Children have the right to a safe environment and to protection from violence and injury. In addition, state authorities should safeguard the child’s well-being considering the rights and duties of his or her parents, legal guardian, or other legally responsible individuals. Institutions, facilities and services that are responsible for the of children should observe standards of safety, health, staff suitability and competent supervision. This is enshrined in article 3 of the Convention on the Rights of the Child, the most widely ratified convention worldwide with 194 signatory states (Jamal, 2014; United Nations [UN], 1989). The WHO-Lancet Commission report released in February 2020 shows that very few countries have attained the Sustainable Development Goals (SGDs) set out 5 years ago.
The mission of healthcare systems in Africa to deliver compassionate and effective care has been constrained by growing populations, increasing burden of disease, political conflict and limited resources. The impacts of these constraints can be substantially alleviated, and the healthcare services strengthened, through the creation and adoption of affordable, accessible and appropriate biomedical engineering systems and technologies. There is an urgent need for building capacities in biomedical engineering, innovation and entrepreneurship in African countries. The African Biomedical Engineering Consortium has been organising a series of Innovators’ Summer Schools to meet this need by empowering students and researchers with entrepreneurial and innovative skills, and facilitating the design and development of robust, appropriate, and commercially viable medical systems and devices. In this paper, we analyse and discuss the impact of six of these schools held between 2012 and 2017. We used a questionnaire-based survey to collect responses from students who had attended the summer schools. The results of this study demonstrate that the teaching-learning model adopted in the ABEC summer schools was largely effective in promoting biomedical engineering skills, career choices, professional networks and partnerships amongst young African engineers and life scientists who attended the summer schools.
On 11 March 2020, the World Health Organisation (WHO) declared a global pandemic as the world experienced the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to 144 countries (World Health Organisation, 2020a). The disease resulting from the virus – coronavirus disease 2019 (COVID-19) – had already overloaded the health systems of many nations. In South Africa, which confirmed its first positive COVID-19 case on 5 March, the pandemic has resulted in extreme measures to prevent its spread, including a national lockdown and various restrictions on movement. It has also resulted in one of the most widespread health communication campaigns since the HIV epidemic during the 2000s. Terms such as "social distancing" and "flattening the curve" have become part of our communal vocabulary due to the extent of health messaging. The communication on practical preventative solutions, such as hand- washing and alternative greeting practices (Prem et al., 2020), has also been shared widely in an easy-to- understand manner. The WHO specifically emphasises the accurate and timely communication of essential health information as imperative to curbing the spread of the virus, and how important such communication is to shifting behaviours and perceptions (WHO, 2020b). In addition, accurate and authoritative information, which inspires trust, is important in combatting the spread of the virus. This has meant innovation in digital health communication.
The first 60 minutes after a trauma are described as “the golden hour.” For each minute of prehospital time, the risk of dying increases by 5% (Sampalis et al., 1999). Since 90% of the global burden of injuries occur in low- and middle-income countries and lead to 5.8 million deaths annually, addressing rapid access to emergency services is critical in these settings (Nielsen et al., 2012). In most low- and middle-income countries (LMICs), there are no formal trauma systems, and many lack organized prehospital care (Nielsen et al., 2012). Emergency medical dispatch and communication systems are a foundational component of emergency medical services (World Health Organization, 2005). Yet there are no established recommendations of creating these systems inLMICs.Rwanda, a country of over 12 million people, is a rapidly developing leader in East Africa. The Ministry of Health of Rwanda established the Service d’Aide Medicale Urgente (SAMU) in 2007, recognizing the need for public emergency medical services. SAMU’s national dispatch center receives roughly 3,000 calls per month through a national 912 hotline. It organizes regional transportation with 260 total ambulances located at hospitals throughout the country and provides prehospital emergency services in the capital city of Kigali with a fleet of 12 ambulances. In the city, each ambulance has a driver, nurse and anesthetist dispatched for every call. Emergency department nursing and anesthetist staff are dispatched from hospitals around the country to respond to regional emergencies. No formal prehospital cadre of the workforce exists although the SAMU staffhave extensive field experience in prehospital care. SAMU has several challenges to rapid prehospital emergency care including lack of addresses beyond the capital city, unclear location data in densely populated areas, complex communication processes with little information about health facility capacity, and no established electronic dispatch system. The average response time for SAMU ambulances was 59 minutes in 2018, but 39% of calls were not completed within the golden hour.
