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A comprehensive resource describing innovative technologies and digital health tools that can revolutionize the delivery of health care in low- to middle-income countries, particularly in remote rural impoverished communities  Revolutionizing Tropical Medicine offers an up-to-date guide for healthcare and other professionals working in low-resource countries where access to health care facilities for diagnosis and treatment is challenging. Rather than suggesting the expensive solution of building new bricks and mortar clinics and hospitals and increasing the number of doctors and nurses in these deprived areas, the authors propose a complete change of mindset. They outline a number of ideas for improving healthcare including rapid diagnostic testing for infectious and non-infectious diseases at a point-of-care facility, together with low cost portable imaging devices. In addition, the authors recommend a change in the way in which health care is delivered. This approach requires task-shifting within the healthcare provision system so that nurses, laboratory technicians, pharmacists and others are trained in the newly available technologies, thus enabling faster and more appropriate triage for people requiring medical treatment. This text: * Describes the current burden of communicable and non-communicable diseases in low- to middle-income countries throughout the world * Describes the major advances in healthcare outcomes in low-to middle-income countries derived from implementation of the United Nations/World Health Organisation's 2000 Millennium Development Goals * Provides a review of inexpensive rapid diagnostic point-of-care tests for infectious diseases in low-resource countries, particularly for people living in remote rural areas * Provides a review of other rapid point-of-care services for assessing hematological function, biochemical function, renal function, hepatic function and status including hepatitis, acid-base balance, sickle cell disease, severe acute malnutrition and spirometry * Explores the use of low-cost portable imaging devices for use in remote rural areas including a novel method of examining the optic fundus using a smartphone and the extensive value of portable ultrasound scanning when x-ray facilities are not available * Describes the use of telemedicine in the clinical management of both children and adults in remote rural settings * Looks to the future of clinical management in remote impoverished rural settings using nucleic acid identification of pathogens, the use of nanoparticles for water purification, the use of drones, the use of pulse oximetry and the use of near-infrared spectroscopy * Finally, it assesses the potential for future healthcare improvement in impoverished areas and how the United Nations/World Health Organization 2015 Sustainable Development Goals are approaching this. Written for physicians, infectious disease specialists, pathologists, radiologists, nurses, pharmacists and other health care workers, as well as government healthcare managers, Revolutionizing Tropical Medicine is a new up-to-date essential and realistic guide to treating and diagnosing patients in low-resource tropical countries based on new technologies.

This chapter describes the global burden of communicable diseases. The majority of the data was sourced from the World Health Organization (WHO) or the Global Burden of Disease Project. The chapter provides definitions of communicable disease, low‐ and middle‐income countries (LMICs), burden of disease, disease elimination, disease eradication and the primary point‐of‐care. Malaria, HIV/AIDS, and tuberculosis remained leading causes of death in the LMICs. The plan of the United Nations (UN) Millennium Development Goals (MDGs) was for countries and development partners to work together to reduce poverty and hunger and to tackle ill health, lack of education, gender inequality, lack of access to clean water and environmental degradation. The MDGs were considered interdependent. They had targets of being achieved by 2015. A number of neglected tropical diseases have been prioritized by the WHO for research, treatment, and prevention. The WHO MDGs have been replaced by the WHO Sustainable Development Goals for the period 2016 to 2030.

Digital health is a collective term for electronic health (eHealth) and mobile health (mHealth) technologies. eHealth is the cost‐effective and secure use of information and communication technology for health and health‐related fields. mHealth is a component of eHealth involving the provision of health services and information via mobile technologies such as mobile phones, tablet computers and personal digital assistants. Electronic learning is a term for the use of electronic technology in learning and teaching. Artificial intelligence, wearable sensors, virtual reality and medical robots are disruptive technologies which are completely changing the way people think and act about healthcare. Wearable sensors and devices can stream data to a doctor’s smartphone, notifying them whenever vital signs become abnormal. Personal digital health assistants and medical chatbots may significantly ease the burden on doctors. Augmented reality creates the illusion that a virtual object is in the physical world.

Over the last decade the development of rapid diagnostic tests for HIV/AIDS, tuberculosis, syphilis, malaria, human African trypanosomiasis, visceral leishmaniasis, dengue fever, influenza, ebola virus disease and yaws have made it infinitely easier to make a fast and accurate diagnosis of these diseases, enabling more rapid initiation of targeted treatment. Many of them can be performed at the primary point‐of‐care, thus avoiding the need for transport to clinics or hospitals, another factor in speeding up the initiation of treatment. The combination of smartphones and Internet access is revolutionizing the provision of specialist medical services to remote rural areas. At the global level at least, some of the Sustainable Development Goals will be achieved and health in the low‐ and middle‐income countries will improve. At the local level the next revolution will be from artificial intelligence through smartphones that have the computing power to search enormous data bases.

