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Background: Ensuring full coverage of childhood vaccination programmes is a persistent challenge in low- and middle-income countries. Urgent action is required to ensure catch up of missed immunisations in children, while simultaneously building trust and demand within communities to sustainably address existing immunization gaps. This paper summarizes the findings of a process evaluation of the 'Let's talk about vaccines' approach by VillageReach in Mozambique and Malawi. The approach used community-based participatory research to identify the barriers to childhood vaccination faced by caregivers and healthcare workers, with human-centered design to codesign potential interventions to improve under two immunization access and uptake. Methods: To evaluate the implementation of the 'Let's talk about vaccines' approach we conducted a qualitative process evaluation guided by the Reach Effectiveness Adoption Implementation Maintenance framework and Consolidated Framework for Implementation Research (CFIR). We completed a total of 76 qualitative interviews and 85 self-administered surveys among caregivers, healthcare workers, health officials and other stakeholders involved in the approach. We transcribed the interviews verbatim and analysed them using thematic analysis and constructs of the RE-AIM and CFIR frameworks. We analysed the survey results in Excel. Results: Key elements of the approach contributing to high fidelity to community-based participatory research principles in both countries, included diverse collaborative study and project teams, involvement of eight caregiver researchers, novel and traditional participatory methods, and extensive mobilization efforts. Success factors for human-centered design in the ideation and prototyping phase included fostering equal participation and empathy, value placed on each participant's input, mitigating inherent power differences, interactive feedback processes, and extensive iterative processes leading to tangible solutions. Challenges included adjusting to new methods and contextual realities. Factors influencing the potential adoption of the approach included locally developed solutions, participant involvement, collaboration, a major advantage over alternative approaches, ease of use of the co-created interventions, alignment with government objectives, and adaptability for system-wide integration into immunization programming. The potential sustainability of the approach was supported by the involvement of health ministries, health professionals, community representatives, and capacity building of local structures. However, resource and incentive constraints posed as a potential challenge to maintaining long-term motivation and action. Conclusion: The evaluation findings from the 'Let's talk about vaccines' approach highlighted key elements for applying community-based participatory research and human-centered design to collaboratively identify immunization barriers and create tangible solutions to overcome them. By integrating these approaches into routine immunization programs, it can potentially improve vaccination efforts for children under two in low and middle-income countries, leading to lasting change. Supporting policies that prioritize community involvement in research, program design and implementation and sustainable funding enhances immunization strategies, ensuring that they are tailored to local needs. Plain English Summary: Childhood vaccinations are important for protecting children worldwide from serious diseases such as measles, diphtheria, and tetanus. However, many children have missed out on important vaccines because of several challenges, especially in low- and middle-income countries. Our evaluation focuses on understanding how participatory activities (community-based participatory research and human-centered design) conducted by VillageReach in several communities in both Mozambique and Malawi included communities in identifying challenges faced in immunizing children under two and developing solutions with caregivers, health providers, and other relevant individuals involved in immunization planning. We interviewed these participants, exploring how the activities were carried out. Soon after the workshops, we asked participants to fill out questionnaires to get immediate feedback. The evaluation results showed what works well in the approach, what challenges exist, as well as what can help and hinder the successful use of these participatory activities. By closely following community-based participatory research and human-centered design, the approach was implemented with success. In this paper, we share lessons from the approach that can help improve participation in childhood immunization efforts in similar communities, aiming to close the gap and reach more children with necessary vaccines. [ABSTRACT FROM AUTHOR] more...

Background: Workplace violence (WPV) is an entity that cuts across all work settings with a high prevalence in the health sector particularly in low and middle-income countries where conditions of care and service are poor. Aim: To determine the prevalence, types and factors associated with violence against healthcare workers in Federal Medical Centre Asaba and to identify the strategies to mitigate its occurrence. Materials and methods: A cross-sectional study was conducted between 1st April and 30th September 2023 amongst 200 consenting clinical health care workers at the Federal Medical Centre Asaba using semi-structured, self-administered questionnaires with 194 correctly filled forms retrieved from the study participants. Data were analyzed using SPSS 25 with a p-value < 0.05 considered significant. Results: The prevalence of WPV in this study was 88.1%. The predominant type of violence experienced was verbal (76.8%) followed by physical assault (12.9%). Patient relatives were the most common perpetrators of WPV experienced. Long waiting periods, unavailability of medical supplies, unexpected death or deterioration of patient's health and shortage of staff were the commonest identifiable risk factors for WPV by the respondents. Conclusion: The prevalence of workplace violence in this study was unacceptably high. There is a need for relevant stakeholders to put in place pragmatic strategies to mitigate this ugly trend as the safety of healthcare workers is vital to the efficient functioning of health systems. [ABSTRACT FROM AUTHOR] more...

Background: Improving the quality of intrapartum and immediate postnatal care is critical for reducing maternal and neonatal mortality in low- and middle-income countries (LMICs). This review aimed to assess the extent of Person-Centred Maternity Care (PCMC) practices during childbirth in LMICs. Methods: We retrieved studies from four databases, including PubMed/Medline, Embase, CINAHL, and Maternal and Infant Care, up to 30 May 2023 and updated 26 April 2024. Additionally, manual searching was performed to identify additional studies. Our study included studies that examined PCMC using PCMC scale. The included studies were assessed using the Joanna Briggs Institute (JBI) checklist for quality appraisal. Findings: Twelve articles out of 888 were retained in the review. Among these, nine studies specifically examined various elements of PCMC, such as dignity and respect, communication and autonomy, and supportive care. The lowest and highest levels of the mean (± SD-standard deviation) PCMC were 46.5 (6.9) and 60.2 (12.3) out of 90 total scores in Ghana and urban Kenya, respectively. The lowest score was reported in the communication and autonomy subscale domain of PCMC at a mean (± SD) score of 8.3 (3.3). Women who were wealthier and educated, and those who received ANC and birthing care by the same health care providers were found to have a higher level of PCMC during childbirth. Whereas those women who did not have ANC follow-up, visited health facilities for ANC in the second or third trimester, stayed at health facilities after birth for 2–7 days, had complications, and received care from auxiliary midwives, nurses, or assisted by unskillled attendants were associated with a lower level of PCMC during childbirth. Conclusions: Our findings indicated that the communication and autonomy components of PCMC are notably low, affecting the rapport between healthcare providers and women, as well as decision-making and the execution of procedures. To enhance PCMC, continuity of care through antenatal and intrapartum care provided by the same healthcare providers, along with fostering a supportive environment for both women and healthcare providers during childbirth is imperative. PROSPERO ID: CRD42023426638. [ABSTRACT FROM AUTHOR] more...

Background: There are limited studies of juvenile dermatomyositis (JDM) in low and middle-income countries (LMIC). Many demonstrate delays to care, high prevalence of severe manifestations, and high mortality. Given the disease-associated damage with JDM, understanding JDM in Africa further is critical. Our objectives are to understand the burden of JDM in Africa and provider access to diagnostic tools and therapy through survey methodology. Methods: A survey (available in English and French) was distributed via WhatsApp to 363 total members of the African League of Associations for Rheumatology (AFLAR; n = 233) and Paediatric Society of the African League Against Rheumatism (PAFLAR; n = 130) from November 2022-January 2023. Topics included respondent specialty, number of JDM patients followed, severe manifestations, and available diagnostic tools and medications (with and without considering cost). Results: Forty-three (12%) of the 363 providers who received the survey started it. Among the 43 who started the survey, 37 (86%) provided consent and manage JDM patients; of these 37 providers, 4 (11%) partially and 16 (43%) fully completed the survey. Most were adult and/or pediatric rheumatologists (n = 19; 95%). Respondents represented all 5 African regions and described 216 children with JDM within the last 10 years. There was high prevalence of calcinosis (as high as 100%) and interstitial lung disease (ILD) (as high as 32%); mortality rates in Kenya (6/42; 14%) and Zambia (2/7; 29%) exceeded the 1–3% mortality reported in studies of high-income countries. Thirteen of 27 diagnostic tools and medications were accessible to ≤ 50% of respondents after considering cost, mostly in Northern or Southern Africa (9/13; 69%). Despite being cost-free, disease assessment tools and physical exam to assess calcinosis were not reported as universally available or accessible. Conclusions: This is the first study to explore experiences of providers caring for children with JDM in Africa. Respondents identified 216 children with JDM seen within the last 10 years, exceeding the 196 children with JDM reported within the last 25 years but likely still underestimating prevalence. Our findings align with reports of severe manifestations and poor outcomes in African children with JDM. Access to many diagnostics and medications is limited, and differences in accessibility parallel regional healthcare disparities. The potential differences in JDM severity warrant systematic study and highlight the need to include patients and providers from LMIC in collaborative research efforts. [ABSTRACT FROM AUTHOR] more...

