Care In Low-income Countries Research Articles

Global health systems strengthening: FIGO's strategic view on reducing maternal and newborn mortality worldwide.

To demonstrate that successful health systems strengthening (HSS) projects have addressed disparities and inequities in maternal and perinatal care in low-income countries. A comprehensive literature review covered the period between 1980 and 2022, focusing on successful HSS interventions within health systems' seven core components that improved maternal and perinatal care. The findings highlight the importance of integrating quality interventions into robust health systems, as this has been shown to reduce maternal and newborn mortality. However, several challenges, including service delivery gaps, poor data use, and funding deficits, continue to hinder the delivery of quality care. To improve maternal and newborn health outcomes, a comprehensive HSS strategy is essential, which should include infrastructure enhancement, workforce skill development, access to essential medicines, and active community engagement. Effective health systems, leadership, and community engagement are crucial for a comprehensive HSS approach to catalyze progress toward universal health coverage and global improvements in maternal and newborn health.

MANAGEMENT AND OUTCOME OF ATOPIC DERMATITIS IN PRIMARY HEALTH CARE IN LOW INCOME COUNTRIES : A SYSTEMATIC REVIEW

Background: Atopic dermatitis is a chronic inflammatory skin disorder that is complicated and recurring. It usually first appears in early childhood and might persist throughout maturity. Aims : This systematic review is to review the management and outcome of atopic dermatitis in primary health care in low income countries. Methods: This study demonstrated compliance with all requirements by means of a comparison with the standards established by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020. Thus, the specialists were able to guarantee that the research was as current as feasible. Publications released between 2014 and 2024 were considered for this search strategy. This was accomplished by utilizing a number of distinct online reference sites, including Pubmed, ScienceDirect, and SagePub. It was determined that reviews, previously published works, and partially completed works would not be included. Result: In the PubMed database, the results of our search brought up 539 articles, whereas the results of our search on SCIENCE DIRECT brought up 9.462 articles, our search on SAGEPUB brought up 1.264 articles. The results of the search conducted for the last year of 2014 yielded a total 425 articles for PubMed, 5.474 articles for SCIENCE DIRECT and 613 articles for SAGEPUB. In the end, we compiled a total of 5 papers, 3 of which came from PubMed, 1 of which came from SCIENCE DIRECT and 1 of which came from SAGEPUB. We included five research that met the criteria. Conclusion: In summary, atopic dermatitis is still a major global public health problem, especially for women and young children as well as in high-income nations. It is important to recognize the profound effects on patients, their families, and economies as well as the financial ramifications.

Cardiology across continents: an interactive, case-based learning series.

Heart University [https://www.heartuniversity.org/] is a free educational website providing structured training curricula with knowledge-based testing and access to webinars and conference recordings for practicing and in-training providers of paediatric and congenital cardiac care. To date, there are over 15,000 registered website users from over 140 countries on Heart University, with over 2,000 training modules and/or recorded educational videos. Heart University has developed an "asynchronous" educational lecture series entitled "Pediatric and Congenital Cardiac Care in Resource-Limited Settings." This recorded lecture series is specifically focused on topics relevant to practicing paediatric and/or congenital cardiac care in low-resource settings.A relatively new initiative, "Cardiology Across Continents," supplements the existing educational resources for providers of paediatric and/or congenital cardiac care in low-income countries and lower-middle-income countries by providing an additional live, interactive, case-based forum. Sessions occur every 1-2 months and focus on challenging cases from diagnostic or management perspective with a view to promote collaboration between partnered institutions. "Cardiology Across Continents" is an expanding initiative that facilitates learning and collaboration between clinicians across varied practice settings via interactive case discussions. We welcome trainees and providers of paediatric and congenital cardiac care to join the sessions and invite any insight that can enhance learning for clinicians around the world. This manuscript describes "Cardiology Across Continents" and discusses the development, history, current status, and future plans of Heart University.

Regional determinants of quality of care for sick children: A multilevel analysis in four countries.

