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Testing telediagnostic obstetric ultrasound in Peru: a new horizon in expanding access to prenatal ultrasound
(BioMed Central Ltd, 2021-12-01)
Ninety-four percent of all maternal deaths occur in low- and middle-income countries, and the majority are preventable. Access to quality Obstetric ultrasound can identify some complications leading to maternal and neonatal/perinatal mortality or morbidity and may allow timely referral to higher-resource centers. However, there are significant global inequalities in access to imaging and many challenges to deploying ultrasound to rural areas. In this study, we tested a novel, innovative Obstetric telediagnostic ultrasound system in which the imaging acquisitions are obtained by an operator without prior ultrasound experience using simple scan protocols based only on external body landmarks and uploaded using low-bandwidth internet for asynchronous remote interpretation by an off-site specialist. Methods: This is a single-center pilot study. A nurse and care technician underwent 8 h of training on the telediagnostic system. Subsequently, 126 patients (68 second trimester and 58 third trimester) were recruited at a health center in Lima, Peru and scanned by these ultrasound-naïve operators. The imaging acquisitions were uploaded by the telemedicine platform and interpreted remotely in the United States. Comparison of telediagnostic imaging was made to a concurrently performed standard of care ultrasound obtained and interpreted by an experienced attending radiologist. Cohen’s Kappa was used to test agreement between categorical variables. Intraclass correlation and Bland-Altman plots were used to test agreement between continuous variables. Results: Obstetric ultrasound telediagnosis showed excellent agreement with standard of care ultrasound allowing the identification of number of fetuses (100% agreement), fetal presentation (95.8% agreement, κ =0.78 (p < 0.0001)), placental location (85.6% agreement, κ =0.74 (p < 0.0001)), and assessment of normal/abnormal amniotic fluid volume (99.2% agreement) with sensitivity and specificity > 95% for all variables. Intraclass correlation was good or excellent for all fetal biometric measurements (0.81–0.95). The majority (88.5%) of second trimester ultrasound exam biometry measurements produced dating within 14 days of standard of care ultrasound. Conclusion: This Obstetric ultrasound telediagnostic system is a promising means to increase access to diagnostic Obstetric ultrasound in low-resource settings. The telediagnostic system demonstrated excellent agreement with standard of care ultrasound. Fetal biometric measurements were acceptable for use in the detection of gross discrepancies in fetal size requiring further follow up.
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FIPOL: An initiative to support research collaborations, resource development, scientific communication, and educational opportunities in psychosocial oncology for Latin America
(Wiley, 2022-03-18)
Key points The goal of FIPOL (Training and Resources in Psychosocial Oncology for Latin America) is to support the development of psychosocial oncology (PO) in Latin American countries FIPOL aims to increase global awareness of academic opportunities in PO and behavioral medicine and facilitates exchanges and collaborations between Spanish‐speaking clinicians and researchers from diverse backgrounds and Spanish‐speaking countries who work in cancer and psychosocial care Professional organizations and networks such as FIPOL may contribute to the long‐term growth of PO in the region and implementation and sustainability of PO practice FIPOL works towards its goals through efforts in training, resource development, collaborative research initiatives, and communication and dissemination with collaborations of Spanish‐speaking colleagues working on cancer and psychosocial care
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Assessment of a brief standardized obstetric ultrasound training program for individuals without prior ultrasound experience
(Lippincott Williams & Wilkins, 2022-10-08)
ABSTRACT: Obstetric volume sweep imaging (OB VSI) is a simple set of transducer movements guided by external body landmarks that can be taught to ultrasound-naive non-experts. This approach can increase access to ultrasound in rural/low-resources settings lacking trained sonographers. This study presents and evaluates a training program for OB VSI. Six trainees without previous formal ultrasound experience received a training program on the OB VSI protocol containing focused didactics and supervised live hands-on ultrasound scanning practice. Trainees then independently performed 194 OB VSI examinations on pregnancies >14 weeks with known prenatal ultrasound abnormalities. Images were reviewed by maternal-fetal medicine specialists for the primary outcome (protocol deviation rates) and secondary outcomes (examination quality and image quality). Protocol deviation was present in 25.8% of cases, but only 7.7% of these errors affected the diagnostic potential of the ultrasound. Error rate differences between trainees ranged from 8.6% to 53.8% ( P < 0.0001). Image quality was excellent or acceptable in 88.2%, and 96.4% had image quality capable of yielding a diagnostic interpretation. The frequency of protocol deviations decreased over time in the majority of trainees, demonstrating retention of training program over time. This brief OB VSI training program for ultrasound-naive non-experts yielded operators capable of producing high-quality images capable of diagnostic interpretation after 3 hours of training. This training program could be adapted for use by local community members in low-resource/rural settings to increase access to obstetric ultrasound.
