Medical Care for Newly Arrived Displaced Persons.

Medical Care for Displaced PersonsThe United Nations High Commissioner for Refugees reports that more than 100 million people have been forcibly displaced from their homes due to persecution, conflict, violence, and human rights violations. Displacement has profound health impacts. Here, Jain and colleagues review medical care for newly displaced persons.

Management of children with danger signs in integrated community case management care in rural southwestern Uganda (2014-2018).

Background: In integrated community case management (iCCM) care, community health workers (CHWs) provide home-based management of fever, diarrhea and fast breathing for children aged <5 y. The iCCM protocol recommends that children with danger signs for severe illness are referred by CHWs to health facilities within their catchment area. This study examines the management of danger signs by CHWs implementing iCCM in a rural context.

Contribution of community health workers to the treatment of common illnesses among under 5-year-olds in rural Uganda.

Background: The control of malaria, pneumonia, and diarrhoea is important for the reduction in morbidity and mortality among children under 5 years. Uganda has adopted the Integrated Community Case Management strategy using Community Health Workers (CHWs) to address this challenge. The extent and trend of these three conditions managed by the CHWs are not well documented.

Four Learner Categories in Global Health Experiences: A Framework for Successful Resident Engagement.

An increasing number of residency programs in the United States now offer global health experiences for trainees, yet many participating residents lack the behaviors and skills needed to engage effectively with local partners and colleagues. In the experience of the authors, trainees working in global settings fall into 1 of 4 learner categories determined by their degree of cultural humility and their willingness to engage with their hosts. This viewpoint proses the concept of "re-orientation," or ongoing structured mentorship, as a way to provide key opportunities for residents to mature in these two important areas during their global experiences.

Long-term quality of integrated community case management care for children in Bugoye Subcounty, Uganda: a retrospective observational study.

Objective: Integrated community case management (iCCM) of childhood illness in Uganda involves protocol-based care of malaria, pneumonia and diarrhoea for children under 5 years old. This study assessed volunteer village health workers' (VHW) ability to provide correct iCCM care according to the national protocol and change in their performance over time since initial training.

Setting: VHWs affiliated with the Ugandan national programme provide community-based care in eight villages in Bugoye Subcounty, a rural area in Kasese District.

Correction: [On Becoming a Global Citizen: Transformative Learning Through Global Health Experiences].

[This corrects the article DOI: 10.1016/j.aogh.

Usage of and satisfaction with Integrated Community Case Management care in western Uganda: a cross-sectional survey.

Background: In some areas of Uganda, village health workers (VHW) deliver Integrated Community Case Management (iCCM) care, providing initial assessment of children under 5 years of age as well as protocol-based treatment of malaria, pneumonia, and diarrhoea for eligible patients. Little is known about community perspectives on or satisfaction with iCCM care. This study examines usage of and satisfaction with iCCM care as well as potential associations between these outcomes and time required to travel to the household's preferred health facility.

Assessing Village Health Workers' Ability to Perform and Interpret Rapid Diagnostic Tests for Malaria 4 Years after Initial Training: A Cross-Sectional Study.

Village health workers (VHWs) in Bugoye subcounty, Uganda, provide integrated community case management (iCCM) care to children younger than 5 years for malaria, pneumonia, and diarrhea. We assessed the longevity of VHWs' skills in performing and reading malaria rapid diagnostic tests (RDTs) 4 years after initial training, comparing VHWs who had completed initial iCCM training 1 year before the study with VHWs who had completed training 4 years before the study. Both groups received quarterly refresher trainings.

A cross-sectional study comparing case scenarios and record review to measure quality of Integrated Community Case Management care in western Uganda.

Background: In Integrated Community Case Management (iCCM), village health workers (VHW) assess and treat malaria, pneumonia and diarrhea using a clinical algorithm. Study objectives included: 1) Compare VHWs' performance on case scenario exercises to record review data; 2) assess impact of formal education on performance in the case scenario exercises.

Methods: 36 VHWs in Bugoye Subcounty, Uganda completed the case scenarios exercise, which included video case scenarios and brief oral case vignettes, between July 2017 and February 2018.

Completion of community health worker initiated patient referrals in integrated community case management in rural Uganda.

Background: Uganda has sought to address leading causes of childhood mortality: malaria, pneumonia and diarrhoea, through integrated community case management (iCCM). The success of this approach relies on community health worker (CHW) assessment and referral of sick children to a nearby health centre. This study aimed to determine rates of referral completion in an iCCM programme in rural Uganda.

Assessment of attitudes and targeted educational needs for refugee care providers in a Ugandan hospital.

Objectives: To evaluate medical trainees' attitudes toward refugee patients in a refugee host country, and to identify educational needs.

Methods: A 54-question cross-sectional questionnaire was administered to a convenience sample of 81 post-graduate medical trainees at Mbarara Regional Referral Hospital, Uganda, in 2016. Descriptive statistics on medical trainees' attitudes and educational needs regarding care for refugees were calculated.