The limited impact of increased access to care on improvements in health outcomes during the Millennium Development Goal era has been attributed, in part, to inadequate quality of care. We identified regional factors associated with health service quality for sick child care in low-income countries and examined whether provider factors interact with regional factors to affect the quality of care. We conducted cross-sectional random intercept four-level linear regression using the most recent Service Provision Assessment and Demographic Health Survey data from four countries (467 from the Democratic Republic of Congo 2018, 2425 from Afghanistan 2018, 2072 from Nepal 2015, and 813 from Senegal 2017). The outcome variable was the service quality score for sick child care, which was measured as the percentage of clinically recommended tasks completed in the integrated management of childhood illness (ranging from 0 to 100). Regional factors were selected based on the High-Quality Health System Framework. The service quality score was found to be positively associated with the proportion of large facilities (β = 8.61; P = 0.004) and the proportion of providers ranked in the top fifth for service quality score (β = 30.15; P < 0.001) in the region. We identified significant cross-level interactions between provider qualifications (β = -16.6; P < 0.001) or job descriptions (β = 12.01; P = 0.002) and the proportion of providers in the top fifth for service quality scores within the region. As the proportion of top-performing providers in a region increased, the increase in the service quality score was more pronounced among providers who were nonmedical doctors or did not have job descriptions than among their counterparts. Our findings indicate that the quality of care for sick children in a region improves with a greater proportion of high-performing providers or larger facilities. Providers who are not medical doctors, or those who have specific job descriptions, tend to benefit more from the presence of these top-performing providers.

Enhancing microsurgical skills in neurosurgery residents of low-income countries: A comprehensive guide

Background: The main objectives of this paper are to outline the essential tools, instruments, and equipment needed to set up a functional microsurgery laboratory that is affordable for low-income hospitals and to identify cost-effective alternatives for acquiring microsurgical equipment, such as refurbished or donated instruments, collaborating with medical device manufacturers for discounted rates, or exploring local suppliers. Methods: Step-by-step instructions were provided on setting up the microsurgery laboratory, including recommendations for the layout, ergonomic considerations, lighting, and sterilization processes while ensuring cost-effectiveness, as well as comprehensive training protocols and a curriculum specifically tailored to enhance microsurgical skills in neurosurgery residents. Results: We explored cost-effective options for obtaining microsurgery simulators and utilizing open-source or low-cost virtual training platforms. We also included guidelines for regular equipment maintenance, instrument sterilization, and establishing protocols for infection control to ensure a safe and hygienic learning environment. To foster collaboration between low-income hospitals and external organizations or institutions that can provide support, resources, or mentorship, this paper shows strategies for networking, knowledge exchange, and establishing partnerships to enhance microsurgical training opportunities further. We evaluated the impact and effectiveness of the low-cost microsurgery laboratory by assessing the impact and effectiveness of the established microsurgery laboratory in improving the microsurgical skills of neurosurgery residents. About microsutures and microanastomosis, after three weeks of training, residents showed improvement in “surgical time” for ten separate simple stitches (30.06 vs. 8.65 min) and ten continuous single stitches (19.84 vs. 6.51 min). Similarly, there was an increase in the “good quality” of the stitches and the suture pattern from 36.36% to 63.63%. Conclusion: By achieving these objectives, this guide aims to empower low-income hospitals and neurosurgery residents with the necessary resources and knowledge to establish and operate an affordable microsurgery laboratory, ultimately enhancing the quality of microsurgical training and patient care in low-income countries.

Equipping undergraduate medical and nursing students with elderly health care assessment skills at Makerere University, College of Health Sciences, Uganda

BackgroundElderly health care training and aging science remain the least prioritized discipline of medical education in many African countries. With scant scientific evidence on elderly health care in low-income countries, coupled with limited exposure to elderly health care training, this project aimed to equip undergraduate health professional students with elderly health care assessment skills and research through an online course and a clinical placement.MethodsStudents (3rd year) underwent online elderly health care training through the Alison courses published by the Advanced Learning Academy in Ireland. The students were then subjected to an online exam with a pass mark of 80%. Students were also trained on standard elderly health care assessment tools through a one-day session. For practical skills on data collection, each student assessed 15 elderly patients at the Mulago National Referral Hospital Assessment Centre. All tools once filled in were assessed for completion. A one-day reflection session was held with students, faculty and the project leads to share findings from the various tools used to assess elderly individuals. The students shared their experiences and provided feedback on the online training as well as the hardships they may have experienced while administering the tools. A certificate of participation was provided to the students at the end of the project.ResultsAll the students (10) gained knowledge on elderly assessment skills, the impact of aging on various body systems, and how to manage common occurrences among elderly individuals. The average score in the post-exam was 82% (standard deviation ± 2.01). All students (10) reported having had this as their first training on the assessment of functionality among elderly individuals.ConclusionsThe students gained knowledge of elderly health assessments as well as the impact of aging on various body systems. They also gained insight into how to care for the elderly holistically with an added understanding of how to manage spinal and traumatic brain injuries.

