Search

Background: Despite progress, under-five mortality remains high, especially in Sub-Saharan Africa and South Asia, where around 13,400 children die daily. Environmental pollutants, including PM2.5 from outdoor air and household air pollution, significantly contribute to these preventable deaths. Methods: This cross-country study combined satellite data with 113 surveys from the IPUMS-DHS dataset (1998–2019) to examine under-five child mortality in 41 developing countries. The integration of Global Annual Particulate Matter with a diameter of 2.5 micrometres or less (PM2.5) Grids from Socioeconomic Data and Applications Center (SEDAC) and geospatial data from the DHS Program enabled a focused analysis of the association between indoor and outdoor air pollution, particularly PM2.5, and child mortality rates using both logistic and multilevel logistic regression models, as well as estimating Population Attributable Fractions (PAF) to quantify the mortality burden attributable to these pollutants. Results: Outdoor air pollution, measured by a one standard deviation increase in PM2.5, significantly increased the risk of child mortality (Odds Ratio [OR]: 1.14; 95% Confidence Interval [CI]: 1.10–1.18; p < 0.001). Moderate and high household air pollution exposure also heightened this risk, with increases of 37% (OR: 1.37; 95% CI: 1.24–1.53; p < 0.001) and 40% (OR: 1.40; 95% CI: 1.26–1.56; p < 0.001), respectively, compared to no exposure. Multilevel models (Models 5a and 10a) produced similar estimates to standard logistic regression, indicating robust associations. Additionally, Population Attributable Fraction analysis revealed that approximately 11.9% of under-five mortality could be prevented by reducing ambient PM2.5 exposure and 12.0% by mitigating household air pollution. The interaction between indoor and outdoor pollution revealed complex dynamics, with moderate and high household exposure associated with a reduction in mortality risk when combined with PM2.5. Geographical disparities were observed, with stronger correlations between outdoor air pollution and child mortality in Africa compared to Asia, and more pronounced impacts in low-income countries. However, household air pollution had stronger association with child mortality in Africa and lower- and middle-income countries. Conclusions: Our findings could serve as a guide for policy development aimed at reducing under-five mortality, ultimately contributing to the attainment of the Sustainable Development Goal (SDGs). [ABSTRACT FROM AUTHOR]

Abstract Background Despite progress, under-five mortality remains high, especially in Sub-Saharan Africa and South Asia, where around 13,400 children die daily. Environmental pollutants, including PM2.5 from outdoor air and household air pollution, significantly contribute to these preventable deaths. Methods This cross-country study combined satellite data with 113 surveys from the IPUMS-DHS dataset (1998–2019) to examine under-five child mortality in 41 developing countries. The integration of Global Annual Particulate Matter with a diameter of 2.5 micrometres or less (PM2.5) Grids from Socioeconomic Data and Applications Center (SEDAC) and geospatial data from the DHS Program enabled a focused analysis of the association between indoor and outdoor air pollution, particularly PM2.5, and child mortality rates using both logistic and multilevel logistic regression models, as well as estimating Population Attributable Fractions (PAF) to quantify the mortality burden attributable to these pollutants. Results Outdoor air pollution, measured by a one standard deviation increase in PM2.5, significantly increased the risk of child mortality (Odds Ratio [OR]: 1.14; 95% Confidence Interval [CI]: 1.10–1.18; p

Abstract Background Mental health problems disproportionately affect young people in developing countries. However, there is limited research on help-seeking behaviours and the social support systems that improve mental wellbeing among vulnerable youth populations. Objective This mixed-methods study aimed to examine the relationship between social support reciprocity and mental health among young informal construction workers in Nigeria, a population at high-risk for occupational and socioeconomic stressors. Methods A cross-sectional survey was administered to 686 informal workers to measure reciprocity, mental health-related quality of life, and covariates. In-depth interviews with 32 participants provided qualitative context. Results Quantitative analyses showed 25% of participants reported poor mental health. Reciprocity positively predicted mental health after controlling for covariates. Qualitative findings revealed reciprocity occurs directly between individuals as well as indirectly through trade unions and religious groups. Indirect exchanges through groups helped address limitations of direct support due to limited resources. Conclusions This study fills important gaps in understanding how social relationships impact mental health in developing country contexts. Findings emphasize the role of collective action and community-based support systems in promoting mental wellbeing among vulnerable populations. Insights can inform culturally relevant, systems-level mental health interventions.

Background: Mental health problems disproportionately affect young people in developing countries. However, there is limited research on help-seeking behaviours and the social support systems that improve mental wellbeing among vulnerable youth populations. Objective: This mixed-methods study aimed to examine the relationship between social support reciprocity and mental health among young informal construction workers in Nigeria, a population at high-risk for occupational and socioeconomic stressors. Methods: A cross-sectional survey was administered to 686 informal workers to measure reciprocity, mental health-related quality of life, and covariates. In-depth interviews with 32 participants provided qualitative context. Results: Quantitative analyses showed 25% of participants reported poor mental health. Reciprocity positively predicted mental health after controlling for covariates. Qualitative findings revealed reciprocity occurs directly between individuals as well as indirectly through trade unions and religious groups. Indirect exchanges through groups helped address limitations of direct support due to limited resources. Conclusions: This study fills important gaps in understanding how social relationships impact mental health in developing country contexts. Findings emphasize the role of collective action and community-based support systems in promoting mental wellbeing among vulnerable populations. Insights can inform culturally relevant, systems-level mental health interventions. [ABSTRACT FROM AUTHOR]

BackgroundIn collaboration with local partners, we reviewed 18 national policy documents across two sub-Saharan African countries identified as pre-dividend nations by the World Bank in 2017: Nigeria and Tanzania. Our aim was to assess national policies in pre-dividend countries and to determine whether national strategies were primed to capitalize on changing demographic structures, maximally attain the demographic dividend, and augment socio-economic growth.MethodsWe conducted policy reviews by focusing on five key sectors of the Gates Institute Demographic Dividend Framework: Family Planning, Maternal and Child Health, Education, Women's Empowerment, and Labor Market. This framework was developed as a tool for countries to apply targeted policies for accelerating the demographic dividend based on their demographic structure. For each component we used a comprehensive list of indicators, defined via a systematic literature review, through which we assessed national policies aimed at maximizing the demographic dividend.ResultsBetween the two countries, we observed persistent gaps in policies targeting family planning. Although more comprehensive, policies addressing maternal and child health, education, women's empowerment, and labor market still lagged in their specificity and measurability. We identified specific policy amendments and alternatives that Nigeria and Tanzania could consider to mitigate these gaps. We also stress the importance of designing measurable policy initiatives across sectors.ConclusionsBased on these recommendations, as Nigeria, Tanzania, and other pre-dividend nations start experiencing rapid demographic changes, they may consider implementing routine policy reviews to strengthen policies across the five key sectors and harness the benefits of a demographic dividend.

Background: The study uncovers micro and macro socioeconomic disparities in terms of health behavior, disease perception, and reception of information. Furthermore, findings shed light on the possible role of health insurance on access to information, disease perception and the adoption of preventive behaviors in the context of a public health emergency such as the COVID-19 pandemic. Methods: This study employed a cross-sectional design using the Philippine Demographic and Health Survey (DHS). With a total of 29,809 respondents, it evaluated the individual or household and systemwide socioeconomic determinants of four different outcomes: receipt of information, disease perception, uptake of free preventive services, and treatment-seeking behavior. In addition to logistic regression models with the socioeconomic variables as the independent variables, models for the evaluation of the moderating effect of insurance ownership were fitted. Predicted probabilities were reported for the analysis of moderating effects. Results: Findings show that individual and householdsocioeconomic determinants affected health-behavior and access to or receipt of information pertinent to the COVID-19 pandemic. Both education and wealth affected the receipt of information such that individuals in more advantaged socioeconomic positions were at least 30% more likely to have received information on COVID-19. Wealth was also associated to treatment-seeking behavior. Regional differences were seen across all dependent variables. Moreover, the study provides evidence that ownership of insurance can close education-based gaps in the uptake of free vaccination and COVID-19 testing. Conclusion: It is imperative that targeted efforts be maximized by utilizing existing strategies and mechanisms to reach the marginalized and disadvantaged segments of the population. Health insurance may give off added benefits that increase proficiency in navigating through the healthcare system. Further research may focus on examining pathways by which health insurance or social policies may be used to leverage responses to public health or environmental emergencies. [ABSTRACT FROM AUTHOR]

Background: Computer vision syndrome has become a significant public health problem, especially in developing countries. Therefore, this study aims to identify the prevalence of computer vision syndrome during the COVID-19 pandemic. Methods: A systematic review and meta-analysis of the literature was conducted using the databases PubMed, Scopus, Web of Science, and Embase up to February 22, 2023, using the search terms "Computer Vision Syndrome" and "COVID-19". Three authors independently performed study selection, quality assessment, and data extraction, and the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used to evaluate study quality. Heterogeneity was assessed using the statistical test I2, and the R version 4.2.3 program was used for statistical analysis. Results: A total of 192 studies were retrieved, of which 18 were included in the final meta-analysis. The total sample included 10,337 participants from 12 countries. The combined prevalence of computer vision syndrome was 74% (95% CI: 66, 81). Subgroup analysis based on country revealed a higher prevalence of computer vision syndrome in Pakistan (99%, 95% CI: 97, 100) and a lower prevalence in Turkey (48%, 95% CI: 44, 52). In addition, subgroup analysis based on study subjects showed a prevalence of 82% (95% CI: 74, 89) for computer vision syndrome in non-students and 70% (95% CI: 60, 80) among students. Conclusion: According to the study, 74% of the participants experienced computer vision syndrome during the COVID-19 pandemic. Given this finding, it is essential to implement preventive and therapeutic measures to reduce the risk of developing computer vision syndrome and improve the quality of life of those affected. Trial registration: The protocol for this systematic review and meta-analysis was registered in the international registry of systematic reviews, the International Prospective Register of Systematic Reviews (PROSPERO), with registration number CRD42022345965. [ABSTRACT FROM AUTHOR]

Abstract Background Most low- and middle-income countries have limited access to cost data that meets the needs of health policy-makers and researchers in health intervention areas including HIV, tuberculosis, and immunization. Unit cost repositories (UCRs)—searchable databases that systematically codify evidence from costing studies—have been developed to reduce the effort required to access and use existing costing information. These repositories serve as public resources and standard references, which can improve the consistency and quality of resource needs projections used for strategic planning and resource mobilization. UCRs also enable analysis of cost determinants and more informed imputation of missing cost data. This report examines our experiences developing and using seven UCRs (two global, five country-level) for cost projection and research purposes. Discussion We identify advances, challenges, enablers, and lessons learned that might inform future work related to UCRs. Our lessons learned include: (1) UCRs do not replace the need for costing expertise; (2) tradeoffs are required between the degree of data complexity and the useability of the UCR; (3) streamlining data extraction makes populating the UCR with new data easier; (4) immediate reporting and planning needs often drive stakeholder interest in cost data; (5) developing and maintaining UCRs requires dedicated staff time; (6) matching decision-maker needs with appropriate cost data can be challenging; (7) UCRs must have data quality control systems; (8) data in UCRs can become obsolete; and (9) there is often a time lag between the identification of a cost and its inclusion in UCRs. Conclusions UCRs have the potential to be a valuable public good if kept up-to-date with active quality control and adequate support available to end-users. Global UCR collaboration networks and greater control by local stakeholders over global UCRs may increase active, sustained use of global repositories and yield higher quality results for strategic planning and resource mobilization.

