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Logie CH, MacKenzie F, Malama K, Lorimer N, Lad A, Zhao M, Narasimhan M, Fahme S, Turan B, Kagunda J, Konda K, Hasham A, Perez-Brumer A. Sexual and reproductive health among forcibly displaced persons in urban environments in low and middle-income countries: scoping review findings. Reprod Health 2024; 21:51. [PMID: 38609975 PMCID: PMC11010352 DOI: 10.1186/s12978-024-01780-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Most forcibly displaced persons are hosted in low- and middle-income countries (LMIC). There is a growing urbanization of forcibly displaced persons, whereby most refugees and nearly half of internally displaced persons live in urban areas. This scoping review assesses the sexual and reproductive health (SRH) needs, outcomes, and priorities among forcibly displaced persons living in urban LMIC. METHODS Following The Joanna Briggs Institute scoping review methodology we searched eight databases for literature published between 1998 and 2023 on SRH needs among urban refugees in LMIC. SHR was operationalized as any dimension of sexual health (comprehensive sexuality education [CSE]; sexual and gender based violence [GBV]; HIV and STI prevention and control; sexual function and psychosexual counseling) and/or reproductive health (antental, intrapartum, and postnatal care; contraception; fertility care; safe abortion care). Searches included peer-reviewed and grey literature studies across quantitative, qualitative, or mixed-methods designs. FINDINGS The review included 92 studies spanning 100 countries: 55 peer-reviewed publications and 37 grey literature reports. Most peer-reviewed articles (n = 38) discussed sexual health domains including: GBV (n = 23); HIV/STI (n = 19); and CSE (n = 12). Over one-third (n = 20) discussed reproductive health, including: antenatal, intrapartum and postnatal care (n = 13); contraception (n = 13); fertility (n = 1); and safe abortion (n = 1). Eight included both reproductive and sexual health. Most grey literature (n = 29) examined GBV vulnerabilities. Themes across studies revealed social-ecological barriers to realizing optimal SRH and accessing SRH services, including factors spanning structural (e.g., livelihood loss), health institution (e.g., lack of health insurance), community (e.g., reduced social support), interpersonal (e.g., gender inequitable relationships), and intrapersonal (e.g., low literacy) levels. CONCLUSIONS This review identified displacement processes, resource insecurities, and multiple forms of stigma as factors contributing to poor SRH outcomes, as well as producing SRH access barriers for forcibly displaced individuals in urban LMIC. Findings have implications for mobilizing innovative approaches such as self-care strategies for SRH (e.g., HIV self-testing) to address these gaps. Regions such as Africa, Latin America, and the Caribbean are underrepresented in research in this review. Our findings can guide SRH providers, policymakers, and researchers to develop programming to address the diverse SRH needs of urban forcibly displaced persons in LMIC. Most forcibly displaced individuals live in low- and middle-income countries (LMICs), with a significant number residing in urban areas. This scoping review examines the sexual and reproductive health (SRH) outcomes of forcibly displaced individuals in urban LMICs. We searched eight databases for relevant literature published between 1998 and 2023. Inclusion criteria encompassed peer-reviewed articles and grey literature. SRH was defined to include various dimensions of sexual health (comprehensive sexuality education; sexual and gender-based violence; HIV/ STI prevention; sexual function, and psychosexual counseling) and reproductive health (antenatal, intrapartum, and postnatal care; contraception; fertility care; and safe abortion care). We included 90 documents (53 peer-reviewed articles, 37 grey literature reports) spanning 100 countries. Most peer-reviewed articles addressed sexual health and approximately one-third centered reproductive health. The grey literature primarily explored sexual and gender-based violence vulnerabilities. Identified SRH barriers encompassed challenges across structural (livelihood loss), health institution (lack of insurance), community (reduced social support), interpersonal (gender inequities), and individual (low literacy) levels. Findings underscore gaps in addressing SRH needs among urban refugees in LMICs specifically regarding sexual function, fertility care, and safe abortion, as well as regional knowledge gaps regarding urban refugees in Africa, Latin America, and the Caribbean. Self-care strategies for SRH (e.g., HIV self-testing, long-acting self-injectable contraception, abortion self-management) hold significant promise to address SRH barriers experienced by urban refugees and warrant further exploration with this population. Urgent research efforts are necessary to bridge these knowledge gaps and develop tailored interventions aimed at supporting urban refugees in LMICs.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada.
- Centre for Gender and Sexual Health Equity, Vancouver, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.
- United Nations University Institute for Water, Environment, and Health, Hamilton, Canada.
| | - Frannie MacKenzie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Kalonde Malama
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Nicole Lorimer
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Anoushka Lad
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Michelle Zhao
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, including the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Sasha Fahme
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Bülent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Julia Kagunda
- Elim Trust, Nairobi, Kenya
- Daystar University, Nairobi, Kenya
| | - Kelika Konda
- Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, USA
| | - Aryssa Hasham
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada
| | - Amaya Perez-Brumer
- Universidad Peruana Cayetano Heredia, Lima, Peru
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Shrestha AB, Taha AM, Siddiq A, Shrestha S, Thakur P, Chapagain S, Sharma S, Halder A, Rajak K, Shah V. Virtual and augmented reality in cardiovascular care in low and middle income country. Curr Probl Cardiol 2024; 49:102380. [PMID: 38191103 DOI: 10.1016/j.cpcardiol.2024.102380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/10/2024]
Abstract
The global health sector has witnessed an escalating integration of Virtual Reality (VR) and Augmented Reality (AR) technologies, particularly in high-income countries. The application of these cutting-edge technologies is gradually extending to Low- and Middle-Income Countries (LMICs), notably in the domain of cardiovascular care. AR and VR technologies are revolutionizing cardiovascular care by offering solutions for diagnosis, medical training, and surgical planning. AR and VR provide detailed and immersive visualizations of cardiac structures, aiding in diagnosis and intervention planning. In cardiovascular care, VR reduces patient-reported pain, eases anxiety, and accelerates post-procedural recovery. AR and VR are also valuable for life support training, creating immersive and controlled learning environments. AR and VR have the potential to significantly impact healthcare in low- and middle-income countries with enhanced accessibility and affordability. This review outlines the existing spectrum of VR and AR adoption and its burgeoning utility in the cardiovascular domain within LMICs.
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Affiliation(s)
- Abhigan Babu Shrestha
- Department of Internal medicine, M Abdur Rahim Medical College, Dinajpur, Bangladesh.
| | | | | | | | - Prince Thakur
- Nepalgunj Medical College and Research Institute, Nepalgunj, Nepal
| | | | | | - Anupam Halder
- Department of Internal Medicine, UPMC Harrisburg, PA, United States
| | - Kripa Rajak
- Department of Internal Medicine, UPMC Harrisburg, PA, United States
| | - Vaibhav Shah
- Department of Internal Medicine, Icahn School of Medicine, Mount Sinai- Elmhurst Hospital Centre, New York, United States
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Troller R, Bawa J, Baker O, Ashcroft J. First experience in laparoscopic surgery in low and middle income countries: A systematic review. World J Gastrointest Surg 2024; 16:546-553. [PMID: 38463379 PMCID: PMC10921192 DOI: 10.4240/wjgs.v16.i2.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/02/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Laparoscopic surgery has reduced morbidity and mortality rates, shorter postoperative recovery periods and lower complication rates than open surgery. It is routine practice in high-income countries and is becoming increasingly common in countries with limited resources. However, introducing laparoscopic surgery in low-and-middle-income countries (LMIC) can be expensive and requires resources, equipment, and trainers. AIM To report the challenges and benefits of introducing laparoscopic surgery in LMIC as well as to identify solutions to these challenges for countries with limited finances and resources. METHODS MEDLINE, EMBASE and Cochrane databases were searched for studies reporting first experience in laparoscopic surgery in LMIC. Included studies were published between 1996 and 2022 with full text available in English. Exclusion criteria were studies considering only open surgery, ear, nose, and throat, endoscopy, arthroscopy, hysteroscopy, cystoscopy, transplant, or bariatric surgery. RESULTS Ten studies out of 3409 screened papers, from eight LMIC were eligible for inclusion in the final analysis, totaling 2497 patients. Most reported challenges were related to costs of equipment and training programmes, equipment problems such as faulty equipment, and access to surgical kits. Training-related challenges were reliance on foreign trainers and lack of locally trained surgeons and theatre staff. The benefits of introducing laparoscopic surgery were economic and clinical, including a reduction in hospital stay, complications, and morbidity/mortality. The introduction of laparoscopic surgery also provided training opportunities for junior doctors. CONCLUSION Despite financial and technical challenges, many studies emphasise the overall benefit of introducing laparoscopic surgery in LMICs such as reduced hospital stay and the related lower cost for patients. While many of the clinical centres in LMICs have proposed practical solutions to the challenges reported, more support is critically required, in particular regarding training.