The response to the challenges arising during the COVID-19 pandemic has seen the rapid implementation of innovative technological solutions which have been built on established knowledge and resources. This has been reflected in infection, prevention and control practices (IPC) to minimise the transmission of the disease. In this article, we review ultraviolet germicidal irradiation (UVGI) as such a technology. We illustrate the way it has traditionally been used in airborne and surface disinfection strategies, and how it has, more recently, been adapted. UVGI has been widely used as an environmental IPC measure against tuberculosis in South Africa, though challenges have been experienced in the implementation of the technology in public healthcare facilities. This has resulted in the development of a knowledge and infrastructure base. We posit that, given the established UVGI resources in South Africa, the technology may be a viable environmental IPC solution for the COVID-19 period and beyond.
South Africa’s National Health Insurance (NHI) program promises to be the vehicle of universal health coverage for the country by 2030. In public healthcare organizations, which are already challenged by under-resourcing and staff shortages, the demands of NHI place a heavy burden on the healthcare workers tasked with managing the associated system changes and delivering services to program specifications. As teams are the units tasked with driving organizational adaptivity and performance in the healthcare sector globally, effective teams are critical for successful NHI implementation. We explore a cost-effective intervention for promoting teamwork in the public healthcare system. A problem-solving game called the marshmallow challenge was used as an experimental intervention at an NHI pilot site, a provincial district hospital, where staff were already familiar with the impending challenges of change management. A qualitative post-game survey was administered to gather data on the experiences of 100 participating hospital staff. Groups also engaged in a post-game reflective discussion. We examine the individuals’ experiences of the game in order to establish how interventions of this kind can empower healthcare workers to practice effective teamwork and team learning and how a psychologically safe environment can be cultivated.
In March of 2020, South Africa responded to the global COVID-19 pandemic by instituting a full lockdown. This meant that only essential services were allowed to operate, causing schools, universities and workplaces to close. The University of Cape Town was about to complete its first term when this occurred. With campuses closed, students were asked to vacate residences and return home. The university went into emergency remote teaching, with all teaching and learning moving online. Students were provided with the necessary resources to access content via the university learning platform, but strict guidelines were set to ensure that the delivery of content was not data or bandwidth intensive. For our master’s-level course on Health Innovation and Design, this posed many challenges. Health Innovation and Design is part of the curriculum for the MPhil in Health Innovation and the MSc in Biomedical Engineering. It utilises design thinking methodologies as an approach to innovate for improvements in health and wellbeing. The course comprises group-based action learning with a project partner and endeavours to promote engaged scholarship (UCT, 2020) by interacting with constituencies outside the university for public good. For 2020, we had secured the provincial Department of Health as our project partner. Our students were going to work with a team on designing and developing an operating theatre information system for scheduling. We would have had our first hospital visit the week after the university closed its on-campus activities.
We developed and pilot tested a sphygmomanometer designed to monitor pregnant women in low-resource settings. Blood pressure was assessed in 138 subjects, including healthy adults (n=85), pregnant women (n=42), and women at-risk for pre-eclampsia (n=11) using the novel sphygmomanometer, manual auscultation, and the GE Dinamap Procare 400. Accuracy of the device was evaluated by comparing measurements of the test device and the Dinamap in healthy volunteers and pregnant women in Texas and in women at risk for pre-eclampsia in Malawi. Measurements from the test device in pregnant and healthy volunteer populations differed from those collected using the auscultatory method by 0.2 mmHg (95% CI: -18.8 to 19.2, systolic) and -2.8 mmHg (95% CI: -21.0 to 15.4, diastolic). In women at risk for pre-eclampsia, measurements with the test device differed from those of the Dinamap on average by 2.9 mmHg (95% CI: -29.3 to 35.1, systolic) and -5.4 mmHg (95% CI: -45.8 to 34.9, diastolic). Compared against the auscultatory method, measurements with the Dinamap differed on average by 0.0 mmHg (95% CI: -31.8 to 31.9, systolic) and -3.7 mmHg (95% CI: -28.6 to 21.3, diastolic). Accuracy was reduced when patients were moving or not seated during measurement. When testing the device against British Hypertension Society standards, the device achieved a grade of A/A in pregnant persons. This sphygmomanometer has the potential to provide low-resource hospitals with an affordable, accurate option for regular blood pressure monitoring. However, algorithm improvements are needed to reduce sensitivity to subject motion and posture.
