Revolutionizing Tropical Medicine

Point-of-Care Tests, New Imaging Technologies and Digital Health

Inbunden, Engelska, 2019

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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 worldDescribes 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 GoalsProvides a review of inexpensive rapid diagnostic point-of-care tests for infectious diseases in low-resource countries, particularly for people living in remote rural areasProvides 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 spirometryExplores 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 availableDescribes the use of telemedicine in the clinical management of both children and adults in remote rural settingsLooks 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 spectroscopyFinally, 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.

Produktinformation

Utgivningsdatum2019-08-09
Mått175 x 244 x 38 mm
Vikt1 497 g
FormatInbunden
SpråkEngelska
Antal sidor768
FörlagJohn Wiley and Sons Ltd
ISBN9781119282648

Tillhör följande kategorier

Biologi inom Naturvetenskap och teknik
Biovetenskap inom Naturvetenskap och teknik

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.

Part I The Health of Low] and Middle]Income Countries Today 11 The Burden of Communicable Diseases in Low] and Middle]Income Countries 3Kerry Atkinson and David Mabey1.1 Introduction 41.2 Definition of a Communicable Disease 41.3 Definition of Low] to Middle]Income Countries 41.4 Definition of Burden of Disease 51.5 Definition of Disease Elimination 71.6 Definition of Disease Eradication 71.7 Definition of the Primary Point]of]Care 71.8 The 2000 Millennium Development Goals (MDGs) and Their Outcomes 71.9 Major Individual Diseases in the LMICs: The Big Three ] Malaria, HIV/AIDS and Tuberculosis 91.10 Other Important Communicable Diseases in the LMICs 171.11 Neglected Tropical Disease (NTDs) Prioritized by the World Health Organisation 21.12 A Comparison of Health Metrics in an LMIC (Papua New Guinea) and a Developed Country (Australia) with a 7 km Distance Between them 311.13 Conclusions 322 The Burden of Non]communicable Diseases in Low] and Middle]Income Countries 37Heiner Grosskurth2.1 Introduction 382.2 Common Non]communicable Diseases in Low- and Middle-Income Countries 382.3 NCD Epidemiology 382.4 Prevention of Non]communicable Diseases 442.5 The Relationship Between Communicable and Non]communicable Diseases 442.6 The Health System Burden of NCDs 462.7 The Economic Impact of NCDs 472.8 The Response to the NCD Epidemic in LMICs 482.9 The Readiness of Primary Healthcare Services in LMICs to Cope with the NCD Burden 502.10 Introducing Effective NCD Control at Primary Care Services: A Practical Approach 522.11 The Role of Primary Healthcare Services in Cancer Prevention and Care 672.12 Evaluating Programmes to Strengthen NCD Services at Primary Care Level 702.13 Conclusions 70Part II How to improve healthcare in low] and middle]income countries by primary point]of]care rapid diagnostic testing 813 The Optimal Features of a Rapid Point-of-Care Diagnostic Test 83David Mabey and Rosanna Peeling3.1 Introduction 833.2 Accuracy Versus Accessibility 833.3 Quality Assurance 843.4 The Importance of Connectivity 853.5 Environmental Friendliness 864 Revolutionizing HIV Healthcare Delivery Through Rapid and Point]of]Care