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Introduction This study aimed to systematically analyze and describe the main challenges of congenital heart diseases (CHDs) in the countries in the Amazon region. Methods The methodology followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist utilizing the Medline, Embase, Lilacs, and Google Scholar databases. The inclusion criteria were articles addressing any topic involving CHD in the Amazon region. Incomplete articles, book chapters, lectures, conference abstracts, and editorials were excluded. Results Nine studies were identified, 7 of which were published in the last decade and were of Colombian and Brazilian origin. The methodology of the studies was cross-sectional and ecological, evaluating the regional and epidemiological factors, challenges to diagnosis and treatment, multidisciplinary team challenges, and the impact of the COVID-19 pandemic. Studies carried out by surgeons demonstrate more existing data regarding the challenges of the health-care system. Conclusions There is growing interest in analyzing the situation of CHD in the region. However, only a few studies are available, mostly on ecological and cross-sectional analysis. These records show the lack of hospital infrastructure and multidisciplinary teams for the diagnosis and treatment of CHD in the Amazon region; we see an initiative by specialists from two countries (Colombia and Brazil) to demonstrate the difficulties by seeking international training programs and government aid to improve the health system situation.

Abstract Background This research investigates the fundamental factors which may stymie or simplify the adoption of m-learning by medical college educators in Sudan. We made use of the Extended Unified Theory of Acceptance and Use Technology (UTAUT) with COVID-19 fear (CF) and social isolation (SIS) as exogenous components. Objective This research aims to find out factors impacting medical students’ behavioural intention to use mobile learning. Methods Data was gathered from 499 undergraduate learners from different universities in Sudan. Partial Least Square (PLS) and structural equation modeling (SEM) were used to examine the data. The results Showed that expected performance, effort expectancy (EE), social influence (SI), facilitation condition (FC), COVID-19 fear, and social isolation (SIS) are predictors of behavioural intentions (BI). In addition, our findings show that COVID-19 fear and social isolation increase student adoption of mobile learning during the COVID-19 epidemics in developing countries. Conclusions The study unveiled that the suggested framework, derived from UTAUT, effectively discerns the factors impacting students’ intentions in mobile learning during pandemics. Sudanese medical students’ can strategize and execute effective classroom environments based on these findings.

Suicide prevention in low- and middle-income countries (LMICs) faces unique challenges due to limited epidemiological data and contextual variations. This article highlights the urgency of addressing suicide, the second leading cause of death among individuals aged 15 to 29 globally, emphasizing the heightened vulnerability during college years. While high-income countries (HICs) have established surveillance systems, LMICs struggle due to inadequate resources, cultural stigma, and competing health priorities. The scarcity of reliable data hinders the formulation of evidence-based prevention programs and national policies. The article advocates for the implementation of surveillance systems on university campuses, utilizing cost-effective online mental health surveys like the WHO International College Student Initiative. Understanding the etiology of suicidal behavior is crucial, with psychosocial stressors affecting both HIC and LMIC college students, but the latter facing additional challenges like gender-based violence and financial stress. Cultural nuances further necessitate qualitative research to design context-sensitive prevention interventions. Access to mental healthcare is identified as a key preventive measure, especially on campuses, but challenges persist in encouraging help-seeking behavior. Digital interventions are proposed as promising solutions, considering their efficacy and potential to bridge treatment gaps in resource-constrained environments.

There is a pressing need to address the noticeable disparity in biomedical research output between High-Income Countries (HICs) and Low-Middle Income Countries (LMICs). This imbalance raises urgent concerns about equity and the impact on global health. Despite being home to most of the global population, LMICs face numerous challenges that hinder their ability to contribute significantly to research. This review explores the factors contributing to the disparities and proposes potential solutions to address this global imbalance. A comprehensive strategy is needed to tackle the differences in biomedical research productivity between high-income and low-middle-income nations. Enhancing global partnerships, ensuring fair allocation of resources, and prioritizing the development of research capabilities are crucial measures in nurturing a more diverse and influential worldwide biomedical research landscape. Closing this divide is essential for advancing scientific inclusivity and tackling the health issues economically disadvantaged countries face.

The Sustainable Development Goal 3 (SDG 3), introduced by United Nations and supported by World Health Organization to ensure healthy lives and promote well-being for individuals of all ages, has become increasingly challenging to achieve. The COVID-19 pandemic has disrupted healthcare systems and overwhelmed medical resources, intensifying health inequalities worldwide. As a result, achieving SDG 3 has become more complex and difficult than ever before.1 The current state of global health reflects significant issues and gaps in achieving the SDG 3 targets. For instance, the global maternal mortality ratio, which only slightly decreased from 227 to 223 per 100,000 live births between 2015 and 2020, indicates insufficient progress towards the target of 70 per 100,000 by 2030. Additionally, while the under-five mortality rate dropped to 37 per 1,000 live births in 2022, and neonatal mortality decreased to 17 per 1,000 live births, significant disparities remain. The high rates of communicable diseases, with 1.3 million new HIV infections and 249 million malaria cases in 2022, highlight persistent global health threats. Drug treatment coverage fell from 11% in 2015 to under 9% in 2022, and vaccination rates for diphtheria, tetanus, pertussis and measles remain below pre-pandemic levels.2 These figures emphasize the need for intensified global efforts, increased investment, and focused interventions to address these disparities and achieve the SDG 3 targets. Despite significant efforts and advancements by developed nations, the overall state and dynamics of global health are suboptimal. The focus on specific health-related challenges in these countries often overshadows critical issues in developing regions, such as the lack of new treatments for tuberculosis.3 This phenomenon impedes the collective effort required to address the global health inequities and delays progress toward achieving SDG 3 targets. The COVID-19 pandemic has demonstrated the interconnectedness of the world and shown that without active and robust participation from developing countries, achieving global health targets is extremely difficult.4,5 However, involving low- and lower-middle-income countries (LICs and LMICs) in building a more resilient global health framework is a gigantic task that requires addressing the unique challenges these nations face in achieving SDG 3.6 These countries are struggling with a range of health-related challenges, including poverty, inadequate access to clean water, maternal and child health issues, and increasing prevalence of infectious and non-communicable diseases.7 Additionally, access to healthcare is uneven, leading to significant disparities among different population groups, particularly in rural areas.8,9 A major hurdle in these countries is poor governance, which obstructs effective health management and appropriate resource allocation.10 This issue is further aggravated by the inadequate healthcare infrastructure, including insufficient facilities, outdated equipment, and a significant shortage of skilled health workers, resulting in compromised quality of care.11,12 A key factor exacerbating the situation is brain drain, driven by low salaries, poor working conditions, and limited career advancement opportunities, which compel healthcare workers to leave their home countries.13 Financial constraints exacerbate these problems, limiting the capacity to invest in and sustain essential health services.14 Additionally, despite facing significant challenges in achieving the SDGs, LICs and LMICs contribute minimally to research on local issues related to achieving the SDG 3 targets, highlighting a global misalignment.11 The existing health data from local research in LMICs often raises concerns about quality and accuracy, making it risky to rely on outdated or unreliable information for aggregation, estimation, and modeling.12,15-18 Addressing these complex challenges requires a coordinated strategy that leverages local strengths and fosters international cooperation. Advancing global health in developing countries demands a comprehensive approach, incorporating innovation, local research, and effective collaboration. The post-pandemic era calls for systematic solutions through reclassifying SDG priorities, coordinating resources, and promoting collaboration across economic, technological, cultural, and political sectors.19 Prioritizing local research and development is essential for tailoring interventions to the specific health needs of LICs and LMICs, where health issues may differ significantly from those in higher-income countries.11 Local research can provide valuable insights into the unique health challenges faced by communities. While, regional and multinational collaboration can strengthen the disease control, facilitate knowledge sharing, and promote collective solutions to common problems.20 Innovative financing mechanisms and broader access to affordable health insurance can significantly improve service delivery.21 Additionally, strengthening health information systems, and supporting local innovations tailored to specific needs can drive further progress.5 Tackling health inequities and investing in preventive care are crucial for reducing disparities and enhancing overall health outcomes.22 Such comprehensive efforts not only benefit local health systems but also make meaningful contributions to global health. No doubt, the journey toward achieving SDG 3 is loaded with challenges, particularly for developing countries. However, by strengthening healthcare systems, implementing good governance, fostering local research, and embracing international cooperation, these nations can overcome their own health challenges and make substantial contributions to the global health progress. The global community must recognize that the health of the world is interconnected, and the success of SDG 3 hinges on our collective efforts to support and uplift the most vulnerable populations.