So much lifesaving medical technology exists in the world, yet so little of it benefits communities with low resources. Purchase price is only one barrier. The World Health Organization found nearly three quarters of devices provided by industrialized countries are not used when they reach low resource communities. Most medical devices and diagnostics fail to operate effectively in environments with power fluctuations, high temperatures, high humidity, dust, insect infiltration, poor availability of spare parts, high-cost consumables, and low staff-to-patient ratio. To provide robust, well-designed products for low-resource environments, devices need to be developed to address the needs of the local clinics, hospitals, and communities. Human-Centered Design (HCD) is a set of tools, processes, and mindsets that can help a team uncover the essential needs of diverse stakeholders involved in the success of medical technology for global health. This paper provides an overview of the HCD techniques we have found most useful in developing medical technology for global health applications. To illustrate the HCD techniques and their benefits, we present a case study of Design that Matters' Firefly phototherapy. The device is now treating newborn jaundice in low-resource hospitals in over 20 low and middle-income countries.
TheCenter for Innovation in Point-of-Care Technologies for HIV/AIDS at Northwestern University (C-THAN) is a partner in the Point-of-Care Technologies Research Network (POCTRN) of the National Institutes of Biomedical Imaging and Bioengineering. POCTRN’s mission is to drivethe development of appropriate point-of-care (POC) diagnostic technologies through collaboration that merges scientific and technological capabilities with clinical need. C-THAN develops POC technologies for improved management of HIV/AIDS in low- and middle-income countries with a focus on sub-Saharan Africa. C-THAN incorporates clinical and user needs with technology expertise and resources to address commercialization and implementation barriers through: 1) assessment of unmet clinical needs in POC testing for HIV/AIDS and its comorbidities; 2) collaborations with physicians, researchers and engineers; 3) development of technical, clinical, industrial and regulatory partnerships; 4) clinical testing of prototype devices; and 5) creation of training opportunities for technology developers, evaluators, and other stakeholders. Technologies supported include tests for detection and monitoring of HIV/AIDS and its common comorbidities including tuberculosis, non-tuberculous mycobacteria, viral hepatitis and HIV-related malignancies. CTHAN relies on collaborations established by Northwestern University in Nigeria, South Africa, Mali and Tanzania, to have impact on the prevention and clinical management of HIV/AIDS.
South Africa has double the world average child road fatality rate, with at least 1 300 children killed every year. A leading contributor to this public health challenge is the lack of safe public transport that enables children to reach schools easily. Minibus taxis (MBTs), South Africa's incarnation of paratransit services, have aimed to fill this gap by providing transport at a reasonably priced fare and a relatively higher frequency, compared with other modes of public transport. However, the informal nature of MBTs means that this form of transport places passengers at a relatively higher risk of road accidents due to the use of unroadworthy vehicles, reckless driving and speeding. This paper provides an overview of the Safe Travel To School (STTS) programme, which was initiated in 2014 with a view to providing a localised intervention that would potentially strengthen the safety of MBTs for scholar transport in South Africa. The programme aims to provide safer travel for child passengers by monitoring driver performance through a tracking device installed in each vehicle and rewarding good driver performance each quarter. A driver recruited into the programme also undergoes health tests and training that covers first aid, defensive driving and road safety training. The literature review that each of these components improves driver performance. A previous evaluation of the programme found that since inception, drivers in the programme have shown better driving performance than general motorists. Thus, the STTS programme potentially provides an implementable practice model for safe scholar transport that is oriented towards a developing country like South Africa.
