Low And Medium Income Countries Research Articles

Association between traumatic brain injury (TBI) patterns and mortality: a retrospective case-control study

Background: Low and medium income countries (LMICs) such as Kenya experience nearly three times more cases of traumatic brain injury (TBI) compared to high income countries (HICs). This is primarily exacerbated by weak health systems especially at the pre-hospital care level. Generating local empirical evidence on TBI patterns and its influence on patient mortality outcomes is fundamental in informing the design of trauma-specific emergency medical service (EMS) interventions at the pre-hospital care level. This study determines the influence of TBI patterns and mortality. Methods: This was a case-control study with a sample of 316 TBI patients. Data was abstracted from medical records for the period of January 2017 to March 2019 in three tertiary trauma care facilities in Kenya. Logistic regression was used to assess influence of trauma patterns on TBI mortality, controlling for patient characteristics and other potential confounders. Results: The majority of patients were aged below 40 years (73%) and were male (85%). Road traffic injuries (RTIs) comprised 58% of all forms of trauma. Blunt trauma comprised 71% of the injuries. Trauma mechanism was the only trauma pattern significantly associated with TBI mortality. The risk of dying for patients sustaining RTIs was 2.83 times more likely compared to non-RTI patients [odds ratio (OR) 2.83, 95% confidence interval (CI) 1.62-4.93, p=0.001]. The type of transfer to hospital was also significantly associated with mortality outcome, with a public hospital having a two times higher risk of death compared to a private hospital [OR 2.18 95%CI 1.21-3.94, p<0.009]. Conclusion: Trauma mechanism (RTI vs non-RTI) and type of tertiary facility patients are transferred to (public vs private) are key factors influencing TBI mortality burden. Strengthening local EMS trauma response systems targeting RTIs augmented by adequately resourced and equipped public facilities to provide quality lifesaving interventions can reduce the burden of TBIs.

Instrumentation for Six Electrode Focused Impedance Method (FIM-6) for the study of localized regions in a volume conductor

Focused Impedance Method (FIM) is a new and simple technique of electrical bio-impedance that provides an opportunity for localized measurement down to reasonable depths of the body surface using skin surface electrodes. Conceived by one of the authors (KSR) and developed in Bangladesh by a group led by him, FIM has potential applications in physiological study and in the detection or diagnosis of diseases and disorders. Being a simple technique, it is particularly suitable for low and medium income countries (LMIC). To obtain long term benefit from any technology it is necessary that the technology is understood and developed indigenously, particularly under the limitation of a resource limited country. Indigenous development also allows for further improvisation, innovation, and application in future. This paper presents the indigenous design and development of the electronic instrumentation necessary for the implementation of six electrode version of Focused Impedance Method (FIM-6) in Nepal. The work involved basic characterization of the necessary circuit blocks developed through experimental validation. In particular, the design of isolating ferrite transformers required for the instrumentation posed a challenge which was solved limiting the range of the instrumentation to range variations encountered in practice on the human body, for which initial experiments were carried out on a live human subject. This led to a simplified design. The values obtained using the developed circuitry appears to give reasonable accuracy and would be useful for further implementation of the instrumentation using PCBs. However, further work can also be taken to improve the design of the current source used and of the transformers. Thus this work satisfies the initial requirement of attempting indigenous development of the FIM technique in an LMIC like Nepal.&#x0D; Bangladesh Journal of Medical Physics Vol.14 No.1 2021 P 1-15

3D printing: can it make surgery more accessible?

The advancement of 3-Dimensional (3D) printing technology has made the design and production of items increasingly ubiquitous amongst the public. This technology is increasingly being used widely in various medical fields. With its increasing cost efficiency and accessibility, it is the author's perspective that 3D technology can improve accessibility to surgical procedures in low- and medium-income countries (LMIC) by providing proceduralists with the basic equipment required to perform routine operations.

Human factors application for healthcare teams in low- and medium-income countries (LMIC) to help improve patient safety and performance

Mistakes will always happen whether at work or in our personal lives. We can never completely eliminate error, but learning and disseminating lessons from these mistakes to others is essential. Human factors application for colleagues in healthcare, particularly in low- and medium-income countries (LMIC) can greatly improve patient safety and aid better team working and staff morale. Factors such as hunger, dehydration anger, and tiredness, all reduce personal performance and can raise the risk of personal error. It is vital that we understand and optimize interaction within the healthcare team members. As part of this, ineffective communication, steep hierarchy and loss of situational awareness can lead to compromised patient safety and potentially serious error.In this paper, we provide a brief overview of human factors for healthcare colleagues in LMIC. We highlight ways to reduce the chances of error and improve patient safety by recognizing and applying various human factors to our day to day practices.