Summary Objective: The objective was to compare the morbidity and mortality data among low birthweight (LBW) infants in two developing countries with different medical facilities, and determine where further improvements are possible, Methods: Data were extracted from the admission records and case notes of neonates with birthweight 0.1). The mortality rate was significantly higher among the VLBW group in WGH than in QCH (p

Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder associated with substantial impairment which considerably burdens healthcare systems worldwide. Research on IBS has largely been conducted in high-income countries posing barriers to the application of diagnostic strategies in low- and middle-income countries (LMICs) due to differences in disease characteristics, healthcare resources, and socioeconomic factors. This review discusses the diagnostic issues associated with LMICs. We present a concise overview of the relevant approaches and propose a diagnostic strategy based on the latest evidence. A positive diagnostic strategy that relies on appropriate symptom-based criteria is crucial within the diagnostic framework. A combination of complete blood count, fecal occult blood test, and complete stool test may reliably identify individuals with suspected IBS who are more likely to have organic diseases, thus justifying the necessity for a colonoscopy. Eventually, we developed a diagnostic algorithm based on a limited setting perspective that summarizes the available evidence and may be applied in LMICs.

Objective To evaluate the admission brain computed tomography (CT) scan findings in patients with traumatic brain injury (TBI) in a low- and middle-income country (LMIC) to predict long-term neurological outcomes.

Abstract The sustainable development goals (SDGs) were established by the United Nations as an international call to eradicate poverty, safeguard the environment, and guarantee that everyone lives in peace and prosperity by 2030. The SDGs aim to balance growth and sustainability in three dimensions: social, economic and environmental. However, in the post-pandemic era, when resources for public development policies are scarce, nations face the problem of prioritizing which SDGs to pursue. A lack of agreement is one of the determinants of low performance levels of the SDGs, and multicriteria decision analysis tools can help in this task, which is especially relevant in developing countries that are falling behind in achieving the SDGs. To test the feasibility and appropriateness of one of these tools, the Fuzzy Logarithm Methodology of Additive Weights, we apply it to prioritize the SDGs in the Dominican Republic, to see if the priorities established are consistent. Seventeen experts were surveyed, and the main result was that Decent work and economic growth was the most important goal for the country. Our findings, consistent with the literature, show the path to similar applications in other developing countries to enhance performance levels in the achievement of the SDGs.

Introduction: Malnutrition is a major public health problem, especially in Low- and Middle-Income Countries (LMICs), contributing significantly to under-five mortality. New strategies are needed to enhance outcomes for childhood malnutrition. Aim: To evaluate the impact of an educational package on mothers of children hospitalised with Severe Acute Malnutrition (SAM). Materials and Methods: This was a hospital-based randomised controlled trial conducted in the Department of Paediatrics at Gajra Raja Medical College, Gwalior, Madhya Pradesh, India. Only children hospitalised between 6 months and 59 months of age with SAM were included and randomised into an Intervention group and a Control group. In the intervention group, verbal, pictorial, and demonstration techniques were used to educate the mothers. Anthropometric measurements of malnourished children and maternal knowledge scores were compared at baseline, 15 days, and two months postdischarge. Frequency and percentage were calculated for qualitative data analysis, while mean values with standard deviations were calculated for quantitative data. Independent t-tests and paired t-tests were applied, and paired t-tests were used for within-group comparisons at different time points. Data was entered into Microsoft Excel software, and analysis was performed using Statistical Package for Social Sciences (SPSS) version 22.0. Results: The mean age of children was 1.4±0.9 years, with the majority below two years of age (86.4%). The male-to-female ratio was 1.04 (n=154 versus n=148). Most subjects belonged to lower or upper-lower socio-economic classes (75%). Mothers were commonly educated up to the primary school level (48%). Both study groups had similar socio-demographic profiles. There was a significant weight gain (p-value

Abstract Background Geopolitical and socioeconomic challenges limit faculty development and clinical teaching in Palestine and many other developing countries. The first, and still only, Family Medicine (FM) residency program is a four-year program based out of An-Najah University in the West Bank. Training in primary care clinics occurs in the final two years and there are many challenges to adequate supervision in the clinical setting that were exacerbated during the pandemic. To improve the readiness for practice skills of 13 Palestinian FM residents a three-month tutorial program was organized in 2020. A nongovernmental organization (NGO) that has worked to support Family Medicine development in the region engaged experienced British and American General Practitioners trained as tutors to offer online tutorials. We examined the program as a case study to understand the factors that facilitated or impaired a positive virtual learning environment in a middle/low income country. Methods The tutors and residents were divided into groups and met virtually between June and September 2020. Evaluations and session reports collected during the program, the text of an online chat, and responses to an online survey two years later were collected. Using thematic analysis techniques, we evaluated the value for the residents at the time and two years later and identified factors that facilitated or impaired a positive virtual learning environment. Results Themes of knowledge, skills, attitudes, cultural disconnects, and tutorial logistics emerged. The group with the most stable tutor pairing, including one Arabic-speaker familiar with the context, was the most engaged. The all-female group formed a chat group to share real-time case questions during clinical practice and focused on skills (e.g. conducting a thorough medication review) and attitudes (e.g. open to sharing and discussing uncertainties). Other groups were less cohesive. Conclusions Transnational tutorials that focused on clinical thinking and decision-making skills were most successful when the tutorial pair was stable, offered familiarity with the language and addressed cultural differences. Intrinsic factors such as lacking the motivation to participate and extrinsic factors such as unstable internet and rolling electric cuts, and clinical structures that made applying new skills challenging were more difficult to address but must be considered.