Quality of care in integrated community case management services in Bugoye, Uganda: a retrospective observational study.

Background: Village health workers (VHWs) in five villages in Bugoye subcounty (Kasese District, Uganda) provide integrated community case management (iCCM) services, in which VHWs evaluate and treat malaria, pneumonia, and diarrhoea in children under 5 years of age. VHWs use a "Sick Child Job Aid" that guides them through the evaluation and treatment of these illnesses. A retrospective observational study was conducted to measure the quality of iCCM care provided by 23 VHWs in 5 villages in Bugoye subcounty over a 2-year period.

On Becoming a Global Citizen: Transformative Learning Through Global Health Experiences.

Background: Globalization has increased the demand for international experiences in medical education. International experiences improve medical knowledge, clinical skills, and self-development; influence career objectives; and provide insights on ethical and societal issues. However, global health rotations can end up being no more than tourism if not structured to foster personal transformation and global citizenship.

Monitoring iCCM referral systems: Bugoye Integrated Community Case Management Initiative (BIMI) in Uganda.

Background: In Uganda, over half of under-five child mortality is attributed to three infectious diseases: malaria, pneumonia and diarrhoea. Integrated community case management (iCCM) trains village health workers (VHWs) to provide in-home diagnosis and treatment of these common childhood illnesses. For severely ill children, iCCM relies on a functioning referral system to ensure timely treatment at a health facility.

The Ethics of Medical Volunteerism.

Responding to disparities in health, thousands of health care providers volunteer annually for short-term medical service trips (MSTs) to serve communities in need as a result of environmental, geographic, historical, or sociopolitical factors. Although well intentioned, short-term MSTs have the potential to benefit and harm those involved, including participants and communities being served. The contexts, resource and time limitations, and language and cultural barriers present ethical challenges.

Career choices and global health engagement: 24-year follow-up of U.S. participants in the Indiana University-Moi University elective.

Background: Global health experiences evoke a profound awareness of cultural differences, inspire learners to prioritize professional values, and provide a lens for addressing global health care challenges. This study compares the long-term career and practice choices of participants in a 2-month Indiana University-Moi University, Kenya elective from 1989-2013 with those of a control group.

Methods: Global health elective (GHE) participants and a random sample of alumni without GHE experience were surveyed on their clinical practice, public health and global health activities.

The relationship of weekend admission and mortality on the public medical wards at a Kenyan referral hospital.

Background: Research has demonstrated disparities in the outcomes of patients admitted to hospital on weekends in high-income countries. No published research has evaluated if any similar discrepancy exists in low-resource settings.

Methods: To determine if any difference in mortality exists between weekend and weekday admissions on the public medical wards at a Kenyan referral hospital, we performed a retrospective observational study of inpatients over a 3-month study period.

Sauti Za Wananchi "voice of the people": patient satisfaction on the medical wards at a Kenyan Referral Hospital.

Introduction: Patient satisfaction is one indicator of healthcare quality. Few studies have examined the inpatient experiences in resource-scarce environments in sub-Saharan Africa.

Methods: To examine patient satisfaction on the public medical wards at a Kenyan referral hospital, we performed a cross-sectional survey focused on patients' satisfaction with medical information and their relationship with staffing and hospital routine.

Kenya's voluntary male medical circumcision program: Translatable lessons for both domestic and international programs.

As a case of translating a healthcare intervention from randomized controlled trial to public health program, Kenya's voluntary male medical circumcision (VMMC) program offers an example of demand generation through active engagement with the population and reducing barriers to uptake. It illustrates various means by which the Kenyan leadership focused on demand generation which have value both domestically and internationally to healthcare leaders. Community and public engagement must start early and continue focused on key stakeholders and spokespersons.

The association between insurance status and in-hospital mortality on the public medical wards of a Kenyan referral hospital.

Background: Observational data in the United States suggests that those without health insurance have a higher mortality and worse health outcomes. A linkage between insurance coverage and outcomes in hospitalized patients has yet to be demonstrated in resource-poor settings.

Methods: To determine whether uninsured patients admitted to the public medical wards at a Kenyan referral hospital have any difference in in-hospital mortality rates compared to patients with insurance, we performed a retrospective observational study of all inpatients discharged from the public medical wards at Moi Teaching and Referral Hospital in Eldoret, Kenya, over a 3-month study period from October through December 2012.

Sickle cell disease and HIV: a case highlighting management challenges for children in a resource-limited setting.

Sickle cell disease (SCD) is a genetic disorder resulting from a mutation in the hemoglobin (Hb) gene. Sickle cell disease results in chronic anemia and a variety of acute and chronic complications that can lead to early mortality. A child with both SCD and HIV presents a management challenge, particularly in a resource-limited setting.