Revolutionizing Tropical Medicine

Part I The Health of Low‐ and Middle‐Income Countries Today 1 1 The Burden of Communicable Diseases in Low‐ and Middle‐Income Countries 3 Kerry Atkinson and David Mabey 1.1 Introduction 4 1.2 Definition of a Communicable Disease 4 1.3 Definition of Low‐ to Middle‐Income Countries 4 1.4 Definition of Burden of Disease 5 1.5 Definition of Disease Elimination 7 1.6 Definition of Disease Eradication 7 1.7 Definition of the Primary Point‐of‐Care 7 1.8 The 2000 Millennium Development Goals (MDGs) and Their Outcomes 7 1.9 Major Individual Diseases in the LMICs: The Big Three ‐ Malaria, HIV/AIDS and Tuberculosis 9 1.10 Other Important Communicable Diseases in the LMICs 17 1.11 Neglected Tropical Disease (NTDs) Prioritized by the World Health Organisation 29 1.12 A Comparison of Health Metrics in an LMIC (Papua New Guinea) and a Developed Country (Australia) with a 7 km Distance Between them 31 1.13 Conclusions 32 Bibliography 32 Webliography 35 2 The Burden of Non‐communicable Diseases in Low‐ and Middle‐Income Countries 37 Heiner Grosskurth 2.1 Introduction 38 2.2 Common Non‐communicable Diseases in Low- and Middle-Income Countries 38 2.3 NCD Epidemiology 38 2.4 Prevention of Non‐communicable Diseases 44 2.5 The Relationship Between Communicable and Non‐communicable Diseases 44 2.6 The Health System Burden of NCDs 46 2.7 The Economic Impact of NCDs 47 2.8 The Response to the NCD Epidemic in LMICs 48 2.9 The Readiness of Primary Healthcare Services in LMICs to Cope with the NCD Burden 50 2.10 Introducing Effective NCD Control at Primary Care Services: A Practical Approach 52 2.11 The Role of Primary Healthcare Services in Cancer Prevention and Care 67 2.12 Evaluating Programmes to Strengthen NCD Services at Primary Care Level 70 2.13 Conclusions 70 Bibliography 70 Webliography 78 Part II How to improve healthcare in low‐ and middle‐income countries by primary point‐of‐care rapid diagnostic testing 81 3 The Optimal Features of a Rapid Point-of-Care Diagnostic Test 83 David Mabey and Rosanna Peeling 3.1 Introduction 83 3.2 Accuracy Versus Accessibility 83 3.3 Quality Assurance 84 3.4 The Importance of Connectivity 85 3.5 Environmental Friendliness 86 References 86 Webliography 87 4 Revolutionizing HIV Healthcare Delivery Through Rapid and Point‐of‐Care Testing 88 Catherine J. Wedderburn, Debrah I. Boeras, and Rosanna W. Peeling 4.1 Synopsis 88 4.2 Introduction 89 4.3 Diagnostic Tests in Resource‐Limited Settings 89 4.4 Challenges of Using Rapid and Point‐of‐Care Testing Within the Context of the Healthcare System 92 4.5 Recent Advances in HIV Diagnosis and Monitoring and Their Impact 93 4.6 WHO Recommendations: POC Diagnostics for Achieving the 90‐90‐90 Goals 98 4.7 Remaining Challenges – Human Resources, Quality Assurance, and Test Selection and Placement 98 4.8 Moving Forward 99 4.9 Conclusions 100 Bibliography 101 Webliography 103 5 Rapid Point‐of‐Care Diagnostic Tests for Tuberculosis 105 Richard Lessells 5.1 Introduction 105 5.2 The Need for Rapid Point‐of‐Care TB Diagnostic Tests 106 5.3 Weaknesses in the TB Diagnostic Cascade 106 5.4 Potential Impact of Rapid Point‐of‐Care Diagnostic Tests 107 5.5 Defining the Diagnostic Needs 107 5.6 Smear Microscopy 107 5.7 Molecular Diagnostic Tests 109 5.8 Loop‐Mediated Isothermal Amplification (LAMP) 112 5.9 Line Probe Assays 113 5.10 Other Molecular Tests 113 5.11 Antigen