo, PT, Luis Fernando Caicedo, MD, Karl Canseco, MD, Christopher Constantino, MD, Felipe Haces Garcia, MD, Jorge Gomez, MD, Nikhil Kurapati, MD, Mariano Gonzalez Lugo, MD, Terence Miller, JD, Wilfredo Agredo Rodriguez, Carlo Emmanuel Sumpaico, MD, Gerald F Harris, PhD https://creativecommons.org/licenses/by/4.0/