Role of integrated crop-livestock systems in improving agriculture production and addressing food security – A review

Integrated crop-livestock systems (ICLS) can be productive, sustainable, and climate-resilient agricultural systems compared to specialized and intensive systems. This review explores the beneficial traits and contributions of ICLS to food security, social and economic benefits, and resilience, and proposes strategies to adopt ICLSs in low-, medium-, and high-income countries. Currently, global food security faces two main challenges. First, one in nine people do not have sufficient protein and energy in their diet, of those 50% are smallholder subsistence farmers and 20% are landless families in the low-and medium-income countries (LMICs). Second, specialized intensive agricultural practices often cause soil and environmental degradation. ICLS is an agricultural practice that could play a significant role in mitigating these challenges. The diversified cropping systems in ICLS can improve the productivity of the principal crop as well as enhance food security through increasing nutritional indicators such as food consumption score and household dietary diversity especially for rural households. An ICLS, therefore, could be a key for achieving food and nutritional security and environmental sustainability both in short and long-terms. While ICLS practices have increased over time, there are still adoption challenges due to lack of investment, sustainable awareness, lack of skills by the producers, and market competition. In LMICs, successful implementation of ICLS requires organizational and/or institutional support to create new marketing opportunities and adoption of ICLS can be improved if government policies provide capital, markets, and educational services to subsistence farmers. These government policies can also increase the producer's knowledge, change farmer's attitudes and enhance trust in organic matter management for sustainable soil management. Therefore, agricultural scientists are challenged to provide fundamental and credible information to integrate crop and livestock production systems so that worldwide adoption of ICLS can be used to increase the agricultural production compatible with food and nutrition security. • Diversified cropping systems in ICLS can improve the productivity of the principal crop as well as enhance food security. • Successful implementation of ICLS requires organizational and/or institutional support to create new marketing opportunities. • Livestock in the ICLS plays a key role in the functioning of the farm through providing animal source foods. • Practicing ICLS would avoid negative consequences of agricultural production such as the loss of biodiversity.

Association between traumatic brain injury (TBI) patterns and mortality: a retrospective case-control study.

Background: Low and medium income countries (LMICs) such as Kenya experience nearly three times more cases of traumatic brain injury (TBI) compared to high income countries (HICs). This is primarily exacerbated by weak health systems especially at the pre-hospital care level. Generating local empirical evidence on TBI patterns and its influence on patient mortality outcomes is fundamental in informing the design of trauma-specific emergency medical service (EMS) interventions at the pre-hospital care level. This study determines the influence of TBI patterns and mortality. Methods: This was a case-control study with a sample of 316 TBI patients. Data was abstracted from medical records for the period of January 2017 to March 2019 in three tertiary trauma care facilities in Kenya. Logistic regression was used to assess influence of trauma patterns on TBI mortality, controlling for patient characteristics and other potential confounders. Results: The majority of patients were aged below 40 years (73%) and were male (85%). Road traffic injuries (RTIs) comprised 58% of all forms of trauma. Blunt trauma comprised 71% of the injuries. Trauma mechanism was the only trauma pattern significantly associated with TBI mortality. The risk of dying for patients sustaining RTIs was 2.83 times more likely compared to non-RTI patients [odds ratio (OR) 2.83, 95% confidence interval (CI) 1.62-4.93, p=0.001]. The type of transfer to hospital was also significantly associated with mortality outcome, with a public hospital having a two times higher risk of death compared to a private hospital [OR 2.18 95%CI 1.21-3.94, p<0.009]. Conclusion: Trauma mechanism (RTI vs non-RTI) and type of tertiary facility patients are transferred to (public vs private) are key factors influencing TBI mortality burden. Strengthening local EMS trauma response systems targeting RTIs augmented by adequately resourced and equipped public facilities to provide quality lifesaving interventions can reduce the burden of TBIs.

The Economics of Energy Efficiency in Developing Countries

Almost all of the world’s energy demand growth is projected to occur in low- and medium-income countries (LMICs). Targeted energy efficiency investments have the potential to mitigate tensions between economic growth objectives and sustainable development commitments. We review the empirical evidence on both the private and social benefits of energy efficiency improvements in LMICs. In addition to direct energy savings, energy efficiency investments can generate indirect benefits such as improved reliability, enhanced energy access, and increased productivity. We highlight the role that energy subsidies, unreliable power supply, and capital constraints may play in the underinvestment in energy efficiency. Increasingly, LMICs are implementing policies and programs aimed at mitigating these barriers. We discuss some recent policy design innovations and emphasize the importance of rigorous evaluation.