Background: Child mortality is a major challenge to public health in Pakistan and other developing countries. Reduction of the child mortality rate would improve public health and enhance human well-being and prosperity. This study recognizes the spatial clusters of child mortality across districts of Pakistan and identifies the direct and spatial spillover effects of determinants on the Child Mortality Rate (CMR). Method: Data of the multiple indicators cluster survey (MICS) conducted by the United Nations International Children's Emergency Fund (UNICEF) was used to study the CMR. We used spatial univariate autocorrelation to test the spatial dependence between contiguous districts concerning CMR. We also applied the Spatial Durbin Model (SDM) to measure the spatial spillover effects of factors on CMR. Results: The study results showed 31% significant spatial association across the districts and identified a cluster of hot spots characterized by the high-high CMR in the districts of Punjab province. The empirical analysis of the SDM confirmed that the direct and spatial spillover effect of the poorest wealth quintile and MPI vulnerability on CMR is positive whereas access to postnatal care to the newly born child and improved drinking water has negatively (directly and indirectly) determined the CMR in Pakistan. Conclusion: The instant results concluded that spatial dependence and significant spatial spillover effects concerning CMR exist across districts. Prioritization of the hot spot districts characterized by higher CMR can significantly reduce the CMR with improvement in financial statuses of households from the poorest quintile and MPI vulnerability as well as improvement in accessibility to postnatal care services and safe drinking water. [ABSTRACT FROM AUTHOR]

Background: About 75.5% of women in Nepal's urban areas receive at least four ANC visits, compared to 61.7% of women in the country's rural areas. Similarly, just 34% of women in the lowest wealth quintile give birth in a medical facility compared to 90% of women in the richest group. As a result of this inequality, the poor in emerging nations suffer since those who are better off can make greater use of the healthcare than those who are less fortunate. This study aims to examine and decompose the contributions of various socioeconomic factors towards MCH service inequality in Nepal in the years 2011 and 2016. Methods: Inequality in MCH services was estimated using concentration curves and their corresponding indices using data from Nepal Demographic Health Survey (NDHS) 2011 and 2016. We examined the inequality across three MCH service outcomes: less than 4 ANC visits, no postnatal checkups within 2 months of delivery and no SBA delivery and decomposed them across observed characteristics of the mothers aged between 15 and 49. Furthermore, Oaxaca-blinder decomposition approach was used to measure and decompose the inequality differential between two time periods. Results: Inequality in MCH services was prevalent for all 3 MCH outcomes in 2011 and 2016, respectively. However, the concentration indices for <4 ANC visits, no SBA delivery, and no postnatal checkups within 2 months of birth increased from -0.2184, -0.1643, and -0.1284 to -0.1871, -0.0504, and -0.0218 correspondingly, showing the decrease in MCH services inequality over two time periods. Wealth index, women's literacy, place of living, mother's employment status, and problem of distance to reach nearest health facility were the main contributors. Conclusion: We find that MCH services are clearly biased towards the women with higher living standards. National policies should focus on empowering women through education and employment, along with the creation of health facilities and improved educational institutions, in order to address inequalities in living standards, women's education levels, and the problem of distance. Leveraging these factors can reduce inequality in MCH services. [ABSTRACT FROM AUTHOR]

Background: Most low- and middle-income countries have limited access to cost data that meets the needs of health policy-makers and researchers in health intervention areas including HIV, tuberculosis, and immunization. Unit cost repositories (UCRs)—searchable databases that systematically codify evidence from costing studies—have been developed to reduce the effort required to access and use existing costing information. These repositories serve as public resources and standard references, which can improve the consistency and quality of resource needs projections used for strategic planning and resource mobilization. UCRs also enable analysis of cost determinants and more informed imputation of missing cost data. This report examines our experiences developing and using seven UCRs (two global, five country-level) for cost projection and research purposes. Discussion: We identify advances, challenges, enablers, and lessons learned that might inform future work related to UCRs. Our lessons learned include: (1) UCRs do not replace the need for costing expertise; (2) tradeoffs are required between the degree of data complexity and the useability of the UCR; (3) streamlining data extraction makes populating the UCR with new data easier; (4) immediate reporting and planning needs often drive stakeholder interest in cost data; (5) developing and maintaining UCRs requires dedicated staff time; (6) matching decision-maker needs with appropriate cost data can be challenging; (7) UCRs must have data quality control systems; (8) data in UCRs can become obsolete; and (9) there is often a time lag between the identification of a cost and its inclusion in UCRs. Conclusions: UCRs have the potential to be a valuable public good if kept up-to-date with active quality control and adequate support available to end-users. Global UCR collaboration networks and greater control by local stakeholders over global UCRs may increase active, sustained use of global repositories and yield higher quality results for strategic planning and resource mobilization. [ABSTRACT FROM AUTHOR]

Abstract Background Eye conditions in children can have negative consequences on visual functioning and quality of life. There is a lack of data on the magnitude of children with eye conditions who need services for effective planning of school eye health programmes. To address this, the School Eye Health Rapid Assessment (SEHRA) tool is being developed to collect data to support school eye health programme planning. Methods The module, ‘the magnitude and nature of local needs in school children’ is the first of six modules in the SEHRA tool. The module outlines a school-based cluster survey designed to determine the magnitude of eye health needs in children. This paper outlines the survey sampling strategy, and sample size calculations. Results The requirements for the SEHRA survey indicate that in regions where a larger sample size is required, or where fewer schools are recruited to the survey, confidence in the accuracy of the data will be lower. Conclusions The SEHRA survey module ‘the magnitude and nature of local needs in school children’ can be applied in any context. In certain circumstances, the confidence in the survey data will be reduced.

High quality health data as collected by health management information systems (HMIS) is an important building block of national health systems. District Health Information System 2 (DHIS2) software is an innovation in data management and monitoring for strengthening HMIS that has been widely implemented in low and middle-income countries in the last decade. However, analysts and decision-makers still face significant challenges in fully utilizing the capabilities of DHIS2 data to pursue national and international health agendas. We aimed to (i) identify the most relevant health indicators captured by DHIS2 for tracking progress towards the Sustainable Development goals in sub-Saharan African countries and (ii) present a clear roadmap for improving DHIS2 data quality and consistency, with a special focus on immediately actionable solutions. We identified that key indicators in child and maternal health (e.g. vaccine coverage, maternal deaths) are currently being tracked in the DHIS2 of most countries, while other indicators (e.g. HIV/AIDS) would benefit from streamlining the number of indicators collected and standardizing case definitions. Common data issues included unreliable denominators for calculation of incidence, differences in reporting among health facilities, and programmatic differences in data quality. We proposed solutions for many common data pitfalls at the analysis level, including standardized data cleaning pipelines, k-means clustering to identify high performing health facilities in terms of data quality, and imputation methods. While we focus on immediately actionable solutions for DHIS2 analysts, improvements at the point of data collection are the most rigorous. By investing in improving data quality and monitoring, countries can leverage the current global attention on health data to strengthen HMIS and progress towards national and international health priorities. [ABSTRACT FROM AUTHOR]

Background: Limited research and studies prove the usefulness of case management for persons with disabilities, which helps disabled employees recover their dignity through medical vocational, and psychological rehabilitation in underdeveloped countries' Return To Work (RTW) programs. Methods: This qualitative case study design involved semi structured interviews with case managers as the primary data source, supplemented by secondary data from BPJS Ketenagakerjaan. Data analysis utilized QDA Miner Lite and Python with ArcGIS integration for descriptive visualization. Results: The RTW program of BPJS Ketenagakerjaan has already adopted ILO's fundamental suggestion, which creates two central themes: internal aspects that are essential to the RTW framework and external variables that impact RTW practice. The key themes produce six main pieces to discuss further: personal skill, personal literacy, providers, guidelines, authorities, and stakeholder support. Conclusion: Return to Work Program benefits companies, and the implementation of a career development service or a partnership with non-governmental organizations guarantees that disabled employees who cannot return to work with their former employers are still in the global economy. [ABSTRACT FROM AUTHOR]

Background: Eye conditions in children can have negative consequences on visual functioning and quality of life. There is a lack of data on the magnitude of children with eye conditions who need services for effective planning of school eye health programmes. To address this, the School Eye Health Rapid Assessment (SEHRA) tool is being developed to collect data to support school eye health programme planning.Methods: The module, 'the magnitude and nature of local needs in school children' is the first of six modules in the SEHRA tool. The module outlines a school-based cluster survey designed to determine the magnitude of eye health needs in children. This paper outlines the survey sampling strategy, and sample size calculations.Results: The requirements for the SEHRA survey indicate that in regions where a larger sample size is required, or where fewer schools are recruited to the survey, confidence in the accuracy of the data will be lower.Conclusions: The SEHRA survey module 'the magnitude and nature of local needs in school children' can be applied in any context. In certain circumstances, the confidence in the survey data will be reduced. [ABSTRACT FROM AUTHOR]

