Description
Book SynopsisA 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.
Table of Contents
Part I The Health of Low‐ and Middle‐Income Countries Today 1
1 The Burden of Communicable Diseases in Low‐ and Middle‐Income 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 Middle‐Income 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 Point‐of‐Care 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 Non‐communicable Diseases in Low‐ and Middle‐Income Countries 37
Heiner Grosskurth
2.1 Introduction 38
2.2 Common Non‐communicable Diseases in Low- and Middle-Income Countries 38
2.3 NCD Epidemiology 38
2.4 Prevention of Non‐communicable Diseases 44
2.5 The Relationship Between Communicable and Non‐communicable 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 middle‐income countries by primary point‐of‐care 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 Point‐of‐Care 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 Resource‐Limited Settings 89
4.4 Challenges of Using Rapid and Point‐of‐Care 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 90‐90‐90 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 Point‐of‐Care Diagnostic Tests for Tuberculosis 105
Richard Lessells
5.1 Introduction 105
5.2 The Need for Rapid Point‐of‐Care TB Diagnostic Tests 106
5.3 Weaknesses in the TB Diagnostic Cascade 106
5.4 Potential Impact of Rapid Point‐of‐Care Diagnostic Tests 107
5.5 Defining the Diagnostic Needs 107
5.6 Smear Microscopy 107
5.7 Molecular Diagnostic Tests 109
5.8 Loop‐Mediated 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 Generation Sequencing 117
5.14 Diagnostic Imaging 117
5.15 Other Diagnostics 118
5.16 Conclusions 118
References 119
6 Rapid Diagnostic Tests for Syphilis 126
David Mabey, Michael Marks, and Rosanna W. Peeling
6.1 Introduction 126
6.2 The Diagnosis of Syphilis 129
6.3 The Impact of POC Testing for Syphilis 131
6.4 Challenges in the Implementation of POC Testing 133
6.5 The Future 134
References 134
7 Point‐of‐Care and Near‐Point‐of‐Care Diagnostic Tests for Malaria: Light Microscopy, Rapid Antigen‐Detecting Tests and Nucleic Acid Amplification Assays 137
Heidi Hopkins, and Jane Cunningham
7.1 Introduction 137
7.2 Diagnosis of Malaria 138
7.3 Light Microscopy of Blood Smears 139
7.4 Rapid Diagnostic Tests for Malaria (mRDTs) 140
7.5 Nucleic Acid Amplification‐Based Tests (NAATs) for Malaria 142
7.6 Impact of Point‐of‐Care Testing for Malaria 143
7.7 Challenges in Implementation of POC Testing for Malaria 144
7.8 The Future 146
Biblography 146
Webliography 156
8 Rapid Diagnostic Tests for Human African Trypanosomiasis 159
Veerle Lejon, Epco Hasker, and Philippe Büscher
8.1 Introduction 159
8.2 The Early Introduction of Immunodiagnostic Tests in the Diagnosis of HAT 160
8.3 CATT/T.b. gambiense: A Breakthrough in the Immunodiagnosis of Gambiense‐HAT 161
8.4 The Changing Epidemiology of Gambiense‐HAT: The Need for Improved Rapid Diagnostic Tests 163
8.5 Second Generation RDTs for HAT 165
8.6 Future Perspectives and Challenges 165
References 166
Webliography 169
9 Rapid Diagnostic Tests for Visceral Leishmaniasis 170
Marleen Boelaert, Suman Rijal, and François Chappuis
9.1 Introduction 170
9.2 Parasitology, a Reference Standard? 171
9.3 Serological Assays 172
9.4 The First Serological Test for Field Use: The Direct Agglutination Assay 173
9.5 The Early Development an Immunochromatographic Test Using the Recombinant Leishmania Antigen rK39 174
9.6 Impact of the VL RDT 174
9.7 Challenges 175
9.8 Other Tests 175
9.9 Discussion 176
9.10 Conclusions 177
References 177
10 A Rapid Diagnostic Test for Dengue 181
Claire Mullender, and James Whitehorn
10.1 Introduction 181
10.2 Clinical Features of Dengue 182
