Amir Sabet Sarvestani

Traditional male circumcision in Uganda: a qualitative focus group discussion analysis.

Background The growing body of evidence attesting to the effectiveness of clinical male circumcision in the prevention of HIV/AIDS transmission is prompting the majority of sub-Saharan African governments to move towards the adoption of voluntary medical male circumcision (VMMC). Even though it is recommended to consider collaboration with traditional male circumcision (TMC) providers when planning for VMMC, there is limited knowledge available about the TMC landscape and traditional beliefs. Methodology and Main Findings During 2010–11 over 25 focus group discussions (FGDs) were held with clan leaders, traditional cutters, and their assistants to understand the practice of TMC in four ethnic groups in Uganda. Cultural significance and cost were among the primary reasons cited for preferring TMC over VMMC. Ethnic groups in western Uganda circumcised boys at younger ages and encountered lower rates of TMC related adverse events compared to ethnic groups in eastern Uganda. Cutting styles and post-cut care also differed among the four groups. The use of a single razor blade per candidate instead of the traditional knife was identified as an important and recent change. Participants in the focus groups expressed interest in learning about methods to reduce adverse events. Conclusion This work reaffirmed the strong cultural significance of TMC within Ugandan ethnic groups. Outcomes suggest that there is an opportunity to evaluate the involvement of local communities that still perform TMC in the national VMMC roll-out plan by devising safer, more effective procedures through innovative approaches.

Obstetrics-based clinical immersion of a multinational team of biomedical engineering students in Ghana

a Department of Mechanical Engineering, University of Michigan, Ann Arbor, USA b Department of Biomedical Engineering, University of Michigan, Ann Arbor, USA c Department of Biomedical Engineering, University of Ghana, Legon – Accra, Ghana d Department of Electrical Engineering, Makerere University, Kampala, Uganda e Design Science Program, University of Michigan, Ann Arbor, USA f Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Ghana

Development of culturally appropriate pictorial cards to facilitate maternal health histories in rural Ghana

Limited health education among community health workers (CHWs) and the high illiteracy rates prevalent in rural settings throughout the world impede the recognition of pregnancy complications and subsequent referral decisions challenging. The aim of the present study was to develop and evaluate culturally appropriate and easily understandable pictorial cards of common pregnancy complications in Ghana. Relying on input from a small sample of pregnant women from two rural regions of Ghana many of the illustrations were revised to be more culturally appropriate and relevant. This study reinforces the importance of involving end-users throughout the development of a diagnostic aid that has major cultural implications. Copyright

Enhancing Video Capsule Endoscopy: Location and Bleeding Detection

Video capsule endoscopy (VCE) is a method used to wirelessly scan the gastrointestinal (GI) tract lumen. Despite the effectiveness of VCE in GI endoscopic procedures, VCE is limited because it lacks the capability to exactly locate itself as well as accurately detect bleeding or clotting within the GI tract. The unreliability of localization combined with inaccurate blood detection in VCE ultimately leads to wired endoscopy for additional diagnosis. In this paper, a method to address localization of the VCE device, also known as a pill camera or capsule, in conjunction with an accurate detection of active bleeding and clotting inside the small intestine, is introduced. The Texas Instruments, ZigBee® kit, which uses a 3D trilateration method will be used for accurate location detection and image transmission throughout the VCE procedure. The system will be interfaced with software providing end users with the path and total distance traveled by the pill capsule within the small intestine. The blood detection system is enhanced by using a minilow energy wireless Raman spectrometry to scan for active bleeding or clots along the small intestinal wall. The employed spectrometry method scans for wavelengths based on blood’s optical characteristics and records any image fitting the exact spectrum. Blood detection and localization data are coupled together and then transferred to an external receiver. These two improvements together will enhance capsule endoscopy procedures and fill the gap created by the existing capsule endoscopy technologies, therefore, meeting the needs of physicians and patients.

User-Based Design Approach to Develop a Traditional Adult Male Circumcision Device

