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Infectious disease is the most common cause of illness and death in Africa, yet health practitioners routinely fail to identify causative microorganisms in most patients. As a result, patients often do not receive the right medicine in time to cure them promptly even when such medicine is available, outbreaks are larger and more devastating than they should be, and the impact of control interventions is difficult to measure. Wrong prescriptions and prolonged infections amount to needless costs for patients and for health systems. In Divining without Seeds, Iruka N. Okeke forcefully argues that laboratory diagnostics are essential to the effective practice of medicine in Africa.The diversity of endemic life-threatening infections and limited public health resources in tropical Africa make the need for basic laboratory diagnostic support even more acute than in other parts of the world. This book gathers compelling case studies of inadequate diagnoses of diseases ranging from fevers—including malaria—to respiratory infections and sexually transmitted diseases. The inherited and widely prevalent health clinic model, which excludes or diminishes the hospital laboratory, is flawed, to often devastating effect. Fortunately, there are new technologies that make it possible to inexpensively implement testing at the primary care level. Divining without Seeds makes clear that routine use of appropriate diagnostic support should be part of every drug delivery plan in Africa and that diagnostic development should be given high priority.

Infectious disease is the most common cause of illness and death in Africa, yet health practitioners routinely fail to identify causative microorganisms in most patients. As a result, patients often do not receive the right medicine in time to cure them promptly even when such medicine is available, outbreaks are larger and more devastating than they should be, and the impact of control interventions is difficult to measure. Wrong prescriptions and prolonged infections amount to needless costs for patients and for health systems. In Divining without Seeds, Iruka N. Okeke forcefully argues that laboratory diagnostics are essential to the effective practice of medicine in Africa. The diversity of endemic life-threatening infections and limited public health resources in tropical Africa make the need for basic laboratory diagnostic support even more acute than in other parts of the world. This book gathers compelling case studies of inadequate diagnoses of diseases ranging from fevers—including malaria—to respiratory infections and sexually transmitted diseases. The inherited and widely prevalent health clinic model, which excludes or diminishes the hospital laboratory, is flawed, to often devastating effect. Fortunately, there are new technologies that make it possible to inexpensively implement testing at the primary care level. Divining without Seeds makes clear that routine use of appropriate diagnostic support should be part of every drug delivery plan in Africa and that diagnostic development should be given high priority.

Background Low-resource settings are often less capable of responding to and implementing available quality research evidence for public healthcare practice and policy development due to various factors. In most low-resource settings, limited empirical evidence is available to help deal with localised factors that contribute to low public health research uptake, particularly from the perspective of key research stakeholders. Methods Although the study initially employed a two-phase exploratory sequential approach, this paper focuses on the results generated from a quantitative approach. Considering the determining factors that affect research uptake in the context of low-resource settings, a measuring instrument was developed and its reliability and validity were assessed using an exploratory factor analysis approach. Results A total of 212 respondents, according to their job roles and titles, were identified as researchers, front-line workers, programme managers, and directors/senior managers of higher learning institutions, indicating that the three constructs applied in the questionnaire, namely (1) individual factors, (2) organisational factors, and (3) research characteristics, demonstrated relatively high reliability with a Cronbach’s alpha of greater than 0.791. Conclusion The study concludes that the instrument can potentially be used to measure factors that affect research uptake in low-resource settings.

Background Integrated diagnosis is crucial for addressing health challenges, particularly in managing comorbidities and chronic conditions. Technological advancements allow for rapid, simultaneous testing and diagnosis of multiple diseases. Integrated diagnosis interventions vary in purpose, models, diseases targeted, populations served, scale, and measured outcomes. This diversity, combined with varying levels of resource availability and health system capacity to respond effectively to positive diagnoses, makes it challenging to identify effective strategies. An effective integrated diagnosis approach can lead to early detection of critical and chronic conditions, improve patient experiences, and ultimately improve disease surveillance. This study aimed to establish core criteria for designing same-day integrated diagnosis interventions in primary care settings to enhance patient experiences and health outcomes in low- and middle-income countries (LMICs). The initial set of criteria was derived from a realist synthesis, which identified the key contextual factors and mechanisms required for such interventions to be effective. Methods A two-round Delphi process engaged an international panel of fifty-five experts from diverse professions to establish consensus on core criteria for effective integrated diagnosis interventions. Predetermined consensus thresholds were set at 70% for critical to include . Results A total of 55 experts participated in the first round. Participants represented various geographical regions, including Africa ( n  = 33), Europe ( n  = 17), Asia ( n  = 2), and the Americas ( n  = 2), and could be categorized into implementers ( n  = 36), policymakers ( n  = 7), and academics ( n  = 12). At the end of Round 1, fourteen of the thirty-three criteria reached a consensus as being critical to include , and nine criteria were removed. In Round 2, a total of 48 out of 55 experts participated and twelve criteria were considered. Four criteria reached a consensus as being critical to include . Through the two rounds of surveys, experts reached a consensus on 18 criteria. Conclusion The study provides key criteria for prioritizing and developing integrated diagnosis interventions in primary care, in low-resource settings, particularly in Africa. The guidance might be invaluable for policymakers, funders, implementers, and manufacturers. The primary goal of integrated diagnosis is to enhance patient experiences and health outcomes. It is essential to consider all critical success factors during intervention design. These criteria may evolve as our understanding of integrated diagnosis advances.