Abstract: Psychosocial evaluations are rarely conducted with community-dwelling individuals, especially those with higher risk of cardiovascular disease. This study aims to evaluate the perceptual stress and cardiovascular risk among women in a large cross-sectional study performed in Brazilian communities. Subjects aged over 18 years were included out of 500 public basic health units (BHU) in Brazil. All subjects were subjected to a clinical consultation and questionnaires application. Data were used to identify healthy lifestyle, smoking status, and self-perception of psychological stress. The National Health and Nutrition Examination Survey (NHANES) risk score (NRS) was used to estimate cardiovascular risk. Ethnicity information was self-reported, considering white versus non-white (black, brown, and mixed-race) women. A total of 93,605 patients were recruited from a primary care setting, of which 62,200 (66.4%) were women. Intense and severe auto-perception of stress was higher within non-white women at home (p < 0.001), at work (p = 0.008), socially (p < 0.001), and financially (p < 0.001) compared to white women. Therefore, the NRS indicates that non-white women had higher cardiovascular risk, lower physical activity, and lower daily vegetables/fruits consumption compared to white women (p < 0.001). Non-white women in Brazilian communities are susceptible to increased stress and cardiovascular disease risk, which adds up to disparities in access to the public health system.

Abstract Background Developing nations have to overcome a number of obstacles to fulfill the Sustainable Development Goals. The Democratic Republic of Congo is one of the five poorest nations in the world and faces several challenges in combating problems related to poverty, health, and sanitation while linking the environment to anthropogenic activities. Methods This study analyzes anthropogenic activities and their impact on the environment while providing access to the public health of the Congolese population based on the objectives of sustainable development. Thirty‐five articles were selected for further analysis as well as relative data. Results In 2022, 21 million cases of malaria were recorded by the national malaria control program, with 13,000 cases of death. The Democratic Republic of Congo has the highest typhoid incidence, with 315 cases per 100,000 people. A number of 31,342 cases of cholera were reported in 2023, according to multiple reports, with 230 deaths, mainly affecting children. In the same year, a triple epidemic of typhoid, shigellosis, and cholera was identified, with 2389 cases and 52 deaths. These observations cause a health emergency, which can be alleviated and resolved by the establishment of an adequate sanitation system. Waste can be recycled and returned to usable raw materials. Conclusion Finally, it will be necessary to establish a water safety management plan to combat all diseases linked to the consumption of nonpotable water and improve national coverage on the treatment of recent cases to reduce and at best avoid observed cases of death.

ABSTRACT Introduction: Proximal femoral nailing for intertrochanteric femur fracture is sometimes a challenging procedure without a traction table, especially if complicated fracture pattern. We aimed to overcome this difficulty with the hook. Materials and Methods: A retrospective study of 60 patients. 28 of the patients reduction was necessitated with a hook (group 1). The other patients did not need to use this technique (group 2, n=32). The collo-diaphyseal angle, lag screw placement, and tip-apex distance were measured using radiographs. Results: There were statistically significant differences between the two groups regarding the Garden Alignment Index, postoperative collo-diaphyseal angle measurements, and tip-apex distance. The Garden Alignment Index was found as 163.92 degrees (dg.) In the frontal plane in group 1, and 154.78 dg in group 2, respectively. In group 1, the tip-apex distance was 16.05 cm, whereas it was 25.32 cm in group 2. The collo-diaphyseal angle was 133.1º in group 1, and 128.65º in group 2. Conclusions: The hook-assisted reduction is beneficial when operating without a traction table; however, it can also be a part of the surgeons’ equipment even when operating on a traction table. When difficulties in obtaining an ideal anatomical reduction in displaced intertrochanteric femoral fractures, we suggest using the hook-assisted reduction technique. Level of Evidence III; Case-control Study.

Abstract Background Cancer was the fifth leading cause of death in Sudan general hospitals in 2020, and its incidence is increasing. Medical students’ cancer education is key in cancer control. Evaluating the current education is the first step in optimizing it. The aim of this study was to assess undergraduate oncology education in Sudan public medical schools as reflected by the graduates of the year 2021–2022. Method This was a cross-sectional institution-based study. A validated online questionnaire was sent between 8 September and 11 November 2022 to graduates who were selected using a stratified random sampling technique from 17 Sudan public medical schools. The data were collected using Google Forms and analyzed using R software version 4.2.2 and Microsoft Excel 2022. Results A total of 707 graduates completed the questionnaire. They reported generally poor exposure to oncology. Palliative and radiation oncology in addition to chemotherapy daycare units were never attended by 76.0%, 72.0%, and 72.0% of graduates, respectively. The massed oncology curriculum was associated with increased hours of lectures dictated to medical (p = 0.005), radiation (p 0.05). Conclusion This study reflected poor exposure to oncology at the undergraduate level in Sudanese public medical schools. The massed oncology curriculum was associated with formal assessment of oncology-related competencies and better exposure to some disciplines, such as radiation and palliative oncology. Nonetheless, it was associated with decreased interest in an oncology career. In spite of the poor exposure, graduates were confident in their skills in oncology-related competencies. Further objective analysis of competence is needed.

No abstract available.

Background We examined the investment development path (IDP) through the perspective of developing countries’ agricultural sector. Our analytical approach indirectly accounts for interactions among countries regarding cross-border resource transfers. Aside from providing knowledge on testing the IDP by inferential statistics, the information would be relevant for policymaking. Identifying the stage(s) in the IDP not only highlights the global appeal of agriculture but also guides firms seeking to expand beyond borders. This information is essential for developing an effective economic strategy. Methods We employed data from 1991 to 2021 for 55 countries from the Food and Agriculture Organization Corporate Statistical Database (FAOSTAT) and applied a fixed effects estimator corrected for serial correlation and non-constant variances. Results and conclusions We found that agriculture in developing countries is currently in stages I and II of the IDP. Broadly, agricultural production requires policies that would increase outward foreign direct investment and inward foreign direct investment. Domestic agricultural businesses in developing countries must develop capacity by learning from foreign multinationals. This would enable agricultural businesses to invest abroad. Such a move would lead to an increase in outward FDI. As this would have resulted from increased GDP per capita, it will lead to movement from the existing stage to higher ones.

Objectives: To identify barriers to safe anaesthesia practice across the South Asian region. Method: The qualitative study was conducted from September 2020 to August 2021 at the Department of Anaesthesiology at a leading medical university after getting exemption from the ethics review committee of the Pakistan Society of Anaesthesiologists. The sample comprised anaesthetists from 6 countries of the South Asian Association for Regional Cooperation. Data was collected through a focus group discussion held virtually using the Zoom app on September 22, 2020. The proceedings were transcribed and the data was subjected to thematic analysis. Results: Of the 12 anaesthetists, 4(33.3%) were from India, 3(25%) from Pakistan, 2(16.7%) from Bangladesh, and 1(8.3%) each from Sri Lanka, Nepal and Afghanistan. There were 2 main themes identified; Safe anaesthesia and barriers to safe anaesthesia. They had 4 and 6 subthemes, respectively. The participants agreed that fresh medical graduates were not choosing anaesthesia as a preferred career specialty. One major concern raised was that qualified anaesthetists were leaving their countries for better-paid jobs abroad. Conclusion: The lack of a definition describing qualified anaesthetists in South Asian countries was pointed out. Lack of basic monitoring and drugs, brain drain, lack of ownership, lack of training programmes, lack of accountability, weak leadership, and disconnect between professional societies and governments were identified as the main barriers to safe anaesthesia. Key Words: Safe practice, Anaesthesia, Developing countries, Developed countries.

