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Problem Many national child health guidelines In Malawi, Nigeria and South Africa are outdated and score poorly on rigorous methods and stakeholder participation. Approach In line with the World Health Organization's (WHO) emphasis on local guideline contextualization, the Global Evidence-Local Adaptation (GELA) project supported multistakeholder processes to adapt evidence-informed recommendations for child health in Malawi, Nigeria and South Africa. The GELA project team convened national steering groups, which conducted structured, iterative priority-setting exercises to identify priority topics. We identified appropriate source guidelines by systematically searching and screening available guidelines. We then matched recommendations in potential source guidelines to the relevant questions, and assessed the guidelines for timeliness and quality. Drawing on WHO's guideline process, we applied the GRADE-ADOLOPMENT process to develop contextualized recommendations from existing guidelines. If no source guideline or reviews were identified, we conducted new evidence syntheses. Local setting Malawi, Nigeria and South Africa are countries with varying health priorities and systems, all transitioning to universal health coverage. Guideline structures differ between countries, with processes largely led from national health ministries. Relevant changes National guideline groups, supported by GELA researchers and government-academic partners, developed five contextually-tailored child health recommendations. For most of these recommendations, additional evidence was required to inform contextually appropriate national decision-making. Formal capacity-building and on-the-job learning enhanced the competencies of national contributors and researchers in evidence-informed decision-making. Lessons learnt Developing context-relevant recommendations requires considerable resources and time. Further investment in strengthening local capacity is needed for sustainable national guideline development. [phrase omitted] Probleme En Afrique du Sud, au Malawi et au Nigeria, de nombreuses lignes directrices nationales relatives a la sante infantile sont obsoletes et affichent de pietres resultats en termes de rigueur des methodes et d'implication des parties prenantes. Approche S'alignant sur l'importance accordee par l'Organisation mondiale de la Sante (OMS) a la contextualisation des lignes directrices locales, le projet Global Evidence - Local Adaptation (GELA) a apporte son soutien a divers processus de collaboration multilaterale afin d'adapter des recommandations sur la sante infantile etayees par des faits en Afrique du Sud, au Malawi et au Nigeria. L'equipe du projet GELA a constitue des groupes de pilotage nationaux, charges d'effectuer des exercices iteratifs et structures de definition des priorites afin de repertorier les principaux themes. Nous avons identifie des lignes directrices de reference en procedant a une recherche et une selection parmi celles disponibles. Ensuite, nous avons compare les recommandations de ces potentielles lignes directrices de reference avec les questions pertinentes, puis nous avons evalue leur qualite et leur actualite. En nous fondant sur le processus d'elaboration de lignes directrices de l'OMS, nous avons applique la methodologie GRADEADOLOPMENT pour formuler des recommandations contextualisees a partir de lignes directrices existantes. Si aucune analyse ni ligne directrice de reference n'avait pu etre degagee, nous etablissions de nouvelles syntheses de preuves. Environnement local L'Afrique du Sud, le Malawi et le Nigeria sont des pays aux priorites et systemes de sante variables, qui operent tous trois une transition vers une couverture sanitaire universelle. Les structures des lignes directrices different d'un pays a l'autre, les processus etant generalement menes par les Ministeres nationaux de la Sante. Changements significatifs Les groupes charges d'elaborer des lignes directrices nationales, avec l'aide des chercheurs GELA et des partenaires gouvernementaux et universitaires, ont emis cinq recommandations adaptees au contexte en matiere de sante infantile. Dans la plupart des cas, la prise de decisions nationales contextualisees necessitait des preuves supplementaires. Le programme de renforcement