Mind the gap: what explains the rural-nonrural inequality in diarrhoea among under-five children in low and medium-income countries? A decomposition analysis

BackgroundDiarrhoea poses serious health problems among under-five children (U5C) in Low-and Medium-Income Countries (LMIC) with a higher prevalence in rural areas. A gap exists in knowledge on factors driving rural-non-rural inequalities in diarrhoea development among U5C in LMIC. This study investigates the magnitude of rural-non-rural inequalities in diarrhoea and the roles of individual-level and neighbourhood-level factors in explaining these inequalities.MethodsData of 796,150 U5C, from 63,378 neighbourhoods across 57 LMIC from the most recent Demographic and Health Survey (2010–2018) was analysed. The outcome variable was the recent experience of diarrhoea while independent variables consist of the individual- and neighbourhood-level factors. Data were analysed using multivariable Fairlie decomposition at p < 0.05 in Stata Version 16 while visualization was implemented in R Statistical Package.ResultsTwo-thirds (68.0%) of the children are from rural areas. The overall prevalence of diarrhoea was 14.2, 14.6% vs 13.4% among rural and non-rural children respectively (p < 0.001). From the analysis, the following 20 countries showed a statistically significant pro-rural inequalities with higher odds of diarrhoea in rural areas than in nonrural areas at 5% alpha level: Albania (OR = 1.769; p = 0.001), Benin (OR = 1.209; p = 0.002), Burundi (OR = 1.399; p < 0.001), Cambodia (OR = 1.201; p < 0.031), Cameroon (OR = 1.377; p < 0.001), Comoros (OR = 1.266; p = 0.029), Egypt (OR = 1.331; p < 0.001), Honduras (OR = 1.127; p = 0.027), India (OR = 1.059; p < 0.001), Indonesia (OR = 1.219; p < 0.001), Liberia (OR = 1.158; p = 0.017), Mali (OR = 1.240; p = 0.001), Myanmar (OR = 1.422; p = 0.004), Namibia (OR = 1.451; p < 0.001), Nigeria (OR = 1.492; p < 0.001), Rwanda (OR = 1.261; p = 0.010), South Africa (OR = 1.420; p = 0.002), Togo (OR = 1.729; p < 0.001), Uganda (OR = 1.214; p < 0.001), and Yemen (OR = 1.249; p < 0.001); and pro-non-rural inequalities in 9 countries. Variations exist in factors associated with pro-rural inequalities across the 20 countries. Overall main contributors to pro-rural inequality were neighbourhood socioeconomic status, household wealth status, media access, toilet types, maternal age and education.ConclusionsThe gaps in the odds of diarrhoea among rural children than nonrural children were explained by individual-level and neighbourhood-level factors. Sustainable intervention measures that are tailored to country-specific needs could offer a better approach to closing rural-non-rural gaps in having diarrhoea among U5C in LMIC.

Development of standard indicators to assess use of electronic health record systems implemented in low-and medium-income countries.

Electronic Health Record Systems (EHRs) are being rolled out nationally in many low- and middle-income countries (LMICs) yet assessing actual system usage remains a challenge. We employed a nominal group technique (NGT) process to systematically develop high-quality indicators for evaluating actual usage of EHRs in LMICs. An initial set of 14 candidate indicators were developed by the study team adapting the Human Immunodeficiency Virus (HIV) Monitoring, Evaluation, and Reporting indicators format. A multidisciplinary team of 10 experts was convened in a two-day NGT workshop in Kenya to systematically evaluate, rate (using Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) criteria), prioritize, refine, and identify new indicators. NGT steps included introduction to candidate indicators, silent indicator ranking, round-robin indicator rating, and silent generation of new indicators. 5-point Likert scale was used in rating the candidate indicators against the SMART components. Candidate indicators were rated highly on SMART criteria (4.05/5). NGT participants settled on 15 final indicators, categorized as system use (4); data quality (3), system interoperability (3), and reporting (5). Data entry statistics, systems uptime, and EHRs variable concordance indicators were rated highest. This study describes a systematic approach to develop and validate quality indicators for determining EHRs use and provides LMICs with a multidimensional tool for assessing success of EHRs implementations.

Association between the Length of Interpregnancy Interval and Pregnancy Outcomes in Women with One Previous Caeserian Section Undergoing a Repeat Caeserian Delivery at Term at Pumwani Maternity Hospital between 2014 and 2018 a Cross-Sectional Study