Attitude, Perceived Barriers, and Challenges Toward Implementing Resource-Appropriate Guidelines for Hematologic Malignancies: Physicians' Survey in Ethiopia.

Cancer care in low-income countries poses formidable challenges. Care may be facilitated by resource-adapted guidelines, such as the National Comprehensive Cancer Network (NCCN) harmonized guidelines for sub-Saharan Africa (NCCN-HG). Understanding physicians' attitudes and knowledge toward guidelines, as well as patient- and resource-related barriers, is essential for promoting their effective implementation. We conducted an online survey among oncologists, hematologists, internists, residents/fellows, and generalists treating hematologic malignancies in Ethiopia. We assessed attitudes toward the use of guidelines, institutional capacity, and barriers/determinants to effective care. Among the 47 physicians completing the survey (representing 64% of Ethiopian professionals treating hematologic malignancies), the majority (85%) reported using guidelines; however, only 22.7% (n = 10) used the NCCN-HG. While overall attitudes toward guidelines were favorable, 57.8% of physicians familiar with the NCCN-HG were either undecided or believed that it lowers the standard of care. Perceived lack of institutional regulation was negatively associated with guideline use (B = -3.23; P = .004). Lack of diagnostic facilities including immunohistochemistry and flow cytometry, supportive care, and poor utilization of guidelines were reported to be determinants of poor patient outcome. Regarding patient factors, 57.4% respondents identified treatment abandonment as an important contributor to poor outcome. Availability of chemotherapy/radiotherapy (89.4%), financial status (85.1%), distance from the hospital (74.5%), and harvest season (65%) had major influences on treatment decisions. Over 80% reported that targeted therapies were unavailable or rarely available. Awareness and usage of the NCCN-HG are limited among Ethiopian physicians. Lack of facilities, therapies, and regulation, in addition to patient-related factors, was identified as barriers to guideline adherence and determinants of poor outcome.

Cervical Cancer Progression in Patients Waiting for Radiotherapy Treatment at a Referral Center in Ethiopia: A Longitudinal Study

ABSTRACT Nonmetastatic cervical cancer is a highly curable malignancy, and radiotherapy (RT) remains the mainstay treatment. Early initiation is critical, and the optimal time to initiate RT for cure is 6 weeks, with a reported 15% decrease in 3-year overall survival for those who wait 40 days. There is considerable variation in the waiting time to initiate RT between countries, with a median time of 27.2 days in Ontario, Canada and 108 days in South Africa. Real-world evidence of cancer progression because of treatment delay is scarce in low-income countries. Ethiopia, a country of 120 million, had a single machine at Tikur Anbessa Specialized Hospital (TASH) until it acquired a linear accelerator very recently. This study aimed to assess the extent of delay in receiving RT and the effect of delay on the natural disease court in patients with cervical cancer treated at TASH. This study was conducted at TASH between January 2019 and May 2020 and evaluated patients at different time points before and after RT. All individuals who were diagnosed with cervical cancer (stage IIB to stage IVA) and booked for RT at TASH were included. Concurrent chemoradiotherapy was administered for cervical cancer with weekly cisplatin as a chemotherapy agent. A total of 115 patients were included in this study. The median time between pathologic diagnosis and booking RT was 19 days, and the median time from booking to RT initiation was 458 days. The total median time from diagnosis to treatment was 477 days, and the median time to disease progression was 51 days. During the waiting period for RT, the stage was reassessed for 105 patients. The number of patients in stage IIB, IIA, and IIIB decreased during this period, whereas the number of patients in stage IVA increased from 20 (17.4%) to 30 (26.1%), 2 (1.8%) developed distant metastasis to the lungs (stage IVB), and 37 died before receiving a phone call for RT. Of 115 patients booked to receive CCRT, only 9 (7.8%) received CCRT, 80 (69.9%) received a single shot of palliative RT due to disease progression, and 25 (21.7%) did not receive RT at all. The mean and median survival times were 20.1 months (95% confidence interval [CI], 18.3–22.7) and 21 months (95% CI, 18.3–23.8), respectively. Waiting time, stage at presentation, distant metastasis during the waiting time, hydronephrosis during the waiting time, and type of treatment were significantly associated with survival. Multivariate cox regression using these variables found that patients with stage IIIB were 2.2 times more likely to die than those with stage IIB (adjusted hazards ratio, 2.2; 95% CI, 1.07–4.48), and patients with stage IVA were 20.95 times more likely to die than patients with stage IIB (adjusted hazards ratio, 20.95; 95% CI, 6.26–70.03). Prolonged waiting time increased the mortality rate of cervical cancer by 2.9 (95% CI, 1.07–4.5). This study provides a significant advancement in our understanding of cervical cancer care in low-income countries. The median waiting time diagnosis to treatment was 477 days, whereas the median waiting period for disease progression was 51 days, resulting in unnecessary disease progression, change in treatment intent from curative to palliative, and increased mortality. These findings highlight the need to increase access to RT services in lower-income nations to reduce wait times and provide better cancer care.