Testing 88Catherine J. Wedderburn, Debrah I. Boeras, and Rosanna W. Peeling4.1 Synopsis 884.2 Introduction 894.3 Diagnostic Tests in Resource]Limited Settings 894.4 Challenges of Using Rapid and Point]of]Care Testing Within the Context of the Healthcare System 924.5 Recent Advances in HIV Diagnosis and Monitoring and Their Impact 934.6 WHO Recommendations: POC Diagnostics for Achieving the 90]90]90 Goals 984.7 Remaining Challenges – Human Resources, Quality Assurance, and Test Selection and Placement 984.8 Moving Forward 994.9 Conclusions 1005 Rapid Point]of]Care Diagnostic Tests for Tuberculosis 105Richard Lessells5.1 Introduction 1055.2 The Need for Rapid Point]of]Care TB Diagnostic Tests 1065.3 Weaknesses in the TB Diagnostic Cascade 1065.4 Potential Impact of Rapid Point]of]Care Diagnostic Tests 1075.5 Defining the Diagnostic Needs 1075.6 Smear Microscopy 1075.7 Molecular Diagnostic Tests 1095.8 Loop]Mediated Isothermal Amplification (LAMP) 1125.9 Line Probe Assays 1135.10 Other Molecular Tests 1135.11 Antigen Tests 1145.12 Combination Diagnostic Packages 1155.13 Next Generation Sequencing 1175.14 Diagnostic Imaging 1175.15 Other Diagnostics 1185.16 Conclusions 1186 Rapid Diagnostic Tests for Syphilis 126David Mabey, Michael Marks, and Rosanna W. Peeling6.1 Introduction 1266.2 The Diagnosis of Syphilis 1296.3 The Impact of POC Testing for Syphilis 1316.4 Challenges in the Implementation of POC Testing 1336.5 The Future 1347 Point]of]Care and Near]Point]of]Care Diagnostic Tests for Malaria: Light Microscopy, Rapid Antigen]Detecting Tests and Nucleic Acid Amplification Assays 137Heidi Hopkins, and Jane Cunningham7.1 Introduction 1377.2 Diagnosis of Malaria 1387.3 Light Microscopy of Blood Smears 1397.4 Rapid Diagnostic Tests for Malaria (mRDTs) 1407.5 Nucleic Acid Amplification]Based Tests (NAATs) for Malaria 1427.6 Impact of Point]of]Care Testing for Malaria 1437.7 Challenges in Implementation of POC Testing for Malaria 1447.8 The Future 1468 Rapid Diagnostic Tests for Human African Trypanosomiasis 159Veerle Lejon, Epco Hasker, and Philippe Büscher8.1 Introduction 1598.2 The Early Introduction of Immunodiagnostic Tests in the Diagnosis of HAT 1608.3 CATT/T.b. gambiense: A Breakthrough in the Immunodiagnosis of Gambiense]HAT 1618.4 The Changing Epidemiology of Gambiense]HAT: The Need for Improved Rapid Diagnostic Tests 1638.5 Second Generation RDTs for HAT 1658.6 Future Perspectives and Challenges 1659 Rapid Diagnostic Tests for Visceral Leishmaniasis 170Marleen Boelaert, Suman Rijal, and François Chappuis9.1 Introduction 1709.2 Parasitology, a Reference Standard? 1719.3 Serological Assays 1729.4 The First Serological Test for Field Use: The Direct Agglutination Assay 1739.5 The Early Development an Immunochromatographic Test Using the Recombinant Leishmania Antigen rK39 1749.6 Impact of the VL RDT 1749.7 Challenges 1759.8 Other Tests 1759.9 Discussion 1769.10 Conclusions 17710 A Rapid Diagnostic Test for Dengue 181Claire Mullender, and James Whitehorn10.1 Introduction 18110.2 Clinical Features of Dengue 18210.3 The Importance of Making a Rapid Diagnosis 18310.4 The Host Response to Infection 18410.5 Existing Diagnostic Strategies 18410.6 Review of Existing Rapid Diagnostic Tests 18610.7 Future Directions 18810.8 Conclusions 18811 Rapid Diagnostic Tests for Influenza 191A.C. Hurt, and I.G. Barr11.1 