Personal digital assistants to collect tuberculosis bacteriology data in Peru reduce delays, errors, and workload, and are acceptable to users: cluster randomized controlled trial

SummaryObjectivesTo evaluate the effectiveness of a personal digital assistant (PDA)-based system for collecting tuberculosis test results and to compare this new system to the previous paper-based system. The PDA- and paper-based systems were evaluated based on processing times, frequency of errors, and number of work-hours expended by data collectors.MethodsWe conducted a cluster randomized controlled trial in 93 health establishments in Peru. Baseline data were collected for 19 months. Districts (n=4) were then randomly assigned to intervention (PDA) or control (paper) groups, and further data were collected for 6 months. Comparisons were made between intervention and control districts and within-districts before and after the introduction of the intervention.ResultsThe PDA-based system had a significant effect on processing times (p<0.001) and errors (p=0.005). In the between-districts comparison, the median processing time for cultures was reduced from 23 to 8 days and for smears was reduced from 25 to 12 days. In that comparison, the proportion of cultures with delays >90 days was reduced from 9.2% to 0.1% and the number of errors was decreased by 57.1%. The intervention reduced the work-hours necessary to process results by 70% and was preferred by all users.ConclusionsA well-designed PDA-based system to collect data from institutions over a large, resource-poor area can significantly reduce delays, errors, and person-hours spent processing data

Scale-up of Multidrug-Resistant Tuberculosis Laboratory Services, Peru

One-sentence summary for table of contents: Strategic design and implementation of these services is feasible in resource-poor settings

Tuberculosis laboratory information systems for resource-poor settings

Thesis (Ph. D.)--Harvard-MIT Division of Health Sciences and Technology, February 2009.Includes bibliographical references (p. 132-143).Multi-drug resistant tuberculosis (MDR-TB) patients in resource-poor settings experience large delays in starting appropriate drug regimens and are often not monitored appropriately due to an overburdened health care system, communication delays, and missing or error-prone data. Medical information systems can be used to alleviate these problems by increasing the timeliness and quality of laboratory information available. The research reported in this thesis developed, implemented, and evaluated two such systems in the urban, resource-poor setting of Lima, Peru in institutions with and without internet. The first part addresses the electronic collection of tuberculosis (TB) laboratory information from multiple institutions without internet. A handheld computer-based system was developed and implemented. A cluster randomized controlled trial and before-and-after comparison showed that this system had a significant effect in reducing processing times from 23 to 8 days, the proportion of cultures with delays >90 days from 9.2% to 0.1%, the number of errors by 57.1%, and the work-hours necessary to process results by 60%. A cost and timeline framework was developed to allow other organizations in resource-poor settings to implement this technology. The second part addresses a web-based system, e-Chasqui, developed to provide electronic communication and reporting of TB laboratory information to health care personnel within institutions with internet. A cluster randomized controlled trial showed that access to e-Chasqui resulted in significantly less time to receipt of test results, a 56% reduction in tests taking over 60 days to arrive and a 98% reduction of results that never arrived, as well as a significantly faster time to culture conversion among patients in intervention versus control centers.(cont.) These two parts describe verified medical informatics tools and an implementation methodology for settings both with and without internet connectivity.by Joaquin Andres Blaya.Ph.D

The U.S. Commitment to Global Health: Recommendations for the New Administration

Outlines the need for making a commitment to improving global health an integral part of U.S. foreign policy. Suggestions include creating a White House Interagency Committee on Global Health and directing more funds to chronic disease programs

Tuberculosis

Asserts that despite progress in controlling tuberculosis (TB), the decline in incidence has been disappointing, pointing to the need for new strategies and more effective tools. HIV/AIDS is one factor that challenges effective control of TB, especially in Southern African countries. Three key elements are needed to achieve effective TB control and to meet the Sustainable Development Goals: (1) early and accurate diagnosis and drug-sensitivity testing, (2) patient access to and completion of effective treatment, and (3) prevention of progression from latent infection to disease. Prevention requires vaccination and screening of individual at high risk as well as interventions such as air disinfection and the use of masks and respirators in hospitals and other congregate settings. Recommendations stress the need to strengthen health systems in high-burden countries by emphasizing community-based care over hospital care; to improve information systems to ensure patient adherence and manage medication supply chains; and to invest in research to develop the necessary interventions. Fundamentally, current global TB control strategies must undergo revision and receive significant research funding

Engineering an EMR System in the Developing WorldNecessity is the Mother of Invention