Tests 114 5.12 Combination Diagnostic Packages 115 5.13 Next Generation Sequencing 117 5.14 Diagnostic Imaging 117 5.15 Other Diagnostics 118 5.16 Conclusions 118 References 119 6 Rapid Diagnostic Tests for Syphilis 126 David Mabey, Michael Marks, and Rosanna W. Peeling 6.1 Introduction 126 6.2 The Diagnosis of Syphilis 129 6.3 The Impact of POC Testing for Syphilis 131 6.4 Challenges in the Implementation of POC Testing 133 6.5 The Future 134 References 134 7 Point‐of‐Care and Near‐Point‐of‐Care Diagnostic Tests for Malaria: Light Microscopy, Rapid Antigen‐Detecting Tests and Nucleic Acid Amplification Assays 137 Heidi Hopkins, and Jane Cunningham 7.1 Introduction 137 7.2 Diagnosis of Malaria 138 7.3 Light Microscopy of Blood Smears 139 7.4 Rapid Diagnostic Tests for Malaria (mRDTs) 140 7.5 Nucleic Acid Amplification‐Based Tests (NAATs) for Malaria 142 7.6 Impact of Point‐of‐Care Testing for Malaria 143 7.7 Challenges in Implementation of POC Testing for Malaria 144 7.8 The Future 146 Biblography 146 Webliography 156 8 Rapid Diagnostic Tests for Human African Trypanosomiasis 159 Veerle Lejon, Epco Hasker, and Philippe Büscher 8.1 Introduction 159 8.2 The Early Introduction of Immunodiagnostic Tests in the Diagnosis of HAT 160 8.3 CATT/T.b. gambiense: A Breakthrough in the Immunodiagnosis of Gambiense‐HAT 161 8.4 The Changing Epidemiology of Gambiense‐HAT: The Need for Improved Rapid Diagnostic Tests 163 8.5 Second Generation RDTs for HAT 165 8.6 Future Perspectives and Challenges 165 References 166 Webliography 169 9 Rapid Diagnostic Tests for Visceral Leishmaniasis 170 Marleen Boelaert, Suman Rijal, and François Chappuis 9.1 Introduction 170 9.2 Parasitology, a Reference Standard? 171 9.3 Serological Assays 172 9.4 The First Serological Test for Field Use: The Direct Agglutination Assay 173 9.5 The Early Development an Immunochromatographic Test Using the Recombinant Leishmania Antigen rK39 174 9.6 Impact of the VL RDT 174 9.7 Challenges 175 9.8 Other Tests 175 9.9 Discussion 176 9.10 Conclusions 177 References 177 10 A Rapid Diagnostic Test for Dengue 181 Claire Mullender, and James Whitehorn 10.1 Introduction 181 10.2 Clinical Features of Dengue 182 10.3 The Importance of Making a Rapid Diagnosis 183 10.4 The Host Response to Infection 184 10.5 Existing Diagnostic Strategies 184 10.6 Review of Existing Rapid Diagnostic Tests 186 10.7 Future Directions 188 10.8 Conclusions 188 References 188 11 Rapid Diagnostic Tests for Influenza 191 A.C. Hurt, and I.G. Barr 11.1 Introduction 191 11.2 Overview of RIDTs 192 11.3 Antigen Detection‐based RIDTs 195 11.4 Nucleic Acid Detection‐based RIDTs 197 11.5 Factors that Alter RIDTs Performance 198 11.6 The Use of RIDTs in LMICs 198 11.7 Conclusions 199 Acknowledgment 199 References 200 12 A Rapid Diagnostic Test for Ebola Virus Disease 202 Catherine Houlihan and Colin Brown 12.1 Case Report 202 12.2 Introduction 203 12.3 Diagnostic Methods to Detect Ebola Virus Disease 203 12.4 Rapid Diagnostic Tests for Ebola Virus Disease for Use in a Point‐of‐Care Facility 206 12.5 Conclusions 209 Bibliography 210 Webliography 212 13 Rapid Diagnostic Tests for Yaws 213 Michael Marks 13.1 Introduction 213 13.2 Epidemiology 214 13.3 Clinical Features 215 13.4 Diagnostic Quandaries 217 13.5 Diagnostic Tests for Yaws 217 13.6 Rapid Diagnostic Tests for Yaws 218 13.7 Molecular Assays 219 References 221 14 Rapid Diagnostic Tests