To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
ENT disease prevalence, risk factors and treatment vary between developed and developing countries. Health provision, particularly disease prevention strategies and surgery, in developing countries is poor, manifesting as a high frequency of common and preventable diseases. Healthcare systems in developing countries are unsustainable, and the technological advances that provide ENT surgery with novel diagnostic and treatment opportunities are inaccessible.
A multifaceted approach is essential to improve the care of patients with ENT diseases in developing countries. Public health efforts must focus on educating the local community, reducing high-risk behaviours and decreasing the frequency of preventable diseases. Governments must be pressured to prioritise the funding of long-term, sustainable efforts with effective disease prevention strategies. Providing local healthcare professionals with high-quality ENT training so that self-sustaining and low-cost care can be delivered, mainly in a primary care setting, is key.
Non-communicable disease diagnosis frequently relies on biochemical measurements but laboratory infrastructure in low-income settings is often insufficient and distances to clinics may be vast. We present a model for point of care (POC) epidemiology as used in our study of chronic disease in the Haiti Health Study, in rural and urban Haiti. Point of care testing (POCT) of creatinine, cholesterol, and hemoglobin A1c as well as physical measurements of weight, height, and waist circumference allowed for diagnosis of diabetes, chronic kidney disease, dyslipidemias, and obesity. Methods and troubleshooting techniques for the data collection of this study are presented. We discuss our method of community-health worker (CHW) training, community engagement, study design, and field data collection. We also discuss the machines used and our quality control across CHWs and across geographical regions. Pitfalls tended to include equipment malfunction, transportation issues, and cultural differences. May this paper provide information for those attempting to perform similar diagnostic and screening studies using POCT in resource poor settings.
The objective of the CAEP Global Emergency Medicine (EM) panel was to identify successes, challenges, and barriers to engaging in global health in Canadian academic emergency departments, formulate recommendations for increasing engagement of faculty, and guide departments in developing a Global EM program.
A panel of academic Global EM practitioners and residents met regularly via teleconference in the year leading up to the CAEP 2018 Academic Symposium. Recommendations were drafted based on a literature review, three mixed methods surveys (CAEP general members, Canadian Global EM practitioners, and Canadian academic emergency department leaders), and panel members’ experience. Recommendations were presented at the CAEP 2018 Academic Symposium in Calgary and further refined based on feedback from the Academic Section.
A total of nine recommendations are presented here. Seven of these are directed towards Canadian academic departments and divisions and intend to increase their engagement in Global EM by recognizing it as an integral part of the practice of emergency medicine, deliberately incorporating it into strategic plans, identifying local leaders, providing tangible supports (i.e., research, administration or financial support, shift flexibility), mitigating barriers, encouraging collaboration, and promoting academic deliverables. The final two recommendations pertain to CAEP increasing its own engagement and support of Global EM.
These recommendations serve as guidance for Canadian academic emergency departments and divisions to increase their engagement in Global EM.
In the early twentieth century, scientists at the Pasteur Institute and its colonial affiliates developed a historically specific form of bacteriological technoscience, which abstracted the human–microbe relationship from its environmental and social context, and created a model for public health governance that operated at the scale of the empire, rather than at the level of individual colonies or regions. Using a case study of tuberculosis management, this article argues that the success of the Pastorian model relied on its technopolitical vision of a universal model of managing human–microbe relations, while, in reality, exploiting precisely those fissures created by the uneven political and scientific landscape of the colonial and scientific world in which it operated. Pastorian bacteriology helped imperial administrators to imagine a globe-spanning, standardized empire, while restricting public health governance to technological innovations, rather than a proposal for social hygiene that would have expanded labour and associational rights for subject populations.
Endoscopic ear surgery is a technique that is growing in popularity. It has potential advantages in the low-resource setting for teaching and training, for the relative ease of transporting and storing the surgical equipment and for telemedicine roles. There may also be advantages to the patient, with reduced post-operative pain, facilitating the ability to complete procedures as out-patients.