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Affiliation(s)
- Rebekka Troller
- Department of Surgery, Medway Maritime Hospital, Gillingham ME7 5NY, Kent, United Kingdom
| | - Jasmine Bawa
- Department of Surgery, University Hospital Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Olivia Baker
- Department of Surgery, University Hospital Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - James Ashcroft
- Department of Surgery, University Hospital Cambridge, Cambridge CB2 0QQ, United Kingdom
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Hood AM, Chaman A, Chen Y, Mufti S. Psychological challenges and quality of life in Pakistani parents of children living with thalassemia. J Pediatr Nurs 2024; 76:132-139. [PMID: 38401235 DOI: 10.1016/j.pedn.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE Children living with thalassemia experience psychological challenges, but despite significant psychosocial burdens, caregivers' psychological wellbeing and quality of life remain understudied, particularly in lower-and-middle-income countries. DESIGN AND METHOD The current study evaluated these relationships in 100 male and female Pakistani caregivers (23-45 years; 61% female) using Ryff's Psychological Well-Being Scale and the Singapore Caregiver Quality of Life Scale. Caregivers completed questionnaires during regularly scheduled clinic visits for their child. RESULTS We found that Pakistani caregivers in our sample generally had significantly lower (30-40 points) quality of life than a referent sample of caregivers of older adults (ps < 0.001). Self-acceptance and personal growth were consistently significant predictors across quality of life domains. Further, significant interactions were observed. Female caregivers with less self-acceptance had worse mental health and wellbeing and impact on daily life (p < .05). Male caregivers with less personal growth had worse physical health wellbeing (p < .05). CONCLUSIONS Our results demonstrate the importance of considering how distinct aspects of psychological wellbeing, rather than just the overall score, relate to the specific quality of life domains among male and female caregivers. PRACTICE IMPLICATIONS Pediatric nurses are at the frontline of service delivery for children and are in a prime position to observe caregivers who could be at high risk for psychological challenges. Given our findings, future clinical interventions should prioritize support services promoting personal growth and self-acceptance for Pakistani caregivers of children living with thalassemia.
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Affiliation(s)
- Anna M Hood
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom.
| | - Aqsa Chaman
- Department of Psychology, Government College University, Lahore, Punjab, Pakistan
| | - Yuhui Chen
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Sarah Mufti
- Department of Psychology, University of Gujrat, Punjab, Pakistan
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Sabharwal S, Leung A, Rodarte P, Singh G, Bwemelo JJ, Taylor AS, Tan J, Trott R. Peer-reviewed publications in orthopaedic surgery from lower income countries: A comparative analysis. SICOT J 2024; 10:6. [PMID: 38305681 PMCID: PMC10836199 DOI: 10.1051/sicotj/2023039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/18/2023] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Musculoskeletal (MSK) disease is a substantial global burden, especially in lower income countries. However, limited research has been published on MSK health by scholars from these countries. We aimed to study the distribution of authorships, including trends in peer-reviewed orthopaedic publications based on each author's affiliated institution's country income status. METHODS Based on a bibliometric search, 119 orthopaedic-related journals were identified using the Journal Citation Reports database. Details of all scientific articles published in these journals between 2012 and 2021 were used to study trends and association between each of the author's affiliated institution's country income status, using the World Bank Classification. RESULTS Of the 133,718 unique articles, 87.6% had at least one author affiliation from a high-income country (HIC), 7.0% from an upper-middle income country (UMIC), 5.2% from a lower-middle income country (LMIC), and 0.2% from a low-income country (LIC). Overall, these articles were cited 1,825,365 times, with 92.5% of citations from HIC-affiliated authors and < 0.1% from LIC-affiliated authors. Over the 10-year study period, HIC-affiliated articles demonstrated the largest increase in the number of publications (9107-14,619), compared to UMIC-affiliated (495-1214), LMIC-affiliated (406-874), and LIC-affiliated articles (4-28). CONCLUSIONS There are large and persistent disparities in orthopaedic research publications based on the country income status of the author's affiliated institution, especially in the higher impact orthopaedic journals. Efforts should be made to increase opportunities for scholars from LICs and LMICs to publish their research in high-impact orthopaedic journals.
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Affiliation(s)
- Sanjeev Sabharwal
- UCSF Benioff Children’s Hospital Oakland, Department of Orthopaedic Surgery 747 52nd Street Oakland CA 94609 USA
- Institute of Global Orthopaedics and Traumatology (IGOT) 2540 23rd Street, Building 7 San Francisco CA 94110 USA
| | - Andrea Leung
- UCSF Benioff Children’s Hospital Oakland, Department of Orthopaedic Surgery 747 52nd Street Oakland CA 94609 USA
| | - Patricia Rodarte
- Institute of Global Orthopaedics and Traumatology (IGOT) 2540 23rd Street, Building 7 San Francisco CA 94110 USA
| | - Gurbinder Singh
- UCSF Benioff Children’s Hospital Oakland, Department of Orthopaedic Surgery 747 52nd Street Oakland CA 94609 USA
| | | | - Annelise S. Taylor
- UCSF Benioff Children’s Hospital Oakland, Department of Orthopaedic Surgery 747 52nd Street Oakland CA 94609 USA
| | - Josephine Tan
- UCSF Benioff Children’s Hospital Oakland, Department of Orthopaedic Surgery 747 52nd Street Oakland CA 94609 USA
| | - Richard Trott
- UCSF Benioff Children’s Hospital Oakland, Department of Orthopaedic Surgery 747 52nd Street Oakland CA 94609 USA
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Kacmarek CN, Johnson NE, Osborn TL, Wasanga C, Weisz JR, Yates BT. Costs and cost-effectiveness of Shamiri, a brief, layperson-delivered intervention for Kenyan adolescents: a randomized controlled trial. BMC Health Serv Res 2023; 23:827. [PMID: 37542304 PMCID: PMC10403919 DOI: 10.1186/s12913-023-09856-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/27/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) have the highest socio-economic burden of mental health disorders, yet the fewest resources for treatment. Recently, many intervention strategies, including the use of brief, scalable interventions, have emerged as ways of reducing the mental health treatment gap in LMICs. But how do decision makers prioritize and optimize the allocation of limited resources? One approach is through the evaluation of delivery costs alongside intervention effectiveness of various types of interventions. Here, we evaluate the cost-effectiveness of Shamiri, a group- and school-based intervention for adolescent depression and anxiety that is delivered by lay providers and that teaches growth mindset, gratitude, and value affirmation. METHODS We estimated the cost-effectiveness of Shamiri using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines for economic evaluations. Changes in depression and anxiety were estimated using the Patient Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder questionnaire (GAD-7) at treatment termination and 7-month follow-up using two definitions of treatment benefit. Cost-effectiveness metrics included effectiveness-cost ratios and cost per number needed to treat. RESULTS Base case cost assumptions estimated that delivering Shamiri cost $15.17 (in 2021 U.S. dollars) per student. A sensitivity analysis, which varied cost and clinical change definitions, estimated it cost between $48.28 and $172.72 to help 1 student in Shamiri, relative to the control, achieve reliable and clinically significant change in depression and anxiety by 7-month follow-up. CONCLUSIONS Shamiri appears to be a low-cost intervention that can produce clinically meaningful reductions in depression and anxiety. Lay providers can deliver effective treatment for a fraction of the training time that is required to become a licensed mental health provider (10 days vs. multiple years), which is a strength from an economic perspective. Additionally, Shamiri produced reliable and clinically significant reductions in depression and anxiety after only four weekly sessions instead of the traditional 12-16 weekly sessions necessary for gold-standard cognitive behavioral therapy. The school setting, group format, and economic context of a LMIC influenced the cost per student; however, broader conclusions about the cost-effectiveness of Shamiri have yet to be determined due to limited economic evaluations of mental health programs in LMICs. TRIAL REGISTRATION This study was registered prior to participant enrollment in the Pan-African Clinical Trials Registry (PACTR201906525818462), registered 20 Jun 2019, https://pactr.samrc.ac.za/Search.aspx .