for the Detection of Sickling Hemoglobin 224 Amina Nardo‐Marino and Tom N. Williams 14.1 Sickle Cell Disease 224 14.2 Diagnosing Sickle Cell Disease 225 14.3 Conclusions 229 Bibliography 229 15 Progress Toward the Development of Rapid Diagnostic Tests for Lymphatic Filariasis and Onchocerciasis 231 Roger B. Peck, Dunia Faulx, and Tala de los Santos 15.1 Introduction 231 15.2 The Development of Rapid Diagnostic Tests 234 15.3 Rapid Diagnostic Tests for Lymphatic Filariasis 234 15.4 Rapid Diagnostic Tests for Onchocerciasis 236 15.5 Next tests and Steps 240 Bibliography 240 Webliography 242 Part III Other tests that can be performed rapidly at the primary‐point‐of-care 245 16 Point‐of‐Care Testing for Blood Counts, HbA1c, Renal Function, Electrolytes, Acid–Base Balance and Hepatitis 247 Mark Shephard, Lara Motta, Brooke Spaeth, Heather Halls, and Lauren Duckworth 16.1 Introduction 248 16.2 Point‐of‐Care Testing for Blood Counts 248 16.3 Point‐of‐Care Testing for HbA1c 252 16.4 Point‐of‐Care Testing for Renal Function 254 16.5 Point‐of‐Care Testing for Electrolytes and Acid–Base Balance 257 16.6 Point‐of‐Care Testing for Hepatitis 261 16.7 Conclusions 265 Bibliography 266 Webliography 268 17 Microscopy Skills: Cell Counts, Gram Stains, Ziehl‐Neelsen Staining (ZN) and Blood Films 270 Michael Harrison 17.1 Introduction 270 17.2 Microscopy 271 17.3 Microscopy in a POC Testing Laboratory 273 17.4 Gram Staining 274 17.5 Ziehl‐Neelsen Stain (ZN) for Mycobacterium tuberculosis 275 17.6 Blood Film Preparation, Staining and Reporting 276 17.7 Conclusions 278 Bibliography 280 Webliography 280 18 India Ink Stain and Cryptococcal Antigen Test for Cryptococcal Infection 281 Hannah K. Mitchell, Joseph N. Jarvis, and Mark W. Tenforde 18.1 Introduction 281 18.2 Diagnosis of Cryptococcal Meningitis 282 18.3 Cryptococcal Antigen Testing (CrAg) 283 18.4 India Ink Stain 285 18.5 CrAg Testing for the Prevention of Cryptococcal Meningitis 286 18.6 Logistical Challenges of CrAg Screening 288 18.7 Non‐Meningeal Cryptococcal Disease 289 18.8 Conclusions 289 References 290 19 Mid Upper Arm Circumference Tapes for Assessment of Severe Acute Malnutrition 294 Jane Crawley, Martha Mwangome, James Berkley, and André Briend 19.1 Introduction 294 19.2 Mid Upper Arm Circumference (MUAC) 296 19.3 Comparison of MUAC with other Anthropometric Indices 296 19.4 MUAC: A Brief Historical Perspective 296 19.5 Technique for Measuring MUAC 297 19.6 MUAC, Mortality Risk, and Definitions of Severe Acute Malnutrition 298 19.7 Conclusions: Use of MUAC in Different Settings 301 References 302 Webliography 304 20 Spirometry for Chronic Obstructive Pulmonary Disease Due to Inhalation of Smoke from Indoor Fires Used for Cooking and Heating 306 Janet G. Shaw, Annalicia Vaughan, Emma Smith, Cai Fong, Svetlana Stevanovic, and Ian A. Yang 20.1 Introduction 306 20.2 Indoor Air Pollution from Burning Biomass 307 20.3 Mechanisms of Lung Damage from Exposure to Biomass Smoke 309 20.4 Biomass Smoke‐Related Chronic Obstructive Pulmonary Disease (COPD) 311 20.5 Detecting Airflow Obstruction in Biomass Smoke‐Related COPD 314 20.6 Lessons Learnt from Clinical Guidelines for the Detection of Cigarette Smoking‐Related COPD 317 20.7 Conclusions 319 Acknowledgments 320 Bibliography 320 Webliography 326 21 Point‐of‐Care Pulse Oximetry for Children in Low‐Resource Settings 327 Carina King, Hamish Graham, and Eric