Objective: The aim of the present study was to identify the risk factors for severe maternal outcomes (SMO) of women with suspected or confirmed infections using the data from the WHO global maternal sepsis study (GLOSS). Methods: We conducted a secondary analysis of the GLOSS cohort study, which involved pregnant or recently pregnant women with suspected or confirmed infection around 713 health facilities in 52 low‐ and middle‐income countries, and high‐income countries. A nested case–control study was conducted within the GLOSS cohort. Cases included infection‐related maternal deaths or near misses, while controls represented non‐SMO. Logistic mixed models, adjusting for country variations, were employed. Using univariate analysis, we calculated crude odds ratios (crude OR) and their 95% confidence interval (95% CI). Variables were identified with less than 16% missing data, and P values less than 0.20 were used to perform the multivariate logistic model multilevel. Results: A total of 2558 women were included in the analysis. As for the cases, 134 patients were found in the pregnant in labor or not in labor group and 246 patients in the postpartum or postabortion group. Pregnant women with prior childbirths faced a 64% increased risk of SMO. Ante‐ or intrapartum hemorrhage increased risk by 4.45 times, while trauma during pregnancy increased it by 4.81 times. Pre‐existing medical conditions elevated risk five‐fold, while hospital‐acquired infections increased it by 53%. Secondary infections raised risk six‐fold. Postpartum/postabortion women with prior childbirths had a 45% elevated risk, and pre‐existing medical conditions raised it by 2.84 times. Hospital‐acquired infections increased risk by 93%. Postpartum hemorrhage increased risk approximately five‐fold, while abortion‐related bleeding doubled it. Previous cesarean, abortion, and stillbirth also elevated risk. Conclusions: Key risk factors for SMO include prior childbirths, hemorrhage, trauma, pre‐existing conditions, and hospital‐acquired or secondary infections. Implementing effective alert systems and targeted interventions is essential to mitigate these risks and improve maternal health outcomes, especially in resource‐limited settings. SYNOPSIS: Accurate detection of risk factors for SMO in infected pregnant women can enhance early warning systems and improve maternal health outcomes in LMICs. [ABSTRACT FROM AUTHOR] more...

Abstract Background Ensuring full coverage of childhood vaccination programmes is a persistent challenge in low- and middle-income countries. Urgent action is required to ensure catch up of missed immunisations in children, while simultaneously building trust and demand within communities to sustainably address existing immunization gaps. This paper summarizes the findings of a process evaluation of the ‘Let’s talk about vaccines’ approach by VillageReach in Mozambique and Malawi. The approach used community-based participatory research to identify the barriers to childhood vaccination faced by caregivers and healthcare workers, with human-centered design to codesign potential interventions to improve under two immunization access and uptake. Methods To evaluate the implementation of the ‘Let’s talk about vaccines’ approach we conducted a qualitative process evaluation guided by the Reach Effectiveness Adoption Implementation Maintenance framework and Consolidated Framework for Implementation Research (CFIR). We completed a total of 76 qualitative interviews and 85 self-administered surveys among caregivers, healthcare workers, health officials and other stakeholders involved in the approach. We transcribed the interviews verbatim and analysed them using thematic analysis and constructs of the RE-AIM and CFIR frameworks. We analysed the survey results in Excel. Results Key elements of the approach contributing to high fidelity to community-based participatory research principles in both countries, included diverse collaborative study and project teams, involvement of eight caregiver researchers, novel and traditional participatory methods, and extensive mobilization efforts. Success factors for human-centered design in the ideation and prototyping phase included fostering equal participation and empathy, value placed on each participant’s input, mitigating inherent power differences, interactive feedback processes, and extensive iterative processes leading to tangible solutions. Challenges included adjusting to new methods and contextual realities. Factors influencing the potential adoption of the approach included locally developed solutions, participant involvement, collaboration, a major advantage over alternative approaches, ease of use of the co-created interventions, alignment with government objectives, and adaptability for system-wide integration into immunization programming. The potential sustainability of the approach was supported by the involvement of health ministries, health professionals, community representatives, and capacity building of local structures. However, resource and incentive constraints posed as a potential challenge to maintaining long-term motivation and action. Conclusion The evaluation findings from the ‘Let’s talk about vaccines’ approach highlighted key elements for applying community-based participatory research and human-centered design to collaboratively identify immunization barriers and create tangible solutions to overcome them. By integrating these approaches into routine immunization programs, it can potentially improve vaccination efforts for children under two in low and middle-income countries, leading to lasting change. Supporting policies that prioritize community involvement in research, program design and implementation and sustainable funding enhances immunization strategies, ensuring that they are tailored to local needs. more...

Background: The significant increase in Alzheimer's disease and related dementia prevalence is a global health crisis, acutely impacting low- and lower-middle and upper-middle-income countries (LLMICs/UMICs). Objective: The objective of this study is to identify key barriers and gaps in dementia care and research in LLMICs and UMICs. Methods: We conducted an international, cross-sectional survey among clinicians and healthcare professionals (n = 249 in 34 countries) across LLMICs and UMICs, exploring patient demographics, use of clinical diagnosis, dementia evaluation, screening/evaluation tools, and care and treatment. Results: Significant disparities were found in diagnostic practices, access to assessments, and access to care. On average, clinicians in LLMICs saw more patients, had less time for evaluations, lower use of formal screening and tools, and less access to biomarkers. They were also under-resourced compared to UMICs. Conclusions: The findings provide insights for policymakers, healthcare organizations, and researchers to address the complex challenges associated with dementia care in diverse settings. Addressing these challenges requires a multipronged approach involving local, national, and international stakeholders. [ABSTRACT FROM AUTHOR] more...

To address community level need and promote equity, speech-language pathologists need to extend beyond a traditional focus on individuals with identified communication needs, to focus on community-level capacity building. This paper presents an example of innovative practice from Ghana, where a volunteer team work to share evidence-based information about speech and language development, and ways to support this, with caregivers and professionals. The team aim to provide information in relevant and accessible ways, to build capacity of families and professionals, using a range of communication channels. The paper commences with a discussion of health literacy and the role speech-language pathologists can play in building health literacy for parents of young children. It then describes the work of the team, presented as an edited interview, framed through the lens of health literacy. It shows how supporting health literacy about communication development is critical where access to clinical services is challenging. [ABSTRACT FROM AUTHOR] more...

Promoting access to mainstream schools for children with disabilities has been highlighted in national and international legislative and policy initiatives. However, children with disabilities’ access to mainstream school remains an important challenge, particularly in low and middle-income countries, such as Bangladesh. We explored barriers and facilitators in accessing education for children with disabilities through a secondary analysis of qualitative data. Results indicate that children with disabilities experience challenges in their endeavour to access education, including stigma, discrimination, inaccessible built environment, and teachers’ negative attitudes towards children with disabilities. However, support from different sources, specifically parents’ strong motivation towards their child’s education and peer support, are great facilitators for children with disabilities in accessing education. We conclude with recommendations for support for parents to advocate for the rights of their children with disabilities in mainstream schools. We also recommend that government should invest resources to make mainstream schools disability friendly. In particular, accessible classrooms and washrooms are essential to enable in-class participation of children with disabilities. Further, investment is needed for teachers’ training on teaching disabled children in mainstream schools. A collaborative approach between policymakers, teachers, professionals, and parents is imperative to achieve inclusive education. [ABSTRACT FROM AUTHOR] more...