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Affiliation(s)
- Corinne N. Kacmarek
- Department of Psychology, American University, 4400 Massachusetts Ave NW, Washington, DC 20016 USA
| | - Natalie E. Johnson
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Totengässlein 3, 4051 Basel, Switzerland
| | - Tom L. Osborn
- Shamiri Institute, 13th Floor, Pioneer Point (CMS Africa), Chania Avenue, Nairobi, Kenya
| | - Christine Wasanga
- Department of Psychology, Kenyatta University, Box 43844, Nairobi, 00100 Kenya
| | - John R. Weisz
- Department of Psychology, Harvard University, 1030 William James Hall, 33 Kirkland Street, Cambridge, MA 02138 USA
| | - Brian T. Yates
- Department of Psychology, American University, 4400 Massachusetts Ave NW, Asbury Building Room 321, Washington, DC, 20016-8062 USA
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Ramakrishnan A, Velmurugan G, Somasundaram A, Mohanraj S, Vasudevan D, Vijayaragavan P, Nightingale P, Swaminathan K, Neuberger J. Prevalence of abnormal liver tests and liver fibrosis among rural adults in low and middle-income country: A cross-sectional study. EClinicalMedicine 2022; 51:101553. [PMID: 35860452 PMCID: PMC9289630 DOI: 10.1016/j.eclinm.2022.101553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Liver disease is the only major chronic disease and mortality is increasing. Earlier detection of liver fibrosis can reduce progression to cirrhosis and hepatocellular carcinoma. Many studies have reported an increased prevalence in liver fibrosis among adults in urban regions but there are few data in physically active rural populations without attributable metabolic risk factors. This aim of this study is to investigate the prevalence of abnormal liver functions tests (LFTs) and liver fibrosis among adults in a rural population. METHODS This cross-sectional study included observations from KMCH-NNCD-II (2017) study (n = 907) from a farming village, Nallampatti, located in South India. We assessed lifestyle (occupation, tobacco use and alcohol consumption using AUDIT-C questionnaire), markers for metabolic diseases (obesity, hypertension, diabetes, hypercholesterolemia), LFTs and markers for hepatitis viruses B and C. 901 participants had transient elastography to assess fibrosis. Participants with abnormal LFTs and significant liver fibrosis (F2-F4) underwent additional liver screening (caeruloplasmin, iron studies and autoimmune hepatitis panel). Multiple logistic regression analyses were performed to understand the association of liver fibrosis with lifestyle and metabolic risk factors after adjustment for co-variates. FINDINGS Significant liver fibrosis (F2-F4) was observed in 14.4%, and cirrhosis in 0.8%. There was an association of liver fibrosis with abnormal LFTs but no association between alcohol consumption, viral hepatitis, hepatic liver screening and liver fibrosis. Among metabolic risk factors, no association was observed for hypertension and hypercholesterolemia but diabetes [OR - 3.206 (95% CI: 1.792 - 5.736)], obesity [1.987 (1.341 - 2.944)] and metabolic syndrome [2.539 (1.680 - 3.836)] showed association with significant liver fibrosis (F2-F4) after adjustment for confounding factors. INTERPRETATION Our results suggest that the prevalence of liver fibrosis in rural population is similar to urban counterparts. The association of metabolic risk factors with liver fibrosis in physically active rural population warrants further investigations in future studies. FUNDING This study is funded by KMCH Research Foundation, India.
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Affiliation(s)
- Arulraj Ramakrishnan
- KMCH Research Foundation, Kovai Medical Center and Hospital, Coimbatore 641 014, Tamil Nadu, India
- Liver Unit, Kovai Medical Center and Hospital, Coimbatore 641 014, Tamil Nadu, India
- Corresponding author at: MRCP, Clinical Scientist & Consultant Hepatologist, KMCH Research Foundation, Liver Unit, Kovai Medical Center & Hospital, Coimbatore 641 014, Tamil Nadu, India.
| | - Ganesan Velmurugan
- KMCH Research Foundation, Kovai Medical Center and Hospital, Coimbatore 641 014, Tamil Nadu, India
| | - Aravindh Somasundaram
- Liver Unit, Kovai Medical Center and Hospital, Coimbatore 641 014, Tamil Nadu, India
| | - Sundaresan Mohanraj
- KMCH Research Foundation, Kovai Medical Center and Hospital, Coimbatore 641 014, Tamil Nadu, India
| | - Dinakaran Vasudevan
- KMCH Research Foundation, Kovai Medical Center and Hospital, Coimbatore 641 014, Tamil Nadu, India
| | - Paari Vijayaragavan
- Liver Unit, Kovai Medical Center and Hospital, Coimbatore 641 014, Tamil Nadu, India
| | - Peter Nightingale
- Statistician, University Hospital Birmingham, Birmingham, B15 2TH United Kingdom
| | - Krishnan Swaminathan
- KMCH Research Foundation, Kovai Medical Center and Hospital, Coimbatore 641 014, Tamil Nadu, India
| | - James Neuberger
- Liver Unit, University Hospital Birmingham, Birmingham, B15 2TH United Kingdom
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Ertl V, Groß M, Mwaka SO, Neuner F. Treating alcohol use disorder in the absence of specialized services - evaluation of the moving inpatient Treatment Camp approach in Uganda. BMC Psychiatry 2021; 21:601. [PMID: 34852824 PMCID: PMC8638348 DOI: 10.1186/s12888-021-03593-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/08/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The gap between service need and service provision for alcohol-related disorders is highest in resource-poor countries. However, in some of these contexts, local initiatives have developed pragmatic interventions that can be carried out with limited specialized personnel. In an uncontrolled treatment study, we aimed to evaluate the feasibility, acceptability, safety, costs and potential effects of an innovative locally developed community-based program (the Treatment Camp) that is based on an inpatient clinic that moves from community to community. METHODS Out of 32 treatment-seeking individuals 25 took part in the one-week Treatment Camp that included detoxification and counseling components. Re-assessments took place 5 and 12 months after their participation. We explored the course of a wide range of alcohol-related indicators, using the Alcohol Use Disorders Identification Test (AUDIT) as primary outcome complemented by a timeline follow-back approach and the Obsessive Compulsive Drinking Scale. Additionally, we assessed impaired functioning, alcohol-related stigmatization, symptoms of common mental health disorders and indicators of family functioning as reported by participants' wives and children. RESULTS All alcohol-related measures decreased significantly after the Treatment Camp and remained stable up to the 12-month-assessment with high effect sizes ranging from 0.89 to 3.49 (Hedges's g). Although 92% of the participants had lapsed at least once during the follow-up period, 67% classified below the usually applied AUDIT cutoff for hazardous drinking (≥ 8) and no one qualified for the dependent range (≥ 20) one year after treatment. Most secondary outcomes including impaired functioning, alcohol-related stigmatization, symptoms of depression and indicators of family functioning followed the same trajectory. CONCLUSIONS We found the Treatment Camp approach to be acceptable, feasible, safe and affordable (approx. 111 USD/patient) and we could obtain preliminary evidence of its efficacy. Due to its creative combination of inpatient treatment and monitoring by medical personnel with local mobility, the Treatment Camp appears to be more accessible and inclusive than other promising interventions for alcohol dependent individuals in resource-poor contexts. Effects of the approach seem to extend to interactions within families, including a reduction of dysfunctional and violent interactions.
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Affiliation(s)
- Verena Ertl
- Clinical Psychology and Biopsychology, Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstraße 25, 85072, Eichstätt, Germany.
- vivo international (www.vivo.org), Konstanz, Germany.
| | - Melissa Groß
- vivo international (www.vivo.org), Konstanz, Germany
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Samuel Okidi Mwaka
- Program for Prevention, Awareness, Counseling and Treatment of Alcoholism (PACTA; www.pactaguluganda.org.ug), Plot 1 Burcoro Road, Wiaworanga, Gulu, Uganda
| | - Frank Neuner
- vivo international (www.vivo.org), Konstanz, Germany
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
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Jensen SKG, Xie W, Kumar S, Haque R, Petri WA, Nelson CA. Associations of socioeconomic and other environmental factors with early brain development in Bangladeshi infants and children. Dev Cogn Neurosci 2021; 50:100981. [PMID: 34198217 PMCID: PMC8254021 DOI: 10.1016/j.dcn.2021.100981] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 06/04/2021] [Accepted: 06/17/2021] [Indexed: 01/25/2023] Open
Abstract
Research from high-income countries shows that experiences impact neural development. We examine EEG in relation to wealth and psychosocial factors in 6 and 36-month-olds from Bangladesh. Wealth and maternal stress is associated with EEG oscillations in 36-month-olds. Neither wealth nor maternal stress is associated with EEG oscillations in 6-month-olds. Environmental influences on EEG may emerge between 6 and 36 months of age.