Background: During the early phase of the COVID-19 vaccine rollout, low and middle-income countries (LMICs) were facing challenges in achieving equitable vaccine delivery. Few studies have contextualized global vaccine distributive injustice into national-specific contexts to understand its impact on vaccine delivery from an equity perspective. We aimed to investigate factors influencing equitable COVID-19 vaccine delivery in the Philippines and to provide recommendations to enhance equitable vaccine delivery in LMICs to prepare for future health emergencies., Methods: The Health Equity Implementation Framework was employed to guide this qualitative study. We recruited participants using purposeful and snowballing sampling strategies. Semi-structured interviews were conducted with participants in person, online, or over the phone. A reflective thematic analysis approach was employed to analyze data., Results: We recruited 38 participants including seven high-level stakeholders from the public and private sectors, 14 health workers, and 17 community members in the province of Negros Occidental, Philippines. Equitable delivery of COVID-19 vaccines was influenced by an interplay of multiple factors operating in different domains. Contextually, the rapidly evolving nature of the COVID-19 virus, ongoing scientific advancements, and international negotiations directed national-level vaccine policies. Political commitment and support were recognized as crucial drivers for successful vaccine delivery, with a strong emphasis on health information framing and communication and adherence to human rights principles. The vulnerability of the health system significantly impacted the timely and effective distribution of vaccines. Furthermore, the geographical characteristics of the Philippines presented unique logistical challenges to vaccine delivery. At the recipient domain, individual perceptions of vaccines, shaped by their socioeconomic status, exposure to (mis)information, social influence, and entrenched religious beliefs, played a major role in their vaccine decisions and thus vaccine coverage regionally. Additionally, vaccine characteristics and operational challenges related to its distribution also impacted fair allocation., Conclusions: The findings highlight the urgent need for LMICs to strengthen their health system resilience and sustainability and use multilevel strategies to build public trust to improve vaccine uptake and coverage. Moreover, each LMIC must be attentive to its unique contextual factors to develop tailored implementation strategies to promote equitable vaccine distribution., (© 2024. The Author(s).)

Background: For a variety of reasons related to biology, behaviour, and environment, a subset of a population known as female sex workers (FSWs) or female transactional sex workers is at increased risk of health, depression, social stigma and access to timely and quality healthcare when needed. In low- and middle-income countries (LMICs), there was lack of understanding regarding the experiences and healthcare utilisation and behaviours, the health burden among them, their experiences, and how they access health care. Using Anderson's behavioural model of health service utilisation as a framework, this review aimed to explore the experiences of, and healthcare seeking behaviours of female sex workers in low-and middle-income countries., Methods: Six relevant databases such as PubMed, Embase, Global Health, Scopus, Web of Science, and Google Scholar were searched for peer-reviewed research articles published between January 1990 and December 2023 that discussed female transactional sex work in low- and middle-income countries. Subject terms such as: low-and middle- incomes, sex workers (female and male), sexually transmitted infections (STIs) in the sex work industry, prostitution, commercial sex, and health-seeking behaviour were used for the databases search. Out of 6,135 articles that were retrieved for the study, 26 met the inclusion criteria. Of the total number of studies, four were reviews, eight were quantitative studies, six were qualitative studies, and two utilised mixed methods., Findings: Results from a thematic analysis of studies that combined quantitative and qualitative methods yielded six overarching themes.The study found that women engaged in sex work for different reasons - to fend for themselves (i.e., livelihood), self-employment and others do it for pleasure. However, force sex or unprotected which can lead to sexually transmitted infections, sexual abuse, job insecurity, were critical risks factors in engaging in sex work. These factors make them vulnerable to predators and health risks. It was found that sex workers were aware of the importance of seeking healthcare, and do make the efforts, however, crucial factors such as difficulty accessing healthcare and maltreatment by healthcare providers and social stigma disincentivises FSW health-seeking behaviours. Sexual workers reported discomfort disclosing their occupations because of the stigma and discrimination which further affects their regular health examinations and obtaining medically approved condoms from healthcare facilities., Conclusion: Complex challenges rooted in economic vulnerability, social marginalisation, and limited access to healthcare afflict female sex workers in LMICs. The maltreatment and stigma can potentially affect LMICs from achieving using health facility care, with potential implications on achieving the universal health coverage goals. Comprehensive, rights-based strategies that address structural injustices and empower these women to live healthier, more secure lives are necessary to address their special needs., (© 2024. The Author(s).)

Abstract Background Diabetes mellitus represents a substantial global health challenge, with prevalence rising in low- and middle-income countries (LMICs). Although diabetes is known to follow a socioeconomic gradient, patterns in LMICs are unclear. This study examined associations between education and diabetes, and diabetes self-management behaviours, in six LMICs. Methods Cross-sectional data for 31,780 participants from China, Ghana, India, Mexico, Russia, and South Africa from the World Health Organization Study on Global AGEing and adult health (SAGE) study were used. Participants aged ≥50 years completed face-to-face interviews between 2007 and 2010. Participants self-reported diabetes diagnosis, physical activity, sedentary time, fruit and vegetable consumption, any special diet/program for diabetes, whether they were taking insulin for diabetes and number of years of education. Height, weight, waist, and hip circumference were measured. Country-specific survey-weighted log-binomial regression models were fitted to examine associations between the number of years of education and self-reported diabetes diagnosis (primary analysis). In secondary analyses, among those with a self-reported diabetes diagnosis, generalised linear regression models were fitted to examine associations between education and i) physical activity, ii) sedentary time, iii) fruit and vegetable consumption, iv) special diet for diabetes, v) taking insulin, vi) BMI, vii) waist circumference and viii) hip circumference. Results There was strong evidence of an association between years of education and diabetes diagnosis in Ghana (RR = 1.09, 95% CI: 1.06–1.13) and India (RR = 1.09, 95% CI: 1.07–1.12) only. In India, greater years of education was associated with higher leisure physical activity, fruit and vegetable intake, rates following a special diet or taking insulin, but also higher mean BMI, waist and hip circumference. Relationships between education and self-management behaviours were rarely seen in the other countries. Conclusions Associations between education and diabetes, and behavioural self-management (India only) was more evident in the two least developed (Ghana and India) of the WHO SAGE countries, indicating increasing diabetes diagnosis with greater numbers of years of education. The lack of gradients elsewhere may reflect shifting risk from higher to lower educated populations. While there was some suggestion that self-management behaviours were greater with increased education in India, this was not observed in the other countries.

Background: Multiparous women are supposed to be able to end their reproductive cycle to decrease population growth. This study aimed to analyze barriers for multiparous women to use long-term contraceptive methods (LTCM) in the Philippines and Indonesia.Methods: The study population was women aged 15-49 years old who have given birth to a live baby > 1 in the Philippines and Indonesia. The weighted sample size was 12,085 Philippines women and 25,543 Indonesian women. To identify variables associated with the use of LTCM, we analyzed place of residence, age group, education level, marital status, employment status, and wealth status. The final step employed multinomial logistic regression.Results: In both countries, the results showed that variables associated with non-user LTCM were younger women, living in rural areas with poor education. Women without partner and unemployed had higher probability to not use LTCM. Finally, low wealth status had a higher probability than the richest multiparous to not use LTCM.Conclusion: The study concluded that there were six barriers for multiparous women to use LTCM in the Philippines and Indonesia. The six obstacles were living in rural areas, being younger, poor education, single, unemployed, and low wealth. [ABSTRACT FROM AUTHOR]

Background: Medication risk communication is essential to ensure the safe use of medicines. However, very few nations worldwide have established effective risk communication systems. To date, the effectiveness of risk communication among healthcare professionals in Malaysia has never been evaluated. Our study aimed to (i) evaluate doctors' and pharmacists' awareness of regulatory risk communication methods; (ii) identify factors predicting the usefulness of these methods; and (iii) compare respondents' preferences for risk communication to outline suggestions for enhancement.Methods: We conducted a nationwide cross-sectional survey covering four commonly used risk communications, namely a national drug bulletin, safety alerts, Direct Healthcare Professional Communication letters (DHPCs), and educational materials. Multiple logistic regression analysis was used to determine the association between independent variables and the usefulness of risk communication. We performed qualitative analysis of free-text responses to gain insights on respondents' perspectives on risk communication.Results: Of the 1146 responses received, 650 were from pharmacists (56.7%). Among the four methods surveyed, 71.5% of respondents were aware of educational materials, while awareness of the other three methods ranged from 20.7 to 53.9%. Pharmacists had higher awareness of all four methods compared to doctors. Private sector respondents were more aware of DHPCs compared to those from the public sector. The strongest predictors for finding risk communication useful were being a pharmacist [odds ratio (OR) = 18.2; 95% CI: 10.98-30.07; p <  0.001], having ≥30 years' work experience [OR = 4.9; 95% CI: 1.98-12.08; p <  0.001], and working in the pharmaceutical industry [OR = 4.6; 95% CI: 1.08-19.72; p = 0.039]. Both doctors and pharmacists preferred risk communication in the English-language and electronic format. However, other preferences differed between the professions and sectors. Analysis of free-text comments revealed five core themes to guide risk communication enhancement strategies.Conclusions: Risk communication awareness differed between public and private sector doctors and pharmacists depending on communication source. Integrating our findings with the theory of effective communication, we provide suggestions for developing strategic plans on enhancing risk communication. Public-private sector collaboration is key in ensuring risk communication effectiveness. [ABSTRACT FROM AUTHOR]

