Urinalysis Screening for Rural Communities

Access to medical care and health screenings is a necessity for patients around the globe, but it can be difficult to provide this without screenings becoming costly or convoluted. In rural and underdeveloped areas, patients are often disadvantaged when it comes to finding reliable and affordable healthcare. The isolation provided by their location and the rising costs of physicians makes it impossible for most impoverished communities to attain personalized care. Because of this, treatable diseases often go unaddressed, allowing diseases to progress to a critical condition. Mortality rates have shown to be higher in communities located in rural areas and among destitute economies. Telemedicine is one solution to improve rural health care by allowing patients to have remote access to health services. Our goal for this project would be to provide simple and fast diagnosis to detect urine albumin levels, urobilinogen, nitrite, as well as pH and glucose levels combined with telemedicine to provide reliable results. Thus far, we have completed tests for the previously mentioned parameters and have reached out to the World Health Partners in order to propose collaboration on the project. We have also reached out to the Computer Engineering team in order to normalize the images captured by the diagnostic device. Once the project reaches its conclusion, we believe that the introduction of this device into rural areas would effectively monitor patient health as well as improve the overall quality of life for those in impoverished conditions

MUMS: Mobile Urinalysis for Maternal Screening

Pregnant women in low-income communities often lack access to the necessary healthcare for successful births. This is frequently due to the high costs of medical care, the remote location of patients, and the infrequency of primary care medical visits. To address this inequity, we have created a mobile application and imaging unit that allows for the low-cost implementation of urinalysis testing, which will aid in the detection of warning signs for prenatal health risks. From a single photo taken with a tablet camera, our application digitizes the results of a standard urinalysis test strip, displays the test results, and tracks the patient test histories. Using early, affordable urinalysis, we can increase the rates early detection, intervention, and successful pregnancies. Our results have shown that our solution can accurately estimate the concentrations of biological compounds found in urine when compared to visual approximations of color comparison charts. Our device is not only more efficient than the alternative, but also more efficient at screening for and detecting potentially fatal health conditions in pregnant women. Ultimately, our solution is a frugal and mobile urinalysis alternative that can feasibly be implemented in rural communities in order to increase early detection of pregnancy complications, allow for early intervention, and improve the probability of successful pregnancies

The epidemiology of chronic kidney disease (CKD) in rural East Africa: A population-based study.

BackgroundChronic kidney disease (CKD) may be common among individuals living in sub-Saharan Africa due to the confluence of CKD risk factors and genetic predisposition.MethodsWe ascertained the prevalence of CKD and its risk factors among a sample of 3,686 participants of a population-based HIV trial in rural Uganda and Kenya. Prevalent CKD was defined as a serum creatinine-based estimated glomerular filtration rate <60 mL/min/1.73m2 or proteinuria (urine dipstick ≥1+). We used inverse-weighting to estimate the population prevalence of CKD, and multivariable log-link Poisson models to assess the associations of potential risk factors with CKD.ResultsThe estimated CKD prevalence was 6.8% (95% CI 5.7-8.1%) overall and varied by region, being 12.5% (10.1-15.4%) in eastern Uganda, 3.9% (2.2-6.8%) in southwestern Uganda and 3.7% (2.7-5.1%) in western Kenya. Risk factors associated with greater CKD prevalence included age ≥60 years (adjusted prevalence ratio [aPR] 3.5 [95% CI 1.9-6.5] compared with age 18-29 years), HIV infection (aPR 1.6 [1.1-2.2]), and residence in eastern Uganda (aPR 3.9 [2.6-5.9]). However, two-thirds of individuals with CKD did not have HIV, diabetes, or hypertension as risk factors. Furthermore, we noted many individuals who did not have proteinuria had dipstick positive leukocyturia or hematuria.ConclusionThe prevalence of CKD is appreciable in rural East Africa and there are considerable regional differences. Conventional risk factors appear to only explain a minority of cases, and leukocyturia and hematuria were common, highlighting the need for further research into understanding the nature of CKD in sub-Saharan Africa

