Health Outcomes Among Garment Workers in Low-Middle Income Countries: A Scoping Review

BackgroundBangladesh is one of the world’s largest garment exporters. Physical working conditions of garment workers are precarious and known to largely affect their health. Research on garment workers’ psychosocial working conditions, however, is scarce. We aimed to quantify psychosocial working conditions of garment workers and possible associations with workers’ health.MethodsWe conducted a cross-sectional survey among 1,118 ready-made garment (RMG) workers in labor colonies in Dhaka, Bangladesh, in February 2021. Descriptive analyses were performed to characterize social stressors (e.g., being bullied at work, poor leadership) and social resources at work (e.g., receiving support at work, vertical trust between management and employees, beneficial leadership) and workers’ health (self-reported overall health and 10 specific health complaints). To examine links of social stressors and social resources with self-reported health outcomes we ran multivariable Poisson regression models yielding prevalence ratios (PR) and 95% confidence intervals (CI).ResultsWe found low to moderate levels of workplace bullying and high levels of poor leadership (i.e., supervisors not caring about workers’ problems). We also found high levels of social support, vertical trust and beneficial leadership (i.e., supervisors taking decisions free of bias). Garment workers frequently suffered from health complaints, first and foremost headache (68.3%), cold (55.3%), and back pain (50.7%). Health outcomes were poorer among workers who reported to be bullied at work versus not bullied (e.g., PR 1.55 [95% CI 1.32–1.92] for poor self-reported health when bullied by colleagues) and health was better among those reporting to feel supported versus unsupported (e.g., PR 0.61 [0.52–0.71] for poor self-reported health when supported by supervisor). Perceived vertical trust between workers and management was weakly associated with better health. Leadership behavior did not display a consistent pattern.ConclusionsOur findings suggest that working conditions of RMG workers are rather good (e.g., characterized by low levels of bullying and high levels of support, vertical trust and beneficial leadership). The majority of workers reported good or very good health, although health complaints were frequently mentioned, first and foremost headache, cold, and back pain. Associations between psychosocial working conditions and health indicate worse working conditions being associated with poorer health.

This scoping review provides an overview of access to reproductive health care for women with physical disabilities in low-middle income and high-income countries from 1995 to 2017. The paper reviews 40 qualitative studies, identified by searching 10 databases including Ovid (Health and psychosocial instruments, NHS economic evaluation database), OVID MEDLINE, Pubmed, Informit (Health and Society, Health collection, Humanities and social sciences collection), ProQuest Central (ProQuest XML), CINAHL Plus (EBSCO), ScienceDirect Journal, Wiley Online Library, Google Scholar, BioMed Central. Nine main themes were identified. They included: unavailable, unreliable or dated health information; removal of participants’ autonomy; limited reproduction-related education; health provider-derived barriers; systemic barriers to access; socio-economic barriers; transportation barriers; Family-related barriers; and reproductive technology barriers. These themes are explored across various country contexts, including high-income countries with high access to reproductive health care, high-income countries with low access, low-middle income countries with high access, and low-middle income countries with low access. Some suggestions for improvements are also outlined.

BACKGROUND Sickle Cell Disease (SCD) is a global health challenge, especially prevalent in Africa, India, and the Middle East, with increasing populations in Europe, America, and Australasia. OBJECTIVES The aim of this study is to assess the global knowledge, awareness, and access to care for individuals with SCD focusing on disparities between low-middle and high income countries. METHODS A cross-sectional survey with 127 participants was conducted in 11 countries across multiple global regions between February and September in 2024. Data were collected through surveys including questions from various scales such as Short Form Health Survey-36 (SF-36). Data were analyzed through descriptive statistics, chi-square tests, and Spearman’s rank correlation analysis, using SPSS (version 29) with a significance level of p < 0.05. RESULTS Findings show significant differences in early diagnosis, with 81.8% of high income country participants diagnosed at birth, compared to 53.1% in low-middle income countries (p < 0.001). While 87.3% of all participants understood SCD as a genetic disorder, awareness of stem cell transplantation was higher in high income countries (95.2%) than in low-middle income countries (63.6%) (p = 0.014). Access to mental health services was also notably higher in high income countries; only 12.1% of participants in low-middle income countries had access to mental health services, compared to 47.4% in high income countries (p = 0.003). CONCLUSION The study underscores the urgent need for comprehensive healthcare strategies, including expanded newborn screening, improved financial support, and enhanced mental health services, particularly in low-middle income countries.