Stroke is a major public health concern in developing countries, where the burden of the disease is high and resources for care are often limited. While progress has been made in improving stroke care, many barriers still exist in providing adequate rehabilitation care for stroke survivors. In this paper we study the case of Costa Rica and how stroke care has been addressed in recent years. It is important to consider the particularities of Costa Rica when working on stroke rehabilitation. The existence of a socialized healthcare system, along with the consolidation of acute stroke management protocols, allows for the adequate management of the early stages. In addition to this, families play a key role in rehabilitation, particularly for a country where there is a lack of medium stay and long-stay rehabilitation centers. Therefore, providing training and education for families is essential in stroke case management. Looking toward the future, there is still a pending need to generate homogeneous stroke rehabilitation protocols throughout the national healthcare system, to ensure equitable access to health care, and to consolidate multidisciplinary groups. At the same time, the implementation of technologies is urgent, particularly considering their potential to help reduce waiting lists. Another goal is enhancing coordination with other state entities and NGOs to advance community, labor or educational reintegration of stroke patients.

Background: The microbiological diagnosis of extrapulmonary tuberculosis (TB) is quite difficult because of paucibacillary load and required radiological, cytohistopathological tests for confirmation along with clinical suspicion in case of cervical TB lymph node, body fluid examination such as pleural fluid, cerebrospinal fluid, ascitic fluid in cases of TB pleurisy, TB meningitis, and abdominal Koch’s and was quiet challenging before inclusion of CBNAAT. Aims and Objectives: The aim of the study was to study epidemiological, clinical profile and pathological diagnosis and management of TB cervical lymph node patients coming to a tertiary care center where, 60 patients were enrolled during a 2.5-month period and were followed up for 8 months. Data were entered in Microsoft Excel and analysis was done by in EP Info (version 7.0). Descriptive statistics was applied in the form of percentage, proportion, and measures of central tendency. Test of significance was applied. Materials and Methods: To study epidemiological, clinical profile and pathological diagnosis and management of TB cervical lymph node patients coming to a tertiary care center where, 60 patients were enrolled during a 2.5-month period and were followed up for 8 months. Data were entered in Microsoft Excel, and analysis was done by in EP Info (version 7.0). Descriptive statistics was applied in the form of percentage, proportion, and measures of central tendency. Test of significance was applied. Results: In this study, 23 cases (38.3%) were male and 37 cases (61.7%) were females, with a female preponderance. The mean age was 27.33 years, with a SD of 93. In this study, maximum number of cases, i.e., 44 cases (73.3%) were seen in the age group of 19–28 years. Neck swelling was the chief presenting complaint among them followed by fever, 36 patients (60%), weight loss 31 (51.7%), anorexia in 28 (46.7%), and cough in 7 patients (11.7%). 75% patients improved after taking antitubercular therapy for 6 months and 5% patients not responded to the treatment till 8 months. Conclusion: There is high incidence of TB cervical lymphadenopathy in developing countries like India.

Context: Getting residency training abroad is a critical motivator in the emigration of Indian medical students. Brain drain is an emerging issue, especially for developing countries as it causes a shortage of trained staff in the donor country. Aim: We aimed to survey Indian medical students to know about their intentions to get trained abroad and to understand the factors influencing their decision. Materials and Methods: In this cross-sectional observational study, we surveyed Indian undergraduate medical students of all professional years, including internship. A validated questionnaire collected data on students’ demographics and educational characteristics, intention to study overseas or stay back in India, and factors influencing their decision. Results: Out of a total of 1199 responses (51.1% males, 48.9% females), 45.0% partakers had planned to pursue their residency abroad, while 33.8% wanted to stay in India and 21.2% were undecided. Better lifestyle and higher pay grades overseas were viewed as the most significant barriers to staying back in India and a key influencer in decision-making among the maximum number of students (412; 76.3%). On the other hand, a whopping 58.2% of participants opined that they wanted to stay back in India for taking care of their parents. Conclusions: Source countries with better healthcare facilities and better incomes tend to attract medical students. Awareness among medical educators regarding constantly changing curricula, a shift to a competency-based education system, better pay grades, limited working hours, and interventions to mitigate workplace violence could help prevent brain drain among Indian medical students and graduates.

Clostridioides difficile infection (CDI) is a well-known cause of hospital-acquired infectious diarrhea in developed countries, though it has not been a top priority in the healthcare policies of developing countries. In the last decade, several studies have reported a wide range of CDI rates between 1.3% and 96% in developing nations, raising the concern that this could represent a healthcare threat for these nations. This review defines developing countries as those with a human development index (HDI) below 0.8. We aim to report the available literature on CDI epidemiology, diagnostics, management, and prevention in developing countries. We identify limitations for CDI diagnosis and management, such as limited access to CDI tests and unavailable oral vancomycin formulation, and identify opportunities to enhance CDI care, such as increased molecular test capabilities and creative solutions for CDI. We also discuss infection prevention strategies, including antimicrobial stewardship programs and opportunities emerging from the COVID-19 pandemic, which could impact CDI care.

It has always been argued that countries should not be inactive about the quality of health services. Therefore, a clear policy needs to be created regarding how quality of health services should be. The present scoping review was aimed to identify and map the available evidence regarding the National Quality Policy and Strategy (NQPS) of the health services in health systems of developing countries, graphically and tabularly. We followed the published methodological guidance of the Joanna Briggs Institute reviews. Also, we employed a narrative thematic synthesis integrated with the systematic analysis using the World Health Organization’s approach of NQPS, and the multiple-streams framework of Kingdon. We included 33 records that met the inclusion criteria; these records were published between 2010 and 2019. Meanwhile, government documents were the most frequent records (61%). Zimbabwe, Indonesia, and Sudan were the most frequent locations (each one 8%). The Ministry of Health was in charge of the ultimate responsibility for developing the NQPS in all identified countries. Besides, 82% of the countries were in the development phase of NQPS formulation, and convergence of three streams was observed in Indonesia, Sudan, and Tanzania. It seems that the African countries were informed about their quality issues, and the need for having NQPS have been more popular with them. We recommend that future research focuses on examining NQPS in terms of prioritizing in the agenda-setting phase of the policy-making cycle, and also, document analysis of all identified NQPS based on the core eight interdependent elements related to the NQPS approach.