A story to tell or not, a glimpse of emergency setting in the low economic country: experience sharing and Review

Delivering efficient emergency health care in low-income countries presents significant challenges due to various factors, including limited resources, inadequate infrastructure, and socio-economic barriers. This article explores the complexities associated with emergency care delivery in resource-limited settings. Issues such as pre-hospital care, triage, waiting times, out-of-pocket expenditures, and the implementation of international protocols with limited resources. The lack of access to well-equipped ambulances, trained personnel, and basic first aid knowledge contributes to the difficulties faced in pre-hospital care. Non-functional triage systems, direct access to emergency rooms, and financial constraints further hinder timely and effective patient care. The implementation of international protocols in settings with limited resources poses additional challenges for healthcare providers and patients.

Exploring the challenges and roles of nurses in delivering palliative care for cancer patients and co-morbidities in Ghana

BackgroundPatients suffering from chronic and life-threatening diseases receive inadequate palliative care in low-income countries, eventually leading to poor quality of life for these patients. Little is known about the experience of delivering palliative care in a low-resource country such as Ghana in comparison to higher-income countries. This study, therefore, aimed to assess the roles and challenges of nurses providing palliative care services for patients with cancer and life-limiting conditions at tertiary Hospitals in Ghana.MethodsThirty oncology nurses at a tertiary Hospital in Ghana participated. All nurses were providing end-of-life care to patients with cancer. A qualitative exploratory-descriptive design and a semi-structured interview guide developed by the researchers were used. Interviews lasted on average forty minutes to 1 h were audio-recorded, and transcribed verbatim. Content analysis was carried out to generate themes and sub-themes.FindingsParticipants were between the ages of 25 and 40 years. A higher percentage of females (n = 17, 57%) participated in the study than males (n = 13, 43%). Two main themes were generated which were the delivery of palliative care and the provision of home care services. The current roles of nurses were centered around pain management, home care services, spiritual needs, and psychological care. Challenges that hindered the implementation of palliative care included distress over expected and unexpected patient mortality, difficulty delivering bad news to patients and families, and frustration with health system resource shortages that negatively impacted patient care.ConclusionPalliative care is one of the essential services provided for patients with life-limiting conditions, and nurses play an active role in the provision of this care. Further research is needed to determine the most effective ways to deliver this care, particularly in developing nations like Ghana.

Effects of Health Insurance on Quality of Care in Low-Income Countries: A Systematic Review.

Objectives: To evaluate the effectiveness of health insurance on quality of care in low-income countries (LICs). Methods: We conducted a systematic review following PRISMA guidelines. We searched seven databases for studies published between 2010 and August 2022. We included studies that evaluated the effects of health insurance on quality of care in LICs using randomized experiments or quasi-experimental study designs. Study outcomes were classified using the Donabedian framework. Results: We included 15 studies out of the 6,129 identified. Available evidence seems to suggest that health insurance has limited effects on structural quality, and its effects on the process of care remain mixed. At the population level, health insurance is linked to improved anthropometric measures for children and biomarkers such as blood pressure and hemoglobin levels. Conclusion: Based on the currently available evidence, it appears that health insurance in LICs has limited effects on the quality of care. Further studies are required to delve into the mechanisms that underlie the impact of health insurance on the quality of care and identify the most effective strategies to ensure quality within insurance programs. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=219984, identifier PROSPERO CRD42020219984.