This paper presents a basic assessment of the financial performance of infrastructure service operators in developing countries. It relies on a new database of 120 companies put together to track the evolution of the cost of capital, the cost of equity and the return of equity for electricity, water and sanitation, railways and port operators in 32 developing countries distributed evenly across low income, low middle income and upper middle income countries. The paper shows that between 1998 and 2002, the average cost of capital in developing countries varied from less than 11% to over 15% across regions and sectors while the cost of equity varied from around 13% to over 22%. Low-middle income countries have recovered relatively well from the East Asia crisis while low income and upper middle income countries have seen their situation deteriorate since the crisis. At the regional level, the main story is that East Asia is recovering quite well from its crisis and that the financial performance of the operators in Africa and Latin America has deteriorated. Eastern Europe and South Asia are doing relatively better but show a large volatility of returns over time and within sectors. At the sectoral level, the railways and the energy sectors have seen their performance deteriorate significantly over the period while the water sector and the port sectors have done relatively better. In all sectors and all regions, the average return to equity has been lower than the cost of equity since the Asian crisis.

# Background Absent or reduced fetal movements (ARFM) are linked to adverse perinatal outcome in high income countries but the significance of this symptom in low and lower middle income countries (LMICs) is less established. The objective of this study was to report the current state of knowledge and practice regarding the association between ARFM and adverse pregnancy outcomes in LMICs. # Methods Systematic literature searches were undertaken in MEDLINE, Web of Science, Google Scholar, LILACS, and AJOL. Studies were included if they reported adverse perinatal outcome(s) following ARFM, clinical management strategies employed following ARFM, or women's knowledge regarding perception of ARFM. Qualitative data were tabulated, where possible meta-analysis was performed on quantitative data. # Results Nineteen full-text papers were included; five studies reported the association between ARFM and stillbirth in LMICs (1466 pregnancies including 296 stillbirths). The likelihood of stillbirth was higher in ARFM (odds ratio 14.13, 95% CI 3.46-57.77). Women's awareness of ARFM as a danger sign varied greatly from 3.1-62.3%. # Conclusions There is a lack of published literature regarding the significance of ARFM in LMICs, but available data suggest a significant association between ARFM and adverse outcomes. Strategies to increase women's awareness require evaluation in LMICs.

BackgroundIntensive care units (ICUs) in lower-middle income countries (LMICs) are suspected to constitute a special risk for patients of acquiring infection due to multiple antibiotic resistant organisms. The aim of this systematic scoping review was to present the data published on ICU-acquired infections and on antimicrobial resistance observed in ICUs in LMICs over a 13-year period. A systematic scoping review was conducted according to the PRISMA extension guideline for scoping reviews and registered in the Open Science Framework.Main body of the abstractArticles were sought that reported on ICU-acquired infection in LMICs between 2005 and 2018. Two reviewers parallelly reviewed 1961 titles and abstracts retrieved from five data banks, found 274 eligible and finally included 51. Most LMICs had not produced reports in Q1 or Q2 journals in this period, constituting a large gap in knowledge. However, from the reported evidence it is clear that the rate of ICU-acquired infections was comparable, albeit approximately 10% higher, in LMICs compared to high income countries. In contrast, ICU mortality was much higher in LMICs (33.6%) than in high income countries (< 20%). Multidrug-resistant Gram-negative species, especially Acinetobacter baumannii and Pseudomonas aeruginosa, and Klebsiella pneumoniae played a much more dominant role in LMIC ICUs than in those in high income countries. However, interventions to improve this situation have been shown to be feasible and effective, even cost-effective.ConclusionsCompared to high income countries the burden of ICU-acquired infection is higher in LMICs, as is the level of antimicrobial resistance; the pathogen distribution is also different. However, there is evidence that interventions are feasible and may be quite effective in these settings.Protocol Registration The protocol was registered with Open Science Framework (https://osf.io/c8vjk)