Introduction 19111.2 Overview of RIDTs 19211.3 Antigen Detection]based RIDTs 19511.4 Nucleic Acid Detection]based RIDTs 19711.5 Factors that Alter RIDTs Performance 19811.6 The Use of RIDTs in LMICs 19811.7 Conclusions 19912 A Rapid Diagnostic Test for Ebola Virus Disease 202Catherine Houlihan and Colin Brown12.1 Case Report 20212.2 Introduction 20312.3 Diagnostic Methods to Detect Ebola Virus Disease 20312.4 Rapid Diagnostic Tests for Ebola Virus Disease for Use in a Point]of]Care Facility 20612.5 Conclusions 20913 Rapid Diagnostic Tests for Yaws 213Michael Marks13.1 Introduction 21313.2 Epidemiology 21413.3 Clinical Features 21513.4 Diagnostic Quandaries 21713.5 Diagnostic Tests for Yaws 21713.6 Rapid Diagnostic Tests for Yaws 21813.7 Molecular Assays 21914 Rapid Diagnostic Tests for the Detection of Sickling Hemoglobin 224Amina Nardo]Marino and Tom N. Williams14.1 Sickle Cell Disease 22414.2 Diagnosing Sickle Cell Disease 22514.3 Conclusions 22915 Progress Toward the Development of Rapid Diagnostic Tests for Lymphatic Filariasis and Onchocerciasis 231Roger B. Peck, Dunia Faulx, and Tala de los Santos15.1 Introduction 23115.2 The Development of Rapid Diagnostic Tests 23415.3 Rapid Diagnostic Tests for Lymphatic Filariasis 23415.4 Rapid Diagnostic Tests for Onchocerciasis 23615.5 Next tests and Steps 240Part III Other tests that can be performed rapidly at the primary]point]of-care 24516 Point]of]Care Testing for Blood Counts, HbA1c, Renal Function, Electrolytes, Acid–Base Balance and Hepatitis 247Mark Shephard, Lara Motta, Brooke Spaeth, Heather Halls, and Lauren Duckworth16.1 Introduction 24816.2 Point]of]Care Testing for Blood Counts 24816.3 Point]of]Care Testing for HbA1c 25216.4 Point]of]Care Testing for Renal Function 25416.5 Point]of]Care Testing for Electrolytes and Acid–Base Balance 25716.6 Point]of]Care Testing for Hepatitis 26116.7 Conclusions 26517 Microscopy Skills: Cell Counts, Gram Stains, Ziehl]Neelsen Staining (ZN) and Blood Films 270Michael Harrison17.1 Introduction 27017.2 Microscopy 27117.3 Microscopy in a POC Testing Laboratory 27317.4 Gram Staining 27417.5 Ziehl]Neelsen Stain (ZN) for Mycobacterium tuberculosis 27517.6 Blood Film Preparation, Staining and Reporting 27617.7 Conclusions 27818 India Ink Stain and Cryptococcal Antigen Test for Cryptococcal Infection 281Hannah K. Mitchell, Joseph N. Jarvis, and Mark W. Tenforde18.1 Introduction 28118.2 Diagnosis of Cryptococcal Meningitis 28218.3 Cryptococcal Antigen Testing (CrAg) 28318.4 India Ink Stain 28518.5 CrAg Testing for the Prevention of Cryptococcal Meningitis 28618.6 Logistical Challenges of CrAg Screening 28818.7 Non]Meningeal Cryptococcal Disease 28918.8 Conclusions 28919 Mid Upper Arm Circumference Tapes for Assessment of Severe Acute Malnutrition 294Jane Crawley, Martha Mwangome, James Berkley, and André Briend19.1 Introduction 29419.2 Mid Upper Arm Circumference (MUAC) 29619.3 Comparison of MUAC with other Anthropometric Indices 29619.4 MUAC: A Brief Historical Perspective 29619.5 Technique for Measuring MUAC 29719.6 MUAC, Mortality Risk, and Definitions of Severe Acute Malnutrition 29819.7 Conclusions: Use of MUAC in Different Settings 30120 Spirometry for Chronic Obstructive Pulmonary Disease Due to Inhalation of Smoke from Indoor Fires Used for Cooking and Heating 306Janet G. Shaw, Annalicia Vaughan, Emma