Burns in the paediatric population are an ongoing public health concern that affects many populations across the globe.In South Africa, burn injuries contribute significantly to the annual disease burden across all ages, with an overall burn mortality rate of 4.2 per 100,000 (Matzopoulos et al., 2015).Burn-related paediatric deaths have been estimated at a rate of 2.8 per 100,000 in this country compared to 0.5 per 100,000 in upper middle-income countries (WHO, 2011).Children younger than 4 years are most at risk for all-cause external burns (Albertyn et al., 2006).A recent South African hospital survey concluded that thermal injuries represent the most common external cause of death in children younger than 4, and the third most common external cause in children younger than 18 (Rode et al., 2011).The Red Cross War Memorial Children's Hospital (RCH) in Cape Town has served as a centre for South African research on the epidemiology and preventability of paediatric burns (e.g.Albertyn et al., 2006;Rode et al., 2011;Van As & Rode, 2006;Wesson et al., 2013).RCH is a paediatric referral hospital that receives an average of approximately 1000 burn admissions per year.Data collected from this cohort indicates that flame-related burns are the second most common cause of burns among children aged 0 to 13 (Wesson et al., 2013) and are responsible for most of the severe injuries and fatalities.Flame-related burns occur at lower rates than hot water scalds; however, because of the associated health and economic impacts, fires and flame injuries have received close and specific attention (e.g.Van Niekerk et al., 2015).It has been estimated that over 16,000 residential fires occurred in Cape Town between 2009 and 2016, of which 7605 were in informal dwellings (Francioli, 2018).The high prevalence of flame-related burns in Cape Town and other regions in South Africa can be better understood by examining the underlying socioeconomic factors that contribute to the elevated risk.These include disparities in housing, housing structures and materials, spatial arrangements, and energy sources, all of which have placed informal settlement populations at high risk of flame-related burns (Van Niekerk et al., 2006).In the Western Cape, it was recently estimated that 44% of municipalities had at least 5% of their respective populations living in informal settlements (SSA, 2016).Children living in densely populated informal housing settlements currently represent the highest population of burn victims at RCH (Wesson et al., 2013).In overcrowded and small living conditions, the proximity of open flames, candles, and other heat sources to flammable material poses a hazard.Young children, especially toddlers, may be prone to grabbing at objects to steady themselves, coming into contact with cooking pots, kettles, heating equipment or candles, and harming themselves directly, or indirectly through contributing to a home fire which might have an impact on them (Van Niekerk et al., 2012).The Fire Prevention Association of South Africa reported 1462 informal settlement fires in Cape Town in 2015 (PFSA, 2018), with such fires reported to result in at least 12 known deaths and hundreds of injuries in 2017 (Tswanya, 2018).Investigations into these fires highlight challenges to the control and management of indoor fires and open flames.The lack of consistent electricity access and use within these settlements, sustains the use of 'traditional' energy sources such as paraffin, coal and firewood, and candles, the latter often a primary light source.These are common in poor households, especially those headed by older pre-electrification generations (Panday & Mafu, 2007).The World Health Organization and other global and regional organisations have emphasised the importance of preventative measures, specifically for use with low income populations that bear the heaviest burden of burn-related morbidity (Forjuoh & Gielen, 2008).Such preventative measures should not only be injury and risk reductive, but should also be cost-effective and capable of reaching individuals at highest risk with relative ease (Peck, 2009).Childsafe South Africa, a not-for-profit organization cased at the RCH, has been active in trying to fill this intervention vacuum and has sought to reduce and prevent intentional and unintentional injuries of all severity through policy and community action and empowerment based on research, education and environmental change, with recommendations for legislation.
Sputum smear microscopy (SSM), the most widely available tool for tuberculosis (TB) detection, has limited performance in paucibacillary patients and requires highly experienced technicians. The objective of this study was to determine whether the addition of sodium dodecyl sulfate (SDS), a detergent that thins sputum, at 4% and 10%, improves the detection of acid-fast bacilli (AFB), the clarity of slides, and the biosafety of the technique. Thirty participants with presumptive TB were enrolled. Three independent, blinded technicians examined the slides. Regular sputum concentrated AFB smear and sputum culture were used as standard control methods. Sputum culture was also performed before and after 10% SDS addition for safety analysis. We found that neither SSM with SDS 4% nor SSM with SDS 10% improved the test's performance. However, slides with 4% and 10% SDS, compared with slides prepared without SDS, had significantly better clarity scores. The 10% SDS-prepared sputum samples were all culture negative. While adding SDS detergent does not improve the performance of SSM slides, it does improve the clarity and biosafety. Where experienced technicians are scarce, especially in low resource settings, use of SDS may enhance the ease of slide reading in sputum smear microscopy.