Diagnostic Color Strip Reader for World Health Partners Clinics

Despite the advancement of medical technology, many people in developing countries like India and Kenya still suffer from treatable diseases. In many of the health clinics in these areas, color strips are used for checkups and diagnosis of diseases. However, a big problem with these color strips is that the diagnosis of color strips take a long time because they have to be manually checked. Currently, World Health Partners (WHP) works with doctors and hospitals in India and Kenya to provide more accessible healthcare through telehealth networks to get consultations from rural clinics to specialists at hospitals. We are working with WHP to streamline the process of color strip diagnosis, by creating an application that goes through the process of reading a color strip in a single step. Our application analyzes an image of a color strip and returns the concentration of the different factors being tested on the color strip. By doing so, we provide a precise analysis of color strips, instead of having to wait for a specialist

Northumbria Police custody health needs assessment

A health needs assessment of detainees in poilce custody in Northumbri

Hypertension testing and treatment in Uganda and Kenya through the SEARCH study: An implementation fidelity and outcome evaluation.

BackgroundHypertension (HTN) is the single leading risk factor for human mortality worldwide, and more prevalent in sub-Saharan Africa than any other region [1]-although resources for HTN screening, treatment, and control are few. Most regional pilot studies to leverage HIV programs for HTN control have achieved blood pressure control in half of participants or fewer [2,3,4]. But this control gap may be due to inconsistent delivery of services, rather than ineffective underlying interventions.MethodsWe sought to evaluate the consistency of HTN program delivery within the SEARCH study (NCT01864603) among 95,000 adults in 32 rural communities in Uganda and Kenya from 2013-2016. To achieve this objective, we designed and performed a fidelity evaluation of the step-by-step process (cascade) of HTN care within SEARCH, calculating rates of HTN screening, linkage to care, and follow-up care. We evaluated SEARCH's assessment of each participant's HTN status against measured blood pressure and HTN history.FindingsSEARCH completed blood pressure screens on 91% of participants. SEARCH HTN screening was 91% sensitive and over 99% specific for HTN relative to measured blood pressure and patient history. 92% of participants screened HTN+ received clinic appointments, and 42% of persons with HTN linked to subsequent care. At follow-up, 82% of SEARCH clinic participants received blood pressure checks; 75% received medication appropriate for their blood pressure; 66% remained in care; and 46% had normal blood pressure at their most recent visit.ConclusionThe SEARCH study's consistency in delivering screening and treatment services for HTN was generally high, but SEARCH could improve effectiveness in linking patients to care and achieving HTN control. Its model for implementing population-scale HTN testing and care through an existing HIV test-and-treat program-and protocol for evaluating the intervention's stepwise fidelity and care outcomes-may be adapted, strengthened, and scaled up for use across multiple resource-limited settings

Indices of Kidney Damage and Cardiovascular Disease Risk Factors in a Semiurban Community of Iloye, South-West Nigeria

Health screening exercises are important, as they enable early detection of diseases in individual subjects and also enable data collection, useful in estimating disease burden in the community. This paper describes the findings of a health screening exercise conducted in a semiurban population of Iloye, by the Rotary Club of Ota, Ogun State, Western Nigeria, as a part of its community-oriented services and projects. Three hundred and twenty six community members were screened during the exercise. There were 189 (57.97%) females and 137 (42.03%) males, with a mean age of 43.5 ± 14.88 yrs. Urinary abnormality and/or creatinine clearance less than 90 mls/min was detected in 147 (45.09%) participants. 99 (30.37%) participants had proteinuria, 16 (4.91%) had haematuria, and 5 (1.53%) participants had both haematuria and proteinuria. Eight (2.45%) participants had GFR less than 60 mls/min. Elevated blood pressure was found in 152 (46.63%), while 3 (0.9%) participants had diabetes, 71 (21.8%) were obese, 16 (4.9%) had hypercholesterolaemia, and 3 (0.9%) had hypertriglyceridaemia. Prevalence of both smoking and alcohol consumption was 6 (1.84%). It was concluded that the prevalence of indices of kidney damage and cardiovascular risk factors is high in Iloye community