10.3 The Importance of Making a Rapid Diagnosis 183
10.4 The Host Response to Infection 184
10.5 Existing Diagnostic Strategies 184
10.6 Review of Existing Rapid Diagnostic Tests 186
10.7 Future Directions 188
10.8 Conclusions 188
References 188
11 Rapid Diagnostic Tests for Influenza 191
A.C. Hurt, and I.G. Barr
11.1 Introduction 191
11.2 Overview of RIDTs 192
11.3 Antigen Detection‐based RIDTs 195
11.4 Nucleic Acid Detection‐based RIDTs 197
11.5 Factors that Alter RIDTs Performance 198
11.6 The Use of RIDTs in LMICs 198
11.7 Conclusions 199
Acknowledgment 199
References 200
12 A Rapid Diagnostic Test for Ebola Virus Disease 202
Catherine Houlihan and Colin Brown
12.1 Case Report 202
12.2 Introduction 203
12.3 Diagnostic Methods to Detect Ebola Virus Disease 203
12.4 Rapid Diagnostic Tests for Ebola Virus Disease for Use in a Point‐of‐Care Facility 206
12.5 Conclusions 209
Bibliography 210
Webliography 212
13 Rapid Diagnostic Tests for Yaws 213
Michael Marks
13.1 Introduction 213
13.2 Epidemiology 214
13.3 Clinical Features 215
13.4 Diagnostic Quandaries 217
13.5 Diagnostic Tests for Yaws 217
13.6 Rapid Diagnostic Tests for Yaws 218
13.7 Molecular Assays 219
References 221
14 Rapid Diagnostic Tests for the Detection of Sickling Hemoglobin 224
Amina Nardo‐Marino and Tom N. Williams
14.1 Sickle Cell Disease 224
14.2 Diagnosing Sickle Cell Disease 225
14.3 Conclusions 229
Bibliography 229
15 Progress Toward the Development of Rapid Diagnostic Tests for Lymphatic Filariasis and Onchocerciasis 231
Roger B. Peck, Dunia Faulx, and Tala de los Santos
15.1 Introduction 231
15.2 The Development of Rapid Diagnostic Tests 234
15.3 Rapid Diagnostic Tests for Lymphatic Filariasis 234
15.4 Rapid Diagnostic Tests for Onchocerciasis 236
15.5 Next tests and Steps 240
Bibliography 240
Webliography 242
Part III Other tests that can be performed rapidly at the primary‐point‐of-care 245
16 Point‐of‐Care Testing for Blood Counts, HbA1c, Renal Function, Electrolytes, Acid–Base Balance and Hepatitis 247
Mark Shephard, Lara Motta, Brooke Spaeth, Heather Halls, and Lauren Duckworth
16.1 Introduction 248
16.2 Point‐of‐Care Testing for Blood Counts 248
16.3 Point‐of‐Care Testing for HbA1c 252
16.4 Point‐of‐Care Testing for Renal Function 254
16.5 Point‐of‐Care Testing for Electrolytes and Acid–Base Balance 257
16.6 Point‐of‐Care Testing for Hepatitis 261
16.7 Conclusions 265
Bibliography 266
Webliography 268
17 Microscopy Skills: Cell Counts, Gram Stains, Ziehl‐Neelsen Staining (ZN) and Blood Films 270
Michael Harrison
17.1 Introduction 270
17.2 Microscopy 271
17.3 Microscopy in a POC Testing Laboratory 273
17.4 Gram Staining 274
17.5 Ziehl‐Neelsen Stain (ZN) for Mycobacterium tuberculosis 275
17.6 Blood Film Preparation, Staining and Reporting 276
17.7 Conclusions 278
Bibliography 280
Webliography 280
18 India Ink Stain and Cryptococcal Antigen Test for Cryptococcal Infection 281
Hannah K. Mitchell, Joseph N. Jarvis, and Mark W. Tenforde
18.1 Introduction 281
18.2 Diagnosis of Cryptococcal Meningitis 282
18.3 Cryptococcal Antigen Testing (CrAg) 283
18.4 India Ink Stain 285
18.5 CrAg Testing for the Prevention of Cryptococcal Meningitis 286
18.6 Logistical Challenges of CrAg Screening 288
18.7 Non‐Meningeal Cryptococcal Disease 289
18.8 Conclusions 289
References 290
19 Mid Upper Arm Circumference Tapes for Assessment of Severe Acute Malnutrition 294
Jane Crawley, Martha Mwangome, James Berkley, and André Briend
19.1 Introduction 294
19.2 Mid Upper Arm Circumference (MUAC) 296
19.3 Comparison of MUAC with other Anthropometric Indices 296
19.4 MUAC: A Brief Historical Perspective 296
19.5 Technique for Measuring MUAC 297
19.6 MUAC, Mortality Risk, and Definitions of Severe Acute Malnutrition 298