Most of the developing countries in the world are facing a well-known challenging factor-like income inequality that affects the issue of balanced growth and welfare. The core goal of this paper is to investigate whether the Human Capital Index (HCI) joined with Good Governance (GG) variables have a significant impact on reducing income inequality in upper middle income (UMI) and lower middle income (LMI) countries or not. The first point is to investigate the relationship between HCI and income inequality and the second one is to find out the joint effect (HCI and GG) on income inequality (Gini Coefficient). The author divides all the countries based on income levels like UMI and LMI countries according to WB. For the UMI, HCI has no significant positive impact on reducing income inequality. However, if HCI works combined with good governance indicators like (HCI*RL), (HCI*RQ), and (HCI*GE), these interacted variables do not have significant power to reduce income inequality in UMI countries. Contrarily, for LMI countries, HCI helps to diminish income inequality significantly. When citizens achieve technical and educational qualifications, it helps them earn more money and shrinks income inequality significantly. Moreover, when HCI joints with good governing variables like PS, RQ, and RL that help to reduce income inequality significantly in LMI countries. There are some significant differences between UMI and LMI in foreign investment, job opportunities, foreign investment, and macroeconomic conditions that generate income-gap. This analysis finds that LMI countries grab influential effect in reducing income inequality in their economy compared to UMI countries.

<h3>Objectives</h3> Weak points of clinical practice in most low middle income (LMIC) countries involve shortage of resources and limited budget that necessitate the need of evidence based health care.¹ One of Obstacles for EBM learning is lack of time in attending standalone face to face lectures, Limited access to literature databases and unfeasible educational facilities at teaching theatre in many LMIC.² Online learning permits physicians to maintain learning in clinical settings. We aim to study differences in post graduate students' achievement if they are taught EBM by face-to-face or by online learning. <h3>Method</h3> We assessed the performance of eleven post-graduate students who completed face-to-face learning module and twelve students accomplished online learning. The teaching materials including lectures, assignments and educational videos were the same in both courses so that any performance difference would be due to the teaching method. Both modules consist of eleven topics discussing EBM cycle for decision making. Clinical scenarios are taught through problem based approach either face to face or by accessing the e-learning discussion forum. Grading involved continuous student activities all over the semester (15%), midterm (25%), oral (15%) and final (30%) exams. Students were evaluated by a project submitted by the end of the semester (15%) that examined student's perception from formulating a clinical question either therapeutic or diagnostic till decision making. Percentage of students satisfaction was calculated about course content evaluation, teaching materials, lecturer evaluation, students' assessment process and finally, fair practices among students. <h3>Results</h3> Mean midterm and final exam scores didn't differ significantly between the two groups (p.759, 721 respectively). Students from both groups achieved almost the same mean score on oral discussion exam (p.31). Students who attended the online learning module had a significantly higher median project score compared to those who attended the face-to-face teaching (p&lt;0.001). Median continuous assessment scores of students that completed face-to–face learning was slightly higher with borderline significance than online teaching score (p0.062). In general, Students from both modules were similarly satisfied about course contents, lecturers and students' assessment process although one third of students felt non-equality and unfair instructors' practice towards them in face-to-face teaching method. <h3>Conclusions</h3> E-learning proved better achievement of postgraduate students. A strong emphasis should be paid towards further dissemination of E-learning of EBM to support the developing era of evidenced based practice in low middle income countries. <h3>References</h3> Kabene SM, Orchard C, Howard JM, et al. The importance of human resources management in health care: A global context. Human Resources for Health2006;4:20. doi:10.1186/1478-4491-4-20 Gagnon MP, Legare F, Labrecque M, et al. Perceived barriers to completing an e-learning program on evidence-based medicine. <i>Informatics in Primary Care</i> 2007;15(2):83−91.