Our Ear Trainer has previously been validated for headlight and microscope otology skills, including foreign body removal and ventilation tube insertion, in both the high- and low-resource setting. This study aimed to assess the Ear Trainer for similar training and assessment of endoscopic ear surgery skills in the low-resource setting. The study was conducted in Uganda on ENT trainees.
Despite a lack of prior experience with endoscopes, with limited practice time most participants showed improvements in: efficiency of instrument movement, steadiness of the camera view obtained, overall global rating of the task and performance time (faster task performance).
These results indicate that the Ear Trainer is a useful tool in the training and assessment of endoscopic ear surgery skills.
The term “golden hour” describes the first 60 minutes after patients sustain injury. In resource-available settings, rapid transport to trauma centers within this time period is standard-of-care. We compared transport times of injured civilians in modern conflict zones to assess the degree to which injured civilians are transported within the golden hour in these environments.
We evaluated PubMed, Ovid, and Web of Science databases for manuscripts describing transport time after trauma among civilian victims of trauma from January 1990 to November 2017.
The initial database search identified 2704 abstracts. Twenty-nine studies met inclusion and exclusion criteria. Conflicts in Yugoslavia/Bosnia/Herzegovina, Syria, Afghanistan, Iraq, Israel, Cambodia, Somalia, Georgia, Lebanon, Nigeria, Democratic Republic of Congo, and Turkey were represented, describing 47 273 patients. Only 7 (24%) manuscripts described transport times under 1 hour. Transport typically required several hours to days.
Anticipated transport times have important implications for field triage of injured persons in civilian conflict settings because existing overburdened civilian health care systems may become further overwhelmed if in-hospital health capacity is unable to keep pace with inflow of the severely wounded.
The term ‘global mental health’ came to the fore in 2007, when the Lancet published a series by that name.
To review all peer-reviewed articles using the term ‘global mental health’ and determine the implicit priorities of scientific literature that self-identifies with this term.
We conducted a systematic review to quantify all peer-reviewed articles using the English term ‘global mental health’ in their text published between 1 January 2007 and 31 December 2016, including by geographic regions and by mental health conditions.
A total of 467 articles met criteria. Use of the term ‘global mental health’ increased from 12 articles in 2007 to 114 articles in 2016. For the 111 empirical studies (23.8% of articles), the majority (78.4%) took place in low- and middle-income countries (LMICs), with the most in Sub-Saharan Africa (28.4%) and South Asia (25.5%) and none from Central Asia. The most commonly studied mental health conditions were depression (29.7%), psychoses (12.6%) and conditions specifically related to stress (12.6%), with fewer studies on epilepsy (2.7%), self-harm and suicide (1.8%) and dementia (0.9%). The majority of studies lacked contextual information, including specific region(s) within countries where studies took place (20.7% missing), specific language(s) in which studies were conducted (36.9% missing), and details on ethnic identities such as ethnicity, caste and/or tribe (79.6% missing) and on socioeconomic status (85.4% missing).
Research identifying itself as ‘global mental health’ has focused predominantly on depression in LMICs and lacked contextual and sociodemographic data that limit interpretation and application of findings.
This study investigated the genetic and environmental contributions to emotional overeating (EOE) and depressive symptoms, and their covariation, in a Sri-Lankan population, using genetic model-fitting analysis. In total, 3957 twins and singletons in the Colombo Twin and Singleton Study-Phase 2 rated their EOE behaviour and depressive symptoms, which were significantly associated (men: r = 0.11, 95% confidence interval (CI) 0.06–0.16, women: r = 0.12, 95% CI 0.07–0.16). Non-shared environmental factors explained the majority of variance in men (EOE e2 = 87%, 95% CI 78–95%; depressive symptoms e2 = 72%, 95% CI 61–83%) and women (EOE e2 = 76%, 95% CI 68–83%; depressive symptoms e2 = 64%, 95% CI 55–74%). Genetic factors were more important for EOE in women (h2 = 21%, 95% CI 4–32%) than men (h2 = 9%, 95% CI 0–20%). Shared-environmental factors were more important for depressive symptoms in men (c2 = 25%, 95% CI 10–36%) than women (c2 = 9%, 95% CI 0–35%). Non-shared environmental factors explained the overlap between depressive symptoms and EOE in women but not in men. Results differed from high-income populations, highlighting the need for behavioural genetic research in global populations.