19.7 Conclusions: Use of MUAC in Different Settings 301
References 302
Webliography 304
20 Spirometry for Chronic Obstructive Pulmonary Disease Due to Inhalation of Smoke from Indoor Fires Used for Cooking and Heating 306
Janet G. Shaw, Annalicia Vaughan, Emma Smith, Cai Fong, Svetlana Stevanovic, and Ian A. Yang
20.1 Introduction 306
20.2 Indoor Air Pollution from Burning Biomass 307
20.3 Mechanisms of Lung Damage from Exposure to Biomass Smoke 309
20.4 Biomass Smoke‐Related Chronic Obstructive Pulmonary Disease (COPD) 311
20.5 Detecting Airflow Obstruction in Biomass Smoke‐Related COPD 314
20.6 Lessons Learnt from Clinical Guidelines for the Detection of Cigarette Smoking‐Related COPD 317
20.7 Conclusions 319
Acknowledgments 320
Bibliography 320
Webliography 326
21 Point‐of‐Care Pulse Oximetry for Children in Low‐Resource Settings 327
Carina King, Hamish Graham, and Eric D. McCollum
21.1 Introduction 327
21.2 Hypoxemia 328
21.3 Pulse Oximetry 330
21.4 Current Situation in Low‐Resource Settings 332
21.5 Current Challenges and Future Opportunities 333
21.6 Conclusions 339
Acknowledgments 339
Bibliography 340
Webliography 343
22 The Use of Near‐Infrared Spectroscopy to Monitor Tissue Oxygenation, Metabolism and Injury in Low Resource Settings 344
Gemma Bale, and Ilias Tachtsidis
22.1 Introduction 344
22.2 Near‐Infrared Spectroscopy 346
22.3 Clinical Applications 349
22.4 Research Applications 350
22.5 The Use of NIRS in Low Resource Settings 350
22.6 Conclusions 355
Bibliography 356
Webliography 357
Part IV Cheap imaging technologies 361
23 The Use of Point‐of‐Care Ultrasound in the Resource‐Limited Setting 363
Tom Heller, Michaëla A.M. Huson, Sabine Bélard, Dan Kaminstein, and Elizabeth Joekes
23.1 Introduction to Point‐of‐Care Ultrasound (POCUS) 365
23.2 Physics and Technical Aspects of Ultrasound 366
23.3 Most Relevant POCUS Applications in the Resource‐Limited Setting 369
23.4 Considerations for Teaching and Implementation 402
23.5 Conclusions 403
Bibliography 403
Webliography 405
24 The Use of Obstetric Ultrasound in Low Resource Settings 406
Helen Allott
24.1 Introduction 406
24.2 Pregnancy‐Related Problems for Which Portable Ultrasound may be Useful 406
24.3 Problems with the Use of Ultrasound Scanning in Limited Resource Settings 407
24.4 Provision of Trained Sonographers 409
24.5 The Perspective of the Pregnant Woman to Antenatal Ultrasound Scanning 410
24.6 Abuse of Ultrasound Scanning in Pregnancy 410
24.7 Advances in Ultrasound Technology (and See Chapter 23) 411
24.8 Targeted Ultrasound Scanning 412
24.9 Conclusions 412
References 413
25 Examining the Optic Fundus and Assessing Visual Acuity and Visual Fields Using Mobile Technology 414
Nigel M. Bolster, and Andrew Bastawrous
25.1 Introduction: The Ascent of Mobile Technology 414
25.2 Visual Acuity 418
25.3 Visual Fields 424
25.4 Smartphone Ophthalmoscopy 427
25.5 Discussion 432
25.6 Conclusions 434
Part V Telemedicine 439
26 Telemedicine for Clinical Management of Adults in Remote and Rural Areas 441
Farhad Fatehi, Monica Taylor, Liam J. Caffery, and Anthony C. Smith
26.1 Introduction 442
26.2 Definitions 443
26.3 Types of Service 444
26.4 Purposes of Telemedicine 444
26.5 Telemedicine for Improving Access to Care 445
26.6 Establishing a Sustainable Telehealth Network: A Case Study from Brazil 445
26.7 Swinfen Telemedicine: A Case Study of Intercontinental Telemedicine 446
26.8 Telemedicine in Natural Disaster Responses 446
26.9 Telemedicine for Remote Training of Healthcare Professionals 447
26.10 Telemedicine for Mental Health (and see Chapter 29) 449
26.11 The Rise of Mobile Health (mHealth) 451
26.12 Social Networking for Clinical Purposes 452
