Expanding access to rehabilitation using mobile health to address musculoskeletal pain and disability

Introduction Musculoskeletal (MSK) disorders such as low back pain and osteoarthritis are a leading cause of disability and the leading contributor to the need for rehabilitation services globally. This need has surpassed the availability of trained clinicians; even in urban areas where services and providers are thought to be more abundant, access can be challenged by transportation options and financial costs associated with travel, care and lost time from work. However, continuing standard of fully in-person rehabilitation care for MSK-associated pain and disability may no longer be necessary. With increased ownership or access to even a basic mobile phone device, and evidence for remote management by trained clinicians, some individuals with MSK disorders may be able to continue their rehabilitation regimen predominantly from home after initial evaluation in primary care or an outpatient clinic. Methods This manuscript describes application of a framework we used to culturally and contextually adapt an evidence-based approach for leveraging digital health technology using a mobile phone (mHealth) to expand access to rehabilitation services for MSK-associated pain and disability. We then conducted a multi-level analysis of policies related to the adapted approach for rehabilitation service delivery to identify opportunities to support sustainability. Results Our study was conducted in Tanzania, a lower-middle income country with their first National Rehabilitation Strategic Plan released in 2021. Lessons learned can be applied even to countries with greater infrastructure or fewer barriers. The seven-step adaptation framework used can be applied in other regions to improve the likelihood of local mHealth adoption and implementation. Our practice and policy assessment for Tanzania can be applied in other regions and used collaboratively with government officials in support of building or implementing a national rehabilitation strategic plan. Conclusion The work described, lessons learned and components of the plan are generalizable globally and can improve access to rehabilitation services using mHealth to address the significant and increasing burden of disability

Performance characteristics and costs of serological tests for brucellosis in a pastoralist community of northern Tanzania

The control of brucellosis across sub-Saharan Africa is hampered by the lack of standardized testing and the use of tests with poor performance. This study evaluated the performance and costs of serological assays for human brucellosis in a pastoralist community in northern Tanzania. Serum collected from 218 febrile hospital patients was used to evaluate the performance of seven index tests, selected based on international recommendation or current use. We evaluated the Rose Bengal test (RBT) using two protocols, four commercial agglutination tests and a competitive enzyme-linked immunosorbent assay (cELISA). The sensitivity, specificity, positive predictive value, negative predictive value, Youden’s index, diagnostic accuracy, and per-sample cost of each index test were estimated. The diagnostic accuracy estimates ranged from 95.9 to 97.7% for the RBT, 55.0 to 72.0% for the commercial plate tests, and 89.4% for the cELISA. The per-sample cost range was $0.69–$0.79 for the RBT, $1.03–$1.14 for the commercial plate tests, and $2.51 for the cELISA. The widely used commercial plate tests performed poorly and cost more than the RBT. These findings provide evidence for the public health value of discontinuing the use of commercial agglutination tests for human brucellosis in Tanzania

Simplified Procedures for Managing Insecticidal Waste: A Case Report of KCMUCo-PAMVERC Vector Control Product Testing Facility in North-Eastern Tanzania.

Insecticide testing facilities that evaluate a variety of vector control products may generate a large number of hazardous wastes from routine operations. These wastes originate from degraded technical grade materials, sprayed substrates with Indoor Residual Spraying (IRS), and redundant stock or working insecticidal solutions. The washing of Long-Lasting Insecticidal Nets (LLINs) during preparation for laboratory and experimental hut trials also contribute to wastewater with insecticide content. Human and environmental exposure to insecticidal waste can occur during transport, categorization, storage, and disposal, resulting in environmental pollution and potential health effects. Various national and international guidelines have been devised for safe disposal and should be strictly followed to avoid adverse effects on humans or environment. To facilitate proper insecticidal waste management, this paper outlines simple but safe practices derived from international and national guidelines that can be adopted by other similar facilities. National and international policies related to chemical management were reviewed and translated into Standard Operating Procedures (SOPs), training pathways, and manuals. National Environmental Management Council (NEMC) assessed the test facility and recommended disposal procedures. NEMC recommendations were followed to construct the soak pits for liquid waste disposal while chemical transporters and incinerators were contracted for solid waste disposal. An environmental expert was contracted for environmental audit and annual monitoring. Studies and activities at the facility were evaluated for their waste generation index. Safety manual and SOPs on risk assessment, waste management and disposal, handling hazardous materials, health and safety procedures, and chemical usage were written. At KCMUCo-PAMVERC, an annual average of 0.02 and 24.9 cubic meters of liquid waste, which mainly includes a mixture of water, insecticides, and solvents, were generated from laboratory experiments (phase I) and semi-field LLIN experiments (phase II), respectively, while the IRS semi-field experiments generated an annual average of 88 L of liquid waste and 6.3 tons of solid waste. An annual average of 0.18 cubic meters of liquid waste results from other sources, including expired laboratory reagents. Well-translated national and international policies/regulations may be adopted by insecticide test facilities for proper and effective waste disposal