Objectives Considering the importance of social determinants of health (SDHs) in promoting the health of residents of informal settlements and their diversity, abundance, and breadth, this study aimed to identify, measure, and rank SDHs for health promotion interventions targeting informal settlement residents in a metropolitan area in Iran. Methods Using a hybrid method, this study was conducted in 3 phases from 2019 to 2020. SDHs were identified by reviewing studies and using the Delphi method. To examine the SDHs among informal settlement residents, a cross-sectional analysis was conducted using researcher-made questionnaires. Multilayer perceptron analysis using an artificial neural network was used to rank the SDHs by priority. Results Of the 96 determinants identified in the first phase of the study, 43 were examined, and 15 were identified as high-priority SDHs for use in health-promotion interventions for informal settlement residents in the study area. They included individual health literacy, nutrition, occupational factors, housing-related factors, and access to public resources. Conclusions Since identifying and addressing SDHs could improve health justice and mitigate the poor health status of settlement residents, ranking these determinants by priority using artificial intelligence will enable policymakers to improve the health of settlement residents through interventions targeting the most important SDHs.

Background: Improper home medicine storage is a global issue that leads to medicine wastage contributing to adverse effects. There have only been a few community-based research studies for in-home drug storage methods, reasons for use and its disposal ways among the consumers of India, until date. Methodology: A descriptive, cross-sectional study was done from April 2023 to June 2023. Data were collected by face-to-face interview of household representative using pretested structured questionnaire on medicines in households, their utilization, storage and disposal practices. Results: Most of the participants (78.3%) were educated to the level of graduation and above and their common reported source of procurement for stored medicines was doctor’s previous prescriptions (61.79%) where 42.5% of them stored medicines for anticipated future use. Commonly stored drugs in households were analgesics and antihistaminics and drugs for digestive system while only 5.3% stored antibiotics mostly for ongoing treatment. Unsafe storage practices like storing medicines without proper labelling (65%) and within reach of children (33.49%) were found in the study. Also, 42.45% participants reported to share stored medicines with family members and friends. Major practice for drug disposal was reported as throwing in household garbage (93.1%). Conclusion: In current study, 100% prevalence of in-home storage medication practices among the well-educated consumers without proper care taken for their use, storage and disposal which may pose a risk to the environment as well as humans.

Background: New psychoactive substances (NPS) have become a global phenomenon, with over 134 countries and territories from all world regions reporting them. Since December 2021, governments, laboratories, and partner agencies have confirmed to the UNODC Early Warning Advisory (EWA) on NPS over 1124 substances. It is agreed that NPS control is one of the most challenging tasks for developing countries. Identifying the present and future threads of NPS is the most challenging task for law enforcement officials. The NPS research has a great impact on substance abuse policy-making and harm reduction strategies. Methods: The data in this study were collected from the official websites of online journals, Google Scholar, UNODC, International Narcotics Control Board (INCB), and the Department of Narcotics Control (DNC). Findings: Among the eleven groups of NPS, synthetic cannabinoids and cathinones are the most prevalent and alarming in developing countries. In Bangladesh, NPS abuse has been first identified in 2016. Almost 60 countries adopted legislative solutions to manage NPS by 2021, with many using or amending existing legislation and others employing novel legal mechanisms. It is widely agreed by researchers that reducing the menace of NPS requires increased awareness among all stakeholders. Conclusion: In the fight against the spread of NPS and its severe effects, law enforcement authorities and healthcare professional training must be seen as crucial aspects as well. Financing is also crucial for international organizations dealing with the NPS impact to continue fighting this war. The only way for policymakers to reduce NPS spread globally is through national and international cooperation.

Abstract Prehospital care (PHC) is critical to the comprehensive and effective functioning of a healthcare system. Given the disproportionate burden of both communicable and non‐communicable diseases in low‐income nations, its significance cannot be understated. In spite of this, many of these nations lack a comprehensive PHC system. Setting up a cost‐effective PHC system in this environment can be difficult and necessitate a variety of stakeholders at various healthcare delivery system levels. Therefore, it is necessary to consider these anticipated barriers and identify feasible solutions for its execution. This will assist in creating a PHC system that is suited to the local needs and achieve sustainable and global health goals. This paper describes the challenges and solutions to establishing a prehospital care service in a low‐resource setting.

Introduction. The birth of premature babies is a public health problem with a high impact on infant morbidity and mortality. About 40% of mortality in children under five years occurs in the first month of life. Objective. To identify the association between maternal sociodemographic factors, premature birth, and mortality in newborns under 37 weeks in Santiago de Cali, 2017-2019. Materials and methods. We conducted a descriptive, cross-sectional study. We evaluated the records of Cali’s Municipal Public Health Office. We calculated the crude and adjusted odd ratios and confidence intervals (95%) using the logistic regression model, data processing in Stata 16, and georeferencing the cases in the QGIS software. Results. From 2017 to 2019, premature babies in Cali corresponded to 11% of births. Poor prenatal care increased 3.13 times the risk of being born before 32 weeks (adjusted OR = 3.13; 95% CI = 2.75 - 3.56) and 1.27 times among mothers from outside the city (adjusted OR = 1.27; 95% CI = 1.15-1.41). Mortality was 4.29 per 1,000 live births. The mortality risk in newborns weighing less than 1,000 g increased 3.42 times (OR = 3.42; 95% CI = 2.85-4.12), delivery by cesarean section in 1.46 (OR = 1.46; CI 95% = 1.14-1.87) and an Apgar score – five minutes after birth– lower than seven in 1.55 times (OR = 1.55; CI 95% = 1.23-1.96). Conclusions. We found that less than three prenatal controls, mothers living outside Cali, afro-ethnicity, and cesarean birth were associated with prematurity of less than 32 weeks. We obtained higher mortality in newborns weighing less than 1,000 g.

Objective: To determine the barriers of joining in-vitro fertilization (IVF) programs among infertile couples in developing countries. Methods: This study assessed infertile couples and the barriers or associated factors resulting in delayed decision-making of joining IVF program by searching databases PubMed, ScienceDirect, EBSCO, ClinicalKey, and Cochrane Library from inception until December 31, 2021. Additional search strategies were snowballing literature search and citation tracking. Results: Eleven articles were included in the scoping review. The cost was the greatest barrier of joining IVF program. Limited access and lack of assisted reproductive technology centers, few qualified infertility trained staff, insufficient government support, low priority in government policy, along with sociocultural factors, such as religion and false beliefs or myths were also majorly considered to be associated obstacles. Conclusions: The main barrier associated with IVF program among infertile couples in developing countries is the high cost of the IVF services.

The Sustainable Development Goals (SDGs) include several nutrition-focused goals. Nutrition has direct effects on the second and third SDGs, namely achieving zero hunger and good health and well-being, as well as indirect effects on the first, fifth, sixth, eighth, and seventeenth. Achievement of SDG goals is a prerequisite for meeting the global nutrition targets by 2025. Despite some improvement, Egypt is falling short of meeting the majority of the nutrition targets. From a public health nutrition perspective, there are several gaps in progress toward the SDGs related to nutrition policies, programs, or intervention levels. Political commitment, multisectoral cooperation, adequate financing, scaling up existing interventions, delivering new policies, and incorporating best practices into national policies are crucial for accelerating nutrition progress. Investing in data needed and the capacity to use it, health system capacity building, service providers training, informing beneficiaries, program monitoring and evaluation, and establishing a nutrition surveillance system to adequately inform policy formation are crucial to achieving the target. In order to provide nutrition interventions in an integrated manner, a multi-systems approach should focus on the food, health, water, and sanitation systems, as well as the education and social protection systems. The food system must support low-cost and nutritionally diverse diets, healthy food environments, and positive practices. In addition, legislation, labeling, taxes, and marketing regulations are significant. In generating evidence, science and academia play a crucial role in accelerating the progress of SDG targets. This article reviews the nutritional problem in Egypt and concludes that long-term sustainable development in Egypt cannot be achieved unless malnutrition is effectively addressed (especially in anemia among preschool and school children, exclusive breastfeeding, and overweight and obesity in adolescents and adults).