D. McCollum 21.1 Introduction 327 21.2 Hypoxemia 328 21.3 Pulse Oximetry 330 21.4 Current Situation in Low‐Resource Settings 332 21.5 Current Challenges and Future Opportunities 333 21.6 Conclusions 339 Acknowledgments 339 Bibliography 340 Webliography 343 22 The Use of Near‐Infrared Spectroscopy to Monitor Tissue Oxygenation, Metabolism and Injury in Low Resource Settings 344 Gemma Bale, and Ilias Tachtsidis 22.1 Introduction 344 22.2 Near‐Infrared Spectroscopy 346 22.3 Clinical Applications 349 22.4 Research Applications 350 22.5 The Use of NIRS in Low Resource Settings 350 22.6 Conclusions 355 Bibliography 356 Webliography 357 Part IV Cheap imaging technologies 361 23 The Use of Point‐of‐Care Ultrasound in the Resource‐Limited Setting 363 Tom Heller, Michaëla A.M. Huson, Sabine Bélard, Dan Kaminstein, and Elizabeth Joekes 23.1 Introduction to Point‐of‐Care Ultrasound (POCUS) 365 23.2 Physics and Technical Aspects of Ultrasound 366 23.3 Most Relevant POCUS Applications in the Resource‐Limited Setting 369 23.4 Considerations for Teaching and Implementation 402 23.5 Conclusions 403 Bibliography 403 Webliography 405 24 The Use of Obstetric Ultrasound in Low Resource Settings 406 Helen Allott 24.1 Introduction 406 24.2 Pregnancy‐Related Problems for Which Portable Ultrasound may be Useful 406 24.3 Problems with the Use of Ultrasound Scanning in Limited Resource Settings 407 24.4 Provision of Trained Sonographers 409 24.5 The Perspective of the Pregnant Woman to Antenatal Ultrasound Scanning 410 24.6 Abuse of Ultrasound Scanning in Pregnancy 410 24.7 Advances in Ultrasound Technology (and See Chapter 23) 411 24.8 Targeted Ultrasound Scanning 412 24.9 Conclusions 412 References 413 25 Examining the Optic Fundus and Assessing Visual Acuity and Visual Fields Using Mobile Technology 414 Nigel M. Bolster, and Andrew Bastawrous 25.1 Introduction: The Ascent of Mobile Technology 414 25.2 Visual Acuity 418 25.3 Visual Fields 424 25.4 Smartphone Ophthalmoscopy 427 25.5 Discussion 432 25.6 Conclusions 434 Part V Telemedicine 439 26 Telemedicine for Clinical Management of Adults in Remote and Rural Areas 441 Farhad Fatehi, Monica Taylor, Liam J. Caffery, and Anthony C. Smith 26.1 Introduction 442 26.2 Definitions 443 26.3 Types of Service 444 26.4 Purposes of Telemedicine 444 26.5 Telemedicine for Improving Access to Care 445 26.6 Establishing a Sustainable Telehealth Network: A Case Study from Brazil 445 26.7 Swinfen Telemedicine: A Case Study of Intercontinental Telemedicine 446 26.8 Telemedicine in Natural Disaster Responses 446 26.9 Telemedicine for Remote Training of Healthcare Professionals 447 26.10 Telemedicine for Mental Health (and see Chapter 29) 449 26.11 The Rise of Mobile Health (mHealth) 451 26.12 Social Networking for Clinical Purposes 452 26.13 The World Health Organization and Telemedicine 456 26.14 Challenges and Barriers to Implementation 457 26.15 Conclusions 459 Bibliography 460 Webliography 461 27 Telemedicine for the Delivery of Specialist Pediatric Services 462 Anthony C. Smith, Monica Taylor, Farhad Fatehi, and Liam J. Caffery 27.1 Introduction 463 27.2 Technical Consideration for Telemedicine in LMICs 464 27.3 Models of Care in Telepediatrics 469 27.4 Swinfen Charitable Trust Telemedicine Service 469 27.5 Selected Examples of SCT Referrals 470 27.6 National and International Telemedicine Services 474 27.7 mHealth Applications for LMICs 