Introduction: The prevalence of abdominal injuries in war and conflict zones, particularly in low‐ and middle‐income countries (LMICs), presents a significant healthcare challenge. These injuries, often resulting from explosive devices, firearms, and shrapnel, lead to high morbidity and mortality rates due to delayed diagnoses, inadequate medical infrastructure, and limited access to specialised care. This review aims to summarise the literature on conflict‐related abdominal injuries in LMICs, highlighting the impact of such trauma on healthcare systems and patient outcomes, and suggesting strategies for improvement. Methods: A comprehensive narrative review was conducted, focusing on studies from contemporary and historical conflict‐ridden nations. Databases such as PubMed, EMBASE, Google Scholar, the Cochrane Library, and Scopus were searched using specific keywords. Inclusion criteria encompassed various study designs and both paediatric and adult populations, with studies providing raw data prioritised. Exclusions included non‐English articles, non‐peer‐reviewed studies, and those not reporting outcomes or involving high‐income countries. Results: The review identified significant challenges in managing war‐related abdominal trauma in LMICs, including a shortage of healthcare personnel and infrastructure, socio‐political barriers, and research gaps. Clinical implications of such injuries include elevated mortality rates, with surgical and nonsurgical management outcomes varying significantly. Positive advancements in diagnostics and surgical techniques have improved survival rates, yet the need for further infrastructural and workforce enhancements remains critical. Conclusion: Abdominal trauma in conflict‐affected LMICs necessitates focused efforts to improve healthcare delivery, including targeted funding for infrastructure and equipment, development of training programs for trauma specialists, and increased humanitarian aid. Bridging research gaps and fostering collaborative efforts are essential for advancing the management of abdominal trauma and enhancing patient outcomes in these challenging environments. [ABSTRACT FROM AUTHOR] more...

Introduction: Approximately 80 % of children with cancer live in resource-limited settings where prompt access to diagnosis and treatment is challenging. Data regarding delays in diagnosis and treatment and outcomes of children with cancer in Kenya are lacking. This study aims to 1) compare the reported and expected number of children with cancer; 2) explore diagnosis, treatment, and total delays; 3) determine patient characteristics that influence delays; and 4) investigate treatment outcomes. Methods: This study combined a retrospective medical records review with a case report. Data on delays and treatment outcomes of children from Bungoma County (Kenya) who were diagnosed with cancer at a large academic hospital between 2010 and 2016 were collected. Results: Between 2010 and 2016, 92 children, an average of 13 per year, were referred from Bungoma. These 13 children constitute only 9 % of the expected 140 children developing cancer in this region. The most common diagnoses were non-Hodgkin lymphoma (17 %) and acute lymphoblastic leukemia (16 %). The median total delay was 108 (7–1731) days. The median diagnosis delay was 97 days, longer than the median treatment delay (3 days; P more...

Abstract Background Diarrheal disease is still the leading cause of morbidity and mortality in children, despite significant progress in diarrhea interventions. Zoonotic transmission is the main cause of the emergence and re-emergence of diseases. Domestic animals are often close to humans, particularly in resource-poor countries. Despite evidence of environmental contamination, there have been limited studies conducted to examine the association between domestic animal exposure and diarrheal disease in low- and middle-income countries (LMIC). Therefore, this systematic review and meta-analysis examines the association between domestic animal exposure and diarrheal disease in children under five years of age in LMIC. Methods The search strategy followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for the reporting of systematic reviews. All appropriate databases were searched to find relevant articles. Research studies were selected for review if they reported an outcome variable that measured diarrhea and exposure variables of any domestic animals. A data extraction form was used to extract information from each study. The quality of the individual articles was assessed using the Joanna Briggs Institute (JBI’s) critical appraisal tools. Publication bias was checked using a funnel plot, Egger’s regression test, and Begg’s test. The heterogeneity of studies was checked using the Galbraith plot and the I-squared test. A sensitivity analysis was conducted, and a meta-analysis was conducted using STATA 17. Results After reviewing 113 articles, 11 articles fulfilled the inclusion criteria hence considered for meta-analysis. The finding of these 11 studies revealed that study participants who had animal exposure had 1.95 higher odds of diarrhea as compared to participants who hadn’t animal exposure (OR: 1.95, 95%CI: 1.25, 2.66). Conclusions and recommendations This study reported that diarrheal disease was associated with study subjects who had domestic animal exposure. Therefore, more comprehensive research is needed on specific behaviors and interventions surrounding animal husbandry that may affect the transmission of pathogens between animals and humans; this would facilitate the design and implementation of measures to reduce animal exposure in the domestic environment. more...

Abstract 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 I2 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. more...

Abstract Background The main barriers to the broad implementation of pediatric minimally invasive surgery (MIS) are technological, technical, and epistemological barriers, as well as the rarity of certain pathologies. These issues are presumed to be more significant in low- and middle-income countries. This study aimed to identify and analyze the factors limiting the diffusion and implementation of pediatric MIS in Brazil. Methods A nationwide cross-sectional survey was conducted via an online questionnaire in Brazil from January 2022 to July 2022. The sample was taken by convenience from the population of pediatric surgeons in Brazil. A total of 187 surgeons were included. The collected data were divided into three sections to evaluate technological, technical, and epistemological limitations to pediatric MIS implementation. Results Although 85% of the participants had previous training, a lack of adequate training was identified as a significant limiting factor, particularly among those who had taken only short courses (42.3% vs. 64.3%, p = 0.033). Only 14% of the participants reported performing MIS for major pediatric procedures. With respect to intracorporeal suturing, 38.1% of the surgeons with extensive training considered it a limiting factor compared with 60.7% (p = 0.029) of those without prior training. Among those without previous training, 61% cited a lack of financial support or encouragement from their department as the reason. Additionally, 65% of the surgeons considered the lack of basic instruments a limiting factor. Although 95% of the participants agreed that simulation training is indispensable, pediatric surgery fellowship programs in Brazil do not include a standardized curriculum or mandatory training in MIS, and only 47% reported providing training space for their current fellows. Conclusion A combination of technological, technical, and epistemological barriers hinders the implementation of pediatric MIS. Despite its limitations, this study serves as a foundational guide for future analysis and overcoming the identified barriers. more...

Background: Diarrheal disease is still the leading cause of morbidity and mortality in children, despite significant progress in diarrhea interventions. Zoonotic transmission is the main cause of the emergence and re-emergence of diseases. Domestic animals are often close to humans, particularly in resource-poor countries. Despite evidence of environmental contamination, there have been limited studies conducted to examine the association between domestic animal exposure and diarrheal disease in low- and middle-income countries (LMIC). Therefore, this systematic review and meta-analysis examines the association between domestic animal exposure and diarrheal disease in children under five years of age in LMIC. Methods: The search strategy followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for the reporting of systematic reviews. All appropriate databases were searched to find relevant articles. Research studies were selected for review if they reported an outcome variable that measured diarrhea and exposure variables of any domestic animals. A data extraction form was used to extract information from each study. The quality of the individual articles was assessed using the Joanna Briggs Institute (JBI's) critical appraisal tools. Publication bias was checked using a funnel plot, Egger's regression test, and Begg's test. The heterogeneity of studies was checked using the Galbraith plot and the I-squared test. A sensitivity analysis was conducted, and a meta-analysis was conducted using STATA 17. Results: After reviewing 113 articles, 11 articles fulfilled the inclusion criteria hence considered for meta-analysis. The finding of these 11 studies revealed that study participants who had animal exposure had 1.95 higher odds of diarrhea as compared to participants who hadn't animal exposure (OR: 1.95, 95%CI: 1.25, 2.66). Conclusions and recommendations: This study reported that diarrheal disease was associated with study subjects who had domestic animal exposure. Therefore, more comprehensive research is needed on specific behaviors and interventions surrounding animal husbandry that may affect the transmission of pathogens between animals and humans; this would facilitate the design and implementation of measures to reduce animal exposure in the domestic environment. [ABSTRACT FROM AUTHOR] more...