Influence of perinatal distress on adverse birth outcomes: A prospective study in the Tigray region, northern Ethiopia.

In low-income countries, where socioeconomic adversities and perinatal distress are common, adverse birth outcomes are significant public health problems. In these settings, perinatal distress, i.e., high symptoms of anxiety, depression, and/or stress during pregnancy, may be linked with adverse birth outcomes. However, few prospective studies have investigated the impact of perinatal distress on adverse birth outcomes such as preterm birth (gestational age <37 weeks), low birth weight (<2.5 kg), and small for gestational age birth (birth weight below the 10th percentile for gestational age and sex). Our main objective was to assess the influence of perinatal distress on adverse birth outcomes. Secondly, to investigate if perinatal distress is an independent risk factor or a mediator in the pathway between socioeconomic adversity and adverse birth outcomes. In a prospective cohort study following 991 women from before 20 weeks of gestation until delivery in northern Ethiopia, we collected self-reported data on distress at a mean of 14.8 (standard deviation [SD] = 1.9) and 33.9 (SD = 1.1) weeks of gestation. Distress was measured using the Edinburgh Postnatal Depression Scale, the anxiety subscale of the Hospital Anxiety and Depression Scale, and the Perceived Stress Scale. To determine birth outcomes, gestational age was estimated from the last menstrual period, fundal palpation, and/or ultrasound, while birth weight was obtained from delivery records and measured within three days after birth for those delivered at home. Logistic regression and mediation analysis were employed to evaluate the impact of perinatal distress on adverse birth outcomes. Perinatal anxiety (OR [95% CI] 1.08 [1.02, 1.13]), depression (1.07 [1.03, 1.11]), stress (1.14 [1.07, 1.22]), and total distress (1.15 [1.07, 1.23]) were all associated with low birth weight, and small for gestational age birth but none did with preterm birth. Mediation analysis demonstrated that perinatal distress was a mediator in the pathway between socioeconomic adversity and adverse birth outcomes. Our study revealed that perinatal distress was linked with adverse birth outcomes and acted as a mediator between socioeconomic adversity and these outcomes. Our findings highlight the importance of screening women for distress and providing appropriate interventions, focusing on women experiencing socioeconomic adversity. Integrating mental health services into primary maternal care in low-income countries could be an effective approach to achieve this.

The need of patients living with cancer for palliative care.

A comprehensive assessment of patients' problems and needs is essential for all patients with chronic diseases, including cancer. This study assesses the problems, unmet needs and requirement for palliative care (PC) among patients with cancer. A descriptive cross-sectional design was employed using a valid self-reported questionnaire. On average, 62% of patients had problems that were unresolved. The need for patients to have more information about their health was identified (75.1%), followed by financial problems because of the illness and ability to afford healthcare (72.9%), and psychological issues, such as depression, anxiety and stress (67.1%). Patients stated that their spiritual needs were not being met (78.8%), and that they were experiencing psychological distress and problems with daily living that needed to be addressed through PC (78%, 75.1%, respectively). A chi-square test revealed that all problems are significantly associated with the need for PC (P<.001). Patients needed more assistance in psychological, spiritual, financial and physical domains, and this can be provided by palliative care. Palliative care in low-income countries is a human right for patients with cancer.

Nanotechnology-Based Diagnostics for Diseases Prevalent in Developing Countries: Current Advances in Point-of-Care Tests.