X-ray imaging is the most frequently employed diagnostic imaging modality in clinical medicine.The damaging effects of ionising radiation, on which X-ray imaging relies, on human tissue have been long known.The heightened risks of ionising radiation to young children in general paediatric practice are well established.Particularly vulnerable tissues include the rapidly dividing cells of the gonads, gut, lung, thyroid and breast (Ron, 2002).The increased oncogenic potential of ionising radiation in children poses significant challenges for modern paediatric practice (Willis & Slovis, 2004).In this context, the Lodox low-dose full-body X-ray imaging system was installed at the trauma unit of the Red Cross War Memorial Children's Hospital in Cape Town, South Africa, in 2004(Douglas et al., 2010).The first diagnostic Lodox imaging system was installed at the trauma unit of Groote Schuur Hospital in Cape Town in 1996 and proved revolutionary in its clinical application for the management of trauma patients, and most notably in those presenting with polytrauma (Beningfield et al., 2003).A second Lodox system was installed elsewhere in South Africa soon thereafter, and the advantages of this new technology as compared with conventional X-ray imaging techniques were highlighted in the international medical literature (Boffard et al., 2006).The first Lodox System installation outside South Africa was in Baltimore, Maryland, United States (Mulligan & Flye, 2006).Polytrauma patients routinely undergo multiple radiographic examinations -skull, cervical spine, chest and pelvis.After positioning of the patient on the trolley of the imaging device, the Lodox system can deliver a full body scan within 13 seconds.The trauma doctor can immediately focus on the anatomical areas of concern and also digitally manipulate the image for better injury detection.The use of Lodox in a polytrauma patient reportedly reduced the imaging time using conventional techniques from an average 48 minutes to 6 minutes, thereby adding an additional 42 minutes to the so called "golden hour" of early trauma management, which, when lost, adversely affects patient outcomes (Zuidgeest et al., 2013).Besides the gain in diagnostic time, the positioning of the Lodox imaging system in the treatment area in the trauma unit, eliminates the time and complications associated with transfer to the radiology suite.After the successful introduction of the Lodox imaging device in the field of trauma care, its usefulness was promptly extended to other fields such as forensic pathology where it is well suited to achieve a detailed survey of the entire body to detect fractures and foreign bodies such as bullets or shrapnel (Knobel, Flash, & Bowie, 2006).The utilization of the Lodox system in paediatric practice, however, arguably yields the most benefits.Whereas the "golden hour" has been described in the management of adult trauma, for children it is of even greater importance to keep the diagnostic duration as brief as possible.Paediatric patients have less physiological reserve in the event of blood loss and consequent decreased supply of cerebral oxygen.Infants and traumatized children are unable to describe their pain and localize symptoms as precisely as older children and adults do.In addition, the majority of children presenting with severe trauma also suffer traumatic brain injury and are obtunded (Maas et al., 2017).Radiological diagnostic tools are therefore critical in achieving an accurate diagnosis in infants and younger children.Radiographs are the most commonly performed special investigation in children post trauma.These are typically performed in a special suite in the radiology department away from the relative safety of the trauma unit, where doctors, nursing staff and equipment are readily available.There are several disadvantages to this routine practice.Notwithstanding inevitable delays, the injured child requires conveyance to the radiology suite -a hazardous journey with numerous detrimental and fatal events having been reported (Mills, Raja & Marin, 2016).It is therefore advantageous for an injured child to be imaged without removal from the clinical treatment area in the trauma unit that is designed and equipped to cope with all manner of clinical challenges.Any medical procedure in a trauma unit can be intimidating and stressful for children (Blount et al., 2016).Resulting emotional upset should be kept to a minimum on humanitarian grounds and for the facilitation of physical and emotional healing.Infants and young children, when removed from their parents or familiar caregivers, generally become more distressed, which aggravates their pain and discomfort causing further anguish and diminished co-operation.Intimidating
This study investigated the ability of a low-cost, mobile device-based game incorporating machine learning to screen participants between ages six and twelve years for attention-deficit/hyperactivity disorder inattentive subtype (ADHDI). Relevant information from literature was incorporated into the game in light of the DSM-V diagnostic criteria. The game has seven back-to-back segments with unique layouts and a visual theme.The ADHD Screening Tool presents a novel patient-testing interface with a cloud-based machine learning classifier (MLC) integrated with a consensus algorithm. The game was tested with 39 clinically diagnosed participants (ADHDIand non-ADHD). Out of nine classifiers tested, the locally-deep support vector machine gave the best results: using leave-one-out cross-validation, this MLC classified data from five game segments for 38 participants with sensitivity of 92.9% and specificity of 82.9%. By making use of the consensus algorithm, the 39th participant was correctly classified according to the clinical diagnosis. The MLC and consensus algorithm were able to classify 39 participants with a sensitivity of 100% and specificity of 87.5%. To overcome participant class imbalance, the synthetic minority oversampling technique (SMOTE) was implemented on game segment data. The SMOTE two-class LDSVM yielded sensitivity of 90.7% and specificity of 94.4%. The study used an internet-connected, commercially available tablet.