Study Design Retrospective review. Purpose A 5-year longitudinal study documenting and comparing patterns of traumatic spinal injuries (TSIs) observed in developing countries. Overview of Literature Current knowledge of the patterns and epidemiology of TSI are based on evidence from developed countries and there is a lack of data from developing countries to enable a comparison of information to formulate healthcare policies. Methods A review of case records of all patients treated at a tertiary level trauma center over a 5-year period (2015–2019) was performed. Epidemiological, clinical, and radiological data were analyzed. Results The incidence of spinal trauma was 6.2% (2,065/33,072) among all trauma patients. Among these 2,065 patients, the mean age was 43.4±16.3 years and 77.3% (n=1,596) were aged 21–60 years. The major cause of injury was falls (52.1%, n=1,069) and 49.8% were high-energy falls (>10 feet [=3.048 m]). In patients with TSI due to falls, injuries occurred at the workplace (n=376), home (n=309), trees (n=151), wells (n=77), and electric poles (n=57). Road traffic accidents contributed to 42% (n=862) of TSIs and predominantly affected motorcyclists (52%, n=467). Around half (53.5%, n=1,005) of all patients were in the lower socioeconomic strata. The most common injury level was thoracic region (37.2%, n=769). Spinal cord injury (SCI) occurred in 49% (n=1,011) of patients and 49.7% (n=1,028) had injuries associated with other organs. Conclusions Our study indicated different demographic patterns and epidemiological features of TSI compared with the Western literature, including a preponderance of young male patients, falls from heights, motorcycle accidents, and a larger percentage of SCI. The high number of falls at workplace indicates a lack of knowledge among the public and policy makers about safety measures.

This study aimed to estimate the return on investments of three population-level tobacco cessation strategies and three pharmacological interventions. The analysis included 124 low- and middle-income countries, and assumed a 10-year investment period (2021–2030). The results indicate that all six cessation programmes could help about 152 million tobacco users quit and save 2.7 million lives during 2021–2030. If quitters were followed until 65 years of age, 16 million lives could be saved from quitting. The combined investment cost was estimated at 1.68 United States dollars (US$) per capita a year, or US$ 115 billion over the period 2021–2030, with Caribbean countries showing the lowest investment cost at US$ 0.50 per capita a year. Return on investments was estimated at 0.79 (at the end of 2030) and 7.50 if benefits were assessed by the time quitters reach the age of 65 years. Disaggregated results by country income level and region also showed a return on investments less than 1.0 in the short term and greater than 1.0 in the medium-to-long term. In all countries, population-level interventions were less expensive and yielded a return on investments greater than 1.0 in the short and long term, with investment cost estimated at US$ 0.21 per capita a year, or US$ 14.3 billion over 2021–2030. Pharmacological interventions were more expensive and became cost beneficial over a longer time. These results are likely conservative and provide support for a phased approach implementing population-level strategies first, where most countries would reach break-even before 2030.

The COVID-19 pandemic has adversely affected medical education worldwide. Developed countries have successfully managed this by adopting modified ways of teaching and assessment and utilizing their resources but low income countries have struggled in managing the challenges they have faced in teaching and assessment. Medical exams have been postponed multiple times because of no clear way forward due to limited resources. This has not only resulted in wasting of the time of students but also adds to desperation and frustration of the students as well as teachers and institutes. Newer modes of information transfer including E-lectures, pre-recorded videos, simulation based learning and assessment (Kahoot, Socrative etc) have been introduced over the past two years. This paper illustrates a modified model for medical exams which may prove a suitable alternative for low income countries during pandemic.

Objective. To describe features of nutritional interventions implemented in Small Island Developing States (SIDS) in the past 20 years. Methods. A rapid scoping review was conducted by searching PubMed and Web of Science databases for interventions conducted in SIDS that sought to improve the nutrition of their populations between 2000 and 2019 inclusive. The Noncommunicable diseases progress monitor 2020 was also examined to assess nutritional policies in SIDS. Results. A total of 174 interventions were implemented in 49 of the 58 SIDS. The greatest proportion were conducted in the Caribbean (75 interventions; 43%), with the Pacific region, and the Atlantic, Indian Ocean, Mediterranean and South China Sea region each implementing about 30% of interventions. Using the NOURISHING framework, most interventions (67%) were implemented at the community and national or policy level, using multiple components of the framework. The greatest proportion of interventions (35%) were educational and awareness raising. Restrictions on physical availability of and increased taxation on alcohol were the most commonly reported policies that were partially or fully achieved; restrictions on fats were the least commonly reported. These findings were generally consistent across the SIDS regions. Conclusions. There is a paucity of nutritional policies in SIDS; the reasons may be linked to their social, economic, and environmental vulnerabilities. Interventions should be expanded beyond education to encompass multiple components of the NOURISHING framework, with multisectoral inclusion to ensure stronger stakeholder collaboration and buy-in. A systematic review is warranted using a fuller range of sources to assess the effectiveness of interventions.

This study aims to assess coronavirus disease 2019 (COVID-19) surveillance methods, health resources, vaccination coverage and income stratification and quantify burdens of disease and death in children and adolescents in the Caribbean. The investigation was a descriptive, cross-sectional study that included 15 Caribbean countries/territories and utilized surveys and secondary data sources. Quarantine and isolation measures were robust and surveillance strategies were similar. Pediatric specialists were available across the region, but few had designated pediatric hospitals or high-dependency units. There were more cases in children on islands with larger populations. Compared to high-income countries/territories, upper and lower middle-income countries/territories had higher disease burdens, fewer doctors and nurses per 1 000 population, lower bed capacities, and lower vaccination coverage. Child and adolescent cases ranged from 0.60% to 16.9%, compared with a global case rate of 20.2% in 2021. By August 2021 there were 33 deaths among children from Haiti, Jamaica, Trinidad and Tobago, and Barbados. The respective case fatality rates for 09-year-olds and 1019-year-olds were 2.80 and 0.70 in Haiti, 0.10 and 0.20 in Jamaica, and 0.00 and 0.14 in Trinidad, compared with 0.17 and 0.1 globally. Overall COVID-19 incidence and mortality in children were consistent with global estimates. Limited resources have been offset by availability of pediatricians across the region, and minimally direct effects on children. Prioritization of admission of specific at-risk groups, training of first responders and vaccination campaigns targeting pregnant women and vulnerable children and adolescents could benefit countries with low vaccine coverage rates and limited resources.