Background. Most newly diagnosed children with cancer live in low-and middle-income countries (LMIC) where challenges in access to diagnosis and treatment cause low survival rates. Objective. To explore factors affecting delays in accessing paediatric oncology care at seven partner hospitals in LMIC (Malawi, Kenya, Tanzania and Kosovo) and one partner hospital in a high-income country (the Netherlands). Delays at community, primary/secondary and tertiary care levels are explored. Methods. Leaders of paediatric oncology un its from all eight partner hospitals were interviewed using self-administered structured questionnaires in July and August 2023. Results. Differences in diagnostics and treatment availability were observed between Dutch and LMIC settings. At the community level, all respondents acknowledged that parents' inability to recognise cancer symptoms can lead to delays. Additional factors in LMICs included financial constraints, health beliefs and traditional medicine usage. At the primary/secondary care levels, all respondents acknowledged that misdiagnosis often delays referrals for children with suspected cancer. LMIC respondents also mentioned staff shortages and lack of health insurance. At the tertiary care level, only LMIC respondents reported delays, citing limited diagnostic or treatment modalities and a shortage of experienced staff. Across all settings, diagnosis delays were longer than treatment delays, with patient delays exceeding doctor delays, as noted by seven respondents. These factors contribute to low childhood cancer survival in LMICs. Conclusion. Delays at all levels hinder prompt access to paediatric oncology care in LMICs. A multi-factorial approach is needed to assure timely access and improve survival. [ABSTRACT FROM AUTHOR] more...

Background: The main barriers to the broad implementation of pediatric minimally invasive surgery (MIS) are technological, technical, and epistemological barriers, as well as the rarity of certain pathologies. These issues are presumed to be more significant in low- and middle-income countries. This study aimed to identify and analyze the factors limiting the diffusion and implementation of pediatric MIS in Brazil. Methods: A nationwide cross-sectional survey was conducted via an online questionnaire in Brazil from January 2022 to July 2022. The sample was taken by convenience from the population of pediatric surgeons in Brazil. A total of 187 surgeons were included. The collected data were divided into three sections to evaluate technological, technical, and epistemological limitations to pediatric MIS implementation. Results: Although 85% of the participants had previous training, a lack of adequate training was identified as a significant limiting factor, particularly among those who had taken only short courses (42.3% vs. 64.3%, p = 0.033). Only 14% of the participants reported performing MIS for major pediatric procedures. With respect to intracorporeal suturing, 38.1% of the surgeons with extensive training considered it a limiting factor compared with 60.7% (p = 0.029) of those without prior training. Among those without previous training, 61% cited a lack of financial support or encouragement from their department as the reason. Additionally, 65% of the surgeons considered the lack of basic instruments a limiting factor. Although 95% of the participants agreed that simulation training is indispensable, pediatric surgery fellowship programs in Brazil do not include a standardized curriculum or mandatory training in MIS, and only 47% reported providing training space for their current fellows. Conclusion: A combination of technological, technical, and epistemological barriers hinders the implementation of pediatric MIS. Despite its limitations, this study serves as a foundational guide for future analysis and overcoming the identified barriers. [ABSTRACT FROM AUTHOR] more...

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 I2 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. [ABSTRACT FROM AUTHOR] more...

This systematic review collected evidence on the burden of non-communicable diseases (NCDs) among professional drivers and reported on the most common factors that increase the risk of NCDs in this specific population in low- and middle-income countries (LMICs). The protocol for this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO). We conducted a thorough search on PubMed/MEDLINE, EMBASE, Scopus, Global Health, Web of Science and Africa-wide information databases on 11 May 2023. We adapted the Joanna Briggs Institute (JBI) tool to assess the quality of the studies. We estimated the prevalence of hypertension, prediabetes, diabetes mellitus (DM), overweight and obesity among professional drivers using a random effect model to compute pooled and subgroup analyses. In addition, we conducted a narrative synthesis of the risk factors and recommendations presented in the included studies. Forty-one studies, including 48 414 study participants, met the criteria for inclusion. The pooled prevalence of hypertension, DM and obesity among professional drivers was 36.7% [95% confidence interval (CI): 31.8–41.6%], 15.2% (95% CI: 7.0–23.4%) and 27.2% (95% CI: 18.7–35.8%), respectively. Unsupportive environment, work stress, sedentary lifestyle, consumption of unhealthy foods and shift work were the most common modifiable risk factors reported. Our findings also show a significant burden of hypertension, DM and obesity among professional drivers in LMICs. The prevalence of DM and obesity was two- and three-fold higher than findings in general populations, respectively. Our findings indicate an urgent need for tailored interventions for different occupation-related risk factors for NCDs among professional drivers in LMICs. [ABSTRACT FROM AUTHOR] more...

As one of the key tools on the precision medicine workbench, high-throughput genetic testing has enormous promise for improving healthcare outcomes. Tunisia has made tremendous progress in acquiring and implementing the technology in the clinical context. However, current utilization does not ensure the whole range of benefits that high-throughput genomic testing provides which impedes the country's ability to move forward into the new era of precision medicine. This issue is primarily related to the current state of Tunisia's healthcare ecosystem and the sociological attributes of its population, creating numerous challenges that must be addressed. In the current review, we aimed to identify and highlight these challenges that may be prevalent in other low and middle-income countries. Essentially, they fall into three main categories that include the socio-economic landscape in Tunisia, which prevents citizens from engaging in precision medicine activities; the current settings of the healthcare system that lack or miss key components for the successful implementation of precision medicine practices; and the inability of the current infrastructure and resources to handle the various challenges related to genomic data and metadata. We also propose five pillar solutions as a framework for addressing all of these challenges, which could strengthen Tunisia's capability for effective precision medicine implementation in today's clinical environment. [ABSTRACT FROM AUTHOR] more...

Transitioning to clean cooking fuels is not only part of achieving SDG7 but also makes a significant contribution to mitigating climate change by reducing carbon emissions. Research projects and pilots across a number of countries in Africa and South Asia have been exploring the suitability and energy performance of different cooking appliances and fuels. The paper presents the first statistical analysis across these multiple datasets to determine the range of energy required to cook dishes using different technologies and fuels. The paper draws out distinctions between African and Asian dishes, notably the impact of energy-intensive dishes prepared mostly in Africa. The paper demonstrates that the standard efficiency-based approaches to comparing the performance of stoves are not appropriate to modern electric cooking devices, so a novel alternative approach based on specific energy consumption and termed energy ratios is developed. Charcoal stoves are shown to use 15 times as much energy as electric pressure cookers (EPCs) to cook African dishes, and a detailed review of how the EPC works explains why this should be. Energy ratios provide a basis for estimating carbon emission reductions associated with transitioning to modern cooking fuels and also for estimating household cooking costs. Fuel and electricity prices from studies show that the cost of cooking with an EPC can be only 20% of the cost of cooking with charcoal, which highlights the potential for modern, energy-efficient electric cooking devices to defy the conventional wisdom of the energy ladder. [ABSTRACT FROM AUTHOR] more...