Undiagnosed hypertension and proteinuria in an outpatient population in Northern Ghana

Background: There is an upsurge in chronic kidney disease incidence worldwide. Late presentation characterises chronic kidney disease in sub-Saharan Africa. Hypertension and proteinuria are independent risk factors for worsening kidney function, irrespective of the cause of the kidney disease. We assessed the prevalence and predictors of hypertension and proteinuria in an outpatient population in Northern Ghana. Methods: We retrospectively reviewed screening data among adults ≥18 years of age in two of Ghana’s Northern regions. The data retrieved included socio-demographic information, blood pressure recordings, urine dipsticks and fingerpick blood glucose levels. The data were analysed for the prevalence of hypertension and proteinuria in the participants. Binary logistic regression analysis was employed to identify the predictors of significant proteinuria in these participants. A p-value <0.05 was considered statistically significant. Results: Total 1018 participants were included in the study, comprising 50.5% males. The prevalence of uncontrolled hypertension was 28.1%, using a blood pressure cut-off value of ≥ 140/90 mmHg. Significant proteinuria (≥ 1+ or 30 mg/dl) was present in 10.7% of the participants. Hypertension (AOR 2.433, 95% CI 1.582-3.742, p<0.001) and hyperglycaemia (AOR 2.226, 95% CI 1.159-4.275, p=0.016) were independent predictors of the presence of significant proteinuria. Conclusions: Uncontrolled hypertension and proteinuria were common in this outpatient population in Northern Ghana. The cost-effectiveness of community-based screening for chronic kidney disease and its risk factors in low-resource settings like Ghana, with the aim to treat to improve outcomes, needs to be explored.

Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative

Extent: 10p.BACKGROUND: Australia's Aboriginal and Torres Strait Islander (Indigenous) populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities. METHODS: We undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4) were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems. RESULTS: The proportion of women presenting for their first antenatal visit in the first trimester ranged from 34% to 49% between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling; 52% of all women received antenatal education and 51% had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70% of identified women being referred to a GP/Obstetrician. CONCLUSION: Participating services had both strengths and weaknesses in the delivery of maternal health care. Increasing access to evidence-based screening and health information (most notably around smoking cessation) were consistently identified as opportunities for improvement across services.Alice R. Rumbold, Ross S. Bailie, Damin Si, Michelle C. Dowden, Catherine M. Kennedy, Rhonda J. Cox, Lynette O’Donoghue, Helen E. Liddle, Ru K. Kwedza, Sandra C. Thompson, Hugh P. Burke, Alex D. H. Brown, Tarun Weeramanthri and Christine M. Connor

Breaking Barriers to Diabetes Management in Rural Communities: Student Nurses Make a Difference Using Point-of-Care Testing

Just as in many parts of the world, rural communities in Cameroon are experiencing a disturbing increase in the prevalence of diabetes. Inadequate or lack of trained personnel, lack of equipment and knowledge deficit about diabetes are among the many factors hindering implementation of control measures. To address this problem, a 14 hour curriculum on the use of point-of-care testing and diabetes management was designed and taught to 14 enrolled nursing students. During their subsequent 12 weeks placement in two rural communities, the students with the involvement of the health center nurses screened for and managed diabetics and high risk cases. A total of 334 clients were screened; overall diabetes prevalence was 4.89%; 11.31% were at high risk; and 35.78% were at risk. The progress reports of the diabetic and high risk clients who were followed-up revealed significant improvements in their health. The health centre nurses gained knowledge and skills in the course of working with the students while the students among many other benefits, improved their leadership skills and accountability awareness. Challenges such as lack of cooperation from lab technicians were overcome