Smith, Cai Fong, Svetlana Stevanovic, and Ian A. Yang20.1 Introduction 30620.2 Indoor Air Pollution from Burning Biomass 30720.3 Mechanisms of Lung Damage from Exposure to Biomass Smoke 30920.4 Biomass Smoke]Related Chronic Obstructive Pulmonary Disease (COPD) 31120.5 Detecting Airflow Obstruction in Biomass Smoke]Related COPD 31420.6 Lessons Learnt from Clinical Guidelines for the Detection of Cigarette Smoking]Related COPD 31720.7 Conclusions 31921 Point]of]Care Pulse Oximetry for Children in Low]Resource Settings 327Carina King, Hamish Graham, and Eric D. McCollum21.1 Introduction 32721.2 Hypoxemia 32821.3 Pulse Oximetry 33021.4 Current Situation in Low]Resource Settings 33221.5 Current Challenges and Future Opportunities 33321.6 Conclusions 33922 The Use of Near]Infrared Spectroscopy to Monitor Tissue Oxygenation, Metabolism and Injury in Low Resource Settings 344Gemma Bale, and Ilias Tachtsidis22.1 Introduction 34422.2 Near]Infrared Spectroscopy 34622.3 Clinical Applications 34922.4 Research Applications 35022.5 The Use of NIRS in Low Resource Settings 35022.6 Conclusions 355Part IV Cheap imaging technologies 36123 The Use of Point]of]Care Ultrasound in the Resource]Limited Setting 363Tom Heller, Michaëla A.M. Huson, Sabine Bélard, Dan Kaminstein, and Elizabeth Joekes23.1 Introduction to Point]of]Care Ultrasound (POCUS) 36523.2 Physics and Technical Aspects of Ultrasound 36623.3 Most Relevant POCUS Applications in the Resource]Limited Setting 36923.4 Considerations for Teaching and Implementation 40223.5 Conclusions 40324 The Use of Obstetric Ultrasound in Low Resource Settings 406Helen Allott24.1 Introduction 40624.2 Pregnancy]Related Problems for Which Portable Ultrasound may be Useful 40624.3 Problems with the Use of Ultrasound Scanning in Limited Resource Settings 40724.4 Provision of Trained Sonographers 40924.5 The Perspective of the Pregnant Woman to Antenatal Ultrasound Scanning 41024.6 Abuse of Ultrasound Scanning in Pregnancy 41024.7 Advances in Ultrasound Technology (and See Chapter 23) 41124.8 Targeted Ultrasound Scanning 41224.9 Conclusions 41225 Examining the Optic Fundus and Assessing Visual Acuity and Visual Fields Using Mobile Technology 414Nigel M. Bolster, and Andrew Bastawrous25.1 Introduction: The Ascent of Mobile Technology 41425.2 Visual Acuity 41825.3 Visual Fields 42425.4 Smartphone Ophthalmoscopy 42725.5 Discussion 43225.6 Conclusions 434Part V Telemedicine 43926 Telemedicine for Clinical Management of Adults in Remote and Rural Areas 441Farhad Fatehi, Monica Taylor, Liam J. Caffery, and Anthony C. Smith26.1 Introduction 44226.2 Definitions 44326.3 Types of Service 44426.4 Purposes of Telemedicine 44426.5 Telemedicine for Improving Access to Care 44526.6 Establishing a Sustainable Telehealth Network: A Case Study from Brazil 44526.7 Swinfen Telemedicine: A Case Study of Intercontinental Telemedicine 44626.8 Telemedicine in Natural Disaster Responses 44626.9 Telemedicine for Remote Training of Healthcare Professionals 44726.10 Telemedicine for Mental Health (and see Chapter 29) 44926.11 The Rise of Mobile Health (mHealth) 45126.12 Social Networking for Clinical Purposes 45226.13 The World Health Organization and Telemedicine 45626.14 Challenges and Barriers to Implementation 45726.15 Conclusions 45927 Telemedicine for the Delivery of Specialist Pediatric Services 462Anthony