Background The intent of this review is to discover the types of inquiry and range of objectives and outcomes addressed in studies of the impacts of Electronic Medical Record (EMR) implementations in limited resource settings in sub-Saharan Africa. Methods A state-of-the-art review characterized relevant publications from bibliographic databases and grey literature repositories through systematic searching, concept-mapping, relevance and quality filter optimization, methods and outcomes categorization and key article analysis. Results From an initial population of 749 domain articles published before February 2015, 32 passed context and methods filters to merit full-text analysis. Relevant literature was classified by type (e.g., secondary, primary), design (e.g., case series, intervention), focus (e.g., processes, outcomes) and context (e.g., location, organization). A conceptual framework of EMR implementation determinants (systems, people, processes, products) was developed to represent current knowledge about the effects of EMRs in resource-constrained settings and to facilitate comparisons with studies in other contexts. Discussion This review provides an overall impression of the types and content of health informatics articles about EMR implementations in sub-Saharan Africa. Little is known about the unique effects of EMR efforts in slum settings. The available reports emphasize the complexity and impact of social considerations, outweighing product and system limitations. Summative guides and implementation toolkits were not found but could help EMR implementers. Conclusion The future of EMR implementation in sub-Saharan Africa is promising. This review reveals various examples and gaps in understanding how EMR implementations unfold in resource-constrained settings; and opportunities for new inquiry about how to improve deployments in those contexts.

Background Human Immunodeficiency Virus (HIV) and type 2 diabetes (T2D) are amongst the leading causes of death in South Africa. The preferred first-line anti-retroviral treatment contains dolutegravir (DTG), shown to increase body weight, may compound the already high rates of obesity and associated risk for T2D. South Africa has widespread food insecurity, making traditional dietary strategies difficult to implement. Time-restricted eating (TRE) may be an appropriate intervention in resource-limited communities. Methods This article outlines the development and feasibility testing of a TRE intervention to inform the design of a TRE randomised controlled trial in women (20–45 years old) living with overweight/obesity and HIV, receiving DTG-based treatment from a resource-limited community in Cape Town, South Africa. Factors influencing TRE adoption were identified using the Capability, Opportunity, Motivation – Behaviour model and the Theoretical Domains Framework, combining in-depth interviews (IDIs) and focus group discussions. Participants from the IDIs went on to participate in a single arm 4-week TRE pilot trial where feasibility was explored in terms of reach, acceptability, applicability, and implementation integrity. An iterative, thematic analysis approach was employed to analyse the qualitative data. Results Participants included 33 isiXhosa -speaking women (mean age 37.1 years, mean BMI 35.9 kg/m 2 ). Thematic analysis identified psychological capability (knowledge of fasting), social influences (cultural preferences, family support), and reflective motivation (awareness of weight, health impact, motivation for TRE) as key factors influencing adoption of TRE for weight management. In a 4-week TRE pilot trial ( n  = 12), retention was 100%. Positive outcomes perceived included improved energy, appetite control and weight loss. TRE was perceived as acceptable, easy, and enjoyable. Family support facilitated adherence, while habitual and social eating and drinking practices were barriers. Compliance was high, aided by self-selected eating times, reminders, and weekly calls. Recommendations included the incorporation of dietary education sessions and text messages to provide additional support and reminders. Conclusions This study indicates that TRE is a feasible weight management strategy in women living with overweight/obesity and HIV, receiving DTG-based treatment in a resource-limited community. These findings will ensure that the forthcoming TRE randomised controlled trial is adapted and optimised to the local South African context.

Background Pandemics have increasingly become more frequent. Globally, between 1970 and 2016, a total of over 1770 disease outbreaks of 38 known and two unknown causes were reported. Vaccines are a key medical countermeasure for most of these outbreaks, however, most of these are developed and tested outside Sub-Saharan Africa. There is underrepresentation of Africa in vaccine clinical trials. This is attributed to poor visibility of existing sites, limited infrastructure and unpredictable regulatory timelines, and lack of capacity and infrastructure for basic science research. Main text We draw on lessons from an Ebola outbreak in Uganda to suggest key factors to establishing a vaccine trial site in a low resource setting. The factors are trained clinical trial staff, availability and adaptation of generic trial protocols, establishment of vaccine cold chain storage facilities, south-south collaborations, in-country stewardship, and close collaboration with ethical and regulatory bodies. Conclusion African institutions could capitalise on the epidemics and the accompanying responses to build capacity for vaccine trials and position themselves to take part in global vaccine trials.