Introduction: Global health partnerships (GHPs) between high income and low income countries are a means of capacity building in education. Literature often focuses on the GHP structure and output, along with retention and experience of local trainees, but neglects the experience of involved faculty. Here, we survey Canadian teaching faculty participating in the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) to describe characteristics of participants and their experience in the program. Methods: EM faculty participating in TAAAC-EM teaching trips from 2011-2016 were invited to complete an online survey in February 2017. Teaching faculty travel for one month and undergo an extensive selection process, pre-departure training and post-trip debriefing. Quantitative and qualitative data were collected and analyzed using basic statistics and inductive thematic analyses respectively. Results: Overall, 19 (N = 30, 63.3%) faculty completed the survey, of which 13 had prior global health experiences (range 1 to > 12 months). On a scale of 1-7, participants rated their mean overall experience as a 5.9 and preparation as a 5.7. Among respondents, 79% would participate in future TAAAC-EM activities, 79% would engage in future global health endeavours, 95% said the experience improved their satisfaction of practicing clinical medicine and 89% said it improved their enjoyment of teaching medicine. However, while 58% stated they would recommend this experience without hesitation to colleagues, the remaining 42% said they would recommend this experience with caveats. This latter group had a lower rated preparedness (MD = 1.398, p = 0.003) and TAAAC-EM experience (MD = 1.545, p = 0.001). Major themes in qualitative responses included that the participants felt that intrinsic motivation and flexible predispositions were necessary to participate. Intrinsic motivation for global health involvement included appreciation and impact for GH, and personal growth. Regarding flexibility, respondents highlighted the importance of having a flexible demeanor to understand, accommodate and ethically address cultural differences and practicing in another context. Conclusion: The type of faculty to recruit for GHPs may require flexible predispositions and intrinsic motivation for GH. These qualities combined with adequate preparation can facilitate overall faculty experiences on global health trips.
Research is lacking around how best to approach trauma care in resource poor settings, particularly in remote areas such as the islands of the South Pacific. Without examples of successful treatment of high-risk cases in these settings, countries are unable to move forward with developing policies and standardized procedures for emergency care.
The Republic of Kiribati is a Pacific Island nation composed of 33 islands spanning over 2,000 miles in the central Pacific Ocean. With the only hospital located on Kiritimati Island and inadequate boat transportation, the government recently committed to providing an aircraft for patients to receive appropriate medical care. In 2016, a 20-year-old female, primigravida, on a neighboring island, failed to progress in labor for 24 hours and needed an emergency cesarean section. A radio call was made to Kiritimati, and a team consisting of a general surgeon, nurse, and a laboratory technician was dispatched. The patient was brought to the local clinic and flown to Kiritimati where a team was prepared to perform the cesarean section.
The successful patient evacuation emphasizes the importance of a dedicated health care team, government commitment, and the constant quality communication when approaching feasibility of trauma and emergency care. (Disaster Med Public Health Preparedness. 2019;13:774–776).
Evidence exists of an increasing prevalence of chronic conditions within developed and developing nations, notably for priority population groups. The need for the collection of geospatial data to monitor the health impact of rapid social-environmental and economic changes occurring in these countries is being increasingly recognized. Rigorous accuracy assessment of such geospatial data is required to enable error estimation, and ultimately, data utility for exploring population health. This research outlines findings from a field-based evaluation exercise of the SOMAARTH DDESS geospatial-health platform. Participatory-based mixed methods have been employed within Palwal-India to capture villager perspectives on built infrastructure across 51 villages. This study, conducted in 2013, included an assessment of data element position and attribute accuracy undertaken in six villages, documenting mapping errors and land parcel changes. Descriptive analyses of 5.1% (n = 455) of land parcels highlighted some discrepancies in position (6.4%) and attribute (4.2%) accuracy, and land parcel changes (17.4%). Furthermore, the evaluation led to a refinement of the existing geospatial health platform incorporating ground-truthed reflections from the participatory field exercise. The evaluation of geospatial data accuracies contributes to understandings on global public health surveillance systems, outlining the need to systematically consider assessment of environmental features in relation to lifestyle-related diseases.