C. Smith, Monica Taylor, Farhad Fatehi, and Liam J. Caffery27.1 Introduction 46327.2 Technical Consideration for Telemedicine in LMICs 46427.3 Models of Care in Telepediatrics 46927.4 Swinfen Charitable Trust Telemedicine Service 46927.5 Selected Examples of SCT Referrals 47027.6 National and International Telemedicine Services 47427.7 mHealth Applications for LMICs 47527.8 Telemedicine Screening Services 47627.9 Telemedicine Support during Disaster Situations 47627.10 Challenges Associated with Telemedicine Adoption in LMICs 47727.11 Telepediatric Case Studies in LMICs 47827.12 Pathology Services 48027.13 Radiographic (Imaging) Services 48027.14 Maternal Health Services 48127.15 Conclusions 48127.16 Acknowledgements 48127.17 Useful Websites 48128 Telemedicine in the Diagnosis and Management of Skin Diseases 488Giselle Prado, Odinaka Anyanwu, and Carrie Kovarik28.1 Introduction 48928.2 Methods of Delivering Teledermatology: Store and Forward Versus Live Interactive Methods 49028.3 The History of Teledermatology 49028.4 Global Teledermatology Programs 49028.5 Teledermatology in Africa 49128.6 BUP: The Botswana – University of Pennsylvania Partnership 49328.7 Teledermatopathology in Botswana 49428.8 Diagnostic Concordance 49528.9 Teledermatology in Asia 49728.10 Teledermatology in Latin America 49728.11 Barriers 49828.12 Costs 49928.13 Education and Training 49928.14 Equipment and Internet Access 49928.15 Privacy Concerns 50028.16 Cultural Hesitancy 50028.17 Language Barriers 50128.18 Availability of Treatments 50128.19 Legal Issues 50128.20 Follow]up 50128.21 Ensuring Success of a New Teledermatology Initiative 50128.22 Conclusions 50229 Digital Technology, Including Telemedicine, in the Management of Mental Illness 505John A Naslund, Sophia M. Bartels, and Lisa A. Marsch29.1 Introduction and Background 50529.2 Why Mental Disorders? 50629.3 Growing Access to Digital Technology and New Opportunities 50829.4 Promising Examples from Low] and Middle]Income Countries 50929.5 Critical Assessment of the Risks and Limitations 51729.6 Future Directions and Implications 51929.7 Conclusions 52430 The Use of Mobile Chest X]Rays for Tuberculosis Telemedicine 531Meghan L. Jardon, Kelsey L. Pomykala, Ishita Desai, and Kara]Lee Pool30.1 Background 53130.2 Lack of Access to Radiology 53230.3 Implementation 53230.4 Cost 53630.5 Sustainability 53630.6 Chest X]Ray Information Technology (IT) 53830.7 Mobile Devices 54030.8 Education to Ensure Sustainability 54130.9 Conclusions 542Part VI The future 54931 An Introduction to Digital Health 551Kerry Atkinson31.1 Introduction 55231.2 The Pillars and Components of Digital Health for Use in the LMICs 55231.3 Smartphones and Internet Access 55431.4 Wearables 55531.5 Personal Digital Assistants and Chatbots 55831.6 Augmented Reality 55831.7 Big Data 55831.8 Artificial Intelligence (AI) 55831.9 The Game Changer – A Smartphone with AI Access 56331.10 Conclusions 56432 Digital Health in Low- and Middle-Income Countries 566Martin Seneviratne and David Peiris32.1 Introduction – The Digital Health Revolution 56732.2 The Current Landscape 56932.3 HIV/AIDS 56932.4 Diabetes Mellitus 57032.5 Maternal Health 57032.6 Core Functionalities 57132.7 Patient]facing Functions 57132.8 Clinician]facing Functions 57332.9 Electronic Medical Record Management 57432.10 Point]of]Care Diagnostic Tests 57532.11 