475 27.8 Telemedicine Screening Services 476 27.9 Telemedicine Support during Disaster Situations 476 27.10 Challenges Associated with Telemedicine Adoption in LMICs 477 27.11 Telepediatric Case Studies in LMICs 478 27.12 Pathology Services 480 27.13 Radiographic (Imaging) Services 480 27.14 Maternal Health Services 481 27.15 Conclusions 481 27.16 Acknowledgements 481 27.17 Useful Websites 481 Bibliography 482 Webliography 486 28 Telemedicine in the Diagnosis and Management of Skin Diseases 488 Giselle Prado, Odinaka Anyanwu, and Carrie Kovarik 28.1 Introduction 489 28.2 Methods of Delivering Teledermatology: Store and Forward Versus Live Interactive Methods 490 28.3 The History of Teledermatology 490 28.4 Global Teledermatology Programs 490 28.5 Teledermatology in Africa 491 28.6 BUP: The Botswana – University of Pennsylvania Partnership 493 28.7 Teledermatopathology in Botswana 494 28.8 Diagnostic Concordance 495 28.9 Teledermatology in Asia 497 28.10 Teledermatology in Latin America 497 28.11 Barriers 498 28.12 Costs 499 28.13 Education and Training 499 28.14 Equipment and Internet Access 499 28.15 Privacy Concerns 500 28.16 Cultural Hesitancy 500 28.17 Language Barriers 501 28.18 Availability of Treatments 501 28.19 Legal Issues 501 28.20 Follow‐up 501 28.21 Ensuring Success of a New Teledermatology Initiative 501 28.22 Conclusions 502 Bibliography 502 29 Digital Technology, Including Telemedicine, in the Management of Mental Illness 505 John A Naslund, Sophia M. Bartels, and Lisa A. Marsch 29.1 Introduction and Background 505 29.2 Why Mental Disorders? 506 29.3 Growing Access to Digital Technology and New Opportunities 508 29.4 Promising Examples from Low‐ and Middle‐Income Countries 509 29.5 Critical Assessment of the Risks and Limitations 517 29.6 Future Directions and Implications 519 29.7 Conclusions 524 Bibliography 525 Webliography 530 30 The Use of Mobile Chest X‐Rays for Tuberculosis Telemedicine 531 Meghan L. Jardon, Kelsey L. Pomykala, Ishita Desai, and Kara‐Lee Pool 30.1 Background 531 30.2 Lack of Access to Radiology 532 30.3 Implementation 532 30.4 Cost 536 30.5 Sustainability 536 30.6 Chest X‐Ray Information Technology (IT) 538 30.7 Mobile Devices 540 30.8 Education to Ensure Sustainability 541 30.9 Conclusions 542 Bibliography 542 Webliography 545 Part VI The future 549 31 An Introduction to Digital Health 551 Kerry Atkinson 31.1 Introduction 552 31.2 The Pillars and Components of Digital Health for Use in the LMICs 552 31.3 Smartphones and Internet Access 554 31.4 Wearables 555 31.5 Personal Digital Assistants and Chatbots 558 31.6 Augmented Reality 558 31.7 Big Data 558 31.8 Artificial Intelligence (AI) 558 31.9 The Game Changer – A Smartphone with AI Access 563 31.10 Conclusions 564 Bibliography 564 Webliography 564 32 Digital Health in Low- and Middle-Income Countries 566 Martin Seneviratne and David Peiris 32.1 Introduction – The Digital Health Revolution 567 32.2 The Current Landscape 569 32.3 HIV/AIDS 569 32.4 Diabetes Mellitus 570 32.5 Maternal Health 570 32.6 Core Functionalities 571 32.7 Patient‐facing Functions 571 32.8 Clinician‐facing Functions 573 32.9 Electronic Medical Record Management 574 32.10 Point‐of‐Care Diagnostic Tests 575 32.11 Epidemiology 575 32.12 Inventory Management and Supply Chain 575 32.13 Challenges to Scale 575 32.14 Emerging Trends and Future Vision 578 32.15 Conclusions 580 Bibliography 