des capacites et l'apprentissage sur le terrain ont permis d'ameliorer les competences des chercheurs et contributeurs nationaux dans les processus decisionnels etayes par des faits. Lecons tirees Mettre au point des recommandations propres a chaque contexte demande du temps et des ressources considerables. D'autres investissements dans le renforcement des capacites locales sont indispensables pour perenniser le developpement national de lignes directrices. [phrase omitted] Situacion Muchas directrices nacionales de salud infantil en Malawi, Nigeria y Sudafrica estan obsoletas y obtienen una puntuacion baja respecto a los metodos rigurosos y la participacion de las partes interesadas. Enfoque En consonancia con el enfasis de la Organizacion Mundial de la Salud (OMS) en la contextualizacion local de las directrices, el proyecto Global Evidence-Local Adaptation (GELA) apoyo procesos multisectoriales para adaptar las recomendaciones basadas en la evidencia a la salud infantil en Malawi, Nigeria y Sudafrica. El equipo del proyecto GELA convoco a grupos directivos nacionales, que realizaron ejercicios estructurados e iterativos de fijacion de prioridades para identificar los temas prioritarios. Se identificaron las directrices fuente apropiadas mediante la busqueda sistematica y el analisis de las directrices disponibles. A continuacion, se compararon las recomendaciones de las posibles directrices fuente con las preguntas pertinentes y se evaluo la oportunidad y la calidad de las directrices. A partir del proceso de elaboracion de directrices de la OMS, se aplico el proceso GRADE-ADOLOPMENT para desarrollar recomendaciones contextualizadas partiendo de las directrices existentes. Si no se identificaba ninguna directriz o revision fuente, se realizaban nuevas sintesis de la evidencia. Marco regional Malawi, Nigeria y Sudafrica son paises con prioridades y sistemas sanitarios diversos, todos ellos en transicion hacia la cobertura sanitaria universal. Las estructuras de las directrices difieren de un pais a otro, y los procesos se dirigen en gran medida desde los ministerios de sanidad nacionales. Cambios importantes Los grupos nacionales de directrices, apoyados por investigadores del GELA y socios gubernamentales y academicos, elaboraron cinco recomendaciones de salud infantil adaptadas a cada contexto. Para la mayoria de estas recomendaciones, se necesitaron pruebas adicionales para fundamentar una toma de decisiones nacional adecuada al contexto. La capacitacion formal y el aprendizaje en el lugar de trabajo mejoraron las competencias de los colaboradores e investigadores nacionales en la toma de decisiones basada en evidencias. Lecciones aprendidas La elaboracion de recomendaciones adaptadas al contexto requiere recursos y tiempo considerables. Se necesita una mayor inversion en el fortalecimiento de la capacidad local para el desarrollo sostenible de directrices nacionales., Introduction Implementation of evidence-informed health guidelines tailored to the health system contexts of low- and middle-income countries is needed to improve health outcomes. Evidence-informed health guidelines are documents containing clinical, [...]

BACKGROUND: In low- and middle-income countries countries, millions of deaths occur annually from household air pollution (HAP), pulmonary tuberculosis (PTB), and HIV-infection. However, it is unknown whether HAP influences PTB risk among people living with HIV-infection. METHODS: We conducted a case-control study among 1,277 HIV-infected adults in Bukavu, eastern Democratic Republic of Congo (February 2018 - March 2019). Cases had current or recent (3h/day and ≥2 times/day and ≥5 days/week were more likely to have PTB (aOR 1·36; 95%CI 1·06-1·75) than those spending less time in the kitchen. Time-weighted average 24h personal CO exposure was related dose-dependently with the likelihood of having PTB, with aOR 4·64 (95%CI 1·1-20·7) for the highest quintile [12·3-76·2 ppm] compared to the lowest quintile [0·1-1·9 ppm]. CONCLUSION: Time spent cooking and personal CO exposure were independently associated with increased risk of PTB among people living with HIV. Considering the high burden of TB-HIV coinfection in the region, effective interventions are required to decrease HAP exposure caused by cooking with biomass among people living with HIV, especially women.