Gestational diabetes mellitus (GDM) has high morbidity and risk for mortality when mismanaged. This is particularly relevant in low- and middle-income countries (LMIC), where GDM related complications occur at a higher rate, with worse outcomes, due to a lack of healthcare resources. Mobile health (mHealth) presents an opportunity to improve the management of GDM in LMIC. We conducted a meta-analysis, which found that using mHealth as an intervention for GDM caused a statistically significant decrease of 0.38 mmol/L (95% CI -0.52 mmol/L to -0.23 mmol/L) in overall blood glucose levels during pregnancy compared to the control group. There was a significantly higher probability of vaginal deliveries in the intervention group than the control group (risk ratio (RR) = 1.18, 95% CI 1.03 to 1.36). It was less likely for new-borns from the intervention group to be diagnosed with hypoglycaemia than new-borns from the control group (RR = 0.67, 95% CI 0.48 to 0.93). This review found evidence for mHealth offering improvements in biological, maternal, perinatal, cognitive and economic outcomes by aiding in the management of GDM. This could be particularly important to LMIC where the lack of resources and high healthcare-related costs contribute to the mismanagement of GDM.
Global health challenges and the proliferation of mobile technologies have been key in the adoption of mHealth for provision of low-cost and equitable healthcare. Evolution of mobile networks to 5G is expected to revolutionise healthcare service delivery due to the stringent performance requirements imposed on 5G. However, because of the open nature of 5G systems, securing patient health information has been identified as a significant barrier to the full adoption of mHealth. In this paper, we propose a security architecture for an mHealth system based on a review of standard principles and guidelines for designing 5G security systems. We present a structured approach for developing and implementing an end-to-end 5G mHealth security system. We propose a security architecture that can be realised using keyless signature infrastructure blockchain, X-tee technology to secure the communication system including hospital and third-party health data networks, physical layer security for securing the wireless interface in access networks, physical unclonable functions, and a trusted execution environment for securing end-user devices. We propose the adoption of network slicing for isolating health systems from other 5G industry verticals. We define system domains that are used to identify security threats and propose mechanisms to mitigate these threats.
Despite substantial expenditure by national tuberculosis (TB) programmes, significant efforts by advocacy groups, and heavy investment in clinical and biomedical research, TB remains a health emergency disproportionately impacting the poorest and most vulnerable in southern Africa and other endemic regions. Personal experiences of TB are varying and contrasting in these areas where misconception, stigma and taboo are commonplace. An urgent need therefore exists for projects that engage community members as active partners in reducing the impact of TB and other diseases. Eh!woza aims to address this need by fostering collaborative interactions between biomedical TB researchers, a conceptual artist, a non-governmental organization, and young people living in Khayelitsha, a township outside Cape Town. In a series of workshops, the project engages high-school learners with biomedical TB research and provides space, guidance and equipment for participants to produce documentaries about personal experiences of TB. Here, we describe the project’s growth, the results of a formal evaluation which suggest that Eh!woza is responsive to changing dynamics within the study setting, and preliminary findings from anthropological research investigating how knowledge is configured within the project. Finally, we consider prospects for expanding the project and briefly discuss challenges whose resolution could ensure long-term sustainability.