Ensuring patient safety is a crucial element in providing high-quality healthcare services. Therefore, this study aimed to assess the current state of patient safety culture in healthcare settings within low- and middle-income countries. A thorough search was conducted across multiple databases, including Science Direct, Scopus, Google Scholar, EMBASE, and PubMed. Data extraction was carried out using Microsoft Excel, and statistical analysis was performed using STATA software (version 14). To evaluate publication bias, methods such as Egger's regression tests, rank tests, and forest plots were utilized. The I2 statistic was used to assess heterogeneity, followed by an overall estimated analysis. Additionally, subgroup analyses were performed based on sample size and type of healthcare. After reviewing 1,143 articles, 21 publications involving 17,782 research participants were selected. The results indicated that the prevalence of patient safety culture in healthcare facilities in low- and middle-income countries was 48.25 percent (95 percent CI: 41.26, 55.24), with an I2 value of 78.8 percent. Among the various dimensions of patient safety culture, teamwork within units received the highest score (67.8%), while non-punitive responses to errors received the lowest score (27.6%). Compared to previous studies, it can be concluded that patient safety cultures in low- and middle-income countries are lacking, underscoring the need for targeted interventions to address this issue. more...

Abstract Introduction The prevalence of abdominal injuries in war and conflict zones, particularly in low‐ and middle‐income countries (LMICs), presents a significant healthcare challenge. These injuries, often resulting from explosive devices, firearms, and shrapnel, lead to high morbidity and mortality rates due to delayed diagnoses, inadequate medical infrastructure, and limited access to specialised care. This review aims to summarise the literature on conflict‐related abdominal injuries in LMICs, highlighting the impact of such trauma on healthcare systems and patient outcomes, and suggesting strategies for improvement. Methods A comprehensive narrative review was conducted, focusing on studies from contemporary and historical conflict‐ridden nations. Databases such as PubMed, EMBASE, Google Scholar, the Cochrane Library, and Scopus were searched using specific keywords. Inclusion criteria encompassed various study designs and both paediatric and adult populations, with studies providing raw data prioritised. Exclusions included non‐English articles, non‐peer‐reviewed studies, and those not reporting outcomes or involving high‐income countries. Results The review identified significant challenges in managing war‐related abdominal trauma in LMICs, including a shortage of healthcare personnel and infrastructure, socio‐political barriers, and research gaps. Clinical implications of such injuries include elevated mortality rates, with surgical and nonsurgical management outcomes varying significantly. Positive advancements in diagnostics and surgical techniques have improved survival rates, yet the need for further infrastructural and workforce enhancements remains critical. Conclusion Abdominal trauma in conflict‐affected LMICs necessitates focused efforts to improve healthcare delivery, including targeted funding for infrastructure and equipment, development of training programs for trauma specialists, and increased humanitarian aid. Bridging research gaps and fostering collaborative efforts are essential for advancing the management of abdominal trauma and enhancing patient outcomes in these challenging environments. more...

OBJECTIVE: Many hospital accreditation programs developed for or implemented in Low and Middle-Income Countries (LMICs), including Sri Lanka, have been discontinued due to multiple factors. This study was conducted to elicit and analyse factors influencing the Sri Lankan hospital accreditation program that was initiated in 2015. DESIGN & SETTING This case study employed document reviews and 18 key informant interviews with stakeholders involved in Sri Lanka's accreditation program. Collected data were thematically analysed. MAIN OUTCOME MEASURES: Data extraction was guided by the constructs of the ACES-GLEAM Framework, which was developed based on the results of a scoping review. RESULTS: Barriers identified were frequent changes in the leadership and strategic plans, lack of awareness and competencies on accreditation among local stakeholders, and non-alignment of accreditation standards with the local health system context hampered by resource and infrastructure constraints. Enablers for program development commonly raised were the commitment of stakeholders, the availability of institutional structures for quality assurance, donor funding from the World Bank, and technical expertise and surveyor training by the Australian Council on Healthcare Standards International. CONCLUSIONS: The study identified that multiple factors contributed to the poor sustainability of the Sri Lankan accreditation program. These findings can be useful reflections and guidelines for the accreditation stakeholders to establish sustainable and effective programs in LMICs. [ABSTRACT FROM AUTHOR] more...

Over the past decade, national statistical offices in low- and middle-income countries have increasingly transitioned to computer-assisted personal interviewing and computer-assisted telephone interviewing for the implementation of household surveys. The byproducts of these types of data collection are survey paradata, which can unlock objective, module- and question-specific, actionable insights on survey respondent burden, survey costs, and interviewer effects – all of which have been understudied in low- and middle-income contexts. This study uses paradata generated by Survey Solutions, a computer-assisted personal interviewing platform used in recent national household surveys implemented by the national statistical offices of Cambodia, Ethiopia, and Tanzania. Across countries, the average household interview, based on a socioeconomic household questionnaire, ranges from 82 to 120 minutes, while the average interview with an adult household member, based on a multi-topic individual questionnaire, takes between 13 to 25 minutes. The paper further provides guidelines on the use of paradata for module-level analysis to aid in operational survey decisions, such as using interview length to estimate unit cost for budgeting purposes as well as understanding interviewer effects using a multilevel model. Our findings, particularly by module, point to where additional interviewer training, fieldwork supervision, and data quality monitoring may be needed in future surveys. [ABSTRACT FROM AUTHOR] more...

To adapt an evidence-based psychological intervention for pregnant women experiencing depressive symptoms and intimate partner violence (IPV) in rural Ethiopia. We conducted a desk review of contextual factors in Sodo, Ethiopia, followed by qualitative interviews with 16 pregnant women and 12 antenatal care (ANC) providers. We engaged stakeholders through participatory theory of change (ToC) workshops, to select the intervention and articulate a programme theory. We used "ADAPT" guidance to adapt the intervention to the context, before mapping potential harms in a "dark logic model". Brief problem-solving therapy developed for South Africa was the most contextually relevant model. We adapted the delivery format (participants prioritised confidentiality and brevity) and training and supervision (addressing IPV). Consensus long-term outcomes in our ToC were ANC providers skilled in detecting and responding to emotional difficulties and IPV, women receiving appropriate support, and emotional difficulties improving. Our dark logic model highlighted the risk of more severe IPV and mental health symptoms not being referred appropriately. Although intervention adaptation is recommended, the process is rarely reported in depth. We comprehensively describe how contextual considerations, stakeholder engagement, programme theory, and adaptation can tailor psychological interventions for the target population in a low-income, rural setting. [ABSTRACT FROM AUTHOR] more...

Background: The Global School Student Health Survey (GSHS) is being carried out by students in various countries across the globe to advance improved health programs for youth. However, in comparison to high-income countries, adolescents in low- and middle-income countries (LMICs) are generally at an early stage of understanding regarding physical activity (PA) and sedentary behavior (SB), often exhibiting low levels of PA and high levels of SB. Furthermore, there is limited evidence connecting PA and SB in school-going adolescents from LMICs. Purpose: The objective of this review was to synthesize the available evidence regarding PA and sedentary behavior among school-going adolescents in LMICs using data from the GSHS. Method: On March 18, 2023, a systematic literature search was performed across four electronic databases, namely Web of Science, PubMed, ScienceDirect, and EBSCO with n odaterestrictions. Studies were eligible if they: (1) utilization of data sourced from the Global Student-based Health Survey; (2) exploration of physical activity; (3) specific focus on adolescents; (4) conducted in low- and middle-income countries; (5) study design encompassing observational; (6) published as English journal articles. Results: Among the 29 studies included in the analysis, the majority revealed elevated levels of sedentary behavior and diminished levels of PA in low- and middle-income countries. Furthermore, notable disparities in physical engagement and sedentary behavior were noted between male and female adolescents (p < 0.001). Augmented PA among teenagers was observed to correlate with higher consumption of vegetables and fruits (AOR = 1.30; 95% CI [1.13--1.50]; p < 0.001), decreased alcohol consumption, and a reduced prevalence of loneliness and depression (aOR 1.37, 95% CI [1.18--1.59]). Conclusions: The results of this review affirm that in contrast to high-income countries, adolescents in low- and middle-income countries (LMICs) are in the early stages of comprehending physical activity, marked by low levels of PA. Physical activity and sedentary behavior in school-going adolescents from LMICs appear to be influenced by factors such as policies, cultural norms, socioeconomic conditions, as well as gender, and age. [ABSTRACT FROM AUTHOR] more...

