Revolutionizing Tropical Medicine

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.

Autorentext

About the Editors KERRY ATKINSON is an Honorary Professor at the University of Queensland Centre for Clinical Research in Brisbane, Australia, and an Adjunct Professor in the Stem Cell Laboratories, Queensland University of Technology at the Translational Research Institute, Brisbane, Queensland, Australia. DAVID MABEY is Professor of Communicable Diseases at the London School of Hygiene and Tropical Medicine, London, UK. He is a physician specializing in infectious and tropical diseases.

Inhalt
Part I The Health of Low and MiddleIncome Countries Today 1

**1 The Burden of Communicable Diseases in Low and MiddleIncome 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 MiddleIncome 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 PointofCare 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 Noncommunicable Diseases in Low and MiddleIncome Countries 37
**Heiner Grosskurth

2.1 Introduction 38

2.2 Common Noncommunicable Diseases in Low- and Middle-Income Countries 38

2.3 NCD Epidemiology 38

2.4 Prevention of Noncommunicable Diseases 44

2.5 The Relationship Between Communicable and Noncommunicable 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 middleincome countries by primary pointofcare 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 PointofCare 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 ResourceLimited Settings 89

4.4 Challenges of Using Rapid and PointofCare 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 909090 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 PointofCare Diagnostic Tests for Tuberculosis 105
**Richard Lessells

5.1 Introduction 105

5.2 The Need for Rapid PointofCare TB Diagnostic Tests 106

5.3 Weaknesses in the TB Diagnostic Cascade 106

5.4 Potential Impact of Rapid PointofCare Diagnostic Tests 107

5.5 Defining the Diagnostic Needs 107

5.6 Smear Microscopy 107

5.7 Molecular Diagnostic Tests 109

5.8 LoopMediated 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 G...