The introduction of point-of-care testing (POCT) has revolutionized medical testing by allowing for simple tests to be conducted near the patient's care point, rather than being confined to a medical laboratory. This has been especially beneficial for developing countries with limited infrastructure, where testing often involves sending specimens off-site and waiting for hours or days for results. However, the development of POCT devices has been challenging, with simplicity, accuracy, and cost-effectiveness being key factors in making these tests feasible. Nanotechnology has played a crucial role in achieving this goal, by not only making the tests possible but also masking their complexity. In this article, recent developments in POCT devices that benefit from nanotechnology are discussed. Microfluidics and lab-on-a-chip technologies are highlighted as major drivers of point-of-care testing, particularly in infectious disease diagnosis. These technologies enable various bioassays to be used at the point of care. The article also addresses the challenges faced by these technological advances and interesting future trends. The benefits of point-of-care testing are significant, especially in developing countries where medical care is shifting towards prevention, early detection, and managing chronic conditions. Infectious disease tests at the point of care in low-income countries can lead to prompt treatment, preventing infections from spreading.

Building cardiac surgical programs in lower-middle income countries

ObjectivesMedical care in low-income countries is often limited by inadequate resources, treatment facilities, and the necessary infrastructure for healthcare delivery. We hypothesized that the development of an independently functioning, internationally supported Kenyan cardiac surgical training program could address these issues through targeted investment. MethodsA review was conducted of the programmatic structure and clinical outcomes from January 2008 to October 2021 at Tenwek Hospital, Bomet, Kenya. Program development phases included (1) cardiovascular care provided by 1 full-time US board-certified cardiothoracic surgeon; (2) short-term volunteer surgical teams from the United States and Canada; and (3) development of a cardiothoracic residency program based on the Society of Thoracic Surgeons training curriculum. Patient demographics and outcomes were analyzed throughout each phase of program development. ResultsA total of 817 cardiac procedures were performed during the study period, including 236 congenital (28.8%) and 581 adult (71.1%) procedures. Endemic rheumatic valvular heart disease predominated (581 patients, 62.3%). Local surgical team case volume grew over the study period, overtaking visiting team volume in 2019. Perioperative mortality was 2.1% and consistent between the visiting teams and the locally trained teams. Surgical training via a 3-year cardiothoracic residency is now in its fourth year, with the 2 graduates now retained as full-time teaching staff. ConclusionsGlobal health partnerships have the potential to address unmet needs in cardiac care within low- and middle-income countries. These data support the concept that acceptable clinical outcomes and consistent growth in volume can be achieved during the transition toward fully independent cardiac surgical care.

Efficacy of an 8-hour education intervention on dementia knowledge, attitude and skills in healthcare professionals in regional hospitals: a nation-wide study from Uganda.

dementia imposes an enormous burden, mainly in low-income countries (LICs). Due to lack of well-trained healthcare professionals, 70-90% of people with dementia do not receive adequate care in LICs. The aim of this study was to evaluate whether a one-day, 8-hour medical education intervention on dementia care improves the knowledge and attitude about and confidence in providing dementia care among healthcare professionals in 8 referral hospitals in UgandaMethods: in this pre-test/post-test study without a control group, participants completed the Alzheimer´s Disease Knowledge Scale (ADKS), Dementia Care Attitude Scale (DCAS), and 9 visual analogue scales (VAS) regarding confidence in specific dementia care skills pre- and post-medical education intervention. in one hundred twelve healthcare professionals (age = 41.7±10.2 years; 54.5% women), the ADKS, DCAS, and VAS scores for recognizing and assessing core dementia symptoms, communicating effectively, providing psycho-education, activating patients mentally and physically, managing behavioral and psychological symptoms, and involving carers in the treatment improved significantly (P < 0.001) post-medical education intervention. our study demonstrates that brief educational interventions are efficacious in strengthening the dementia literacy among healthcare professionals in a low-income country. Future research should explore whether such brief educational interventions also result in implementation of efficacious dementia care into routine clinical practice and whether it ultimately may lead to improved health outcomes in patients and formal and informal caregivers.

Stroke services in the Middle East and adjacent region: A survey of 34 hospital-based stroke services.

Acute stroke care is complex and requires multidisciplinary networking. There are insufficient data on stroke care in the Middle East and adjacent regions in Asia and Africa. Evaluate the state of readiness of stroke programs in the Middle East North Africa and surrounding regions (MENA+) to treat acute stroke. Online questionnaire survey on the evaluation of stroke care across hospitals of MENA+ region between April 2021 and January 2022. The survey was completed by 34/50 (68%) hospitals. The median population serviced by participating hospitals was 2 million. The median admission of patients with stroke/year was 600 (250-1,100). The median length of stay at the stroke units was 5 days. 34/34 (100%) of these hospitals have 24/7 CT head available. 17/34 (50%) have emergency guidelines for prehospital acute stroke care. Mechanical thrombectomy with/without IVT was available in 24/34 (70.6%). 51% was the median (IQR; 15-75%) of patients treated with IVT within 60 min from arrival. Thirty-five minutes were the median time to reverse warfarin-associated ICH. This is the first large study on the availability of resources for the management of acute stroke in the MENA+ region. We noted the disparity in stroke care between high-income and low-income countries. Concerted efforts are required to improve stroke care in low-income countries. Accreditation of stroke programs in the region will be helpful.