Abstract Introduction Only one-quarter of smokers in Pakistan attempt to quit smoking, and less than 3% are successful. In the absence of any literature from the country, this study aimed to explore factors motivating and strategies employed in successful smoking cessation attempts in Pakistan, a lower-middle-income country. Methods A survey was carried out in Karachi, Pakistan, amongst adult (≥ 18 years) former smokers (individuals who had smoked ≥100 cigarettes in their lifetime but who had successfully quit smoking for > 1 month at the time of survey). Multivariable logistic regression, with number of quit attempts (single vs. multiple) as the dependent variable, was performed while adjusting for age, sex, monthly family income, years smoked, cigarettes/day before quitting, and having suffered from a smoking-related health problem. Results Out of 330 former smokers, 50.3% quit successfully on their first attempt with 62.1% quitting “cold turkey”. Only 10.9% used a cessation aid (most commonly nicotine replacement therapy: 8.2%). Motivations for quitting included self-health (74.5%), promptings by one’s family (43%), and family’s health (14.8%). Other social pressures included peer-pressure to quit smoking (31.2%) and social avoidance by non-smokers (22.7%). Successful smoking cessation on one’s first attempt was associated with being married (OR: 4.47 [95% CI: 2.32–8.61]), employing an abrupt cessation mode of quitting (4.12 [2.48–6.84]), and telling oneself that one has the willpower to quit (1.68 [1.04–2.71]). Conclusion In Pakistan, smoking cessation is motivated by concern for self-health and family’s health, family’s support, and social pressures. Our results lay a comprehensive foundation for the development of smoking-cessation interventions tailored to the population of the country. Implications Little is known about the patterns and strategies employed by smokers who are attempting to quit smoking, especially in lower-middle-income countries like Pakistan. Likewise, there are very few smoking cessation programs designed to assist in quitting. Our study will allow for a better understanding of the culture-specific motivating factors and strategies that most contributed to successful quit attempts. Based on these results, evidence based smoking cessation interventions can be developed tailored to the socioeconomic demographic of our country and region, including smoking cessation clinics and public outreach and media campaigns highlighting key elements of successful smoking cessation.

Abstract Background Hardcore smoking behaviours and test of hardening are seldom reported from low-and-middle-income countries (LMICs). We report country-wise changes in smoking behaviors between two sequential surveys and explored ecologically the relationship between MPOWER scores and smoking behaviors including hardcore smoking. Methods We analysed sequential Global Adult Tobacco Survey (GATS) data done at least at five years interval in 10 countries namely India, Bangladesh, China, Mexico, Philippines, Russia, Turkey, Ukraine, Uruguay, and Vietnam. We estimated weighted prevalence rates of smoking behaviors namely current smoking (both daily and non-daily), prevalence of hardcore smoking (HCS) among current smokers (HCSs%) and entire surveyed population (HCSp%), quit ratios (QR), and the number of cigarettes smoked per day (CPD). We calculated absolute and relative (%) change in rates between two surveys in each country. Using aggregate data, we correlated relative change in current smoking prevalence with relative change in HCSs% and HCSp% as well as explored the relationship of MPOWER score with relative change in smoking behaviors using Spearman’ rank correlation test. Results Overall daily smoking has declined in all ten countries lead by a 23% decline in Russia. In India, Bangladesh, and Philippines HCSs% decreased as the smoking rate decreased while HCSs% increased in Turkey (66%), Vietnam (33%) and Ukraine (15%). In most countries, CPD ranged from 15 to 20 sticks except in Mexico (7.8), and India (10.4) where CPD declined by 18 and 22% respectively. MPOWER scores were moderately correlated with HCSs% in both sexes (r = 0.644, p = 0.044) and HCSp% (r = 0.632, p = 0.05) and among women only HCSs% (r = 0.804, p = 0.005) was significantly correlated with MPOWER score. Conclusion With declining smoking prevalence, HCS had also decreased and quit rates improved. Ecologically, a positive linear relationship between changes in smoking and HCS is a possible evidence against ‘hardening’. Continued monitoring of the changes in quitting and hardcore smoking behaviours is required to plan cessation services.

Abstract Background Following the COVID-19 pandemic, school closures were part of the global public health response to limit community spread of the virus. In recent times, there has been an emphasis on safe school re-opening. This concept is likely to differ between developed and developing country settings. There are however no published studies on barriers hindering safe school re-opening within developing country contexts. This study evaluates aspects of the school health program (SHP) in some selected Nigerian schools that might relate to the pandemic control during school re-opening. Methods In 2017, we conducted a cross-sectional survey of the SHP of 146 registered primary schools in Gwagwalada Area Council in Abuja, Nigeria. These schools provided services to about 54,562 students. We used direct observational methods and interviewer-administered questionnaires to assess the SHP of each school. We compare SHP characteristics that might relate to COVID-19 control in schools across government-owned (public) and privately-owned (private) schools using a pre-defined framework. Results Public school to pupil ratios was more than six times that of private schools. Only 6.9% of all surveyed schools employed qualified health personnel. Although 8 in every 10 schools conducted health talks for communicable disease control, the use of temporary isolation and school-based immunization were low at 1.4 and 2.7% respectively. Pipe-borne water access was present in 4 of 10 schools, with public schools having more limited access than private schools (p = 0.009). Similarly, less proportion of public schools had access to soap for handwashing (p

Purpose: Quantitative epidemiological tools are routinely used to assess adolescent diet and physical activity (PA) constructs (behaviour, knowledge, and awareness) as risk factors for non-communicable diseases. This study sought to synthesize evidence on the quantitative epidemiological tools that have been used to assess adolescent diet and PA constructs in low to middle-income countries (LMIC).Methods: A systematised review was conducted using 3 databases (EbscoHost, Scopus and Web of Science).Results: We identified 292 LMIC studies assessing adolescent diet and PA. Identified studies predominantly explored behavioural (90%) constructs with a paucity of studies investigating knowledge and awareness. The majority of studies used subjective (94%) and self-administered (78%) tools. Only 39% of LMIC studies used tools validated for their contexts.Conclusions: The findings highlight the need for more contextual tools for assessing adolescent diet and PA in LMICs. Diet and PA measurement tools used in future research will need to incorporate measures of knowledge and awareness for a more comprehensive understanding of the epidemiology of diet and PA in adolescents. Furthermore, there is a need for more evidence on the reliability and validity of these tools for use, in both cross sectional and longitudinal studies, in LMIC contexts. [ABSTRACT FROM AUTHOR]

Background: Studies in Africa have examined the association between helmet use and injury prevention, however, there has been no systematic review to synthesize the literature within an African context nor has there been any meta-analysis examining the effect of helmet use on injury prevention.Methods: The review was performed in accordance with the Joanna Briggs Institute for Systematic Reviews. Articles were searched using several databases (e.g. CINAHL, OVID Medline) and select gray literature (e.g. TRID) sources. Articles were included if they were quantitative studies published in English between 2000 and 2019 and examined the association between motorcycle helmet use with head injuries, hospitalizations, and deaths in low- and lower-middle income countries in Africa with comprehensive motorcycle helmet laws. A meta-analysis was performed using pooled effect sizes assessing the impact of helmet use on reducing head injuries.Results: After screening 491 articles, eight studies met the inclusion criteria. Helmet use ranged from 0 to 43%. The mean age of being involved in a crash was 30 years with males being two times more likely to be involved in motorcycle crashes than females. Drivers (riders) were more likely to be involved in a crash, followed by passengers and then pedestrians. Helmet use reduced injury severity and provided an 88% reduction in serious head injuries (OR 0.118, 95% CI: 0.014-0.968, p = 0.049).Conclusions: In our study, helmet usage significantly reduced the likelihood of fatal head injuries. African countries with no helmet laws should consider adopting helmet use policies to reduce severe head related injuries from motorcycle crashes. [ABSTRACT FROM AUTHOR]

Background: Frequent mutations of the COVID-19 virus, such as the Delta and Omicron variants, have prolonged the pandemic. Rich countries have approved the booster shots (3rd doses) of vaccine, but this causes further delay of vaccination in developing countries. This raises the risk of further mutations, which may lower the efficacy of currently available vaccines. As herd immunity by universal vaccination is essential to end the pandemic, the COVID-19 Vaccine Global Access (COVAX) facility has been established to provide developing countries with subsidized vaccines. However, a critical issue is that the developing countries also need to effectively deploy vaccines to citizens. Although this argument suggests positive effects of good national governance on vaccination coverage, to the best of our knowledge, there is no cross-country evidence on the role of national governance in increasing the coverage of COVID-19 vaccines among citizens. The goal of this study was to examine the association between the national governance and vaccination coverage among developing countries.Methods: Using cross-country data, an ordinary least squares regression was conducted to examine the association between the national governance index and three outcomes: (1) the number of days until the administration of the first dose in the country since December 2019, (2) the number of doses per 100 citizens as of the end of July 2021, and (3) the selection of approved vaccine manufacturers. The results were compared between the model including all countries and the model excluding the member countries of Organisation for Economic Co-operation and Development (OECD).Results: A one standard deviation increase in the national governance index was associated with 9.1 days (95%CI: -15.76, -2.43) earlier administration of vaccines in the country, and a 12.1 dose increase (95%CI: 4.76, 19.34) per 100 citizens. These associations were larger in the non-OECD sample. The results also indicated the role of governance in the selection of the administered vaccines.Conclusion: The provision of subsidized vaccines alone is not sufficient to control the spread of infection in developing countries; logistical and administrative support should also be offered, especially in countries with poor governance.Trial Registration: Not applicable. [ABSTRACT FROM AUTHOR]

Abstract Background Children with uncomplicated severe acute malnutrition are managed routinely within out-patient malnutrition treatment programs. These programs do not offer maternal mental health support services, despite maternal mental health playing a significant role in the nutritional status of children. Additionally, the burden of maternal Common Mental Disorders (CMDs) is poorly described among mothers of children attending these programs. This study thus determined the burden and risk factors for maternal CMDs among children attending out-patient malnutrition clinics in rural North-western Nigeria. Methods We conducted a cross-sectional study among 204 mothers of children with severe acute malnutrition who attending eight out-patient malnutrition clinics in Jigawa, North-western Nigeria. We used the World Health Organization Self-Reporting Questionnaire-20 (WHO SRQ-20) screening tool, a recognised and validated proxy measure for CMDs to identify mothers with CMDs. The prevalence of maternal CMDs was determined by identifying the proportion of mothers with SRQ scores of ≥8. Risk factors for CMD were determined using multivariable logistic regression. Results Maternal CMD prevalence in children attending these facilities was high at 40.7%. Non-receipt of oral polio vaccine (OPV) (AOR 6.23, 95%CI 1.85 to 20.92) increased the odds for CMD. While spousal age above 40 (AOR 0.95, 95%CI 0.90 to 0.99) and long years spent married (AOR 0.92, 95%CI 0.85 to 0.98) decreased the odds for CMD. Conclusions Our findings indicate maternal CMD burden is high in out-patient malnutrition clinics in North-western Nigeria. Maternal mental health services would need to be integrated into the community management of acute malnutrition programs to provide more holistic care, and possibly improve long-term outcomes after discharge from these programs.