Telehealth approaches can address health care access barriers and improve care delivery in resource-limited settings around the globe. Yet, telehealth adoption in Africa has been limited, due in part to an insufficient understanding of effective strategies for implementation. This study aimed to conduct a multi-level formative evaluation identifying barriers and facilitators for implementing telehealth among health service providers and patients in Central Uganda. We collected surveys characterizing telehealth perceptions, barriers, and preferences from health care providers and patients seeking primary care in the Central Region of Uganda from January 2022 to July 2022. Survey development was informed by the technology acceptance model and evaluated predictors of technology acceptance (ie, perceived usefulness, ease of use, and attitudes). We used descriptive statistics to characterize telehealth perceptions and examined differences according to provider and patient characteristics using Student t tests. Nearly 79% (n=48) of 61 providers surveyed had used telehealth, and perceptions were generally favorable. While 93.4% (n=57) reported that telehealth adds value to clinical practice, less than half (n=30, 49.2%) felt telehealth was more efficient than in-person visits. Provider-reported barriers to telehealth included technology challenges for the patient (34/132, 26%), low patient engagement (25/132, 19%), and lack of implementation support (24/132, 18%). Telehealth use was lower among the 91 surveyed patients, with only 19.8% (n=18) having used telehealth. Although 89% (n=81) of patients reported saving time with telehealth approaches, 33.3% (n=30) of patients reported that telehealth made them feel uncomfortable, and 43.8% (n=39) reported concerns about confidentiality. Over 72% (n=66) of patients who had used telehealth previously reported satisfaction with the telehealth services they received. Several differences in perceptions of telehealth according to patient's self-reported health status were observed. Perceptions of telehealth were generally favorable, although higher among providers than patients. Barriers impeding telehealth use include technology challenges and the lack of infrastructure and implementation support. Findings from this study can inform the implementation of acceptable telehealth approaches to address disparities propagated by health care access barriers in Sub-Saharan Africa.

Background The views of practitioners at the sharp end of health care provision are now recognised as a valuable source of intelligence that can inform efforts to improve patient safety in high-income countries. Yet despite growing policy emphasis on patient safety in low-income countries, little research examines the views of practitioners in these settings. We aimed to give voice to how healthcare workers in two East African hospitals identify and explain the major obstacles to ensuring the safety of patients in their care. Methods We conducted in-depth, face to face interviews with healthcare workers in two East African hospitals. Our sample included a total of 57 hospital staff, including nurses, physicians, technicians, clinical services staff, administrative staff and hospital managers. Results Hospital staff in low-income settings offered broadly encompassing and aspirational definitions of patient safety. They identified obstacles to patient safety across three major themes: material context, staffing issues and inter-professional working relationships. Participants distinguished between the proximal influences on patient safety that posed an immediate threat to patient care, and the distal influences that generated the contexts for such hazards. These included contexts of severe material deprivation, but also the impact of relational factors such as teamwork and professional hierarchies. Structures of authority, governance and control that were not optimally aligned with achieving patient safety were widely reported. Conclusions As in high-income countries, the accounts of healthcare workers in low-income countries provide sophisticated and valuable insights into the challenges of patient safety. Though the impact of resource constraints and weak governance structures are particularly marked in low-income countries, the congruence between accounts of health workers in diverse settings suggest that the origins and solutions to patient safety problems are likely to be similar everywhere and are rooted in human factors, resources, culture and behaviour. While additional resources are essential to patient safety improvement in low-income settings, such resources on their own will not be sufficient to secure the changes needed.

While ear, nose, and throat (ENT) diseases are a substantial threat to global health, comprehensive reviews of ENT services in Southern Africa remain scarce. This scoping review provides a decade-long overview of ENT services in Southern Africa and identifies gaps in healthcare provision. From the current literature, we hope to provide evidence-based recommendations to mitigate the challenges faced by the resource-limited ENT service. PubMed, Web of Science, EBSCOhost, Cochrane Library, Cochrane Library, and Scopus. On several databases, we conducted a comprehensive literature search on both quantitative and qualitative studies on ENT services in Southern Africa, published between 1 January 2014 and 27 February 2024. The extracted data from the analyzed studies was summarized into themes. Four themes in the fourteen studies included in the final analysis described the existing ENT services in Southern Africa: 1. Workforce scarcity and knowledge inadequacies, 2. Deficiencies in ENT infrastructure, equipment, and medication, 3. Inadequate ENT disease screening, management, and rehabilitation and 4. A lack of telehealth technology. The Southern African ENT health service faces many disease screening, treatment, and rehabilitation challenges, including critical shortages of workforce, equipment, and medication. These challenges, impeding patient access to ENT healthcare, could be effectively addressed by implementing deliberate policies to train a larger workforce, increase ENT funding for equipment and medication, promote telehealth, and reduce the patient cost of care.