Caesarean childbirth and associated factors during Covid-19 pandemic at public hospitals in the Sidama region, Southern Ethiopia

BackgroundThe increasing number of caesarean births worldwide concerns pregnant women, obstetric service providers, and the country's economy. Unnecessary caesarean childbirth increases childbirth complications and the cost of health care in low-income countries, including Ethiopia.ObjectiveThis study aims to assess caesarean birth and associated factors at the Sidama region public hospitals, Southern Ethiopia, 2020.MethodsAn institution-based cross-sectional study was conducted among 484 women who gave birth at public hospitals in the Sidama region. A multi-stage sampling technique was employed. The data were collected from 1st to 30th of July 2020 by face-to-face interviews using a semi-structured questionnaire (see Table S1: see supplementary materials associated with this article on line), and the wealth index was analysed by principal component analysis. Backward logistic regression used an adjusted odds ratio and a 95% confidence interval to assess the strength and association between the caesarean section and its associated factors. A P-value of < 0.05 was used to declare statistical significance.ResultCaesarean childbirth in this study was 34.3%. In this study, partograph monitoring (AOR = 2.23, CI = 1.13, 4.38), previous caesarean birth (AOR = 3.21, CI = 1.28,8.17), having genital cutting/mutilation (AOR = 2.51, CI = 1.14,5.53), intermittent cardiotocography monitoring during childbirth (AOR = 2.3, CI = 1.14, 4.49), absence of companionship during delivery (AOR = 4.97, CI = 2.37, 10.43) and is not remembering the last normal menstrual period (AOR = 3.12, CI = 1.40,6.94) had increased the odds of caesarean birth.ConclusionStudies show that the prevalence of caesarean has alarmingly increased in both developed and developing countries. However, the magnitude of caesarean section differs from country to country and in rural and urban areas; the magnitude of caesarean section in this study is much higher than the WHO recommends threshold. The local health bureau and obstetric care providers should pay attention to the caesarean section and need intervention in partograph plotting, companionship, cardiotocography, and female genital mutilation.

Surgical, Obstetric, and Anesthetic Mortality Measurement at a Ugandan Secondary Referral Hospital

(Anesth Analg. 2021;133:1608–1616) In low- and middle-income countries, health care systems may have limited ability to safely treat surgical disorders. An appropriate standardized metric is needed to assess hospital and patient outcomes in terms of safe surgical care in low-income countries. The perioperative mortality rate (POMR) is one metric used to compare the quality and safety of hospitals in high- and low-income countries. In Uganda, the Mbarara Regional Referral Hospital (MRRH) is a government-funded hospital located in a rural area. This study examined surgical deaths over one year at this hospital with the aim of determining a suitable mortality metric to measure outcomes and assess care delivery in this limited-resource health system. The hypothesis was that the majority of admission deaths did not involve an operation.

Do Limited-Resource Hospitals Improve Medical Care Utilization in Underdeveloped Areas: Evidence From Mobile Hospitals in Indonesia

Limited physical access to health facilities contributes to inadequate medical care in low-income countries. Therefore, to fill the supply gap, the Indonesian government built limited-resource hospitals in impoverished areas. This study examines whether the existence of those hospitals improves medical care usage. Difference-in-differences adapted for continuous treatment methodologies was applied with exploitation of timing implementations of mobile hospital establishments. In the process, national representatives’ survey data, hospital characteristics, and travel distance from various sources were used. Public hospitals’ existence was discovered to cause substantial travel distance reduction, with outpatient and inpatient healthcare services becoming more accessible on the main islands compared with outer islands. On the basis of these results, expanding health facilities and improving infrastructures in poor regions broadly are essential for improving healthcare access.