BackgroundIn 1996, Brazil became the first developing country to provide free, universal access to HAART, laboratory monitoring, and clinical care to any eligible patient. As of June 2014, approximately 400,000 patients were under treatment, making it the most comprehensive HIV treatment initiative implemented thus far in a middle-income country, worldwide. The Brazilian epidemic is highly concentrated among men who have sex with men (MSM).MethodsFour national information systems were combined and Cox regression was used to conduct retrospective cohort analysis of HAART availability/access on all-cause mortality among MSM diagnosed with AIDS reported to the information systems between 1998-2008, adjusting for demographic, clinical, and behavioral factors and controlling for spatially-correlated survival data by including a frailty effect. Multiple imputation by chained equations was used to handle missing data.ResultsAmong 50,683 patients, 10,326 died during the 10 year of period. All-cause mortality rates declined following introduction of HAART, and were higher among non-white patients and those starting HAART with higher viral load and lower CD4 counts. In multivariable analysis adjusted for race, age at AIDS diagnosis, and baseline CD4 cell count, MSM diagnosed in latter periods had almost a 50% reduction in the risk of death, compared to those diagnosed between 1998-2001 (2002-2005 adjHR: 0.54, 95% CI:0.51-0.57; 2006-2008 adjHR: 0.51, 95% CI:0.48-0.55). After controlling for spatially correlated survival data, mortality remained higher among those diagnosed in the earliest diagnostic cohort and lower among non-white patients and those starting HAART with higher viral load and lower CD4 lymphocyte counts.ConclusionsUniversal and free access to HAART has helped achieve impressive declines in AIDS mortality in Brazil. However, after a 10-years follow-up, differential AIDS-related mortality continue to exist. Efforts are needed to identify and eliminate these health disparities, therefore improving the Brazilian response towards HIV/AIDS epidemic.

Background: The available literature indicates that there are significant differences in maternal mortality according to maternal origin in high income countries. The aim of this study was to examine the trend in the maternal mortality rate and its most common causes in Spain in recent years and to analyse its relationship with maternal origin.Methods: This was a cross-sectional study of all live births as well as those resulting in maternal death in Spain during the period between 2000 and 2018. A descriptive analysis of the maternal mortality rate by cause, region of birth, maternal age, marital status, human development index and continent of maternal origin was performed. The risk of maternal death was calculated using univariate and multivariate logistic regression analyses, with adjustment for certain variables included in the descriptive analysis.Results: There was a total of 293 maternal deaths and 8,439,324 live births during the study period. The most common cause of maternal death was hypertensive disorders of pregnancy. The average maternal death rate was 3.47 per 100,000 live births. The risk of suffering from this complication was higher for immigrant women from less developed countries. The adjusted effect of maternal HDI score over maternal mortality was OR = 0.976; 95% CI 0.95 - 0.99; p = 0.048; therefore, a decrease of 0.01 in the maternal human development index score significantly increased the risk of this complication by 2.4%.Conclusions: The results of this study indicate that there are inequalities in maternal mortality according to maternal origin in Spain. The human development index of the country of maternal origin could be a useful tool when estimating the risk of this complication, taking into account the origin of the pregnant woman. [ABSTRACT FROM AUTHOR]

Background: High rates of child malnutrition are a major public health concern in developing countries, particularly among vulnerable communities. Midday meals programs can be effective for combatting childhood malnutrition among older children. However, their use in early childhood is not well documented, particularly within South Asia. Anthropometric measures and other socioeconomic data were collected for children below the age of 5 years living in selected Sri Lankan tea plantations, to assess the effectiveness of midday meals as a nutrition intervention for improving growth among young children.Methods: The study exploits a natural experiment whereby the provision of the midday meals program is exogenously determined at the plantation level, resulting in comparable treatment and control groups. Longitudinal data was collected on heights and weights of children, between 2013 and 2015. Standardized weight-for-age, height-for-age and weight-for-height, and binary variables for stunting, wasting and underweight are constructed, following WHO guidelines. All modelling uses STATA SE 15. Random-effects regression with instrumental variables is used for modelling standardized growth while random-effects logistic regression is used for the binary outcomes. Robustness analysis involves different estimation methods and subsamples.Results: The dataset comprises of longitudinal data from a total of 1279 children across three tea plantations in Sri Lanka, with 799 children in the treatment group and 480 in the control group. Results show significant positive effects of access to the midday meals program, on the growth of children. A child with access to the midday meals intervention reports an average standardized weight-for-age 0.03 (±0.01) and height-for-age 0.05 (±0.01) units higher than a similar child without access to the intervention. Importantly, access to the intervention reduces the likelihood of being underweight by 0.45 and the likelihood of wasting by 0.47. The results are robust to different model specifications and across different subsamples by gender, birthweight and birth-year cohort.Conclusions: Midday meals programs targeting early childhood can be an effective intervention to address high rates of child malnutrition, particularly among vulnerable communities in developing countries like Sri Lanka. [ABSTRACT FROM AUTHOR]

Abstract Background The rising burden of premature mortality for Non-Communicable Diseases (NCDs) in developing countries necessitates the institutionalization of a comprehensive surveillance framework to track trends and provide evidence to design, implement, and evaluate preventive strategies. This study aims to conduct an organization-based prospective cohort study on the NCDs and NCD-related secondary outcomes in adult personnel of the Mashhad University of Medical Sciences (MUMS) as main target population. Methods This study was designed to recruit 12,000 adults aged between 30 and 70 years for 15 years. Baseline assessment includes a wide range of established NCD risk factors obtaining by face-to-face interview or examination. The questionnaires consist of demographic and socioeconomic characteristics, lifestyle pattern, fuel consumption and pesticide exposures, occupational history and hazards, personal and familial medical history, medication profile, oral hygiene, reproduction history, dietary intake, and psychological conditions. Examinations include body size and composition test, abdominopelvic and thyroid ultrasonography, orthopedic evaluation, pulse wave velocity test, electrocardiography, blood pressure measurement, smell-taste evaluation, spirometry, mammography, and preferred tea temperature assessment. Routine biochemical, cell count, and fecal occult blood tests are also performed, and the biological samples (i.e., blood, urine, hair, and nail) are stored in preserving temperature. Annual telephone interviews and repeated examinations at 5-year intervals are planned to update information on health status and its determinants. Results A total of 5287 individuals (mean age of 43.9 ± 7.6 and 45.9% male) were included in the study thus far. About 18.5% were nurses and midwives and 44.2% had at least bachelor’s degree. Fatty liver (15.4%), thyroid disorders (11.2%), hypertension (8.8%), and diabetes (4.9%) were the most prevalent NCDs. A large proportion of the population had some degree of anxiety (64.2%). Low physical activity (13 ± 22.4 min per day), high calorie intake (3079 ± 1252), and poor pulse-wave velocity (7.2 ± 1.6 m/s) highlight the need for strategies to improve lifestyle behaviors. Conclusion The PERSIAN Organizational Cohort study in Mashhad University of Medical Sciences is the first organizational cohort study in a metropolitan city of Iran aiming to provide a large data repository on the prevalence and risk factors of the NCDs in a developing country for future national and international research cooperation.

Abstract Background Approximately 66% of children under the age of 5 in Sub-Saharan African countries do not reach their full cognitive potential, the highest percentage in the world. Because the majority of studies investigating child cognitive development have been conducted in high-income countries (HICs), there is limited knowledge regarding the determinants of child development in low- and middle-income countries (LMICs). Methods This analysis includes 401 mother-child dyads from the South Africa and Tanzania sites of the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) longitudinal birth cohort study. We investigated the effect of psychosocial and environmental determinants on child cognitive development measured by the Wechsler Preschool Primary Scales of Intelligence (WPPSI) at 5 years of age using multivariable linear regression. Results Socioeconomic status was most strongly associated with child cognitive development (WPSSI Score Difference (SD):14.27, 95% CI:1.96, 26.59). Modest associations between the organization of the home environment and its opportunities for cognitive stimulation and child cognitive development were also found (SD: 3.08, 95% CI: 0.65, 5.52 and SD: 3.18, 95% CI: 0.59, 5.76, respectively). Conclusion This study shows a stronger association with child cognitive development at 5 years of age for socioeconomic status compared to more proximal measures of psychosocial and environmental determinants. A better understanding of the role of these factors is needed to inform interventions aiming to alleviate the burden of compromised cognitive development for children in LMICs.

Abstract Background Organisational culture (OC) has increasingly become a crucial factor in defining healthcare practice and management. However, there has been little research validating and adapting OCAI (organisational culture assessment instrument) to assess OC in healthcare settings in developing countries, including Vietnam. The purpose of this study is to validate the OCAI in a hospital setting using key psychometric tests and confirmatory factor analysis (CFA). Methods This is a cross-sectional study. Self-administered structured questionnaire was completed by 566 health professionals from a Vietnamese national general hospital, the General Hospital of Quang Nam province. The psychometric tests and CFA were utilized to detect internal reliability and construct validity of the instrument. Results The Cronbach’s alpha coefficients (α-reliability statistic) ranged from 0.6 to 0.8. In current culture, the coefficient was 0.80 for clan and 0.60 for adhocracy, hierarchy and market dimension, while in expected culture, the coefficient for clan, adhocracy, hierarchy, and market dimension was 0.70, 0.70, 0.70 and 0.60, respectively. The CFA indicated that most factor loading coefficients were of moderate values ranging from 0.30 to 0.60 in both current and expected culture model. These models are of marginal good fit. Conclusions The study findings suggest that the OCAI be of fairly good reliability and construct validity in measuring four types of organisational culture in healthcare setting in resource-constrained countries such as Vietnam. This result is a first step towards developing a valid Vietnamese version of the OCAI which can also provide a strong case for future research in the field of measuring and managing organisational culture.