Studies of infants growing up in high-income countries reveal developmental changes in electroencephalography (EEG) power whereby socioeconomic factors - specifically, low SES and low income - are associated with lower EEG power in infants aged newborn to nine months. In the current paper we explore relationships of spectral EEG power across three regions (frontal, central, and parietal) and four frequency bands (theta, alpha, beta, and gamma) with socioeconomic and psychosocial factors in a cohort of n = 160 6-month-old infants and n = 187 36-month-old children living in Dhaka, Bangladesh. Household wealth is assessed as a multi-dimensional composite score encompassing income, assets, and housing materials. Psychosocial factors include maternal perceived stress and family caregiving activities. Among the 6-month-old infants we do not observe any association of household wealth or psychosocial factors with EEG power. Among the 36-month-old children, we find that household wealth is negatively associated absolute power in the beta and gamma bands across frontal, central, and parietal electrodes. We also find that higher reports of maternal perceived stress are associated with more absolute theta power in frontal and central regions in the 36-month-old children. The finding of a negative relationship of household wealth with beta and gamma power in 36-month-old children differs from findings previously observed in infants in high-income countries. Overall, findings suggest that children’s environment continues to influence the development of EEG oscillations and provide support for the utility of EEG to quantify developmental effects of early life experiences on neural functional outcomes in low income countries.
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Affiliation(s)
- Sarah K G Jensen
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Boston College School of Social Work, Boston College, MA, USA
| | - Wanze Xie
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Swapna Kumar
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | | | - William A Petri
- University of Virginia, Infectious Diseases & International Health, Charlottesville, VA, USA
| | - Charles A Nelson
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Harvard Graduate School of Education, Cambridge, MA, USA.
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10
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Scott N, Win TM, Tidhar T, Htay H, Draper B, Aung PTZ, Xiao Y, Bowring A, Kuschel C, Shilton S, Kyi KP, Naing W, Aung KS, Hellard M. Hepatitis C elimination in Myanmar: Modelling the impact, cost, cost-effectiveness and economic benefits. Lancet Reg Health West Pac 2021; 10:100129. [PMID: 34327345 PMCID: PMC8315611 DOI: 10.1016/j.lanwpc.2021.100129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
Abstract
Background Myanmar has set national hepatitis C (HCV) targets to achieve 50% of people diagnosed and 50% treated by 2030. The WHO has additional targets of reducing incidence by 80% and mortality by 65% by 2030. We aimed to estimate the impact, cost, cost-effectiveness and net economic benefit of achieving these targets. Methods Mathematical models of HCV transmission, disease progression and the care cascade were calibrated to 15 administrative regions of Myanmar. Cost data were collected from a community testing and treatment program in Yangon. Three scenarios were projected for 2020-2030: (1) baseline (current levels of testing/treatment); and testing/treatment scaled up sufficiently to reach (2) the national strategy targets; and (3) the WHO targets. Findings Without treatment scale-up, 333,000 new HCV infections and 97,000 HCV-related deaths were estimated to occur in Myanmar 2020-2030, with HCV costing a total $100 million in direct costs (testing, treatment, disease management) and $10.4 billion in lost productivity. In the model, treating 55,000 people each year was sufficient to reach the national strategy targets and prevented a cumulative 40,000 new infections (12%) and 25,000 HCV-related deaths (25%) 2020-2030. This was estimated to cost a total $189 million in direct costs ($243 per DALY averted compared to no treatment scale-up), but only $9.8 billion in lost productivity, making it cost-saving from a societal perspective by 2024 with an estimated net economic benefit of $553 million by 2030. Reaching the WHO targets required further treatment scale-up and additional direct costs but resulted in greater longer-term benefits. Interpretation Current levels of HCV testing and treatment in Myanmar are insufficient to reach the national strategy targets. Scaling up HCV testing and treatment in Myanmar to reach the national strategy targets is estimated to generate significant health and economic benefits. Funding Gilead Sciences.
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Affiliation(s)
- Nick Scott
- Burnet Institute Melbourne, 85 Commercial Rd, Melbourne 3004, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, 553St Kilda Rd, Melbourne 3004, Victoria, Australia
| | - Thin Mar Win
- Burnet Institute Myanmar, Second floor, 226U Wisara Road, Wizaaya Plaza, Bahan Township, Yangon, Myanmar
| | - Tom Tidhar
- Burnet Institute Melbourne, 85 Commercial Rd, Melbourne 3004, Victoria, Australia
| | - Hla Htay
- Burnet Institute Myanmar, Second floor, 226U Wisara Road, Wizaaya Plaza, Bahan Township, Yangon, Myanmar
| | - Bridget Draper
- Burnet Institute Melbourne, 85 Commercial Rd, Melbourne 3004, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, 553St Kilda Rd, Melbourne 3004, Victoria, Australia
| | - Phyo Thu Zar Aung
- Burnet Institute Melbourne, 85 Commercial Rd, Melbourne 3004, Victoria, Australia
| | - Yinzong Xiao
- Burnet Institute Melbourne, 85 Commercial Rd, Melbourne 3004, Victoria, Australia.,University of Melbourne, Parkville 3010, Victoria, Australia
| | - Anna Bowring
- Burnet Institute Melbourne, 85 Commercial Rd, Melbourne 3004, Victoria, Australia
| | - Christian Kuschel
- Burnet Institute Melbourne, 85 Commercial Rd, Melbourne 3004, Victoria, Australia
| | - Sonjelle Shilton
- Foundation for Innovative New Diagnostics (FIND), Yangon, Myanmar
| | - Khin Pyone Kyi
- Myanmar Liver Foundation, 33-35, First Floor, Pathein Street, KyunTaw (Middle) Ward, Sanchaung Township, Yangon, Myanmar
| | - Win Naing
- Department of Hepatology, 500 bedded Specialty Hospital, University of Medicine, Yangon, Myanmar
| | - Khin Sanda Aung
- National Hepatitis Control Program, Myanmar Ministry of Health, Myanmar
| | - Margaret Hellard
- Burnet Institute Melbourne, 85 Commercial Rd, Melbourne 3004, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, 553St Kilda Rd, Melbourne 3004, Victoria, Australia.,University of Melbourne, Parkville 3010, Victoria, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne 3004, Victoria, Australia.,The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne 3000, Victoria, Australia
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11
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Stevenson AG, Tooke L, Edwards EM, Mangiza M, Horn D, Heys M, Abayneh M, Chimhuya S, Ehret DEY. The use of data in resource limited settings to improve quality of care. Semin Fetal Neonatal Med 2021; 26:101204. [PMID: 33579628 DOI: 10.1016/j.siny.2021.101204] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Quality improvement is driven by benchmarking between and within institutions over time and the collaborative improvement efforts that stem from these comparisons. Benchmarking requires systematic collection and use of standardized data. Low- and middle-income countries (LMIC) have great potential for improvements in newborn outcomes but serious obstacles to data collection, analysis, and implementation of robust improvement methodologies exist. We review the importance of data collection, internationally recommended neonatal metrics, selected methods of data collection, and reporting. The transformation from data collection to data use is illustrated by several select data system examples from LMIC. Key features include aims and measures important to neonatal team members, co-development with local providers, immediate access to data for review, and multidisciplinary team involvement. The future of neonatal care, use of data, and the trajectory to reach global neonatal improvement targets in resource-limited settings will be dependent on initiatives led by LMIC clinicians and experts.