Accurate and timely information on health intervention coverage, quality, and equity is the foundation of public health practice. To achieve this, countries have made efforts to improve the quality and availability of community health data by implementing the community health information system that is used to collect data in the field generated by community health workers and other community-facing providers. Despite all the efforts, evidence on the current state is scant in Low Middle Income Countries (LMICs). To summarize the available evidence on the current implementation status, lessons learned and implementation challenges of community health information system (CHIS) in LMICs. We conducted a scoping review that included studies searched using electronic databases like Pubmed/Medline, World Health Organization (WHO) Library, Science Direct, Cochrane Library. We also searched Google and Google Scholar using different combinations of search strategies. Studies that applied any study design, data collection and analysis methods related to CHIS were included. The review included all studies published until February 30, 2022. Two authors extracted the data and resolved disagreements by discussion consulting a third author. A total of 1,552 potentially relevant articles/reports were generated from the initial search, of which 21 were considered for the final review. The review found that CHIS is implemented in various structures using various tools across different LMICs. For the CHIS implementation majority used registers, family folder/card, mobile technologies and chalk/white board. Community level information was fragmented, incomplete and in most cases flowed only one way, with a bottom-up approach. The review also indicated that, technology particularly Electronic Community Health Information System (eCHIS) and mobile applications plays a role in strengthening CHIS implementation in most LMICs. Many challenges remain for effective implementation of CHIS with unintegrated systems including existence of parallel recording & reporting tools. Besides, lack of resources, low technical capacity, shortage of human resource and poor Information Communication Technology (ICT) infrastructure were reported as barriers for effective implementation of CHIS in LMICs. Generally, community health information system implementation in LMICs is in its early stage. There was not a universal or standard CHIS design and implementation modality across countries. There are also promising practices on digitalizing the community health information systems. Different organizational, technical, behavioural and economic barriers exist for effective implementation of CHIS. Hence, greater collaboration, coordination, and joint action are needed to address these challenges. Strong leadership, motivation, capacity building and regular feedback are also important to strengthen the CHIS in LMICs. Moreover, CHIS should be transformed in to eCHIS with integration of different technology solutions. Local ownership is also critical to the long-term sustainability of CHIS implementation.

BACKGROUND:Global burden of disease (GBD) provides the estimates of mortality and morbidity, while case fatality rate (CFR) helps in understanding the severity of the disease. People infected with severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) with underlying medical conditions have shown higher levels of unfavorable outcomes including mortality. We assessed the association of SARS-CoV-2 CFR with disability-adjusted life years (DALY) of various comorbidities in the low-middle income countries (LMIC) and high-income countries (HIC) to study the relationship of coronavirus disease-19 (COVID-19) mortality with GBDs and to understand the linkage between COVID-19 mortality and comorbidities.MATERIALS AND METHODS:This was an ecological study with secondary data analysis comparing the DALY of various morbidities from GBD with CFR of COVID-19. Gross domestic product was the basis of stratifying 177 countries into low-middle income (LMIC) and high-income groups (HIC). The mortality was analyzed using Pearson correlation and linear regression.RESULTS:The median global CFR of SARS-CoV-2 was 2.15. The median CFR among LMIC (n = 60) and HIC (n = 117) was 2.01 (0.00–28.20) and 2.29 (0.00–17.26), respectively. The regression analysis found that, in both LMIC and HIC, maternal disorders were associated with higher SARS-CoV-2 CFR, while tuberculosis, mental health disorders, and were associated with lower CFR. Further, in LMIC, musculoskeletal disorders and nutritional deficiencies were associated with higher CFR, while respiratory disorders were associated with lower CFR.CONCLUSIONS:SARS-CoV-2 infection appears to be a systemic disease. Individuals with comorbidities, such as maternal disorders, neurological diseases, musculoskeletal disorders, and nutritional deficiencies, have poorer outcomes with COVID-19, leading to higher mortality.

Artificial intelligence (AI) has been integrated into dentistry for improvement of current dental practice. While many studies have explored the utilization of AI in various fields, the potential of AI in dentistry, particularly in low-middle income countries (LMICs) remains understudied. This scoping review aimed to study the existing literature on the applications of artificial intelligence in dentistry in low-middle income countries. A comprehensive search strategy was applied utilizing three major databases: PubMed, Scopus, and EBSCO Dentistry & Oral Sciences Source. The search strategy included keywords related to AI, Dentistry, and LMICs. The initial search yielded a total of 1587, out of which 25 articles were included in this review. Our findings demonstrated that limited studies have been carried out in LMICs in terms of AI and dentistry. Most of the studies were related to Orthodontics. In addition gaps in literature were noted such as cost utility and patient experience were not mentioned in the included studies.