Abstract Background Cervical cancer is almost entirely preventable through vaccination and screening, yet remains one of the ‘gravest threats to women’s lives’ according to the World Health Organization. Specific high-risk subtypes of human papillomavirus (HR-HPV) are well-established as the primary cause of cervical cancer. Uganda has one of the highest cervical cancer incidence rates in the world (54.8 per 100,000) as a result of limited screening access and infrastructure. The integration of a self-collected cervical cancer screening program using HPV testing within existing community-based primary health care services could increase access to screening and reduce cervical cancer rates among Ugandan women. Methods Using a pragmatic, sequential, cluster randomized trial design; we will compare the effectiveness of two cervical cancer screening models for self-collected HPV testing: 1) community health worker recruitment (door-to-door); and 2) community health meetings. In Mayuge district, Uganda, 31 villages are randomized to one of two treatment arms. Due to the nature of this trial, blinding is not possible. Women are eligible to participate if they have no previous history of hysterectomy or treatment for cervical cancer or pre-cancer and are aged 25–49 years old. All participants receive an integrated package of cervical cancer screening and education. Samples are tested for HPV using GeneXpert point of care testing. All women who test positive for HR-HPV types are referred to a designated health centre for follow-up inspection by Visual Inspection with Acetic acid (VIA) and treatment with thermal ablation. The primary outcome for the trial is the number of women who attend follow-up for VIA screening at a designated Health Centre after a positive HR-HPV test out of all women screened per arm. Secondary outcomes include: cervical cancer screening knowledge; patient-reported experience measures for self-collected cervical cancer screening; and HPV incidence. Discussion Results from this study will inform the national scale-up of cervical cancer screening in Uganda, aligning with the World Health Organization’s target of achieving cervical cancer elimination through the pillar of increased HPV screening coverage. Trial registration ISRCTN, ISRCTN12767014. Registered 14 May 2019, https://doi.org/10.1186/ISRCTN12767014; clinicaltrials.gov, NCT04000503; Registered 27 June 2019, https://clinicaltrials.gov/ct2/show/NCT04000503 Protocol version January 8, 2020, version 1.

Background: Antimicrobial resistance (AMR) constitutes a major threat to global health. While antimicrobial misuse or overuse is one of the main drivers for AMR, little is known about the extent to which antibiotic misuse is due to a lack of national government-led efforts to enforce rational use in low and middle-income countries (LMICs)., Methods: To assess antimicrobial stewardship and national implementation measures currently in place for optimizing antimicrobial use and for slowing the spread of AMR, we invited public health experts from 138 LMICs to participate in a Global Survey of Experts on Antimicrobial Resistance (GSEAR). Key coverage measures, as reported by experts, were compared across countries and also juxtaposed with estimates collected in the 2020-21 World Health Organization-organized Tripartite AMR Country Self-Assessment Survey (TrACSS)., Results: A total of 352 completed surveys from 118 LMICs were analysed. Experts in 67% of the surveyed countries reported a national action plan (NAP) on AMR, 64% reported legislative policies on antimicrobial use, 58% reported national training programs for health professionals, and 10% reported national monitoring systems for antimicrobials. 51% of LMICs had specific targeted policies to limit the sale and use of protected or reserve antibiotics. While 72% of LMICs had prescription requirements for accessing antibiotics, getting antibiotics without a prescription was reported to be possible in practice in 74% of LMICs. On average, country efforts reported in TrACSS were substantially higher than those seen in GSEAR., Conclusions: In many LMICs, despite the existence of policies aimed at slowing down the spread of AMR, there are still significant gaps in their implementation and enforcement. Increased national efforts in the areas of enforcement and monitoring of antibiotic use as well as regular monitoring of national efforts are urgently needed to reduce inappropriate antibiotic use in LMICs and to slow the spread of AMR globally., (© 2024. The Author(s).)

Introduction: Head lice infestation remains a persistent public health concern among primary school children in resource-limited settings, affecting their well-being and academic performance. Despite previous studies, there is no consistent evidence on the prevalence and factors associated with head lice infestation. This study aimed to determine the prevalence and factors related to head lice infestation among primary school children in low and middle-income countries., Methods: This review was conducted by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Relevant electronic databases, including PubMed, Cochrane Library, Web of Science, Science Direct, AJOL, and Google Scholar, were used to retrieve articles. The study included only published articles written in English languages between December 01, 2014 to January 31, 2024 for studies reporting the prevalence of head lice infestation or associated factors among primary school children in low- and middle-income countries. This review has been registered on PROSPERO with Prospero registration number CRD42024506959. The heterogeneity of the data was evaluated using the I 2 statistic. A meta-analysis was conducted using STATA 17 software, with a 95% confidence interval. Publication bias was evaluated using funnel plots and statistical tests, such as Egger's and Beggs's tests, to identify publication biases in the included studies. Meta-regression was also carried out to assess the source of publication of publication bias., Results: The review included 39 studies involving 105,383 primary school children. The pooled prevalence of head lice infestation among primary school children in low- and middle-income countries was 19.96% (95% CI; 13.97, 25.95). This review also found out that being a girl was 3.71 times (AOR = 3.71; 95% CI: 1.22-11.26) more likely to have head lice infestation as compared to boys, while children with a previous history of infestation were 4.51 times (AOR = 4.51; 95% CI: 2.31-8.83) more likely to have head lice infestation as compared to their counterparts., Conclusion: The overall prevalence of head lice infestation among primary school children in low- and middle-income countries was found to be high. Female gender, children who had a previous history of infestation, and family size were significant predictors of head lice infestation. As a result, policymakers and program administrators should focus on the identified determinants., (© 2024. The Author(s).)

Background: Decision making process for Official Development Assistance (ODA) for healthcare sector in low-income and middle-income countries involves multiple agencies, each with their unique power, priorities and funding mechanisms. This process at country level has not been well studied.Methods: This paper developed and applied a new framework to analyze decision-making process for priority setting in Ethiopia, Nigeria, and Tanzania, and collected primary data to validate and refine the model. The framework was developed following a scoping review of published literature. Interviews were then conducted using a pre-determined interview guide developed by the research team. Transcripts were reviewed and coded based on the framework to identify what principles, players, processes, and products were considered during priority setting. Those elements were further used to identify where the potential capacity of local decision-makers could be harnessed.Results: A framework was developed based on 40 articles selected from 6860 distinct search records. Twenty-one interviews were conducted in three case countries from 12 institutions. Transcripts or meeting notes were analyzed to identify common practices and specific challenges faced by each country. We found that multiple stakeholders working around one national plan was the preferred approach used for priority setting in the countries studied.Conclusions: Priority setting process can be further strengthened through better use of analytical tools, such as the one described in our study, to enhance local ownership of priority setting for ODA and improve aid effectiveness. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus represents a substantial global health challenge, with prevalence rising in low- and middle-income countries (LMICs). Although diabetes is known to follow a socioeconomic gradient, patterns in LMICs are unclear. This study examined associations between education and diabetes, and diabetes self-management behaviours, in six LMICs.Methods: Cross-sectional data for 31,780 participants from China, Ghana, India, Mexico, Russia, and South Africa from the World Health Organization Study on Global AGEing and adult health (SAGE) study were used. Participants aged ≥50 years completed face-to-face interviews between 2007 and 2010. Participants self-reported diabetes diagnosis, physical activity, sedentary time, fruit and vegetable consumption, any special diet/program for diabetes, whether they were taking insulin for diabetes and number of years of education. Height, weight, waist, and hip circumference were measured. Country-specific survey-weighted log-binomial regression models were fitted to examine associations between the number of years of education and self-reported diabetes diagnosis (primary analysis). In secondary analyses, among those with a self-reported diabetes diagnosis, generalised linear regression models were fitted to examine associations between education and i) physical activity, ii) sedentary time, iii) fruit and vegetable consumption, iv) special diet for diabetes, v) taking insulin, vi) BMI, vii) waist circumference and viii) hip circumference.Results: There was strong evidence of an association between years of education and diabetes diagnosis in Ghana (RR = 1.09, 95% CI: 1.06-1.13) and India (RR = 1.09, 95% CI: 1.07-1.12) only. In India, greater years of education was associated with higher leisure physical activity, fruit and vegetable intake, rates following a special diet or taking insulin, but also higher mean BMI, waist and hip circumference. Relationships between education and self-management behaviours were rarely seen in the other countries.Conclusions: Associations between education and diabetes, and behavioural self-management (India only) was more evident in the two least developed (Ghana and India) of the WHO SAGE countries, indicating increasing diabetes diagnosis with greater numbers of years of education. The lack of gradients elsewhere may reflect shifting risk from higher to lower educated populations. While there was some suggestion that self-management behaviours were greater with increased education in India, this was not observed in the other countries. [ABSTRACT FROM AUTHOR]

Introduction: Only one-quarter of smokers in Pakistan attempt to quit smoking, and less than 3% are successful. In the absence of any literature from the country, this study aimed to explore factors motivating and strategies employed in successful smoking cessation attempts in Pakistan, a lower-middle-income country.Methods: A survey was carried out in Karachi, Pakistan, amongst adult (≥ 18 years) former smokers (individuals who had smoked ≥100 cigarettes in their lifetime but who had successfully quit smoking for > 1 month at the time of survey). Multivariable logistic regression, with number of quit attempts (single vs. multiple) as the dependent variable, was performed while adjusting for age, sex, monthly family income, years smoked, cigarettes/day before quitting, and having suffered from a smoking-related health problem.Results: Out of 330 former smokers, 50.3% quit successfully on their first attempt with 62.1% quitting "cold turkey". Only 10.9% used a cessation aid (most commonly nicotine replacement therapy: 8.2%). Motivations for quitting included self-health (74.5%), promptings by one's family (43%), and family's health (14.8%). Other social pressures included peer-pressure to quit smoking (31.2%) and social avoidance by non-smokers (22.7%). Successful smoking cessation on one's first attempt was associated with being married (OR: 4.47 [95% CI: 2.32-8.61]), employing an abrupt cessation mode of quitting (4.12 [2.48-6.84]), and telling oneself that one has the willpower to quit (1.68 [1.04-2.71]).Conclusion: In Pakistan, smoking cessation is motivated by concern for self-health and family's health, family's support, and social pressures. Our results lay a comprehensive foundation for the development of smoking-cessation interventions tailored to the population of the country.Implications: Little is known about the patterns and strategies employed by smokers who are attempting to quit smoking, especially in lower-middle-income countries like Pakistan. Likewise, there are very few smoking cessation programs designed to assist in quitting. Our study will allow for a better understanding of the culture-specific motivating factors and strategies that most contributed to successful quit attempts. Based on these results, evidence based smoking cessation interventions can be developed tailored to the socioeconomic demographic of our country and region, including smoking cessation clinics and public outreach and media campaigns highlighting key elements of successful smoking cessation. [ABSTRACT FROM AUTHOR]