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Affiliation(s)
| | - Lloyd Tooke
- Neonatal Department, Groote Schuur Hospital, Cape Town, South Africa.
| | - Erika M Edwards
- University of Vermont College of Engineering and Mathematical Sciences, Department of Mathematics and Statistics, USA; University of Vermont Larner College of Medicine, Department of Pediatrics, Burlington, VT, USA; Vermont Oxford Network, Burlington, VT, USA.
| | | | - Delia Horn
- University of Vermont Larner College of Medicine, Department of Pediatrics, Burlington, VT, USA.
| | - Michelle Heys
- Great Ormond Street Institute for Child Health, University College London, UK; East London NHS Foundation Trust, West Ham Lane Health Centre, London, UK.
| | - Mahlet Abayneh
- St Paul's Hospital Millennium Medical College, Addis, Ababa, Ethiopia.
| | - Simbarashe Chimhuya
- Department of Paediatrics, Faculty of Medicine and Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe.
| | - Danielle E Y Ehret
- University of Vermont Larner College of Medicine, Department of Pediatrics, Burlington, VT, USA; Vermont Oxford Network, Burlington, VT, USA.
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12
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Benavides JA, Streicker DG, Gonzales MS, Rojas-Paniagua E, Shiva C. Knowledge and use of antibiotics among low-income small-scale farmers of Peru. Prev Vet Med 2021; 189:105287. [PMID: 33677408 PMCID: PMC8636688 DOI: 10.1016/j.prevetmed.2021.105287] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/12/2021] [Accepted: 01/24/2021] [Indexed: 12/28/2022]
Abstract
The extensive use and misuse of antibiotics in the livestock sector is one of the main drivers of the emergence and spread of antimicrobial resistance. Although small-scale farms constitute most of the livestock production in low and middle-income countries, knowledge and use of antibiotics among these populations is sparse. We conducted 201 questionnaires to estimate the use and knowledge of antibiotics by small-scale farmers located in the coastal area of the Lima region of Peru. Our results show that farmers had a small number of livestock (e.g. average of 11 cows, 7 pigs and 19 chickens per farm) and 80 % earned less than minimum wage. More than half of farmers reported at least one episode of respiratory disease, diarrhea, mastitis, skin lesion or post-parturition infection in their animals during the previous year, and 40 % of these episodes were treated with antibiotics. Farmers reported using 14 different antibiotics, most commonly oxytetracycline (31 % of episodes treated with antibiotics), penicillin (21 %), gentamicin (19 %) and trimethoprim-sulfamethazine (18 %). The third-generation cephalosporin ceftiofur was occasionally used to treat mastitis. Most farmers relied on veterinarians to prescribe (95 % of respondents) and administer (59 %) antibiotics. Only half of farmers knew what micro-organisms can be treated with antibiotics and the degree of knowledge of antibiotics (based on a 5-question metric) was positively correlated with respondents’ educational level, monthly income, knowledge of the animal health authority, farm area, number of cows and knowledge of an antiparasitic drug. In contrast, knowledge of antibiotics was not correlated with respondents’ age, gender, main occupation, knowledge of a veterinarian or household size. Potential misuse of antibiotics was reported, including 21 % of framers reporting stopping the treatment when clinical signs disappear and infrequent use of antibiotics to treat parasites or animals not eating. Our study highlights poor knowledge and potential misuse of antibiotics among small-scale farmers in coastal Peru, but high reliance on veterinarians for prescription and administration. Strengthening farmers' relationships with veterinarians and improving the diagnostic capacity of the veterinary sector could result in more judicious antibiotic use on these farms.
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Affiliation(s)
- Julio A Benavides
- Departamento de Ecología y Biodiversidad, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile; Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Graham Kerr Building, Glasgow, Scotland, UK; Centro de Investigación para la Sustentabilidad, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile; Millennium Nucleus for Collaborative Research on Bacterial Resistance MICROB-R, Santiago, Chile.
| | - Daniel G Streicker
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Graham Kerr Building, Glasgow, Scotland, UK; MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Milagros S Gonzales
- Facultad de Medicina Veterinaria y Zootecnia de la Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Elizabeth Rojas-Paniagua
- Facultad de Medicina Veterinaria y Zootecnia de la Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos Shiva
- Facultad de Medicina Veterinaria y Zootecnia de la Universidad Peruana Cayetano Heredia, Lima, Peru
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13
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Zimmerman A, Halligan S, Skeen S, Morgan B, Fraser A, Fearon P, Tomlinson M. PTSD symptoms and cortisol stress reactivity in adolescence: Findings from a high adversity cohort in South Africa. Psychoneuroendocrinology 2020; 121:104846. [PMID: 32919210 DOI: 10.1016/j.psyneuen.2020.104846] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is implicated in the pathophysiology of post-traumatic stress disorder (PTSD). However, there has been little study of HPA stress reactivity in association with PTSD symptoms (PTSS) in children; and there is limited research on PTSD in low and middle-income countries, where trauma exposure is more common and co-occurring stressors more likely. METHOD We assessed the relationship between PTSS and cortisol stress reactivity in children aged 13 years (N = 291) from an impoverished South African community. HPA axis stress reactivity was indexed by salivary cortisol during the Trier Social Stress Test (TSST). RESULTS In regression analyses both trauma exposure and PTSS showed small inverse associations with total cortisol output (area under the curve with respect to ground) during the TSST, but PTSS effects did not withstand correction for covariates. In addition, hierarchical linear modelling (HLM) found that PTSS were associated with alterations in the shape of the profile of cortisol reactivity that were moderated by sex. In girls, PTSS were associated with reduced linear slope but larger quadratic slopes, whereas the opposite pattern was found in boys. Thus, elevated PTSS were associated with overall blunted profiles of cortisol stress reactivity in girls, but a larger quadratic slope in boys reflects a steeper cortisol increase and decline in boys. There was no relationship between trauma exposure (with or without PTSS) and cortisol reactivity profiles in HLM analyses. CONCLUSION In children from a high adversity, low and middle income country context, sex specific associations were found between PTSS and cortisol responses to psychosocial stress. Further research should probe HPA axis functioning more comprehensively in such populations to understand the biological associations of PTSS.
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14
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Ko Ko T, Dickson-Gomez J, Yasmeen G, Han WW, Quinn K, Beyer K, Glasman L. Informal workplaces and their comparative effects on the health of street vendors and home-based garment workers in Yangon, Myanmar: a qualitative study. BMC Public Health 2020; 20:524. [PMID: 32306950 PMCID: PMC7168952 DOI: 10.1186/s12889-020-08624-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/31/2020] [Indexed: 11/29/2022] Open
Abstract
Background Globally, two billion workers are employed informally but there is limited research on the relationship between informal work and health. Existing studies have focused on informality as an employment condition, with little emphasis on the diversity of physical and social contexts in which informal work takes place. The study considers the diversity of informal workplaces and explores the ways in which this diversity might influence health and well-being of two informal occupational groups in Yangon, the former capital of Myanmar. Methods We conducted 21 field observations and 47 semi-structured interviews with street vendors and home-based garment workers based in Yangon, Myanmar. A constant comparative method was used to identify and compare how the physical characteristics of their informal workplaces affect their health for these two informal subgroups. Results Although both street vendors and home-based garment workers work informally, their exposure to occupational health and income risks are specific to the physical features of their informal workplaces. Street vendors, who work in public spaces with minimal coverage, are more likely to experience the direct effects of outdoor pollution, inclement weather and ergonomic risks from lifting, carrying and transporting heavy merchandise while home-based garment workers, many of whom live and work in unsanitary housing and deprived neighborhoods, are more likely to experience pollution in or near their homes, and ergonomic risks from poor posture. Similarly, although both groups face safety challenges, street vendors face urban violence and abuse during their commute and at vending points whereas home-based garment workers felt unsafe in their home-based workplaces due to the presence of crime and violence in their neighborhoods. Conclusion While informal employment is universally characterized by lack of social protection, exposure to occupational health and income risks for subpopulations of informal workers is determined by the specific physical and social environments of their workplaces. Efforts to improve the health of informal workers should consider the contexts in which informal work takes place to develop tailored interventions for subpopulations of informal workers.