HIV/AIDS is a devastating global epidemic responsible for more than 25 million deaths since 1981 [1]. The World Health Organization (WHO) concludes that “adult male circumcision is the first and thus far only proven efficacious biomedical intervention for the prevention of sexually transmitted HIV infection in adults” [2]. Thus, public health organizations, along with most of Africa’s ministries of health, have either launched or are preparing to launch mass male circumcision roll-out plans [3]. In subSaharan Africa, adult male circumcision occurs in both clinical settings and traditional ceremonies. Unlike male infant circumcision, adult circumcision requires suturing for homeostasis and wound closure that makes the procedure more difficult and longer, thus resulting in higher complication rates [4]. ShangRing and PrePex, both of which have attracted the attention of public health authorities in Africa, are new devices that claim to accommodate clinical adult male circumcision by enabling less-trained health workers to perform the task [5,6]. Traditional male circumcision (TMC) ceremonies are often considered a rite of passage into manhood for boys between ages 6–24; however, these ceremonies are associated with high adverse events, as high as 48%, including bleeding, infection, excessive pain, lacerations, erectile dysfunction, and even death [7]. A detailed description of TMC practice and its cultural importance in Uganda has been discussed in [8]. However, devices such as the ShangRing and PrePex are not suitable for use in traditional settings due to their cultural inappropriateness, complexity and high cost. Given the continuing practice of TMC in sub-Saharan Africa, there is a need for a biomedical intervention to ensure safe, healthy, and effective outcomes. Addressing health and safety concerns and adopting a pragmatic user-based approach throughout the design and revision process allowed us to develop a culturally acceptable, low-cost, single-use, and safe device for use in TMC. The co-creative design process, which involved the end-users, is explained here.

Cost effectiveness of medical devices to diagnose pre-eclampsia in low-resource settings

Background Maternal mortality remains a major health challenge facing developing countries, with pre-eclampsia accounting for up to 17 percent of maternal deaths. Diagnosis requires skilled health providers and devices that are appropriate for low-resource settings. This study presents the first cost-effectiveness analysis of multiple medical devices used to diagnose pre-eclampsia in low- and middle-income countries (LMICs). Methods Blood pressure and proteinuria measurement devices, identified from compendia for LMICs, were included. We developed a decision tree framework to assess the cost-effectiveness of each device using parameter values that reflect the general standard of care based on a survey of relevant literature and expert opinion. We examined the sensitivity of our results using one-way and second-order probabilistic multivariate analyses. Results Because the disability-adjusted life years (DALYs) averted for each device were very similar, the results were influenced by the per-use cost ranking. The most cost-effective device combination was a semi-automatic blood pressure measurement device and visually read urine strip test with the lowest combined per-use cost of

Assistive Device for the Insertion of Subcutaneous Contraceptive Implants

0.2004 and an incremental cost effectiveness ratio of

Adult Male Circumcision Device for Use in Clinical Settings

93.6 per DALY gained relative to a baseline with no access to diagnostic devices. When access to treatment is limited, it is more cost-effective to improve access to treatment than to increase testing rates or diagnostic device sensitivity. Conclusions Our findings were not sensitive to changes in device sensitivity, however they were sensitive to changes in the testing rate and treatment rate. Furthermore, our results suggest that simple devices are more cost-effective than complex devices. The results underscore the desirability of two design features for LMICs: ease of use and accuracy without calibration. Our findings have important implications for policy makers, health economists, health care providers and engineers.

Medical device compendium for the developing world: a new approach in project and service-based learning for engineering graduate students

Providing access to family planning services in lowand middle-income countries (LMICs) is a major focus of the global health community [1]. The World Bank estimates that only 45% of the demand for contraceptive services in subSaharan Africa is satisfied [2]. The availability of long-term contraceptive methods is particularly important for women who prefer to space pregnancies by two or more years. Intrauterine and subcutaneous implant contraceptive methods are the most effective reversible contraception methods available [3]. Subcutaneous implants are single (or double) rods that contain etonogestrel and are inserted subdermally on the inner side of a womans non-dominant arm [4]. Single-rod devices (e.g., Implanon, Nexplanon) can prevent pregnancy for up to three years while two-rod devices (e.g., Jadelle, Sino-implant) can prevent pregnancy for up to five years. In addition, implants do not require maintenance or effort on the part of the user, allow women to return to fertility quickly, and have very low failure rates [5]. While the benefits of implantable contraceptives are significant, major barriers exist that prevent wider usage; namely, the training and skill required for performing insertion/removal procedures. This barrier is exacerbated in rural areas where access to health clinics, medical devices, and trained clinicians is more limited. This paper details the design of an innovative task shifting device that enables community healthcare workers to insert subcutaneous contraceptive implants. The ultimate goal of this work is to lower the barrier to adoption of long-term contraceptive implants for rural women in LMICs.

APPLYING DESIGN ETHNOGRAPHY TO PRODUCT EVALUATION: A CASE EXAMPLE OF A MEDICAL DEVICE IN A LOW-RESOURCE SETTING

Sub-Saharan Africa is the region most heavily affected by HIV, ccounting for 67% of HIV positive cases and 72% of AIDS eaths globally in 2007. Public health officials believe adult male ircumcision can be an effective HIV prevention intervention and ecommend task shifting as an approach to increase the volume of ale circumcisions performed in sub-Saharan Africa. Current cale up complications in sub-Saharan Africa include high proceural cost, clinical tools complexity, trained human resources