26.13 The World Health Organization and Telemedicine 456
26.14 Challenges and Barriers to Implementation 457
26.15 Conclusions 459
Bibliography 460
Webliography 461
27 Telemedicine for the Delivery of Specialist Pediatric Services 462
Anthony C. Smith, Monica Taylor, Farhad Fatehi, and Liam J. Caffery
27.1 Introduction 463
27.2 Technical Consideration for Telemedicine in LMICs 464
27.3 Models of Care in Telepediatrics 469
27.4 Swinfen Charitable Trust Telemedicine Service 469
27.5 Selected Examples of SCT Referrals 470
27.6 National and International Telemedicine Services 474
27.7 mHealth Applications for LMICs 475
27.8 Telemedicine Screening Services 476
27.9 Telemedicine Support during Disaster Situations 476
27.10 Challenges Associated with Telemedicine Adoption in LMICs 477
27.11 Telepediatric Case Studies in LMICs 478
27.12 Pathology Services 480
27.13 Radiographic (Imaging) Services 480
27.14 Maternal Health Services 481
27.15 Conclusions 481
27.16 Acknowledgements 481
27.17 Useful Websites 481
Bibliography 482
Webliography 486
28 Telemedicine in the Diagnosis and Management of Skin Diseases 488
Giselle Prado, Odinaka Anyanwu, and Carrie Kovarik
28.1 Introduction 489
28.2 Methods of Delivering Teledermatology: Store and Forward Versus Live Interactive Methods 490
28.3 The History of Teledermatology 490
28.4 Global Teledermatology Programs 490
28.5 Teledermatology in Africa 491
28.6 BUP: The Botswana – University of Pennsylvania Partnership 493
28.7 Teledermatopathology in Botswana 494
28.8 Diagnostic Concordance 495
28.9 Teledermatology in Asia 497
28.10 Teledermatology in Latin America 497
28.11 Barriers 498
28.12 Costs 499
28.13 Education and Training 499
28.14 Equipment and Internet Access 499
28.15 Privacy Concerns 500
28.16 Cultural Hesitancy 500
28.17 Language Barriers 501
28.18 Availability of Treatments 501
28.19 Legal Issues 501
28.20 Follow‐up 501
28.21 Ensuring Success of a New Teledermatology Initiative 501
28.22 Conclusions 502
Bibliography 502
29 Digital Technology, Including Telemedicine, in the Management of Mental Illness 505
John A Naslund, Sophia M. Bartels, and Lisa A. Marsch
29.1 Introduction and Background 505
29.2 Why Mental Disorders? 506
29.3 Growing Access to Digital Technology and New Opportunities 508
29.4 Promising Examples from Low‐ and Middle‐Income Countries 509
29.5 Critical Assessment of the Risks and Limitations 517
29.6 Future Directions and Implications 519
29.7 Conclusions 524
Bibliography 525
Webliography 530
30 The Use of Mobile Chest X‐Rays for Tuberculosis Telemedicine 531
Meghan L. Jardon, Kelsey L. Pomykala, Ishita Desai, and Kara‐Lee Pool
30.1 Background 531
30.2 Lack of Access to Radiology 532
30.3 Implementation 532
30.4 Cost 536
30.5 Sustainability 536
30.6 Chest X‐Ray Information Technology (IT) 538
30.7 Mobile Devices 540
30.8 Education to Ensure Sustainability 541
30.9 Conclusions 542
Bibliography 542
Webliography 545
Part VI The future 549
31 An Introduction to Digital Health 551
Kerry Atkinson
31.1 Introduction 552
31.2 The Pillars and Components of Digital Health for Use in the LMICs 552
31.3 Smartphones and Internet Access 554
31.4 Wearables 555
31.5 Personal Digital Assistants and Chatbots 558
31.6 Augmented Reality 558
31.7 Big Data 558
31.8 Artificial Intelligence (AI) 558
31.9 The Game Changer – A Smartphone with AI Access 563
31.10 Conclusions 564
Bibliography 564
Webliography 564
32 Digital Health in Low- and Middle-Income Countries 566
Martin Seneviratne and David Peiris
32.1 Introduction – The Digital Health Revolution 567
32.2 The Current Landscape 569
32.3 HIV/AIDS 569
32.4 Diabetes Mellitus 570
32.5 Maternal Health 570
32.6 Core Functionalities 571
32.7 Patient‐facing Functions 571