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Affiliation(s)
- Thant Ko Ko
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, USA.
| | - Julia Dickson-Gomez
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, USA
| | - Gisèle Yasmeen
- Institute of Asian Research, School of Public Policy and Global Affairs, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wai Wai Han
- Department of Medical Research, Ministry of Health and Sports, No 5, Ziwaka Road, Dagon Township, Yangon, 11191, Myanmar
| | - Katherine Quinn
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kirsten Beyer
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, USA
| | - Laura Glasman
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
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15
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Knipe DW, Gunnell D, Pieris R, Priyadarshana C, Weerasinghe M, Pearson M, Jayamanne S, Hawton K, Konradsen F, Eddleston M, Metcalfe C. Socioeconomic position and suicidal behaviour in rural Sri Lanka: a prospective cohort study of 168,000+ people. Soc Psychiatry Psychiatr Epidemiol 2019; 54:843-855. [PMID: 30790026 PMCID: PMC6656893 DOI: 10.1007/s00127-019-01672-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/12/2019] [Indexed: 11/15/2022]
Abstract
PURPOSE Lower socioeconomic position (SEP) is associated with an increased risk of suicidal behaviour in high income countries, but this association is not established in low- and middle-income countries (LMIC). METHODS We investigated the association of SEP with suicidal behaviour in a prospective cohort study of 168,771 Sri Lankans followed up for episodes of attempted suicide and suicide. SEP data were collected at baseline at the household and individual level at the start of the follow-up period. We used multilevel Poisson regression models to investigate the association of SEP at community, household and individual levels with attempted suicide/suicide. RESULTS Lower levels of asset ownership [IRR (95% CI) suicide 1.74 (0.92, 3.28); attempted suicide 1.67 (1.40, 2.00)] and education [suicide 3.16 (1.06, 9.45); attempted suicide 2.51 (1.70, 3.72)] were associated with an increased risk of suicidal behaviour. The association of these measures of SEP and attempted suicide was stronger in men than women. Individuals living in deprived areas [1.42 (1.16, 1.73)] and in households with a young female head of household [1.41 (1.04, 1.93)] or a temporary foreign migrant [1.47 (1.28, 1.68)] had an elevated risk of attempted suicide. Farmers and daily wage labourers had nearly a doubling in risk of attempted suicide compared to other occupations. CONCLUSIONS Improved employment opportunities, welfare and mental health support services, as well as problem-solving skills development, may help support individuals with poorer education, farmers, daily wage labourers, individuals in young female-headed households and temporary foreign migrant households.
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Affiliation(s)
- D W Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall 2.12, 39 Whatley Road, Bristol, BS8 2PS, UK.
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | - D Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall 2.12, 39 Whatley Road, Bristol, BS8 2PS, UK
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - R Pieris
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - C Priyadarshana
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - M Weerasinghe
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka
| | - M Pearson
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - S Jayamanne
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - K Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - F Konradsen
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M Eddleston
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Pharmacology, Toxicology and Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - C Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall 2.12, 39 Whatley Road, Bristol, BS8 2PS, UK
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Munodawafa M, Mall S, Lund C, Schneider M. Process evaluations of task sharing interventions for perinatal depression in low and middle income countries (LMIC): a systematic review and qualitative meta-synthesis. BMC Health Serv Res 2018; 18:205. [PMID: 29566680 PMCID: PMC5865346 DOI: 10.1186/s12913-018-3030-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 03/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perinatal depression is common in low and middle income countries (LAMICs). Task sharing interventions have been implemented to treat perinatal depression in these settings, as a way of dealing with staff shortages. Task sharing allows lay health workers to provide services for less complex cases while being trained and supervised by specialists. Randomized controlled trials suggest that these interventions can be effective but there is limited qualitative information exploring barriers and facilitators to their implementation. This systematic review aims to systematically review current qualitative evidence of process evaluations of task sharing interventions for perinatal depression in LAMICs in relation to the United Kingdom (UK) Medical Research Council (MRC) framework for conducting process evaluations. METHODS We searched Medline/ PubMed, PsycINFO, Scopus, Cochrane Library and Web of science for studies from LAMICS using search terms under the broad categories of: (a) "maternal depression'" (b) "intervention" (c) "lay counsellor" OR "community health worker" OR "non-specialist" and (d) "LAMICs". Abstracts were independently reviewed for inclusion by two authors. Full text articles were screened and data for included articles were extracted using a standard data extraction sheet. Qualitative synthesis of qualitative evidence was conducted. RESULTS 8420 articles were identified from initial searches. Of these, 26 full text articles were screened for eligibility with only three studies meeting the inclusion criteria. Main findings revealed that participants identified the following crucial factors: contextual factors included physical location, accessibility and cultural norms. Implementation factors included acceptability of the intervention and characteristics of the personnel. Mechanisms included counsellor factors such as motivating and facilitating trust; intervention factors such as use of stories and visual aids, and understandability of the content; and participant factors such as shared experience, meeting learning needs, and meeting expectations. CONCLUSIONS While task sharing has been suggested as an effective way of filling the treatment gap for perinatal depression, there is a paucity of qualitative research exploring barriers and facilitators to implementing these interventions. Qualitative process evaluations are crucial for the development of culturally relevant interventions.
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Affiliation(s)
- Memory Munodawafa
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, South Africa.
| | - Sumaya Mall
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, South Africa.,King's College London, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, South Africa.,Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Fekadu A, Hailu A, Makonnen E, Belete A, Yimer G. Short-term impact of celebrating the international clinical trial day: experience from Ethiopia. Trials 2017; 18:332. [PMID: 28716101 PMCID: PMC5513083 DOI: 10.1186/s13063-017-2081-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 07/01/2017] [Indexed: 11/29/2022] Open
Abstract
Just over 2 years ago on 20 May 2014, we celebrated the first International Clinical Trial Day (ICTD) in Ethiopia at the College of Health Sciences, Addis Ababa University. The main aim of the celebration was to express solidarity with clinical researchers, particularly clinical trialists, across the world. Since this first celebration, several major steps have been taken with potential for improving the conduct of clinical trials in our institution and more broadly within the country. These have included policy impact, particularly commitment from the government and the institution for supporting clinical trials and for the broader improvement of access to medicines. A Clinical Trial Unit, led by a multi-disciplinary team of researchers, has been established. A regional centre of excellence is being established to build regional capacity for translational research and clinical trials. These are important outputs attributable to the celebration of the ICTD. We encourage ICTD celebration at institutions conducting clinical research. This is likely to have unanticipated positive institutional, national and even regional consequences.
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Affiliation(s)
- Abebaw Fekadu
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia. .,Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. .,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK.
| | - Asrat Hailu
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia.,Department of Microbiology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eyasu Makonnen
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia.,Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Anteneh Belete
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia.,Department of Pharmaceutics, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getnet Yimer
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia.,Department of Pharmacology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Ssemata AS, Gladding S, John CC, Kiguli S. Developing mentorship in a resource-limited context: a qualitative research study of the experiences and perceptions of the makerere university student and faculty mentorship programme. BMC Med Educ 2017; 17:123. [PMID: 28709464 PMCID: PMC5513376 DOI: 10.1186/s12909-017-0962-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 07/10/2017] [Indexed: 05/23/2023]
Abstract
BACKGROUND The aim of mentorship is to build the mentees capacity, enhance their skills and improve their ability to produce desired outcomes. However, the mentoring relationship is vulnerable to a number of challenges that may undermine its effectiveness and sustainability. We aimed to explore the experiences and perceptions of student and junior faculty mentees and senior faculty mentors at the Makerere University College of Health Sciences and identify the key factors defined by mentees and mentors as necessary for a successful mentorship program. METHODS A qualitative design involving focus group discussions (FGDs) and key informant interviews (KII) was used. A total of eight KII and four FGDs were conducted, audio recorded and transcribed verbatim. Open coding of the transcripts was performed, and major themes were identified through multiple readings based on thematic analysis. RESULTS Six key themes were shared by the mentees and mentors including: 1) defining the role of the mentor; 2) desired characteristics of a mentor and a mentoring relationship, with an emphasis on mutual trust and respect; 3) overlapping roles of mentors and supervisors; 4) issues with the process for identifying mentors, including the benefits and drawbacks of the mentee selecting mentor vs. being assigned a mentor; 5) current barriers to mentoring, including lack of knowledge about current program, lack of formal structure, uncertainly about who should initiate relationship, and unclear roles and expectations and 6) recommendations for the future development of mentoring programme, including the need for a formalized programme, and training adapted to the local context. CONCLUSIONS The mentees and mentors described the role of the mentor and desired characteristics of mentors and a mentoring relationship similarly. Most concerns about mentoring occurred when current mentoring programmes and practices were not well aligned with these desired characteristics. Recommendations for future development of mentoring included greater formalization of mentoring with mentoring programmes based on shared expectations and adapted to the local context.