Background: Following the COVID-19 pandemic, school closures were part of the global public health response to limit community spread of the virus. In recent times, there has been an emphasis on safe school re-opening. This concept is likely to differ between developed and developing country settings. There are however no published studies on barriers hindering safe school re-opening within developing country contexts. This study evaluates aspects of the school health program (SHP) in some selected Nigerian schools that might relate to the pandemic control during school re-opening.Methods: In 2017, we conducted a cross-sectional survey of the SHP of 146 registered primary schools in Gwagwalada Area Council in Abuja, Nigeria. These schools provided services to about 54,562 students. We used direct observational methods and interviewer-administered questionnaires to assess the SHP of each school. We compare SHP characteristics that might relate to COVID-19 control in schools across government-owned (public) and privately-owned (private) schools using a pre-defined framework.Results: Public school to pupil ratios was more than six times that of private schools. Only 6.9% of all surveyed schools employed qualified health personnel. Although 8 in every 10 schools conducted health talks for communicable disease control, the use of temporary isolation and school-based immunization were low at 1.4 and 2.7% respectively. Pipe-borne water access was present in 4 of 10 schools, with public schools having more limited access than private schools (p = 0.009). Similarly, less proportion of public schools had access to soap for handwashing (p < 0.001). Adequate classroom ventilation was present in 63% of surveyed schools, with private schools having more limited ventilation (p < 0.001).Conclusions: Overcrowding and infrastructural deficits within developing country contexts represent barriers to safe school re-opening during the COVID-19 pandemic. In these settings, there needs to be tailored and innovative strategies which consider local practical realities when designing the COVID-19 control programs during school re-opening. [ABSTRACT FROM AUTHOR]

Background: Hardcore smoking behaviours and test of hardening are seldom reported from low-and-middle-income countries (LMICs). We report country-wise changes in smoking behaviors between two sequential surveys and explored ecologically the relationship between MPOWER scores and smoking behaviors including hardcore smoking.Methods: We analysed sequential Global Adult Tobacco Survey (GATS) data done at least at five years interval in 10 countries namely India, Bangladesh, China, Mexico, Philippines, Russia, Turkey, Ukraine, Uruguay, and Vietnam. We estimated weighted prevalence rates of smoking behaviors namely current smoking (both daily and non-daily), prevalence of hardcore smoking (HCS) among current smokers (HCSs%) and entire surveyed population (HCSp%), quit ratios (QR), and the number of cigarettes smoked per day (CPD). We calculated absolute and relative (%) change in rates between two surveys in each country. Using aggregate data, we correlated relative change in current smoking prevalence with relative change in HCSs% and HCSp% as well as explored the relationship of MPOWER score with relative change in smoking behaviors using Spearman' rank correlation test.Results: Overall daily smoking has declined in all ten countries lead by a 23% decline in Russia. In India, Bangladesh, and Philippines HCSs% decreased as the smoking rate decreased while HCSs% increased in Turkey (66%), Vietnam (33%) and Ukraine (15%). In most countries, CPD ranged from 15 to 20 sticks except in Mexico (7.8), and India (10.4) where CPD declined by 18 and 22% respectively. MPOWER scores were moderately correlated with HCSs% in both sexes (r = 0.644, p = 0.044) and HCSp% (r = 0.632, p = 0.05) and among women only HCSs% (r = 0.804, p = 0.005) was significantly correlated with MPOWER score.Conclusion: With declining smoking prevalence, HCS had also decreased and quit rates improved. Ecologically, a positive linear relationship between changes in smoking and HCS is a possible evidence against 'hardening'. Continued monitoring of the changes in quitting and hardcore smoking behaviours is required to plan cessation services. [ABSTRACT FROM AUTHOR]

Background: To assess if physical distancing measures to control the COVID-19 pandemic can be relaxed, one of the key indicators used is the reproduction number R. Many developing countries, however, have limited capacities to estimate R accurately. This study aims to demonstrate how health production function can be used to assess the state of COVID-19 transmission and to determine a risk-based relaxation policy.Methods: The author employs a simple "bridge" between epidemiological models and production economics to establish the cumulative number of COVID-19 cases as a short-run total product function and to derive the corresponding marginal product, average product, and production elasticity. Three crucial dates defining the states of transmission, labelled red, yellow, and green zones, are determined. Relaxation policy is illogical in the "red zone" and is not recommended in the "yellow zone". In the "green zone", relaxation can be considered. The Bayesian probability of near term's daily cases meeting a policy target is computed. The method is applied to France, Germany, Italy, the UK, and the US, and to Indonesia as an example of application in developing countries.Results: This study uses data from the WHO COVID-19 Dashboard, beginning from the first recording date for each country until February 28, 2021. As of June 30, 2020, France, Germany, Italy, and the UK had arrived at the "green zone" but with a high risk of transmission re-escalations. In the following weeks, their production elasticities were rising, giving a signal of accelerated transmissions. The signal was corroborated by these countries' rising cases, making them leaving the "green zone" in the later months. By February 28, 2021, the UK had returned to the "green zone", France, Germany, and Italy were still in the "yellow zone", while the US reached the "green zone" at a very high number of cases. Despite being in the "red zone", Indonesia relaxed its distancing measures, causing a sharp rise of cases.Conclusions: Health production function can show the state of COVID-19 transmission. A rising production elasticity gives an early warning of transmission escalations. The elasticity is a useful parameter for risk-based relaxation policy. [ABSTRACT FROM AUTHOR]

Background: The continuing impetus for universal health coverage has given rise to publicly funded health insurance schemes in lower-middle income countries. However, there is insufficient understanding of how universal health coverage schemes impact gender equality and equity. This paper attempts to understand why utilization of a publicly funded health insurance scheme has been found to be lower among women compared to men in a southern Indian state. It aims to identify the gender barriers across various social institutions that thwart the policy objectives of providing financial protection and improved access to inpatient care for women.Methods: A qualitative study on the Chief Minister's Comprehensive Health Insurance Scheme was carried out in urban and rural impoverished localities in Tamil Nadu, a southern state in India. Thirty-three women and 16 men who had a recent history of hospitalization and 14 stakeholders were purposefully interviewed. Transcribed interviews were content analyzed based on Naila Kabeer's Social Relations Framework using gender as an analytical category.Results: While unpacking the navigation pathways of women to utilize publicly funded health insurance to access inpatient care, gender barriers are found operating at the household, community, and programmatic levels. Unpaid care work, financial dependence, mobility constraints, and gender norms emerged as the major gender-specific barriers arising from the household. Exclusions from insurance enrollment activities at the community level were mediated by a variety of social inequities. Market ideologies in insurance and health, combined with poor governance by State, resulted in out-of-pocket health expenditures, acute information asymmetry, selective availability of care, and poor acceptability. These gender barriers were found to be mediated by all four institutions-household, community, market, and State-resulting in lower utilization of the scheme by women.Conclusions: Health policies which aim to provide financial protection and improve access to healthcare services need to address gender as a crucial social determinant. A gender-blind health insurance can not only leave many pre-existing gender barriers unaddressed but also accentuate others. This paper stresses that universal health coverage policy and programs need to have an explicit focus on gender and other social determinants to promote access and equity. [ABSTRACT FROM AUTHOR]

Background: Children with uncomplicated severe acute malnutrition are managed routinely within out-patient malnutrition treatment programs. These programs do not offer maternal mental health support services, despite maternal mental health playing a significant role in the nutritional status of children. Additionally, the burden of maternal Common Mental Disorders (CMDs) is poorly described among mothers of children attending these programs. This study thus determined the burden and risk factors for maternal CMDs among children attending out-patient malnutrition clinics in rural North-western Nigeria.Methods: We conducted a cross-sectional study among 204 mothers of children with severe acute malnutrition who attending eight out-patient malnutrition clinics in Jigawa, North-western Nigeria. We used the World Health Organization Self-Reporting Questionnaire-20 (WHO SRQ-20) screening tool, a recognised and validated proxy measure for CMDs to identify mothers with CMDs. The prevalence of maternal CMDs was determined by identifying the proportion of mothers with SRQ scores of ≥8. Risk factors for CMD were determined using multivariable logistic regression.Results: Maternal CMD prevalence in children attending these facilities was high at 40.7%. Non-receipt of oral polio vaccine (OPV) (AOR 6.23, 95%CI 1.85 to 20.92) increased the odds for CMD. While spousal age above 40 (AOR 0.95, 95%CI 0.90 to 0.99) and long years spent married (AOR 0.92, 95%CI 0.85 to 0.98) decreased the odds for CMD.Conclusions: Our findings indicate maternal CMD burden is high in out-patient malnutrition clinics in North-western Nigeria. Maternal mental health services would need to be integrated into the community management of acute malnutrition programs to provide more holistic care, and possibly improve long-term outcomes after discharge from these programs. [ABSTRACT FROM AUTHOR]

Purpose: Rehabilitation is a set of services designed to increase functioning and improve wellbeing across the life course. Despite being a core part of Universal Health Coverage, rehabilitation services often receive limited public expenditure, especially in lower income countries. This leads to limited service availability and high out of pocket payments for populations in need of care. The purpose of this research was to assess the association between macroeconomic conditions and rehabilitation expenditures across low-, middle-, and high-income countries and to understand its implications for overall rehabilitation expenditure trajectory across countries., Materials and Methods: We utilized a panel data set from the World Health Organization's Global Health Expenditure Database comprising the total rehabilitation expenditure for 88 countries from 2016 to 2018. Basic macroeconomic and population data served as control variables. Multiple regression models were implemented to measure the relationship between macroeconomic conditions and rehabilitation expenditures. We used four different model specifications to check the robustness of our estimates: pooled data models (or naïve model) without control, pooled data models with controls (or expanded naïve model), fixed effect models with all controls, and lag models with all controls. Log-log specifications using fixed effects and lag-dependent variable models were deemed the most appropriate and controlled for time-invariant differences., Results: Our regression models indicate that, with a 1% increase in economic growth, rehabilitation expenditure would be associated with a 0.9% and 1.3% increase in expenditure. Given low baseline levels of existing rehabilitation expenditure, we anticipate that predicted increases in rehabilitation expenditure due to economic growth may be insufficient to meet the growing demand for rehabilitation services. Existing expenditures may also be vulnerable during periods of economic recession., Conclusion: This is the first known estimation of the association between rehabilitation expenditure and macroeconomic conditions. Our findings demonstrate that rehabilitation is sensitive to macroeconomic fluctuations and the path dependency of past expenditures. This would suggest the importance of increased financial prioritization of rehabilitation services and improved institutional strengthening to expand access to rehabilitation services for populations., (© 2024. The Author(s).)