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Breast ultrasound volume sweep imaging: A new horizon in expanding imaging access for breast cancer detection
(Wiley, 2022-07-08)
The majority of people in the world lack basic access to breast diagnostic imaging resulting in delay to diagnosis of breast cancer. In this study, we tested a volume sweep imaging (VSI) ultrasound protocol for evaluation of palpable breast lumps that can be performed by operators after minimal training without prior ultrasound experience as a means to increase accessibility to breast ultrasound. METHODS: Medical students without prior ultrasound experience were trained for less than 2 hours on the VSI breast ultrasound protocol. Patients presenting with palpable breast lumps for standard of care ultrasound examination were scanned by a trained medical student with the VSI protocol using a Butterfly iQ handheld ultrasound probe. Video clips of the VSI scan imaging were later interpreted by an attending breast imager. Results of VSI scan interpretation were compared to the same-day standard of care ultrasound examination. RESULTS: Medical students scanned 170 palpable lumps with the VSI protocol. There was 97% sensitivity and 100% specificity for a breast mass on VSI corresponding to 97.6% agreement with standard of care (Cohen's κ = 0.95, P < .0001). There was a detection rate of 100% for all cancer presenting as a sonographic mass. High agreement for mass characteristics between VSI and standard of care was observed, including 87% agreement on Breast Imaging-Reporting and Data System assessments (Cohen's κ = 0.82, P < .0001). CONCLUSIONS: Breast ultrasound VSI for palpable lumps offers a promising means to increase access to diagnostic imaging in underserved areas. This approach could decrease delay to diagnosis for breast cancer, potentially improving morbidity and mortality.
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Sustainable Volume Sweep Imaging Lung Teleultrasound in Peru: Public Health Perspectives from a New Frontier in Expanding Access to Imaging
(Frontiers Media SA, 2023-01-01)
Background: Pulmonary disease is a common cause of morbidity and mortality, but the majority of the people in the world lack access to diagnostic imaging for its assessment. We conducted an implementation assessment of a potentially sustainable and cost-effective model for delivery of volume sweep imaging (VSI) lung teleultrasound in Peru. This model allows image acquisition by individuals without prior ultrasound experience after only a few hours of training. Methods: Lung teleultrasound was implemented at 5 sites in rural Peru after a few hours of installation and staff training. Patients were offered free lung VSI teleultrasound examination for concerns of respiratory illness or research purposes. After ultrasound examination, patients were surveyed regarding their experience. Health staff and members of the implementation team also participated in separate interviews detailing their views of the teleultrasound system which were systematically analyzed for key themes. Results: Patients and staff rated their experience with lung teleultrasound as overwhelmingly positive. The lung teleultrasound system was viewed as a potential way to improve access to imaging and the health of rural communities. Detailed interviews with the implementation team revealed obstacles to implementation important for consideration such as gaps in lung ultrasound understanding. Conclusions: Lung VSI teleultrasound was successfully deployed to 5 health centers in rural Peru. Implementation assessment revealed enthusiasm for the system among members of the community along with important areas of consideration for future teleultrasound deployment. This system offers a potential means to increase access to imaging for pulmonary illness and improve the health of the global community.
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Prevalence of and Factors Associated with Childhood Anaemia in Remote Villages of the Peruvian Amazon: A Cross-Sectional Study and Geospatial Analysis
(Oxford University Press, 2023-08-01)
Background: Anaemia is a public health problem in Peru. In the Loreto region of the Amazon, ≥50% of children may be anaemic, although insufficient information exists for rural villages. Methods: To generate more data about childhood anaemia in the Peruvian Amazon, haemoglobin was measured as part of a trachoma survey in 21 randomly selected villages. All children 1–9 y of age from 30 randomly selected households per village were recruited. Anaemia was classified according to the World Health Organization guidelines and a socio-economic status (SES) index was created for each household using principal component analysis. Spatial autocorrelation was determined using Moran’s I and Ripley’s K function. Results: Of 678 children with complete haemoglobin data, 25.4% (95% confidence interval [CI] 21.2 to 30.1) had mild-or-worse anaemia and 22.1% (95% CI 15.6 to 30.3) had moderate-or-worse anaemia. Mild-or-worse anaemia was more common among children whose primary source of drinking water was surface water (prevalence ratio [PR] 1.26 [95% CI 1.14 to 1.40], p<0.001) and who were in the lowest SES tercile (PR 1.16 [95% CI 1.02 to 1.32], p=0.021). Moderate-or-worse anaemia was more common among boys (PR 1.32 [95% CI 1.09 to 1.60], p=0.005). No evidence of geospatial clustering was found. Conclusions: Remote villages of the Amazon would benefit from interventions for childhood anaemia and the poorest households would have the most to gain. Integrating anaemia screening into neglected tropical diseases surveys is an opportunity to use public health resources more efficiently.
