Barriers to initiating tuberculosis treatment in sub-Saharan Africa: a systematic review focused on children and youth

Background: Tuberculosis (TB) is the deadliest infectious disease globally, with 10.4 million people infected and more than 1.8 million deaths in 2015. TB is a preventable, treatable, and curable disease, yet there are numerous barriers to initiating treatment. These barriers to treatment are exacerbated in low-resource settings and may be compounded by factors related to childhood. Objective: Timely initiation of tuberculosis (TB) treatment is critical to reducing disease transmission and improving patient outcomes. The aim of this paper is to describe patient- and system-level barriers to TB treatment initiation specifically for children and youth in sub-Saharan Africa through systematic review of the literature. Design: This review was conducted in October 2015 in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Six databases were searched to identify studies where primary or secondary objectives were related to barriers to TB treatment initiation and which included children or youth 0–24 years of age. Results: A total of 1490 manuscripts met screening criteria; 152 met criteria for full-text review and 47 for analysis. Patient-level barriers included limited knowledge, attitudes and beliefs regarding TB, and economic burdens. System-level barriers included centralization of services, health system delays, and geographical access to healthcare. Of the 47 studies included, 7 evaluated cost, 19 health-seeking behaviors, and 29 health system infrastructure. Only 4 studies primarily assessed pediatric cohorts yet all 47 studies were inclusive of children. Conclusions: Recognizing and removing barriers to treatment initiation for pediatric TB in sub-Saharan Africa are critical. Both patient- and system-level barriers must be better researched in order to improve patient outcomes

Qualitative Analysis of Palliative Care for Pediatric Patients With Cancer at Bugando Medical Center: An Evaluation of Barriers to Providing End-of-Life Care in a Resource-Limited Setting

Purpose: Palliative care remains an urgent, neglected need in the developing world. Global disparities in end-of-life care for children, such as those with advanced cancers, result from barriers that are complex and largely unstudied. This study describes these barriers at Bugando Medical Center, one of three consultant hospitals in Tanzania, to identify areas for palliative care development suitable to this context. Methods: In-depth interviews were conducted with 20 caregivers of pediatric patients with cancer and 14 hospital staff involved in pediatric end-of-life care. This was combined with 1 month of participant observation through direct clinical care of terminally ill pediatric patients. Results: Data from interviews as well as participant observation revealed several barriers to palliative care: financial, infrastructure, knowledge and cultural (including perceptions of pediatric pain), and communication challenges. Although this study focused on barriers, what also emerged were the unique advantages of end-of-life care in this setting, including community cohesiveness and strong faith background. Conclusion: This study provides a unique but focused description of barriers to palliative care common in a low-resource setting, extending beyond resource needs. This multidisciplinary qualitative approach combined interviews with participant observation, providing a deeper understanding of the logistical and cultural challenges in this setting. This new understanding will inform the design of more effective—and more appropriate—palliative care policies for young patients with cancer in the developing world

Adapting Satellite Soundings for Operational Forecasting within the Hazardous Weather Testbed

In this paper, we describe how researchers and weather forecasters work together to make satellite sounding data sets more useful in severe weather forecasting applications through participation in National Oceanic and Atmospheric Administration (NOAA)’s Hazardous Weather Testbed (HWT) and JPSS Proving Ground and Risk Reduction (PGRR) program. The HWT provides a forum for collaboration to improve products ahead of widespread operational deployment. We found that the utilization of the NOAA-Unique Combined Atmospheric Processing System (NUCAPS) soundings was improved when the product developer and forecaster directly communicated to overcome misunderstandings and to refine user requirements. Here we share our adaptive strategy for (1) assessing when and where NUCAPS soundings improved operational forecasts by using real, convective case studies and (2) working to increase NUCAPS utilization by improving existing products through direct, face-to-face interaction. Our goal is to discuss the lessons we learned and to share both our successes and challenges working with the weather forecasting community in designing, refining, and promoting novel products. We foresee that our experience in the NUCAPS product development life cycle may be relevant to other communities who can then build on these strategies to transition their products from research to operations (and operations back to research) within the satellite meteorological community