Purpose: Improving access to education and training for those providing wheelchair and seating assistive technology to meet personal posture and mobility requirements, as a basic human right, is a priority. This review considers education and training available to personnel within low and lower middle income countries (LLMIC), to ascertain where gaps in knowledge exist and identify human resource education priorities.Method: A scoping review, mapping out existing scientific and grey literature within the field between 1993 and 2017 was conducted. The search strategy included use of online databases, manual analogue searches and key stakeholder informant advice. A content analysis process was applied to organize the literature retrieved and extract key themes.Results: Education and training in LLMIC appears ad hoc and limited, however, there is growing recognition as to its importance, notably by the World Health Organization and nongovernmental organizations, delivering education initiatives to a number of countries, along with the development of a credentialing test. Inconsistency exists regarding personnel responsible for wheelchair provision, with no specific professional clearly recognized to oversee the system within many LLMIC.Conclusions: Education and training is required for all stakeholders involved in wheelchair provision. Advocating for programme development to enhance personnel skills, build capacity and ensure best practice is a priority. Pilot sites, delivering and credentialing appropriate wheelchair provision education and training within context should be considered. Measuring outcomes and transferable skills should be part of education programme delivery structures. Considering a new discipline responsible for oversight of wheelchair provision should be investigated.Implications for rehabilitationEducation and training is an essential step in the wheelchair provision process in the bid to obtain an appropriate wheelchair via appropriate provision services. However, it is more than education and training; its a human rights issue.Mandatory education and training needs to be a requirement for all stakeholders involved in wheelchair provision.Key wheelchair personnel need to establish their central role in this arena.The study raises awareness as to the importance of working with governments to commit to building sustainable wheelchair provision infrastructures.

The prenatal environment is now recognized as a key driver of non-communicable disease risk later in life. Within the developmental origins of health and disease (DOHaD) paradigm, studies are increasingly identifying links between maternal morbidity during pregnancy and disease later in life for offspring. Nutrient restriction, metabolic disorders during gestation, such as diabetes or obesity, and maternal immune activation provoked by infection have been linked to adverse health outcomes for offspring later in life. These factors frequently co-occur, but the potential for compounding effects of multiple morbidities on DOHaD-related outcomes has not received adequate attention. This is of particular importance in low- or middle-income countries (LMICs), which have ongoing high rates of infectious diseases and are now experiencing transitions from undernutrition to excess adiposity. The purpose of this scoping review is to summarize studies examining the effect and interaction of co-occurring metabolic or nutritional stressors and infectious diseases during gestation on DOHaD-related health outcomes. We identified nine studies in humans - four performed in the United States and five in LMICs. The most common outcome, also in seven of nine studies, was premature birth or low birth weight. We identified nine animal studies, six in mice, two in rats and one in sheep. The interaction between metabolic/nutritional exposures and infectious exposures had varying effects including synergism, inhibition and independent actions. No human studies were specifically designed to assess the interaction of metabolic/nutritional exposures and infectious diseases. Future studies of neonatal outcomes should measure these exposures and explicitly examine their concerted effect.

Purpose: The overuse of medical imaging is a key component of medical resource overutilization. Primary reasons for this include high costs, overdiagnosis, incidental findings and direct harms. Although the overuse of medical imaging is well-researched in high income countries, it is still unclear what evidence there is for the overuse of medical imaging in low-middle income countries (LMICs). Understanding the extent of medical imaging overuse in LMICs could encourage doctors and policymakers to address the problem of overuse, which may facilitate better use of limited resources. Methods and Materials: A scoping review was performed according to the PRISMA Extension for Scoping Reviews Checklist. Electronic academic databases Medline via Ovid, Embase and CINAHL were searched for relevant studies. Results: Forty studies were identified, with a total of 42,413 patient participants across 15 LMICs. Computed tomography (CT) scan was the most frequent imaging modality of study (20/40), followed by magnetic resonance imaging (MRI) (13/40), and ultrasound (US) (6/40). Guidelines were used as a tool to define imaging overuse in 58% (23/40) of the included studies. However, only 5% (2/40) of studies used local guidelines. The overall results of the review showed that 35% of MRI, 55% of CT, 40% of radiography, 62% of ultrasound and 12% of single-photon emission computed tomography (SPECT) investigations were recorded as an overuse. Conclusion: The results of this study show that there is evidence for the widespread overuse of medical imaging in LMICs, including the overuse of CT, MRI, radiography, ultrasound and SPECT. The majority of studies demonstrated a lack of local imaging guidelines. Future research may focus on developing guidelines designed for the local disease epidemiology and the financial context of the locality, to better identify overuse and promote more contextually appropriate imaging practices.

Occupational safety and health interventions to protect young workers from hazardous work – A scoping review