Over the past decade, national statistical offices in low- and middle-income countries have increasingly transitioned to computer-assisted personal interviewing and computer-assisted telephone interviewing for the implementation of household surveys. The byproducts of these types of data collection are survey paradata, which can unlock objective, module- and question-specific, actionable insights on survey respondent burden, survey costs, and interviewer effects – all of which have been understudied in low- and middle-income contexts. This study uses paradata generated by Survey Solutions, a computer-assisted personal interviewing platform used in recent national household surveys implemented by the national statistical offices of Cambodia, Ethiopia, and Tanzania. Across countries, the average household interview, based on a socioeconomic household questionnaire, ranges from 82 to 120 minutes, while the average interview with an adult household member, based on a multi-topic individual questionnaire, takes between 13 to 25 minutes. The paper further provides guidelines on the use of paradata for module-level analysis to aid in operational survey decisions, such as using interview length to estimate unit cost for budgeting purposes as well as understanding interviewer effects using a multilevel model. Our findings, particularly by module, point to where additional interviewer training, fieldwork supervision, and data quality monitoring may be needed in future surveys. [ABSTRACT FROM AUTHOR] more...

The Covid-19 pandemic has highlighted the importance of health technologies to mitigate against the spread of the disease and improve care, dominantly including life-saving vaccines. But the pandemic has also highlighted that the current biopharmaceutical business model, based on the enclosure of these technologies and on the immense accumulation of capital it enables, leads to vast inequalities in healthcare particularly in low and middle-income countries. We believe that the pharmaceutical industry has a moral duty to enable and enact global solidarity through tech sharing instead of tech hoarding, but judging by current technology transfer practices we question their willingness to assume their role in organizing healthcare markets through solidaristic principles. In the absence of a voluntary adoption of solidaristic principles and practices by biopharmaceutical firms, the institutionalization of global solidarity as a fundamental organizing principle for healthcare markets is necessary to strengthen resilience and know-how globally. With this call, we add to existing conceptualizations of solidarity by (a) introducing a global level of solidarity and (b) thinking through the concept not as an abstract humanistic stance but as a concrete organizing principle for global healthcare markets. [ABSTRACT FROM AUTHOR] more...

Introduction: Malignant causes of biliary obstruction are common in low and middle-income countries (LMICs) and patients usually present late with unresectable masses. The options for endoscopic and surgical management are scarce in many LMICs. In settings with access to ultrasound and fluoroscopy, percutaneous biliary drainage (PBD) is a promising and minimally invasive option for relieving obstruction and improving the quality of life of these patients. Method: We present a case series of six patients in northwestern Nigeria with cholestatic jaundice caused by malignant biliary obstruction successfully treated by PBD. Results: In five cases, imaging revealed a locally invasive pancreatic head mass causing obstruction. One of the patients had obstruction from biopsy-proven cholangiocarcinoma. Three patients had internal biliary drainage past the obstruction and three patients had only external biliary drainage due to the severity of the obstructions. One patient with internal drainage went on to cholangioplasty and deployment of the balloon-expandable stent over the stenotic segment. All procedures were uncomplicated and patients had a gradual clearance of jaundice and resolution of pruritus. Two of the elderly patients died within six months of the procedure (one from hepatic encephalopathy and the other from stroke). The remaining four survived but were lost to follow-up by 10 months. Conclusions: PBD is a feasible and beneficial option for decompressing malignant biliary obstruction in LMICs. more...

Stroke is defined as a syndrome of rapidly developing clinical signs of focal or global disturbance of cerebral function with symptoms lasting 24 hours or longer or leading to death with no apparent cause other than of vascular origin. In the current management of stroke in developed countries, stroke units form a vital part of the care pathway. Stroke units save lives, reduce disability, mitigate against complications such as aspiration pneumonitis, facilitate early discharge home with timely interventions by a Multidisciplinary Team. Whilst the burden of stroke has decreased in high income countries, this decrease is lowest in sub-Saharan Africa. more...

Abstract Introduction Physician-brief advice has been utilized in high-income countries to promote smoking cessation among cancer patients. Empirical evidence on its effectiveness among cancer patients in low and middle-income countries (LMICs) is lacking. The gap could be due to inadequate training, and competing healthcare priorities, leading to insufficient implementation of targeted smoking cessation interventions in oncology settings. We undertook this scoping review to determine if physician-brief advice is effective in promoting smoking cessation among cancer patients in LMICs. Methods We conducted a literature search of all relevant articles across five databases: Cochrane Central Register of Controlled Trials, Cochrane Library (Tobacco Addiction Group trials), World Conference on Lung Cancer proceedings, PubMed, and Google Scholar up to November 2023, using pre-defined inclusion criteria and keywords. The study population was cancer survivors in LMICs, the intervention was smoking cessation advice by a physician in a clinic or oncology center during a consultation, and the outcome was the effect of smoking cessation programs in discontinuing smoking among cancer survivors in LMICs. Results Overall, out of every 10 cancer patients in LMICs, about seven were smokers, and one-half had received physician-brief advice for smoking cessation. Physician-brief advice was more likely to be delivered to patients with smoking-related cancer (Cohen’s d = 0.396). This means that there is a noticeable difference between patients with smoking-related cancer compared to those with cancer unrelated to smoking. Smoking cessation failure was due to the inability to cope with the symptoms of withdrawal, missed smoking cessation clinic visits, mental health disorders, limited time and resources, and minimal patient-physician contact. Conclusion There is very little literature on the frequency of use or the efficacy of physician-brief advice on smoking cessation in LMICs. The literature suggests that cancer patients in LMICs have low self-efficacy to quit smoking, and smoking cessation is rarely part of cancer care in LMICs. Physicians in LMICs should be trained to use motivational messages and good counseling techniques to improve smoking cessation among cancer patients. Policymakers should allocate the resources to implement physician-brief advice and design training programs for physicians focusing on physician-brief advice tailored to cancer patients. more...

Many critical policy decisions, from strategic investments to the allocation of humanitarian aid, rely on data about the geographic distribution of wealth and poverty. Yet many poverty maps are out of date or exist only at very coarse levels of granularity. Here we develop microestimates of the relative wealth and poverty of the populated surface of all 135 low- and middle-income countries (LMICs) at 2.4 km resolution. The estimates are built by applying machine-learning algorithms to vast and heterogeneous data from satellites, mobile phone networks, and topographic maps, as well as aggregated and deidentified connectivity data from Facebook. We train and calibrate the estimates using nationally representative household survey data from 56 LMICs and then validate their accuracy using four independent sources of household survey data from 18 countries. We also provide confidence intervals for each microestimate to facilitate responsible downstream use. These estimates are provided free for public use in the hope that they enable targeted policy response to the COVID-19 pandemic, provide the foundation for insights into the causes and consequences of economic development and growth, and promote responsible policymaking in support of sustainable development. more...