While Electronic Medical Record (EMR) systems continue to improve the efficacy of healthcare delivery in the West, they have yet to be widely deployed in the developing world, where more than 90% of the global disease burden exists. The benefits afforded by an EMR notwithstanding, there is some skepticism regarding the feasibility of operationalizing an EMR system in a low-resource setting. This dissertation challenges these preconceptions and advances the understanding of the problems faced when implementing EMR systems to support healthcare delivery in a developing-world setting.Our methodology relies primarily on eight years of in-field experimentation and study. To facilitate a better understanding of the needs and challenges, we created a pilot system in a large government central hospital in Malawi, Africa. Learning from the pilot we developed and operationalized a point-of-care EMR system for managing the care and treatment of patients receiving antiretroviral therapy, which we put forth as a demonstration of feasibility in a developing-world setting.The pilot identified many unique challenges of healthcare delivery in the developing world, and reinforced the need to engineer solutions from scratch rather than blindly transplant systems developed in and for the West. Three novel technologies were developed over the course of our study, the most significant of which is the touchscreen clinical workstation appliance. Each of the novel technologies and their contribution towards successful implementation are described in the context of both an engineering and a risk management framework. A small comparative study to address data quality concerns associated with a point-of-care approach concluded that there was no significant difference in the accuracy of data collected through the use of a prototype point-of-care system compared to that of data entered retrospectively from paper records. We conclude by noting that while feasibility has been demonstrated the greatest challenge to sustainability is the lack of financial resources to monitor and support EMR systems once in place

Engaging ICTs as a “Tool” for eHealth prioritization on human development and poverty reduction in the African region

The association connecting information and communication technologies (ICTs) and well-being or poverty remains vague and research today has resulted to divergent conclusions. This paper defines ICTs as “tools” that facilitate communication and the processing and transmission of information and the sharing of knowledge by electronic means. In the African region context, we examine ICTs utilization that aims to improve the provision, access and information management in the health sector. This paper considers access to information as very important benefits that can be achieved in many areas including economic growth, education and healthcare. In healthcare, the roles that ICT plays in ensuring that health information is provided to healthcare providers and consumers to support improving the health of individuals and strengthening health systems, disease detection and prevention are crucial to development and poverty reduction as stated in the UN’s MDGs. For example, access to appropriate information can minimise visits to physicians and periods of hospitalisation for patients suffering from chronic conditions, such as asthma, diabetes, hypertension and HIV/AIDS. This will in turn reduce the cost of healthcare provision. ICTs have the potential to impact almost every aspect of health sector. The paper then proposed how ICTs can be used to reduce poverty and ensure that health information is well administered and reaches the right people, at the right time and in the right form

Infectious diseases snapshot 2008

The axis of CDC's efforts toward prevention, detection, and control of infectious diseases is the Coordinating Center for Infectious Diseases. CCID comprises four national centers with unique and complementary missions and capacities. CCID collectively envisions a world safe from infectious diseases and microbial threats, both naturally occurring and those that are intentionally spread. This document provides a snapshot of CCID's budget and highlights many of the policies, programs, and collaborative activities that were undertaken in 2008 to advance CDC's public health mission.Overview -- CCID National Centers [National Center for Immunization and Respiratory Diseases (NCIRD), National Center for HIV, Hepatitis, STD, and TB Prevention (NCHHSTP), National Center for Preparedness, Detection, and Control of Infectious Diseases (NCPDCID), National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED)] -- CDC collaborative partners -- CCID at work abroad--global health -- Infectious diseases budget overview -- CDC advisors on infectious diseases -- Appendix: CCID provides funding to the following international organizations and universities -- Glossary200

Infectious diseases snaphot 2008

The axis of CDC's efforts toward prevention, detection, and control of infectious diseases is the Coordinating Center for Infectious Diseases. CCID comprises four national centers with unique and complementary missions and capacities. CCID collectively envisions a world safe from infectious diseases and microbial threats, both naturally occurring and those that are intentionally spread. This document provides a snapshot of CCID's budget and highlights many of the policies, programs, and collaborative activities that were undertaken in 2008 to advance CDC's public health mission.Overview -- CCID National Centers [National Center for Immunization and Respiratory Diseases (NCIRD), National Center for HIV, Hepatitis, STD, and TB Prevention (NCHHSTP), National Center for Preparedness, Detection, and Control of Infectious Diseases (NCPDCID), National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED)] -- CDC collaborative partners -- CCID at work abroad--global health -- Infectious diseases budget overview -- CDC advisors on infectious diseases -- Appendix: CCID provides funding to the following international organizations and universities -- Glossary200