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Affiliation(s)
- Andrew S. Ssemata
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sophia Gladding
- Department of Medicine, University of Minnesota, Minneapolis, MN USA
| | - Chandy C. John
- Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University, Indianapolis, IN USA
| | - Sarah Kiguli
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Kochhar S, Bonhoeffer J, Jones CE, Muñoz FM, Honrado A, Bauwens J, Sobanjo-Ter Meulen A, Hirschfeld S. Immunization in pregnancy clinical research in low- and middle-income countries - Study design, regulatory and safety considerations. Vaccine 2017; 35:6575-6581. [PMID: 28479177 PMCID: PMC5714435 DOI: 10.1016/j.vaccine.2017.03.103] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 03/23/2017] [Accepted: 03/29/2017] [Indexed: 11/29/2022]
Abstract
Immunization of pregnant women is a promising public health strategy to reduce morbidity and mortality among both the mothers and their infants. Establishing safety and efficacy of vaccines generally uses a hybrid design between a conventional interventional study and an observational study that requires enrolling thousands of study participants to detect an unknown number of uncommon events. Historically, enrollment of pregnant women in clinical research studies encountered many barriers based on risk aversion, lack of knowledge, and regulatory ambiguity. Conducting research enrolling pregnant women in low- and middle-income countries can have additional factors to address such as limited availability of baseline epidemiologic data on disease burden and maternal and neonatal outcomes during and after pregnancy; challenges in recruiting and retaining pregnant women in research studies, variability in applying and interpreting assessment methods, and variability in locally acceptable and available infrastructure. Some measures to address these challenges include adjustment of study design, tailoring recruitment, consent process, retention strategies, operational and logistical processes, and the use of definitions and data collection methods that will align with efforts globally.
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Affiliation(s)
- Sonali Kochhar
- Global Healthcare Consulting, Delhi, India; Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Jan Bonhoeffer
- Brighton Collaboration Foundation, Basel, Switzerland; University of Basel Children's Hospital, Basel, Switzerland
| | - Christine E Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | | | - Angel Honrado
- Synapse Research Management Partners, Barcelona, Spain
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Bright T, Felix L, Kuper H, Polack S. A systematic review of strategies to increase access to health services among children in low and middle income countries. BMC Health Serv Res 2017; 17:252. [PMID: 28381276 PMCID: PMC5382494 DOI: 10.1186/s12913-017-2180-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 03/21/2017] [Indexed: 12/02/2022] Open
Abstract
Background Universal Health Coverage is widely endorsed as the pivotal goal in global health, however substantial barriers to accessing health services for children in low and middle-income countries (LMIC) exist. Failure to access healthcare is an important contributor to child mortality in these settings. Barriers to access have been widely studied, however effective interventions to overcome barriers and increase access to services for children are less well documented. Methods We conducted a systematic review of effectiveness of interventions aimed at increasing access to health services for children aged 5 years and below in LMIC. Four databases (EMBASE, Global Health, MEDLINE, and PSYCINFO) were searched in January 2016. Studies were included if they evaluated interventions that aimed to increase: health care utilisation; immunisation uptake; and compliance with medication or referral. Randomised controlled trials and non-randomised controlled study designs were included in the review. A narrative approach was used to synthesise results. Results Fifty seven studies were included in the review. Approximately half of studies (49%) were conducted in sub-Saharan Africa. Most studies were randomised controlled trials (n = 44; 77%) with the remaining studies employing non-randomised designs. Very few studies were judged as high quality. Studies evaluated a diverse range of interventions and various outcomes. Supply side interventions included: delivery of services at or closer to home and service level improvements (eg. integration of services). Demand side interventions included: educational programmes, text messages, and financial or other incentives. Interventions that delivered services at or closer to home and text messages were in general associated with a significant improvement in relevant outcomes. A consistent pattern was not noted for the remaining studies. Conclusions This review fills a gap in the literature by providing evidence of the range and effectiveness of interventions that can be used to increase access for children aged ≤5 years in LMIC. It highlights some intervention areas that seem to show encouraging trends including text message reminders and delivery of services at or close to home. However, given the methodological limitations found in existing studies, the results of this review must be interpreted with caution. Systematic review registration PROSPERO CRD420160334200 Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2180-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tess Bright
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
| | - Lambert Felix
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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21
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Chersich MF, Martin G. Priority gaps and promising areas in maternal health research in low- and middle-income countries: summary findings of a mapping of 2292 publications between 2000 and 2012. Global Health 2017; 13:6. [PMID: 28153038 PMCID: PMC5288934 DOI: 10.1186/s12992-016-0227-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 12/12/2016] [Indexed: 11/26/2022] Open
Abstract
This commentary sums the findings of a series of papers on a study that mapped the global research agenda for maternal health. The mapping reviewed published interventional research across low— and middle-income countries (LMICs) from 2000 to 2012, specifically focusing on investigating the topics covered by this research, the methodologies applied, the funding landscape and trends in authorship attribution. The overarching aim underpinning the mapping activities was to evaluate whether research and funding align with causes of maternal mortality, and thereby highlight gaps in research priorities and governance. Fifteen reviewers from 8 countries screened 35,078 titles and abstracts, and extracted data from 2292 full-text articles. Over the period reviewed, the volume of publications rose several-fold, especially from 2004 to 2007. The methodologies broadened, increasingly encompassing qualitative research and systematic review. Malaria and HIV research dominated over other topics, while sexually-transmitted infection research progressively diminished. Health systems and health promotion research increased rapidly, but were less frequently evaluated in trials or published in high-impact journals. Relative to disease burden, hypertension had double the publications of haemorrhage. Many Latin American countries, China and Russia had relatively few papers per billion US dollars Gross Domestic Product. Total LMIC lead authorships rose substantially, but only a quarter of countries had a local first author lead on >75% of their research, with levels lowest in sub-Saharan Africa. The median Impact Factor of high-income country led papers was 3.1 and LMIC-led 1.8. The NIH, USAID and Gates Foundation constituted 40% of funder acknowledgements, and addressed similar topics and countries. The commentary notes that increases in outputs and broadening of methodologies suggest research capacity has expanded considerably, allowing for more nuanced, systems-based and context-specific studies. However, funders seemingly duplicate efforts, with topics and countries either receiving excessive or little attention. Better coordinated funding might reduce duplication and allow researchers to develop highly-specialised expertise. Repeated scrutiny of research agendas and funding may foment shifts in priorities. Building leadership capacity in LMICs and reconsidering authorship guidelines is needed.
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Affiliation(s)
- Matthew F Chersich
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. .,Centre for Health Policy and MRC Health Policy Research Group, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
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Arjadi R, Nauta MH, Scholte WF, Hollon SD, Chowdhary N, Suryani AO, Bockting CLH. Guided Act and Feel Indonesia (GAF-ID) - Internet-based behavioral activation intervention for depression in Indonesia: study protocol for a randomized controlled trial. Trials 2016; 17:455. [PMID: 27639557 PMCID: PMC5027079 DOI: 10.1186/s13063-016-1577-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 08/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is a leading cause of disease burden across the world. However, in low-middle income countries (LMICs), access to mental health services is severely limited because of the insufficient number of mental health professionals available. The WHO initiated the Mental Health Gap Action Program (mhGAP) aiming to provide a coherent strategy for closing the gap between what is urgently needed and what is available in LMICs. Internet-based treatment is a promising strategy that can be made available to a large number of people now that Internet access is increasing rapidly throughout the world. The present study will investigate whether such an Internet-based treatment for depression is effective in Indonesia. METHODS An Internet-based behavioral activation treatment, with support by lay counselors who will provide online feedback on the assignments and supportive phone contact to encourage participants to work in the program (Guided Act and Feel Indonesia/GAF-ID), is compared to an online-delivered minimal psychoeducation without any support (psychoeducation/PE). Initial assessment for inclusion is based on a Patient Health Questionnaire-9 (PHQ-9) score of at least 10 and meeting criteria for major depressive disorder or persistent depressive disorder as assessed using the Structured Clinical Interview for DSM-5 (SCID-5). Participants with depression (N = 312) will be recruited and randomly assigned to GAF-ID or PE. Overall assessments will be done at baseline, post intervention (10 weeks from baseline) and follow-ups (3 months and 6 months from baseline). The primary outcome is the reduction of depression symptoms as measured by the PHQ-9 after 10 weeks from baseline. DISCUSSION To our knowledge, this is the first study in Indonesia that examines the effectiveness of an Internet-based intervention for depression in a randomized controlled trial. The hope is that it can serve as a starting point for bridging the mental health gap in Indonesia and other LMICs. TRIAL REGISTRATION Nederlands Trial Register ( www.trialregister.nl ): NTR5920 , registered on 1 July 2016.