IntroductionKangaroo mother care (KMC) is among the most cost-effective and easily accessible solutions for improving the survival and wellbeing of small newborns. In this study, we examined the barriers and facilitators to continuity of KMC at home following hospital discharge in rural Uganda.MethodsWe conducted this study in five districts in east-central Uganda, within six hospitals and at the community level. We used a qualitative approach, with two phases of data collection. Phase 1 comprised in-depth interviews with mothers who practiced KMC with their babies and caretakers who supported them and key informant interviews with health workers, district health office staff, community health workers, and traditional birth attendants. We then conducted group discussions with mothers of small newborns and their caretakers. We held 65 interviews and five group discussions with 133 respondents in total and used a thematic approach to data analysis.ResultsIn hospital, mothers were sensitized and taught KMC. They were expected to continue practicing it at home with regular returns to the hospital post-discharge. However, mothers practiced KMC for a shorter time at home than in the hospital. Reasons included being overburdened with competing domestic chores that did not allow time for KMC and a lack of community follow-up support by health workers. There were increased psycho-social challenges for mothers, alongside some dangerous practices like placing plastic cans of hot water near the baby to provide warmth. Respondents suggested various ways to improve the KMC experience at home, including the development of a peer-to-peer intervention led by mothers who had successfully done KMC and community follow-up of mothers by qualified health workers and community health workers.ConclusionDespite wide acceptance of KMC by health workers, challenges to effective implementation persist. Amid the global and national push to scale up KMC, potential difficulties to its adherence post-discharge in a rural, resource-limited setting remain. This study provides insights on KMC implementation and sustainability from the perspectives of key stakeholders, highlighting the need for a holistic approach to KMC that incorporates its adaptability to community settings and contexts. more...

Abstract Background Despite advancements in acute stroke care, acute stroke patients present late for care resulting in high mortality and poor functional outcomes. This study determined the prevalence of pre-hospital delay and associated factors among adult acute stroke patients in Uganda. Methods In a hospital based, cross-sectional study, one hundred and forty-three study participants with confirmed acute stroke presenting to the emergency units of Mulago and Kiruddu national referral hospitals were enrolled. Using an interviewer-administered questionnaire, details on sociodemographics, onset of stroke, arrival at the tertiary facility, health system and clinical factors were collected. Descriptive statistics and modified Poisson regression analyses were performed to determine factors associated with prehospital delay. Results Among the 143 study participants, nearly two-thirds (79/146) had ischemic stroke while a third (59/143) had haemorrhagic stroke. The mean age was 59 years (SD 16) and 51.7% of acute stroke patients were males. Ninety one percent (130/143) presented to the emergency unit after 3 hours. The majority (124/143) reported visiting lower-level facilities prior to referral to the tertiary facility. Staying outside Kampala district (PR: 1.28 (1.22–1.34), p more...

With the rapid advancement of health delivery, there has been a renewed interest in conducting research among healthcare professionals in Nepal. However, concern is there regarding availability of funds and mechanisms of awarding. The purpose of this scoping review is to map the available evidence regarding the evolution and current status of health research funding in Nepal and to highlight gaps and areas for future research. We searched three databases for empirical papers and several gray literature. Our search, conducted between March and April 2024 yielded 76 documents of which 30 that met the selection criteria were included in the scoping review. Almost all studies identified lack of funding as a deterrent to research. We found a paucity of research focusing on the role of researchers in funding decision-making. Our findings revealed that there are 12 national and four international organizations providing funds for research. University Grant Commission is the largest funder from Nepal whereas the Research Council of Norway is the biggest international funder. There were certain barriers and facilitators for obtaining funds identified by this scoping review. Further efforts are needed to increase the amount and availability of funds in Nepal to enable high-quality research. more...

Background The Global School Student Health Survey (GSHS) is being carried out by students in various countries across the globe to advance improved health programs for youth. However, in comparison to high-income countries, adolescents in low- and middle-income countries (LMICs) are generally at an early stage of understanding regarding physical activity (PA) and sedentary behavior (SB), often exhibiting low levels of PA and high levels of SB. Furthermore, there is limited evidence connecting PA and SB in school-going adolescents from LMICs. Purpose The objective of this review was to synthesize the available evidence regarding PA and sedentary behavior among school-going adolescents in LMICs using data from the GSHS. Method On March 18, 2023, a systematic literature search was performed across four electronic databases, namely Web of Science, PubMed, ScienceDirect, and EBSCO with n odaterestrictions. Studies were eligible if they: (1) utilization of data sourced from the Global Student-based Health Survey; (2) exploration of physical activity; (3) specific focus on adolescents; (4) conducted in low- and middle-income countries; (5) study design encompassing observational; (6) published as English journal articles. Results Among the 29 studies included in the analysis, the majority revealed elevated levels of sedentary behavior and diminished levels of PA in low- and middle-income countries. Furthermore, notable disparities in physical engagement and sedentary behavior were noted between male and female adolescents (p < 0.001). Augmented PA among teenagers was observed to correlate with higher consumption of vegetables and fruits (AOR = 1.30; 95% CI [1.13–1.50]; p < 0.001), decreased alcohol consumption, and a reduced prevalence of loneliness and depression (aOR 1.37, 95% CI [1.18–1.59]). Conclusions The results of this review affirm that in contrast to high-income countries, adolescents in low- and middle-income countries (LMICs) are in the early stages of comprehending physical activity, marked by low levels of PA. Physical activity and sedentary behavior in school-going adolescents from LMICs appear to be influenced by factors such as policies, cultural norms, socioeconomic conditions, as well as gender, and age. more...

The global burden of tobacco use disproportionately affects low and middle-income countries (LMIC) where over 80% of the world’s tobacco users reside. Despite the significant health risks, smoking cessation interventions are not prioritized in LMIC. This letter-to-the-editor advocates for strengthening smoking cessation efforts in LMIC by integrating routine screening for tobacco use, physician-delivered counseling, and the treatment of tobacco-related co-morbidities into standard healthcare practices. By normalizing the discussion around smoking cessation and providing tailored interventions, healthcare providers can more effectively support smokers in quitting, ultimately improving public health outcomes and reducing the burden of tobacco-related co-morbidities. more...

Background The Exemplars in Under-5 Mortality (U5M) was a multiple cases study of how six low- and middle-income countries (LMICs), Bangladesh, Ethiopia, Nepal, Peru, Rwanda, and Senegal, implemented health system delivered evidence-based interventions (EBIs) to reduce U5M between 2000 and 2015 more effectively than others in their regions or with similar economic growth. Using implementation research, we conducted a cross-country analysis to compare decision-making pathways for how these countries chose, implemented, and adapted strategies for health system-delivered EBIs that mitigated or leveraged contextual factors to improve implementation outcomes in reducing amenable U5M. Methods The cross-country analysis was based on the hybrid mixed methods implementation research framework used to inform the country case studies. The framework included a common pathway of Exploration, Preparation, Implementation, Adaptation, and Sustainment (EPIAS). From the existing case studies, we extracted contextual factors which were barriers, facilitators, or determinants of strategic decisions; strategies to implement EBIs; and implementation outcomes including acceptability and coverage. We identified common factors and strategies shared by countries, and individual approaches used by countries reflecting differences in contextual factors and goals. Results We found the six countries implemented many of the same EBIs, often using similar strategies with adaptations to local context and disease burden. Common implementation strategies included use of data by decisionmakers to identify problems and prioritize EBIs, determine implementation strategies and their adaptation, and measure outcomes; leveraging existing primary healthcare systems; and community and stakeholder engagement. We also found common facilitators included culture of donor and partner coordination and culture and capacity of data use, while common barriers included geography and culture and beliefs. We found evidence for achieving implementation outcomes in many countries and EBIs including acceptability, coverage, equity, and sustainability. Discussion We found all six countries used a common pathway to implementation with a number of strategies common across EBIs and countries which contributed to progress, either despite contextual barriers or by leveraging facilitators. The transferable knowledge from this cross-country study can be used by other countries to more effectively implement EBIs known to reduce amenable U5M and contribute to strengthening health system delivery now and in the future. [ABSTRACT FROM AUTHOR] more...