Abstract Background and Aims Hepatitis C (HCV) programs face challenges, especially linked to key populations to achieve World Health Organization (WHO) goals of eliminating hepatitis. Médecins Sans Frontières and Mozambique's Ministry of Health first implemented HCV treatment in Maputo, in 2016 and harm reduction activities in 2017. Methods We retrospectively analyzed routine data of patients enrolled between December 2016 and July 2021. Genotyping was systematically requested up to 2018 and subsequently in cases of treatment failure. Sustainable virological response was assessed 12 weeks after the end of treatment by sofosbuvir‐daclatasvir or sofosbuvir‐velpatasvir. Results Two hundred and two patients were enrolled, with 159 (78.71%) males (median age: 41 years [interquartile range (IQR): 37.10, 47.00]). Risk factors included drug use (142/202; 70.29%). One hundred and eleven genotyping results indicated genotype 1 predominant (87/111; 78.37%). Sixteen patients presented genotype 4, with various subtypes. The people who used drugs and HIV coinfected patients were found more likely to present a genotype 1. Intention‐to‐treat analysis showed 68.99% (89/129) cure rate among the patients initiated and per‐protocol analysis, 88.12% (89/101) cure rate. Nineteen patients received treatment integrated with opioid substitution therapy, with a 100% cure rate versus 59.37% (38/64) for initiated ones without substitution therapy (p

Inflammatory bowel disease (IBD), once considered a disease of the Western hemisphere, has emerged as a global disease. As the disease prevalence is on a steady rise, management of IBD has come under the spotlight. 5-Aminosalicylates, corticosteroids, immunosuppressive agents and biologics are the backbone of treatment of IBD. With the advent of biologics and small molecules, the need for surgery and hospitalization has decreased. However, economic viability and acceptability is an important determinant of local prescription patterns. Nearly one-third of the patients in West receive biologics as the first/initial therapy. The scenario is different in developing countries where biologics are used only in a small proportion of patients with IBD. Increased risk of reactivation of tuberculosis and high cost of the therapy are limitations to their use. Thiopurines hence become critical for optimal management of patients with IBD in these regions. However, approximately one-third of patients are intolerant or develop adverse effects with their use. This has led to suboptimal use of thiopurines in clinical practice. This review article discusses the clinical aspects of thiopurine use in patients with IBD with the aim of optimizing their use to full therapeutic potential.

Food knowledge (FK) is one of the factors that contribute to malnutrition conditions in developing countries, together with food safety, food security and food access. FK is defined as ‘the competence to understand healthy nutrition concepts’; it impacts individuals’ life due to its relationship with food behaviour and eating habits. Therefore, acting on FK can represent a starting point for improving the health status of vulnerable populations. The authors present a total score of an FK questionnaire (FKQ) and its relation to the socio-demographic characteristics of a specific target population: Tanzanian women of childbearing age. The results of the manuscript complement evidence of construct validity of the FKQ by providing an algorithm to compute a total score as a measure of FK. The strength of this tool, and its score, lies in the fact that the questionnaire has been validated and is easy to administer.

Abstract Bronchial dilatation is a potentially serious and irreversible clinical and radiological entity. It is an often underdiagnosed condition, particularly in developing countries. This clinical image presents bronchial dilatations of casual discovery associated with radiographic images suggestive of progressive pulmonary tuberculosis. Thoracic imaging remains crucial in the diagnosis of bronchopulmonary diseases.

Introduction: The study aimed to assess the impact of a modified paediatric basic life support (BLS) training on paediatric nurses' knowledge and skills in the main tertiary level public hospital in Rwanda. Methods: A prospective, before-and-after educational intervention study was performed. Nurses working in the paediatric department at Centre Hospitalier Universitaire de Kigali (CHUK) were enrolled after consenting to the study. A modified BLS training was administered using didactic lectures, videos, case discussions, and simulations. Knowledge and skills were assessed before, immediately and six months after the training, using the American Heart Association (AHA) multiple-choice questions test and simulation scenarios. Ethical approval from the hospital's investigational review board was obtained before the start of the study. Results: Fifty-seven nurses working in paediatric department were included in the study, most with advanced nursing degrees. At baseline, only 3.5% scored above 80% on the knowledge test and none were able to perform high-quality one-rescuer CPR. Knowledge and high-quality one-rescuer CPR skills improved significantly immediately after the training, with 63.2% scoring above 80% and 63.2% capable of performing high-quality one-rescuer CPR (p

Electronic medical records (EMR) are extensively used in developed countries to manage patient records and facilitate consultations and follow-up of treatment. This has resulted in centralised databases where different services and clinicians can quickly access patient data to support healthcare delivery. However, adoption and usage of EMR in developing countries is not common and, in most cases, non-existent. Clinicians are dependent on patients keeping their own records manually with no centralised database to manage and control the patient medical history. The key objective of this study was to investigate the propensity of clinicians and senior management personnel in healthcare facilities to adopt EMR and evaluate the contextual factors that impact or impede adoption. Using Davis's technology adoption model extended with other factors, this study determined if contextual or situational factors are associated with barriers that impede adoption of EMRs in developing countries. Using a cross-sectional quantitative research approach, a questionnaire was designed to collect data across four states in the Niger Delta region of Nigeria. Stratified random sampling was used to select healthcare facilities that participated in the survey and selection of respondents from each healthcare facility. Data was collected by trained research assistants and a total of 1,177 valid responses were received and analysed using factor analysis and multiple regression analysis. The results from the analysis show that usefulness, critical success factors, awareness and relative advantage significantly influence clinicians' intention to adopt EMRs. Surprisingly, infrastructure availability was not statistically significant. Meanwhile, risk and data security both negatively influence adoption, indicating that user perception of risk and safety of their data decreases their propensity to adopt EMRs. The results from this study suggests that usefulness and anticipated success factors in facilitating operations within healthcare facilities have a great influence on user adoption of EMRs. Awareness, training and education of users on the effectiveness of EMRs and their usefulness will increase adoption. The results will be beneficial in helping government and healthcare leaders formulate policies that will guide and support adoption of EMR. Other policy recommendations and suggestions for future research were also proffered.

Objectives Given the importance of social determinants of health in promoting the health of slum residents, this study was conducted with the aim of identifying the main dimensions and components of these determinants. Methods This scoping review study was conducted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A comprehensive search was performed of PubMed, ProQuest, Scopus, and Web of Science for articles conducted from 2010 to the end of 2019. Studies were selected based on inclusion criteria, with a special focus on studies dealing with the social determinants of physical and mental health or illness. Results Thirty-three articles were selected to extract information on the social determinants of health. After reviewing the articles, 7 main dimensions (housing, socioeconomic status of the family, nutrition, neighborhood characteristics, social support and social capital, occupational factors, and health behaviors) and 87 components were extracted as social determinants of health among slum dwellers. Conclusions This framework could be used by planners, managers, and policy-makers when making decisions affecting the health of these settlements’ residents due to the common characteristics of slums around the world, especially in developing countries.