Summary Background Purpose Data sources Study selection Data extraction Data synthesis Limitations Conclusions Some dietary recommendations continue to recommend carbohydrate restriction as a cornerstone of dietary advice for people with diabetes.We compared the cardiometabolic effects of diets higher in both fiber and carbohydrate with lower carbohydrate lower fiber diets in type 1 or type 2 diabetes.MEDLINE, Embase, and the Cochrane Database of Systematic Reviews up to June 24, 2024, with additional hand searching.Randomized controlled trials in which both dietary fiber and carbohydrate amount had been modified were identified from source evidence syntheses on carbohydrate amount in people with diabetes.Two reviewers independently.Ten eligible trials including 499 participants with diabetes (98% with T2) were identified from the potentially eligible 828 trials included in existing evidence syntheses. Pooled findings indicate that higher fiber higher carbohydrate diets reduced HbA1c (mean difference [MD] −0.50% [95% confidence interval −0.99 to −0.02]), fasting insulin (MD −0.99 μIU/mL [−1.83 to −0.15]), total cholesterol (MD −0.16 mmol/L [−0.27 to −0.05]) and low‐density lipoprotein cholesterol (MD −0.16 mmol/L (−0.31 to −0.01) when compared with lower carbohydrate lower fiber diets. Trials with larger differences in fiber and carbohydrate intakes between interventions reported greater reductions. Certainty of evidence for these outcomes was moderate or high, with most outcomes downgraded due to heterogeneity unexplained by any single variable.Our predefined scope excluded trials with co‐interventions such as energy restriction, which may have provided addition information.Findings indicate the greater importance of promoting dietary fiber intakes, and the relative unimportance of carbohydrate amount in recommendations for people with diabetes. [ABSTRACT FROM AUTHOR]

Mental health conditions constitute a major burden of disease for adolescents globally and can lead to significant adverse consequences. This systematic review aimed to identify if psychosocial interventions are effective in preventing mental health conditions in adolescents already experiencing emotional problems. We searched for randomized controlled trials comparing psychosocial interventions for preventing mental health conditions with care as usual in adolescents aged 10-19 who are experiencing symptoms of emotional problems. We searched PubMed/Medline, PsycINFO, ERIC, EMBASE, and ASSIA databases to identify studies. We found 82 eligible studies (n = 13,562 participants). Findings show that interventions can reduce mental health conditions and increase positive mental health. Across all reported time points, psychosocial interventions showed significant, small-to moderate-sized beneficial effects on preventing mental health conditions (SMD: -0.26, 95% CI [-0.42, -0.19] and small positive effects on positive mental health (SMD: 0.17, 95% CI [0.097, 0.29]. There were no statistically significant pooled findings suggesting that psychosocial interventions had either a positive or negative effect on self-harm or suicide; aggressive, disruptive and oppositional behavior; substance use; or school attendance. Despite the positive findings, a critical gap exists in the design of effective psychosocial interventions to reduce self-harm and suicide, and other risk behaviors in adolescents with symptoms of emotional problems., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: In low- and middle-income countries countries, millions of deaths occur annually from household air pollution (HAP), pulmonary tuberculosis (PTB), and HIV-infection. However, it is unknown whether HAP influences PTB risk among people living with HIV-infection., Methods: We conducted a case-control study among 1,277 HIV-infected adults in Bukavu, eastern Democratic Republic of Congo (February 2018 - March 2019). Cases had current or recent (<5y) PTB (positive sputum smear or Xpert MTB/RIF), controls had no PTB. Daily and lifetime HAP exposure were assessed by questionnaire and, in a random sub-sample (n=270), by 24-hour measurements of personal carbon monoxide (CO) at home. We used multivariable logistic regression to examine the associations between HAP and PTB., Results: We recruited 435 cases and 842 controls (median age 41 years, [IQR] 33-50; 76% female). Cases were more likely to be female than male (63% vs 37%). Participants reporting cooking for >3h/day and ≥2 times/day and ≥5 days/week were more likely to have PTB (aOR 1·36; 95%CI 1·06-1·75) than those spending less time in the kitchen. Time-weighted average 24h personal CO exposure was related dose-dependently with the likelihood of having PTB, with aOR 4·64 (95%CI 1·1-20·7) for the highest quintile [12·3-76·2 ppm] compared to the lowest quintile [0·1-1·9 ppm]., Conclusion: Time spent cooking and personal CO exposure were independently associated with increased risk of PTB among people living with HIV. Considering the high burden of TB-HIV coinfection in the region, effective interventions are required to decrease HAP exposure caused by cooking with biomass among people living with HIV, especially women., (© 2024. The Author(s).)