Introduction: Physician-brief advice has been utilized in high-income countries to promote smoking cessation among cancer patients. Empirical evidence on its effectiveness among cancer patients in low and middle-income countries (LMICs) is lacking. The gap could be due to inadequate training, and competing healthcare priorities, leading to insufficient implementation of targeted smoking cessation interventions in oncology settings. We undertook this scoping review to determine if physician-brief advice is effective in promoting smoking cessation among cancer patients in LMICs. Methods: We conducted a literature search of all relevant articles across five databases: Cochrane Central Register of Controlled Trials, Cochrane Library (Tobacco Addiction Group trials), World Conference on Lung Cancer proceedings, PubMed, and Google Scholar up to November 2023, using pre-defined inclusion criteria and keywords. The study population was cancer survivors in LMICs, the intervention was smoking cessation advice by a physician in a clinic or oncology center during a consultation, and the outcome was the effect of smoking cessation programs in discontinuing smoking among cancer survivors in LMICs. Results: Overall, out of every 10 cancer patients in LMICs, about seven were smokers, and one-half had received physician-brief advice for smoking cessation. Physician-brief advice was more likely to be delivered to patients with smoking-related cancer (Cohen's d = 0.396). This means that there is a noticeable difference between patients with smoking-related cancer compared to those with cancer unrelated to smoking. Smoking cessation failure was due to the inability to cope with the symptoms of withdrawal, missed smoking cessation clinic visits, mental health disorders, limited time and resources, and minimal patient-physician contact. Conclusion: There is very little literature on the frequency of use or the efficacy of physician-brief advice on smoking cessation in LMICs. The literature suggests that cancer patients in LMICs have low self-efficacy to quit smoking, and smoking cessation is rarely part of cancer care in LMICs. Physicians in LMICs should be trained to use motivational messages and good counseling techniques to improve smoking cessation among cancer patients. Policymakers should allocate the resources to implement physician-brief advice and design training programs for physicians focusing on physician-brief advice tailored to cancer patients. [ABSTRACT FROM AUTHOR] more...

The paper presents a cross-country analysis of 25 low and lower-middle-income countries to investigate the impact of COVID-19 on educational policymaking. The study utilises variables from the Internet Inclusive Index and the Digital Skills Gap Index to explore the relationship between internet access and digital skills gaps in these countries. A descriptive and correlation analysis is conducted to understand trends and associations between the variables from data for the selected countries. The analysis shows a positive correlation between internet domains and digital skills gap scores. The paper also presents insights from low and middle-income countries to understand the challenges and responses to e-learning policy during the Pandemic. The evidence from the analysis suggests that countries with higher scores on internet domains pre-pandemic were in a better position to absorb the external shocks caused by the Pandemic. The paper's findings highlight the importance of addressing the digital divide and promoting internet inclusivity in these countries to improve their ability to adapt to external shocks and ensure continuity of learning during crises such as the COVID-19 Pandemic. [ABSTRACT FROM AUTHOR] more...

The provision of breast cancer care tends to vary substantially from one breast unit to another. To provide state-of-the-art patient-centered care to women diagnosed with breast cancer, adoption and adherence to structured treatment algorithms, protocols, and international guidelines are essential. In this review, we endeavor to audit breast cancer care at our tertiary cancer center against published EUSOMA guidelines. This was a retrospective study with an observational design. All patients who completed recommended treatment for breast diseases at our institute from January 1, 2018 to December 31, 2018 were included and evaluated. Data were retrieved from patient e-prescriptions and medical records. Analysis was performed using Microsoft Office 2010 to measure how our practices compared to EUSOMA quality indicators (QIs). Clinical assessments, imaging, and preoperative work-up of breast cancer patients met EUSOMA standards. Prognostic and predictive characterization of tumors was performed in all cases. Surgical management of invasive cancer and ductal carcinoma in situ (DCIS) was in accordance with the guidelines. Adherence to postoperative radiation and adjuvant endocrine therapy was adequate. More mastectomies were performed in patients with invasive cancers measuring <3 cm. Overtreatment was avoided in every other subgroup. Adjuvant and neoadjuvant chemotherapy and targeted adjuvant therapy were adequately utilized unlike neoadjuvant targeted therapy. Minimal attrition was noted in patient follow-up. This extensive audit has set a benchmark for future annual audits and helped highlight areas where improvement of service delivery is needed. [ABSTRACT FROM AUTHOR] more...

Abstract Background Women with advanced uterine cervical cancer suffer from a combination of moderate to severe physical, psychological, social, and spiritual distress due to their disease and are in need of palliative care to improve their quality of life. Approximately 85% of the women live in the low- and middle-income countries. Whether these women and their families access palliative care is not known. Objectives To understand the geographic accessibility, availability, financial accessibility, and acceptability of palliative care by patients with advanced cervical cancer and their families. Methods We conducted a Systematic review following PRISMA guidelines in CINAHL, Cochrane Central Register of Controlled Trials, MEDLINE, PsychINFO, PubMed and Scopus for the core concepts: palliative care, access, advanced uterine cervical cancer. Eligible articles were published in English, contained original data on experiences of patients and/or caregivers including symptoms management, and discussed available resources, communication, satisfaction, and healthcare utilization. Results Overall there was limited access to palliative care with the few available facilities located in cities, far from the rural areas where most women lived. Pervasive poverty was common with poor affordability of healthcare, travelling, accommodation, and subsistence expenses. Misconceptions and poor knowledge of the disease, cultural beliefs and attitudes, and other health system insufficiencies also presented challenges for access. Conclusion Concerted effort should be made to improve availability of palliative care facilities. Health education to address misconceptions and other cognitive barriers that limit access among cervical cancer patients and their families should be urgently undertaken in the LMICs. more...

Abstract Progress on surgical system strengthening has been slow due to a disconnect between evidence generation and the information required for effective policymaking. This systematic mapping review sought to assess critical research gaps in the field of global surgery guided by the World Health Organisation Health Systems building block framework, analysis of authorship and funding patterns, and an exploration of emerging research partnership networks. Literature was systematically mapped to identify, screen, and synthesize results of publications in the global surgery field between 2015 and March 2022. We searched four databases and included literature published in seven languages. A social network analysis determined the network attributes of research institutions and their transient relationships in shaping the global surgery research agenda. We identified 2,298 relevant studies out of 92,720 unique articles searched. Research output increased from 453 in 2015-16 to 552 in 2021-22, largely due to literature on Covid-19 impacts on surgery. Sub-Saharan Africa (792/2298) and South Asia (331/2298) were the most studied regions, although high-income countries represented a disproportionate number of first (42%) and last (43%) authors. Service delivery received the most attention, including the surgical burden and quality and safety of services, followed by capacity-building efforts in low- and middle-income countries. Critical research in economics and financing, essential infrastructure and supplies, and surgical leadership necessary to guide policy decisions at the country level were lacking. Global surgical systems remain largely under-researched. Knowledge diffusion requires an emphasis on developing sustainable research partnerships and capacity across low- and middle-income countries. A renewed focus must be given to equipping countries with tools for effective decision-making to enhance investments in high-quality surgical services. more...

Abstract Data is an essential tool for valid and reliable healthcare management. Access to high-quality data is critical to ensuring the early identification of problems, the design of appropriate interventions, and the effective implementation and evaluation of health intervention outcomes. During the COVID-19 pandemic, the need for strong information systems and the value of producing high-quality data for timely response and tracking resources and progress have been very evident across countries. The availability of and access to high-quality data at all levels of the health systems of low and middle-income countries is a challenge, which is exacerbated by multiple parallels and poorly integrated data sources, a lack of data-sharing standards and policy frameworks, their weak enforcement, and inadequate skills among those handling data. Completeness, accuracy, integrity, validity, and timeliness are challenges to data availability and use. “Big Data” is a necessity and a challenge in the current complexities of health systems. In transitioning to digital systems with proper data standards and policy frameworks for privacy protection, data literacy, ownership, and data use at all levels of the health system, skill enhancement of the staff is critical. Adequate funding for strengthening routine information systems and periodic surveys and research, and reciprocal partnerships between high-income countries and low- and middle-income countries in data generation and use, should be prioritized by the low- and middle-income countries to foster evidence-based healthcare practices. more...