580 Webliography 583 33 Nucleic Acid Detection of Tuberculosis Via Innovative Point‐of‐Care Nanotechnologies Targeted for Low Resource Settings 584 Benjamin Y.C. Ng, Eugene J.H. Wee, Nicholas P. West, and Matt Trau 33.1 Introduction 584 33.2 Nucleic Acid Detection of Tuberculosis 585 33.3 The Availability of Rapid Diagnostic Tests at the Peripheral Healthcare Level 585 33.4 Leveraging Innovative Nanotechnologies for Point‐of‐Care TB Diagnosis 587 33.5 Sample Preparation Workflow 589 33.6 Nanotechnologies for TB DNA Sensing and Readouts 590 33.7 Quantitative DNA Detection Methodologies 592 33.8 Drug‐resistant Tuberculosis 594 33.9 Conclusions 595 References 596 34 The Use of Functional Nanoparticles for Water Purification 600 Jing Zhang, Chuanping Feng, and Chengzhong Yu 34.1 Introduction 600 34.2 Disinfection 602 34.3 Adsorption 607 34.4 Electrochemistry 609 34.5 Conclusions and Future Perspectives 609 References 610 35 The Use of Drones in the Delivery of Rural Healthcare 615 Debrah I. Boeras, Blanche C. Collins, and Rosanna W. Peeling 35.1 Challenges in Healthcare Delivery – Opportunities for Innovation 616 35.2 The Need for Disruptive Solutions for Healthcare Delivery in Rural Areas 616 35.3 The Use of Drones for Healthcare Delivery 617 35.4 Further Focus on Uptake of Drone Technology by Different Countries 621 35.5 Models of Potential Public‐Private Collaboration 622 35.6 Promises and Challenges of the Use of Drones in Healthcare Delivery 623 35.7 Outlook for the Future 624 35.8 Conclusions 626 Bibliography 626 Webliography 630 36 Implementation of Point‐of‐Care Tests: Lessons Learnt 633 Rosanna W. Peeling, and Debrah I. Boeras 36.1 Synopsis 633 36.2 Healthcare Needs in Low‐ and Middle‐Income Countries 634 36.3 Rapid Diagnostic Tests for Human Immunodeficiency Virus (HIV) Disease (and See Chapter 4) 636 36.4 Rapid Diagnostic Tests for Syphilis (and See Chapter 6) 637 36.5 Rapid Diagnostic Tests for Tuberculosis (TB) (and See Chapter 5) 638 36.6 Rapid Diagnostic Tests for Malaria (and See Chapter 7) 638 36.7 Lessons Learnt from the Implementation of POC Tests 639 36.8 Lessons Learnt from the Implementation of POC Tests for Three Diseases 640 36.9 The Way Forward 642 36.10 The New Paradigm for Technological Innovation and Implementation 643 36.11 Conclusions 644 Bibliography 644 Webliography 648 37 Useful Electronic Healthcare Resources Available for Those Working in Remote Settings 649 Tyler Evans 37.1 Introduction 649 37.2 General Web‐Based Resources 650 37.3 Travel Medicine 651 37.4 The Big Three Communicable Diseases in Low‐ and Middle‐Income Countries (LMICs) 652 37.5 Hepatitis C 656 37.6 Other Infectious Diseases (IDs) 657 37.7 Dermatology 657 37.8 Obstetrics and Gynecology 658 37.9 Pediatrics 658 37.10 Psychiatry 658 37.11 Emergency Medicine (EM) 659 37.12 Preventive Health 659 37.13 Disease Mapping 660 37.14 Pharmaceuticals 660 37.15 Online Courses 661 37.16 Recommended Books 661 37.17 Institutions, Societies and Books 662 Webliography 663 38 The Future – How Do We Get from Here to There? 666 Kerry Atkinson and David Mabey 38.1 Progress to Date 667 38.2 Major Factors Adversely Affecting Global Health 670 38.3 Continue Doing What Works 674 38.4 New Measures for Improving Remote Rural Healthcare 674 38.5 The UN 2015 Sustainable Development Goals for 2016–2030 677 38.6 Conclusions 681 Bibliography 682 Webliography 683 Glossary 684 Index 693