Surgery for chronic suppurative otitis media performed in low- and middle-income countries creates specific challenges. This paper describes the equipment and a variety of techniques that we find best suited to these conditions. These have been used over many years in remote areas of Nepal.
Results and conclusion
Extensive chronic suppurative otitis media is frequently encountered, with limited pre-operative investigation or treatment possible. Techniques learnt in better-resourced settings with good follow up need to be modified. The paper describes surgical methods suitable for resource-poor conditions, with rationales. These include methods of tympanoplasty for subtotal wet perforations, hearing reconstruction in wet ears and open cavities, large aural polyps, and canal wall down mastoidectomy with cavity obliteration. Various types of autologous ossiculoplasty are described in detail for use in the absence of prostheses. The following topics are discussed: decision-making for surgery on wet or best hearing ears, children, bilateral surgery, working with local anaesthesia, and obtaining adequate consent in this environment.
There is poor availability of ear and hearing services globally, because of a lack of infrastructure, funding, equipment and appropriately trained personnel. When deciding upon delivery of ear and hearing services, an approach based upon community assessment is advocated, with subsequent asset mapping and acquisition.
Some of the challenges to delivery of care in resource-constrained or remote environments are acknowledged, with discussion of several existing models of service delivery, and their advantages and disadvantages. Public health and telehealth are also mentioned. This article may assist those trying to set up new programmes in ear and hearing health.
This article explores the introduction of smallpox vaccination into Nepal in 1816 at the request of the Nepalese government; the king, however, was not vaccinated, contracted the disease and died. British hopes that vaccination would be extended throughout the country did not eventuate. The article examines the significance of this early appearance of vaccination in Nepal for both Nepalese and British, and relates it to the longer history of smallpox control and eventual eradication. When the Nepalese requested World Health Organization (WHO) assistance with communicable disease control in the mid-twentieth century little had changed for most Nepalese. We know about the events in 1816 through the letters of the newly imposed British Resident after Nepal’s military defeat in the Anglo-Nepal War (1814–16). By also drawing on other sources and foregrounding Nepal, it becomes possible to build up a more extensive picture of smallpox in Nepal that shows not only boundaries and limits to colonial authority and influence but also how governments may adopt and use technologies on their own terms and for their own purposes. Linking 1816 to the ultimately successful global eradication programme 150 years later reminds us of the need to think longer term as to why policies and programmes may or may not work as planned.
Current debates about precision medicine take different perspectives on its relevance and value in global health. The term has not yet been applied to disaster medicine or humanitarian health, but it may hold significant value. An interpretation of the term for global public health and disaster medicine is presented here for application to vulnerable populations. Embracing the term may drive more efficient use and targeting of limited resources while encouraging innovation and adopting the new approaches advocated in current humanitarian discourse.
PatelRB.Precision Health in Disaster Medicine and Global Public Health. Prehosp Disaster Med. 2018;33(6):565–566.
For the World Health Organization (WHO), the 1978 Alma-Ata Declaration marked a move away from the disease-specific and technologically-focused programmes of the 1950s and 1960s towards a reimagined strategy to provide ‘Health for All by the Year 2000’. This new approach was centred on primary health care, a vision based on acceptable methods and appropriate technologies, devised in collaboration with communities and dependent on their full participation. Since 1948, the WHO had used mass communications strategies to publicise its initiatives and shape public attitudes, and the policy shift in the 1970s required a new visual strategy. In this context, community health workers (CHWs) played a central role as key visual identifiers of Health for All. This article examines a period of picturing and public information work on the part of the WHO regarding CHWs. It sets out to understand how the visual politics of the WHO changed to accommodate PHC as a new priority programme from the 1970s onwards. The argument tracks attempts to define CHWs and examines the techniques employed by the WHO during the 1970s and early 1980s to promote the concept to different audiences around the world. It then moves to explore how the process was evaluated, as well as the difficulties in procuring fresh imagery. Finally, the article traces these representations through the 1980s, when community approaches came under sustained pressure from external and internal factors and imagery took on the supplementary role of defending the concept.