Epidemiology 57532.12 Inventory Management and Supply Chain 57532.13 Challenges to Scale 57532.14 Emerging Trends and Future Vision 57832.15 Conclusions 58033 Nucleic Acid Detection of Tuberculosis Via Innovative Point]of]Care Nanotechnologies Targeted for Low Resource Settings 584Benjamin Y.C. Ng, Eugene J.H. Wee, Nicholas P. West, and Matt Trau33.1 Introduction 58433.2 Nucleic Acid Detection of Tuberculosis 58533.3 The Availability of Rapid Diagnostic Tests at the Peripheral Healthcare Level 58533.4 Leveraging Innovative Nanotechnologies for Point]of]Care TB Diagnosis 58733.5 Sample Preparation Workflow 58933.6 Nanotechnologies for TB DNA Sensing and Readouts 59033.7 Quantitative DNA Detection Methodologies 59233.8 Drug]resistant Tuberculosis 59433.9 Conclusions 59534 The Use of Functional Nanoparticles for Water Purification 600Jing Zhang, Chuanping Feng, and Chengzhong Yu34.1 Introduction 60034.2 Disinfection 60234.3 Adsorption 60734.4 Electrochemistry 60934.5 Conclusions and Future Perspectives 60935 The Use of Drones in the Delivery of Rural Healthcare 615Debrah I. Boeras, Blanche C. Collins, and Rosanna W. Peeling35.1 Challenges in Healthcare Delivery – Opportunities for Innovation 61635.2 The Need for Disruptive Solutions for Healthcare Delivery in Rural Areas 61635.3 The Use of Drones for Healthcare Delivery 61735.4 Further Focus on Uptake of Drone Technology by Different Countries 62135.5 Models of Potential Public]Private Collaboration 62235.6 Promises and Challenges of the Use of Drones in Healthcare Delivery 62335.7 Outlook for the Future 62435.8 Conclusions 62636 Implementation of Point]of]Care Tests: Lessons Learnt 633Rosanna W. Peeling, and Debrah I. Boeras36.1 Synopsis 63336.2 Healthcare Needs in Low] and Middle]Income Countries 63436.3 Rapid Diagnostic Tests for Human Immunodeficiency Virus (HIV) Disease (and See Chapter 4) 63636.4 Rapid Diagnostic Tests for Syphilis (and See Chapter 6) 63736.5 Rapid Diagnostic Tests for Tuberculosis (TB) (and See Chapter 5) 63836.6 Rapid Diagnostic Tests for Malaria (and See Chapter 7) 63836.7 Lessons Learnt from the Implementation of POC Tests 63936.8 Lessons Learnt from the Implementation of POC Tests for Three Diseases 64036.9 The Way Forward 64236.10 The New Paradigm for Technological Innovation and Implementation 64336.11 Conclusions 64437 Useful Electronic Healthcare Resources Available for Those Working in Remote Settings 649Tyler Evans37.1 Introduction 64937.2 General Web]Based Resources 65037.3 Travel Medicine 65137.4 The Big Three Communicable Diseases in Low] and Middle]Income Countries (LMICs) 65237.5 Hepatitis C 65637.6 Other Infectious Diseases (IDs) 65737.7 Dermatology 65737.8 Obstetrics and Gynecology 65837.9 Pediatrics 65837.10 Psychiatry 65837.11 Emergency Medicine (EM) 65937.12 Preventive Health 65937.13 Disease Mapping 66037.14 Pharmaceuticals 66037.15 Online Courses 66137.16 Recommended Books 66137.17 Institutions, Societies and Books 66238 The Future – How Do We Get from Here to There? 666Kerry Atkinson and David Mabey38.1 Progress to Date 66738.2 Major Factors Adversely Affecting Global Health 67038.3 Continue Doing What Works 67438.4 New Measures for Improving Remote Rural Healthcare 67438.5 The UN 2015 Sustainable Development Goals for 2016–2030 67738.6 Conclusions 681Bibliography 682Webliography 683Glossary 684Index 693