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When Scaling Up Isn't Enough: The Impacts of Peru's Mental Health Care Reform on Adolescents
(National Institutes of Health, 2025-12-01)
In the last 15 years, coalitions of individuals and institutions worldwide have been calling for global policies to close the treatment gap for people living with mental disorders. This paper seeks to contribute to the literature on the effects of the diffusion of these global mental health polices by exploring their implementation and impact in Peru. Aligned with the Movement for Global Mental Health, Peru has carried out a mental health reform aimed at scaling up mental health care in public facilities. Using the human rights-based framework of availability, accessibility, acceptability, and quality, this paper examines the reform's effects on a population prioritized by global and Peruvian policies: adolescents. The analysis, based on qualitative research, illustrates how the reform's overemphasis on scaling up access to pharmaceutical treatment neglects critical issues such as health system capacity, the availability of trained human resources, the need for intercultural approaches tailored to adolescents, and information systems that adequately monitor policy impact. The analysis also highlights how a reform that promotes pharmacological treatment creates risks of abuse by private actors involved in the marketing of psychiatric medications.
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Navigating strategies for intercultural maternal and newborn care in Latin America and the Caribbean: a scoping review
(Oxford University Press, 2026-06-01)
In Latin America and the Caribbean (LAC), women from racial and ethnic minority groups experience disproportionately worse maternal health outcomes. In addition to facing barriers to accessing maternity services, they often receive culturally inappropriate care. To address these inequities, a range of intercultural approaches to maternal and newborn care has been implemented across the region. However, the extent and nature of these initiatives over the past decade remain underexplored. We conducted a scoping review to identify, categorize, and describe strategies for promoting intercultural maternal and newborn care in LAC. We searched nine databases and grey literature for studies published in English, Spanish, or Portuguese between 2013 and 2024. This review identified 75 studies and 16 strategy categories across 13 countries. Most studies addressed Indigenous populations and employed qualitative methods. Strategies were grouped into four cross-cutting domains: (i) healthcare adaptations and workforce capacity building, (ii) intercultural communication and knowledge exchange, (iii) community engagement, and (iv) institutional support and governance. The identified strategies engaged stakeholders at the community, facility, and system levels. Based on these findings, we developed a framework for interculturality in maternal and newborn care. Our analysis indicates that sustainable implementation depends on addressing structural barriers and integrating intercultural principles into health system planning, service delivery, policy, and governance. The proposed framework can inform research, policymaking, and development of intercultural maternal and newborn care initiatives in LAC and other culturally diverse settings.
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Institutional Corruption in the Political Economy of Global Mental Health: Challenges for Transformative Human Rights Praxis
(National Institutes of Health, 2025-12-01)
Through an exploration of the impacts of institutional corruption in global mental health, we argue here that deploying human rights-based approaches to health must go beyond rhetoric regarding equity in access to treatment to address power structures that systematically perpetuate harm against diverse people in specific contexts. First, applying human rights to mental health in transformative ways requires upending the biomedical paradigm that both locates mental health within people's brains and imbues psychiatric expertise as an unchallengeable authority in defining mental health conditions. Second, such change in approaches to mental health has proved challenging due in significant measure to institutional corruption, defined as a systemic, legal influence that diverts the institution from its purpose. We focus on institutional corruption driven by financial influences of the pharmaceutical industry in combination with the guild interests of the psychiatric profession. Third, we sketch the relation between institutional corruption and the spread of neoliberal policy imperatives on the financing and organization of mental health services in lower-middle and middle-income countries. Finally, we question the metrics deployed in global health that reaffirm existing presumptions in mental health systems, such as coverage, which can foster institutionalized corruption. We conclude that focusing on institutional corruption allows us to understand the need for new forms of health governance aligned with transformative human rights praxis.
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265 Migration and health research in turbulent times: navigating and strengthening evidence and politics, for improved evidence-based policy across regions
(Oxford University Press, 2025-12-01)
WKS 27: Impact of a changing political environment on research on migration and health in Europe and Latin America: Challenges and opportunities, B305 (FCSH), September 5, 2025, 09:00 - 10:00 Amidst rising political polarization and widespread funding cuts, migration and health research is increasingly constrained, with growing implications for evidence-informed policymaking. This round table convenes experts from the European and Latin American Regional Hubs of Lancet Migration, a global initiative launched following the 2018 UCL–Lancet Commission on Migration and Health and from WHO Health and Migration to reflect on how best to jointly respond to these challenges. The session aims to foster dialogue on how researchers can respond to today's complex geopolitical realities and safeguard the integrity and impact of migration health research. Guided by the WHO Research Agenda on health, migration and displacement and its implementation, the discussion will explore global, regional and national experiences and strategies for adapting to shifting priorities, and the role of research agenda setting in a constrained funding environment. Panellists will examine the role of researchers and policy makers in prioritising the topic of health and migration in politically unstable environments, the use of evidence and opportunities for translation by policymakers, and the ethical tensions surrounding objectivity and independence in research. This session underscores that evidence dissemination and translation into policy in migration and health is under threat. It calls for collective action by global academics and policy makers to anticipate and respond to evolving political and financial pressures to continue to prioritise this topic. By sharing cross-regional and global insights and strengthening networks, the round table seeks to equip researchers with tools to remain effective and resilient in their work—despite mounting external constraints.
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