Global philanthropy is a significant source of financial resources in contemporary international relations, and it has provoked intense debates about the appropriateness of involving private foundations in global policymaking. Despite these facts, International Relations as a discipline has shown remarkably little reference to philanthropy as an important and relevant actor in global politics. In this article, I make the case for explicitly incorporating philanthropy into international relations analyses. Drawing on both historical examples and contemporary cases from the global health space, I show how philanthropy exerts a unique and independent influence within international society and that it needs to be understood holistically rather than focusing solely on individual philanthropic organisations. I also discuss how this expanding influence raises serious questions about accountability and legitimacy. Rather than making an argument about the appropriateness of philanthropy’s involvement in international society, this article aims to make the case for philanthropy’s analytical inclusion within the discipline.
At the heart of surgical care needs to be the education and training of staff, particularly in the low-income and/or resource-poor setting. This is the primary means by which self-sufficiency and sustainability will ultimately be achieved. As such, training and education should be integrated into any surgical programme that is undertaken. Numerous resources are available to help provide such a goal, and an open approach to novel, inexpensive training methods is likely to be helpful in this type of setting.
The need for appropriately trained audiologists in low-income countries is well recognised and clearly goes beyond providing support for ear surgery. However, where ear surgery is being undertaken, it is vital to have audiology services established in order to correctly assess patients requiring surgery, and to be able to assess and manage outcomes of surgery. The training requirements of the two specialties are therefore intimately linked.
This article highlights various methods, resources and considerations, for both otolaryngology and audiology training, which should prove a useful resource to those undertaking and organising such education, and to those staff members receiving it.
Chronic suppurative otitis media is a massive public health problem in numerous low- and middle-income countries. Unfortunately, few low- and middle-income countries can offer surgical therapy.
A six-month long programme in Cambodia focused on training local surgeons in type I tympanoplasty was instigated. Qualitative educational and quantitative surgical outcomes were evaluated in the 12 months following programme completion. A four-month long training programme in mastoidectomy and homograft ossiculoplasty was subsequently implemented, and the preliminary surgical and educational outcomes were reported.
A total of 124 patients underwent tympanoplasty by the locally trained surgeons. Tympanic membrane closure at six weeks post-operation was 88.5 per cent. Pure tone audiometry at three months showed that 80.9 per cent of patients had improved hearing, with a mean gain of 17.1 dB. The trained surgeons reported high confidence in performing tympanoplasty. Early outcomes suggest the local surgeons can perform mastoidectomy and ossiculoplasty as safely as overseas-trained surgeons, with reported surgeon confidence reflecting these positive outcomes.
The training programme has demonstrated success, as measured by surgeon confidence and operative outcomes. This approach can be emulated in other settings to help combat the global burden of chronic suppurative otitis media.
In a crisis-prone world, the number of internally displaced persons (IDPs) uprooted by both armed conflicts and environmental disasters has drastically increased and displacement risks have intensified. Despite the growing attention within global security and development agendas to sexual and reproductive health and rights (SRHR), there remain striking gaps in addressing SRHR in crisis situations, particularly among IDP women and girls. This article examines the continuum between social reproduction in times of crisis and the material and ideological conditions that restrict women’s bodily autonomy in everyday life. Using the case of the Philippines where millions of people are routinely affected by conflict and disaster-induced displacements, it argues that the failure to recognise the centrality of women’s health and bodily autonomy not only hinders the sustainable provision of care and domestic labour during and after crisis, but also fundamentally constrains how security is enacted within these spaces. Thus, the article highlights an urgent need to rethink the gendered political economy of crisis responses as a building block for stemming gendered violence and depletion of social reproductive labour at the household, state, and global levels.