32.8 Clinician‐facing Functions 573
32.9 Electronic Medical Record Management 574
32.10 Point‐of‐Care Diagnostic Tests 575
32.11 Epidemiology 575
32.12 Inventory Management and Supply Chain 575
32.13 Challenges to Scale 575
32.14 Emerging Trends and Future Vision 578
32.15 Conclusions 580
Bibliography 580
Webliography 583
33 Nucleic Acid Detection of Tuberculosis Via Innovative Point‐of‐Care Nanotechnologies Targeted for Low Resource Settings 584
Benjamin Y.C. Ng, Eugene J.H. Wee, Nicholas P. West, and Matt Trau
33.1 Introduction 584
33.2 Nucleic Acid Detection of Tuberculosis 585
33.3 The Availability of Rapid Diagnostic Tests at the Peripheral Healthcare Level 585
33.4 Leveraging Innovative Nanotechnologies for Point‐of‐Care TB Diagnosis 587
33.5 Sample Preparation Workflow 589
33.6 Nanotechnologies for TB DNA Sensing and Readouts 590
33.7 Quantitative DNA Detection Methodologies 592
33.8 Drug‐resistant Tuberculosis 594
33.9 Conclusions 595
References 596
34 The Use of Functional Nanoparticles for Water Purification 600
Jing Zhang, Chuanping Feng, and Chengzhong Yu
34.1 Introduction 600
34.2 Disinfection 602
34.3 Adsorption 607
34.4 Electrochemistry 609
34.5 Conclusions and Future Perspectives 609
References 610
35 The Use of Drones in the Delivery of Rural Healthcare 615
Debrah I. Boeras, Blanche C. Collins, and Rosanna W. Peeling
35.1 Challenges in Healthcare Delivery – Opportunities for Innovation 616
35.2 The Need for Disruptive Solutions for Healthcare Delivery in Rural Areas 616
35.3 The Use of Drones for Healthcare Delivery 617
35.4 Further Focus on Uptake of Drone Technology by Different Countries 621
35.5 Models of Potential Public‐Private Collaboration 622
35.6 Promises and Challenges of the Use of Drones in Healthcare Delivery 623
35.7 Outlook for the Future 624
35.8 Conclusions 626
Bibliography 626
Webliography 630
36 Implementation of Point‐of‐Care Tests: Lessons Learnt 633
Rosanna W. Peeling, and Debrah I. Boeras
36.1 Synopsis 633
36.2 Healthcare Needs in Low‐ and Middle‐Income Countries 634
36.3 Rapid Diagnostic Tests for Human Immunodeficiency Virus (HIV) Disease (and See Chapter 4) 636
36.4 Rapid Diagnostic Tests for Syphilis (and See Chapter 6) 637
36.5 Rapid Diagnostic Tests for Tuberculosis (TB) (and See Chapter 5) 638
36.6 Rapid Diagnostic Tests for Malaria (and See Chapter 7) 638
36.7 Lessons Learnt from the Implementation of POC Tests 639
36.8 Lessons Learnt from the Implementation of POC Tests for Three Diseases 640
36.9 The Way Forward 642
36.10 The New Paradigm for Technological Innovation and Implementation 643
36.11 Conclusions 644
Bibliography 644
Webliography 648
37 Useful Electronic Healthcare Resources Available for Those Working in Remote Settings 649
Tyler Evans
37.1 Introduction 649
37.2 General Web‐Based Resources 650
37.3 Travel Medicine 651
37.4 The Big Three Communicable Diseases in Low‐ and Middle‐Income Countries (LMICs) 652
37.5 Hepatitis C 656
37.6 Other Infectious Diseases (IDs) 657
37.7 Dermatology 657
37.8 Obstetrics and Gynecology 658
37.9 Pediatrics 658
37.10 Psychiatry 658
37.11 Emergency Medicine (EM) 659
37.12 Preventive Health 659
37.13 Disease Mapping 660
37.14 Pharmaceuticals 660
37.15 Online Courses 661
37.16 Recommended Books 661
37.17 Institutions, Societies and Books 662
Webliography 663
38 The Future – How Do We Get from Here to There? 666
Kerry Atkinson and David Mabey
38.1 Progress to Date 667
38.2 Major Factors Adversely Affecting Global Health 670
38.3 Continue Doing What Works 674
38.4 New Measures for Improving Remote Rural Healthcare 674
38.5 The UN 2015 Sustainable Development Goals for 2016–2030 677
38.6 Conclusions 681
Bibliography 682
Webliography 683
Glossary 684
Index 693