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Affiliation(s)
- Retha Arjadi
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Faculty of Psychology, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Maaike H. Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Willem F. Scholte
- Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
- Equator Foundation, Diemen, The Netherlands
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN USA
| | | | - Angela O. Suryani
- Faculty of Psychology, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Claudi L. H. Bockting
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
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Moore JE, Uka S, Vogel JP, Timmings C, Rashid S, Gülmezoglu AM, Straus SE. Navigating barriers: two-year follow up on recommendations to improve the use of maternal health guidelines in Kosovo. BMC Public Health 2016; 16:987. [PMID: 27633514 PMCID: PMC5025590 DOI: 10.1186/s12889-016-3641-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 09/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there are a growing number of initiatives aimed at supporting guideline implementation in resource-constrained settings, few studies assess progress on achieving next steps and goals after the initial activities are completed and the initial funding period has ended. The aim of the current study was to conduct a qualitative process evaluation of progress, barriers, facilitators, and proposed solutions to operationalize nine recommendations to prepare Kosovo to implement the 2012 World Health Organization (WHO) prevention and treatment of postpartum haemorrhage guideline. METHODS/DESIGN In 2012, we co-created nine recommendations designed to support implementing the WHO's guideline on the prevention and treatment of postpartum haemorrhage in Kosovo. The current study uses a realist evaluation approach to assess activities and progress two years after the recommendations were developed. The study involved conducting qualitative focus groups and one-on-one interviews with participants from the first meeting to evaluate the activities and progress on the nine recommendations. RESULTS Forty-three participants provided insights into the barriers and opportunities experienced to date and proposed future directions. Although progress has been made towards implementation of a number of the recommendations, scaling up has been limited by barriers, such as lack of awareness, limited resources, and evaluation challenges. Participants proposed addressing these barriers by building within- and between-country partnerships to facilitate guideline implementation. In addition, participants reported less progress on implementing recommendations related to broader cultural changes, which indicates a need for specific and actionable recommendations to operationalize implementation efforts. CONCLUSIONS In the two years since the initial meeting, there has been mixed progress on the recommendations. Based on participant feedback, we refined the recommendations so that they can be operationalized by health care system stakeholders in Kosovo to further support implementation efforts. It is beneficial to share these lessons learned throughout the implementation process to inform next steps in Kosovo and offer ideas for use in other settings.
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Affiliation(s)
- Julia E. Moore
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Sami Uka
- World Health Organization Country Office, Pristina, Kosovo
| | - Joshua P. Vogel
- Department of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Caitlyn Timmings
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Shusmita Rashid
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - A. Metin Gülmezoglu
- Department of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Sharon E. Straus
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, 1 King’s College Circle, Medical Sciences Building, Toronto, ON M5S 1A8 Canada
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Fekadu A, Medhin G, Selamu M, Shiferaw T, Hailemariam M, Rathod SD, Jordans M, Teferra S, Lund C, Breuer E, Prince M, Giorgis TW, Alem A, Hanlon C. Non-fatal suicidal behaviour in rural Ethiopia: a cross-sectional facility- and population-based study. BMC Psychiatry 2016; 16:75. [PMID: 27000122 PMCID: PMC4802839 DOI: 10.1186/s12888-016-0784-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 03/17/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Injury related to self-harm is one of the leading causes of global disease burden. As a formative work for a programme to implement comprehensive mental healthcare in a rural district in Ethiopia, we determined the 12-month prevalence of non-fatal suicidal behaviour as well as factors associated with this behaviour to understand the potential burden of the behaviour in the district. METHOD Population-based (n = 1485) and facility-based (n = 1014) cross-sectional surveys of adults, using standardised, interview-based measures for suicidality (items on suicide from the Composite International Diagnostic Interview), depressive symptoms (the Patient Health Questionnaire) and alcohol use disorders (Alcohol Use Disorder Investigation Test; AUDIT). RESULTS The overall 12-month prevalence of non-fatal suicidal behaviour, consisting of suicidal ideation, plan and attempt, was 7.9 % (95 % Confidence Interval (CI) = 6.8 % to 8.9 %). The prevalence was significantly higher in the facility sample (10.3 %) compared with the community sample (6.3 %). The 12-month prevalence of suicide attempt was 4.4 % (95 % CI = 3.6 % to 5.3 %), non-significantly higher among the facility sample (5.4 %) compared with the community sample (3.8 %). Over half of those with suicidal ideation (56.4 %) transitioned from suicidal ideation to suicide attempt. Younger age, harmful use of alcohol and higher depression scores were associated significantly with increased non-fatal suicidal behaviours. The only factor associated with transition from suicidal ideation to suicide attempt was high depression score. Only 10.5 % of the sample with suicidal ideation had received any treatment for their suicidal behaviour: 10.8 % of the community sample and 10.2 % of the facility sample. Although help seeking increased with progression from ideation to attempt, there was no statistically significant difference between the groups. CONCLUSION Non-fatal suicidal behaviour is an important public health problem in this rural district. A more in-depth understanding of the context of the occurrence of the behaviour, improving access to care and targeting depression and alcohol use disorder are important next steps. The role of other psychosocial factors should also be explored to assist the provision of holistic care.
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Affiliation(s)
- Abebaw Fekadu
- />Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- />Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, King’s College London, London, UK
| | - Girmay Medhin
- />Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Medhin Selamu
- />Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsion Shiferaw
- />Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Maji Hailemariam
- />Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sujit D Rathod
- />Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Jordans
- />Department of Research and Development, HealthNet Transcultural Psychosocial Organisation, Amsterdam, The Netherlands
| | - Solomon Teferra
- />Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Crick Lund
- />Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Erica Breuer
- />Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Martin Prince
- />Health Service and Population Research Department, Institute of Psychiatry, King’s College London, London, UK
| | - Tedla W. Giorgis
- />Republic of Ethiopia Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Atalay Alem
- />Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- />Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- />Health Service and Population Research Department, Institute of Psychiatry, King’s College London, London, UK
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Chatham-Stephens K, Caravanos J, Ericson B, Landrigan P, Fuller R. The pediatric burden of disease from lead exposure at toxic waste sites in low and middle income countries. Environ Res 2014; 132:379-83. [PMID: 24853976 DOI: 10.1016/j.envres.2014.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 03/28/2014] [Accepted: 04/05/2014] [Indexed: 05/20/2023]
Abstract
BACKGROUND The impact of lead from toxic waste sites on children in low and middle income countries has not been calculated due to a lack of exposure data. We sought to calculate this impact in Disability Adjusted Life Years (DALYs). MATERIALS AND METHODS Using an Integrated Exposure Uptake Biokinetic (IEUBK) model, we converted soil and drinking water lead levels from sites in the Blacksmith Institute's Toxic Sites Identification Program (TSIP) into mean blood lead levels (BLLs). We then calculated the incidence of mild mental retardation (MMR) and DALYs resulting from these BLLs. RESULTS The TSIP included 200 sites in 31 countries with soil (n=132) or drinking water (n=68) lead levels, representing 779,989 children younger than 4 years of age potentially exposed to lead. Environmental lead levels produced a range of BLLs from 1.56 to 104.71 µg/dL. These BLLs equated to an estimated loss of 5.41-8.23 IQ points, resulting in an incidence of MMR of 6.03 per 1000 population and 76.1 DALYs per 1000 population. DISCUSSION Soil and water lead levels at toxic waste sites predict BLLs that lower the intelligence quotient (IQ), with the resulting MMR potentially limiting individual- and country-level development. The preventable burden of disease produced by these sites highlights the need for toxic waste sites to be systematically identified, evaluated, and remediated.
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Affiliation(s)
- Kevin Chatham-Stephens
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY 10029, USA.
| | - Jack Caravanos
- School of Public Health at Hunter College, City University of New York, 2180 Third Avenue, New York, NY 10035, USA; Blacksmith Institute, 475 Riverside Drive, Suite 860, New York, NY 10115, USA
| | - Bret Ericson
- Blacksmith Institute, 475 Riverside Drive, Suite 860, New York, NY 10115, USA
| | - Philip Landrigan
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY 10029, USA
| | - Richard Fuller
- Blacksmith Institute, 475 Riverside Drive, Suite 860, New York, NY 10115, USA
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