This chapter summarizes the most common non‐communicable diseases (NCDs) in low‐ and middle‐income countries (LMICs). It looks at the epidemiology of a selection of common NCDs in LMICs and of risk factors associated with NCDs, as well as the overlap between NCDs and communicable diseases. This is followed by data on the burden that NCDs represent for health services, and the economic consequences associated with NCDs at patient, health system and macroeconomic levels. The chapter explores how health services in LMICs currently cope with the growing NCD burden, identifying the challenges they encounter. It provides practical guidance on how to improve the performance of NCD services, based on the experience from a control program implemented in East Africa and ends with guidance on how to evaluate programs that aim to improve NCD services at the primary healthcare level.

In common with many emerging technologies, the use of ultrasound scanning for obstetric diagnosis has a worldwide reach. The use and abuse of ultrasound in pregnancy has already proliferated in resource‐limited settings and will continue to do so, with widening availability fueled by both technological improvements and decreasing costs. This chapter shows an example of a normal ultrasound image of a 16 week old human fetus. Many pregnancy‐related problems and abnormalities might be detected by the provision of routine ultrasound services. There have been many undoubtedly well‐meant attempts to introduce obstetric ultrasound scanning in low resource settings, often reporting various measures of success. In order to maximize benefit for patients and stem the potential for abuse, the obstetric ultrasound community must work to define globally recognized standards for training, regulation and implementation in accordance with practice that is evidence‐based.

The optimal features of a point‐of‐care (POC) diagnostic test can be summarized by ASSURED that is Afordable, Sensitive, Specific, User‐friendly, Rapid and Robust, Equipment‐free and Deliverable to end‐users. Ensuring the quality of both POC tests and that of testing performed at hundreds or thousands of different sites by healthcare workers, who are not skilled in reading test results, is a major challenge. Many POC test manufacturers now incorporate connectivity into POC and near‐POC instruments. The Ebola crisis demonstrated the importance of integrating digital technology with a new generation of POC molecular tests that are highly sensitive and specific. As more and more diagnostic tests are used in both urban and rural areas, there should be more effort devoted to mitigating the environmental impact of these tests. Although individual tests do not pose a significant risk, many thousands of tests performed at each site pose environmental risks.

17.1 Introduction 17.2 Microscopy 17.3 Microscopy in a POC Laboratory 17.4 Gram Staining 17.5 Ziehl‐Neelsen Stain (ZN) for Mycobacterium Tuberculosis 17.6 Blood Film Preparation, Staining and Reporting 17.6.1 Manual Preparation of a Blood Film 17.6.2 Staining of the Blood Film 17.6.3 Alternative Diff‐Quick Method 17.7 Conclusions

Point‐of‐care (POC) testing for tuberculosis (TB) encompasses testing of people admitted to hospital, testing of people attending a peripheral clinic, or testing people in a community setting or at home. This chapter includes discussion on the diagnostic technologies that are suitable for use in these contexts and appraises the evidence around their use in POC testing programs. Direct observation of Mycobacterium tuberculosis organisms by microscopy remains the primary diagnostic method for TB in much of the world. Limitations of microscopy include the inability to discriminate between M. tuberculosis and non‐tuberculous mycobacteria, to determine the viability of organisms and to detect drug resistance. Xpert MTB/RIF Ultra has been developed as a next generation assay to overcome some of the limitations of the original Xpert MTB/RIF test. Line probe assays are rapid molecular diagnostic tests that can detect M. tuberculosis and drug resistance.

Epocrates is a publisher of mobile device software applications, designed to provide information about drugs to doctors and other healthcare professionals. There are a number of organizations that have invested heavily in providing free electronic resources to clinicians who may need assistance. The Centers for Disease Control and Prevention has provided a number of helpful resources for clinicians, including a comprehensive core curriculum, which is available online, as well as animated web courses, which also providing continuing medical education credit. Clinicians working in remote settings in the global south, including low‐ and middle‐income countries, seem to preserve relative parity to literature and data as do those based in academic centers in the developed world in the global north. Based on the burden of disease, most clinicians are aware that the overwhelming majority of communicable diseases influencing morbidity and mortality are malaria, HIV/AIDS and tuberculosis.