Background: This study investigates the influence of Global Smoking Prevalence (GSP) on Stroke Death Rates (SDR) across 27 countries categorized into High-Income Countries (HIC), Upper Middle-Income Countries (UMIC), Lower Middle-Income Countries (LMIC), and Low-Income Countries (LIC)., Methods: Analysing data from two distinct periods (1990-1999 and 2010-2019), countries exhibiting an increased SDR were selected. The study uses a polynomial regression model, treating income groups as cross-sectional and years as time series data., Results: Results from the regression model reveal that 17 countries observed a significant impact of GSP on SDR, with only Turkey, Solomon Islands, and Timor-Leste resulting in negative values. However, the study emphasises that out of all 27 countries, the highest occurrence of the impact of GSP on SDR has been reported in the LMIC stratum for the period under review., Conclusion: It is evident that GSP affects the risk of incidence of stroke death, specifically in the LMIC stratum. Furthermore, it has been identified that GSP is a major preventable risk factor affecting global mortality. To mitigate the risk of stroke death attributable to smoking prevalence, necessary preventive steps should be adopted to encourage smoking cessation, and essential policies should be implemented to reduce the burden of SDR., (© 2024. The Author(s).)

Introduction: Disasters such as earthquakes, conflict, or landslides result in traumatic injuries creating surges in rehabilitation and assistive technology needs, exacerbating pre-existing unmet needs. Disasters frequently occur in countries where existing rehabilitation services are underdeveloped, hindering response to rehabilitation demand surge events., Aims: The primary aim of this scoping review is therefore to synthesize the evidence on rehabilitation and assistive technology preparedness and response of health systems in LMICs to the demand associated with disasters and conflict situations. A secondary aim was to summarize related recommendations identified in the gathered literature., Methodology: A scoping review was conducted using the Arksey and O'Malley framework to guide the methodological development. The results are reported in accordance with PRISMA-ScR. Four bibliographic databases were used: CINHAL, Cochrane, Pubmed, Scopus and. Key international organisations were also contacted. The search period was from 2010-2022. Eligible publications were categorized for analysis under the six World Health Organization health systems buildings blocks., Results: The findings of this scoping review suggest that rehabilitation is poorly integrated into health systems disaster preparedness and response in LMICs. Of the 27 studies included in the scoping review, 14 focused on service delivery, 6 on health workforce, 4 on health information systems and 3 on the leadership and governance building block. No study focused on financing nor assistive technology. This review found the most frequently referenced recommendations for actions that should be taken to develop rehabilitation services in disasters to be: the provision early and multi-professional rehabilitation, including the provision of assistive technology and psychological support, integrated community services; disaster response specific training for rehabilitation professionals; advocacy efforts to create awareness of the importance of rehabilitation in disasters; and the integration of rehabilitation into disaster preparedness and response plans., Conclusion: Findings of this scoping review suggest that rehabilitation is poorly integrated into health systems disaster preparedness and response in LMIC's, largely due to low awareness of rehabilitation, undeveloped rehabilitation health systems and a lack of rehabilitation professionals, and disaster specific training for them. The paucity of available evidence hinders advocacy efforts for rehabilitation in disaster settings and limits the sharing of experiences and lessons learnt to improve rehabilitation preparedness and response. Advocacy efforts need to be expanded., (© 2024. The Author(s).)

Introduction: Given the absence of international guidelines on the joint management and control of tuberculosis (TB) and type 2 diabetes mellitus (T2D), the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (The Union) launched in 2011 a policy framework to address the growing syndemic burden of TB-T2D. This review aimed at mapping the available evidence on the implementation of the Union-WHO Framework, explicitly, or bi-directional TB-T2D health programs as an initiative for co-management in patients in low- and middle-income countries (LMIC)., Methods: A rapid review was performed based on a systematic search in PubMed and Web of Science electronic databases for peer-reviewed articles on The Union-WHO Framework and bi-directional interventions of TB and T2D in LMIC. The search was restricted to English language articles and from 01/08/2011 to 20/05/2022., Results: A total of 24 articles from 16 LMIC met the inclusion criteria. Four described the implementation of The Union-WHO Framework and 20 on the bi-directional interventions of TB and T2D. Bi-directional activities were found valuable, feasible and effective following the Union-WHO recommendations. Limited knowledge and awareness on TB-T2D comorbidity was identified as one of the barriers to ensure a functional and effective integration of services., Conclusions: This review revealed that it is valuable, feasible and effective to implement bi-directional TB and T2D activities (screening and management) according to the Union-WHO Framework recommendations, especially in countries that face TB-T2D syndemic. Additionally, it was apparent that gaps still exist in research aimed at providing evidence of costs to implement collaborative activities. There is need for TB and T2D services integration that should be done through the well-stablished TB programme. This integration of two vertical programmes, could ensure patient-centeredness, continuum of care and ultimately contribute for health systems strengthening., (© 2024. The Author(s).)

Abstract Background Malnutrition is one of the major contributors to child mortality in Ethiopia. Currently established, child nutrition status is assessed by four anthropometric indicators. However, there are other factors affecting children’s anthropometric statuses. Thus, the main objective of this paper is to explore some of the determinants of child anthropometric indicators in Ethiopia. Methods Data from GROW (the Growing Nutrition for Mothers and Children), a survey including 1261 mothers and 1261 children was carried out in Ethiopia in 2016. Based on the data gathered, the goal of GROW is to improve the nutritional status of women of reproductive age (15–49), as well as boys and girls under 5 years of age in Ethiopia. In order to investigate the association between different factors and child anthropometric indicators, this study employs various statistical methods, such as ANOVA, T-test, and linear regressions. Results Child’s sex (confidence intervals for (wasting = − 0.782, − 0.151; stunting = − 0.936,-0.243) (underweight = − 0.530, − 0.008), child’s age (confidence intervals for (wasting = − 0.020, 0.007; stunting = − 0.042,-0.011) (underweight = − 0.025, − 0.002), maternal MUAC (confidence intervals for (wasting = 0.189, 0.985; BMI-for-age = 0.077, 0.895), maternal education (stunting = 0.095, 0.897; underweight = 0.120, 0.729), and open defecation (stunting = 0.055, 0.332; underweight = 0.042, 0.257) were found to be significantly associated with anthropometric indicators. Contrary to some findings, maternal dietary diversity does not present significance in aforementioned child anthropometric indicators. Conclusion Depending on the choice of children anthropometric indicator, different conclusions were drawn demonstrating the association between each factor to child nutritional status. Results showed child’s sex, age, region, open defecation, and maternal MUAC significantly increases the risk of child anthropometric indicators. Highlighting the factors influencing child undernutrition will help inform future policies and programs designed to approach this major problem in Ethiopia.

Abstract Background In Cameroon, the National Tuberculosis Control Program that applies selective directly observed treatments faces difficulties in its implementation for a lack of resources, leading to only 65% of patients with sputum smear-positive pulmonary tuberculosis being cured after 6 months of treatment. This study aimed to evaluate the effectiveness of daily Short Message Service reminders to increase adherence and the proportion of adult tuberculosis patients cured after 6 months of treatment. Methods A simple blinded, randomised controlled, multicentre study carried out in 12 Treatment and Diagnostic Centres of Yaoundé. The patients included were randomly assigned to two groups: patients in the intervention group received daily SMS reminders in addition to the usual treatment; those in the control group received the usual treatment only. The primary outcomes were the number and proportion of treatment success at 5 months, and the number and proportion of patients cured at 6 months. Data analysis was by intention to treat. Results Two hundred and seventy-nine participants were randomized into intervention group (n = 137) and control group (n = 142). At five months, there were 111 treatment success (81%) in the intervention group and 106 (74.6%) in the control group (OR = 1.45 [0.81, 2.56]; p = 0.203). At 6 months, there were 87 patients cured (63.5%) in the intervention group and 88 (62%) in the control group (OR = 1.06 [0.65, 1.73]; p = 0.791). The number of drop-outs at 6 months was 47 (34.3%) in intervention group, and 46 (32.4%) in the control group. 48.9% (23/47) and 39.1% (18/46) of these drop-outs were sputum-negative at 5 months. At three different appointments, there were no significant differences between the two groups in any secondary outcomes. Very high and similar satisfaction was found for general management of patients in both groups: 99.5 and 99.2% (p = 0.41). Conclusions Our study suggests that SMS reminders do not increase treatment success and cure proportions. However, the low proportion of patients cured at 6 month may be an underestimation due to a high dropout rate between the fifth and the sixth months of treatment. Future trials should focus on reducing the dropout rate. Trial registration The trial was registered on the Pan-African Clinical Trials Registry (PACTR201307000583416 of 22 July 2013) and the protocol was published.