Background: Whilst the literature on the complementarity and substitutability of foreign direct investment (FDI) on domestic investment (DI) is not uncommon, the facet of food manufacturing is non-existent. This paper fills this void by investigating the effect of FDI on DI in the food manufacturing sector for developing, economies in transition and developed countries. Methods: Using an unbalanced panel data of 49 countries from 1993 to 2016, from FAOSTAT, estimated by the system generalised method of moments (GMM), the Wald statistics for the short and long-run effects of FDI on DI were computed for the development groups. Results: Developed economies experienced a crowd-out effect of FDI on DI in the short run, whilst the others experienced no significant effect. In the case of the long run, the food manufacturing sectors of all three development groups exhibited a crowd-out effect. The effect in the long run for all development groups together is a crowd-in. Analysing all country groups together could mask the results of the various country groups. Conclusions: A review of investment policies to prioritise FDI entry mode that favour domestic investment is needed. Improvement of the investment regulatory and administrative efficiency among others are recommended.

By the beginning of the twenty-first century, the trend of digitalization has been widely appreciated. At first, digitalization became famous for social networks (e.g., Facebook, Twitter etc.), professional networks (e.g., LinkedIn, ResearchGate etc.), online banking, cryptocurrencies (e.g., Bitcoin etc.), education (e.g., Coursera etc.), and dating (e.g., Tinder etc.). Digitalization has been widely accepted by governments for state businesses. International chambers of commerce and multinational companies are utilizing digital means to access new markets and to operate and expand their businesses. A revolutionary shift in digitalization occurred in famous start-ups, such as Uber and Airbnb etc. The current COVID-19 pandemic has promoted digitalization on a mass scale, when social distancing has become a primary infection prevention measure (Qian and Jiang, 2020). Europe and the United States (US) have been points of origin for digital products, later extending to China, India, and the rest of the world. Digitalization has been a good management practice for developed economies but a challenge for developing countries. Usually, developing countries develop digitalization from foreign aid because of a lack of local funding and economic instability. Dependence on foreign aid usually limits independent policymaking because of the funding agency’s interests. In this editorial, we present digitalization in Pakistan as an example of sustainability challenges faced by developing countries.

Background: Standardised neonatal referral forms (NRFs) facilitate effective communication between healthcare providers and ensure continuity of care between facilities, which are essential for patient safety. We sought to determine the essential data items, or core clinical information (CCI), that should be conveyed for neonatal inter-hospital transfer in resource-limited settings (Rounds 1 to 3) and to create an NRF suitable for our setting (Round 4). Methods: We conducted an international, four-round, modified Delphi-consensus study. Round-1 was a literature and internet search to identify existing NRFs. In Round-2 and -3, participants were Rwandan clinicians and international paediatric healthcare practitioners who had worked in Rwanda in the five years before the study. These participants evaluated the draft items and proposed additional items to be included in an NRF. Round-4 focused on creating the NRF and used five focus groups of Rwandan general practitioners at district hospitals. Results: We identified 16 pre-existing NRFs containing 125 individual items. Of these, 91 items met the pre-defined consensus criteria for inclusion in Round-2. Only 33 items were present in more than 50% of the 16 NRFs, confirming the need for this consensus study. In Round-2, participants proposed 12 new items, six of which met the pre-defined consensus criteria. In Round-3, participants scored items for importance, and 57 items met the final consensus criteria. In Round-4, 29 general practitioners took part in five focus groups; a total of 16 modifications were utilised to finalise the NRF. Conclusions: We generated a novel, robust, NRF that may be readily employed in resource-limited settings to communicate the essential clinical information to accompany a neonate requiring inter-hospital transfer.

Objective. To describe the needs of academic staff conducting non-communicable disease (NCD) research at the University of the West Indies, Mona Campus in Jamaica. Methods. Utilizing a cross-sectional design an online survey was created using the research electronic data capture application (REDCap); it was disseminated via email to 708 academic staff members in the Faculties of Medical Sciences and Science & Technology between September and November 2018. Participants were asked to indicate their level of access to expertise, training and equipment for conducting research. Descriptive analysis was conducted using STATA version 14. Results. Most respondents were women (74.2%), predominantly scientists (33.1%) or specialist physicians (22.6%). Less than 2/3 of respondents reported publishing research findings in peer reviewed journals, with a quarter not disseminating their research findings in any medium. Resources for field research/data collection, epidemiological methods and principles, and data management/data analysis were generally available. However, there was limited access to training, expertise and equipment in emerging techniques for NCD research such as metabolomics, bioinformatics/analysis of large-scale data sets and health economics. Additional challenges included limited access to financing for research, inadequate workspace and poor administrative support for conducting research. Conclusions. There is a need for more local research seed funding, stronger administrative support for researchers, and opportunities for training in cutting edge NCD research techniques. Jamaican researchers could benefit from being part of a regional research centre of excellence with critical research skills and equipment that builds research networks and strengthens the NCD research response.

Introduction: Gastric acidity plays an important role in the protection of infants against various pathogens from the environment. The histamine-2 receptor blockers (H2-blockers) are off-labeled drugs that are frequently prescribed in preterm neonates to prevent stress ulcers. The impact of the H2-blockers on the development of the necrotizing enterocolitis (NEC) in preterm infants is still controversial, particularly in the developing world. Materials and Methods: One hundred twenty-two preterm infants were enrolled in the study. The multivariate logistic regression model was used to identify potential postnatal risk factors associated with NEC. Results: Preterm infants (n = 51) with total NEC, medical NEC, and surgical NEC had the highest rate of receiving ranitidine compared with controls (n = 71) (39.2%, 19.6%, and 47.6%, p < 0.05). Logistic regression analysis revealed that ranitidine use and nosocomial infections were significantly associated with NEC development (odds ratios 1.55 and 3.3). Conclusions: We confirm that ranitidine administration was associated with an increased risk of NEC in preterm infants. H2-blockers use should be only administered in very strictly selected cases after careful consideration of the risk-benefit ratio.

While transfusion of blood and blood products is instinctively linked to the provision of emergent care, blood and blood products are also routinely used for the treatment of subacute and chronic conditions. Despite the efforts of the World Health Organization and others, developing countries are faced with a three-part problem when it comes to access to and delivery of transfusions: insufficient supply, excessive demand, and inadequate quality of available supply. Developing countries rely heavily on replacement and remunerated donors rather than voluntary nonremunerated donors due to concerns regarding donation- and transfusion-transmitted infection as well as local and cultural beliefs. While increased awareness of HIV and improved testing techniques have jointly reduced infection-related apprehensions and improved the quality of available blood and blood products, continued efforts are warranted to bolster testing for other bloodborne pathogens. Similarly, although prevalence rates of anemia are high in some areas of the world, success in adequate widespread management of these conditions has been limited. One of the keys to expanding access to high-quality blood and blood products is thus to improve medical management of conditions that would otherwise require transfusion. Through a three-pronged approach to address quantity, quality, and demand, developing countries can enable themselves to build toward self-sufficient blood management services and increased independence from the support of international organizations.