Caesarean sections constitute major surgery, and are associated with immediate maternal and perinatal risks with implications on future pregnancies. After a caesarean delivery, the World Health Organization (WHO) recommends an Inter-pregnancy Interval (IPI) of at least 24 months to lower the risk of adverse maternal and perinatal outcomes in the subsequent pregnancy. However, whether the recommendation confers obstetric benefits is unclear as there’s paucity of data in low- and medium-income countries (LMIC). The objective was to determine the association between IPI length and maternal and neonatal outcomes in women with one previous caesarian section undergoing a repeat caesarian delivery at term in Pumwani Maternity Hospital between 1st January 2014 and 31st December 2018. A cross-sectional study was done where patients who had delivered via repeat caesarean section at term between 1st January 2014 and 31st December 2018 were evaluated. The files of 625 patients were retrieved and IPI was determined from the time interval between a previous caesarean section delivery and the beginning of the subsequent pregnancy, established from the date of the last normal menstrual period as recorded or extrapolated from an early trimester obstetric scan. The files were allotted to study groups as follows: = 170), 24 - 29 months/intermediate IPI (n = 384), and 60+ months/long IPI (n = 121) and data on sociodemographic/reproductive characteristics and maternal and neonatal outcomes abstracted and uploaded to SPSS (version 21) worksheet. Descriptive, bivariate, and multivariate logistic regression analyses were done and a p-value of 0.05 was considered statistically significant. The demographic and reproductive characteristics were comparable across the three IPI groups. Maternal outcomes such as uterine rupture, post-partum haemorrhage (PPH), blood transfusions, preeclampsia, and maternal mortality were comparable across short, intermediate, and long IPI. Some neonatal outcomes, however, showed evidence of an association with IPI. These were prematurity (p = 0.03) and developing congenital malformations (p = 0.01). Other neonatal outcomes (birth outcomes, birth weight, Apgar at 5, and NBU admission) were similar. In conclusion, maternal outcomes are comparable when the IPI after a repeat caesarean section at term is short, intermediate, and long. Congenital anomalies and premature births should be anticipated when the IPI is long (more than 59 months).

Implementing oncology clinical trials in Nigeria: a model for capacity building

BackgroundThere is both higher mortality and morbidity from cancer in low and medium income countries (LMICs) compared with high income countries (HICs). Clinical trial activities and development of more effective and less toxic therapies have led to significant improvements in morbidity and mortality from cancer in HICs. Unfortunately, clinical trials remain low in LMICs due to poor infrastructure and paucity of experienced personnel to execute clinical trials. There is an urgent need to build local capacity for evidence-based treatment for cancer patients in LMICs.MethodsWe conducted a survey at facilities in four Teaching Hospitals in South West Nigeria using a checklist of information on various aspects of clinical trial activities. The gaps identified were addressed using resources sourced in partnership with investigators at HIC institutions.ResultsDeficits in infrastructure were in areas of patient care such as availability of oncology pharmacists, standard laboratories and diagnostic facilities, clinical equipment maintenance and regular calibrations, trained personnel for clinical trial activities, investigational products handling and disposals and lack of standard operating procedures for clinical activities. There were two GCP trained personnel, two study coordinators and one research pharmacist across the four sites. Interventions were instituted to address the observed deficits in all four sites which are now well positioned to undertake clinical trials in oncology. Training on all aspects of clinical trial was also provided.ConclusionsPartnerships with institutions in HICs can successfully identify, address, and improve deficits in infrastructure for clinical trial in LMICs. The HICs should lead in providing funds, mentorship, and training for LMIC institutions to improve and expand clinical trials in LMIC countries.

Magnitude and determinants of multimorbidity and health care utilization among patients attending public versus private primary care: a cross-sectional study from Odisha, India

BackgroundMultimorbidity in primary care is a challenge not only for developing countries but also for low and medium income countries (LMIC). Health services in LMIC countries are being provided by both public and private health care providers. However, a critical knowledge gap exists on understanding the true extent of multimorbidity in both types of primary care settings.MethodsWe undertook a study to identify multimorbidity prevalence and healthcare utilization among both public and private primary care attendees in Odisha state of India. A total of 1649 patients attending 40 primary care facilities were interviewed using a structured multimorbidity assessment questionnaire collecting information on 22 chronic diseases, medication use, number of hospitalization and number of outpatient visits.ResultThe overall prevalence of multimorbidity was 28.3% and nearly one third of patients of public facilities and one fourth from private facilities had multimorbidity. Leading diseases among patients visiting public facilities included acid peptic diseases, arthritis and chronic back pain. No significant difference in reporting of hypertension and diabetes across the facilities was seen. Besides age, predictors of multimorbidity among patients attending public facilities were, females [AOR: 1.6; 95% CI 1.1–1.3] and non-aboriginal groups [AOR: 1.6; 95%CI 1.1–2.3] whereas, in private females [AOR: 1.6; 95%CI 1.1–2.4], better socioeconomic conditions [AOR 1.4; 95% CI 1.0–2.1] and higher educational status [primary school completed [AOR 2.6; 95%CI 1.6–4.2] and secondary schooling and above [AOR 2.0; 95%CI 1.1–3.6] with reference to no education were seen to be the determinants of multimorbidity. Increased number of hospital visits to public facilities were higher among lower educational status patients [IRR: 1.57; 95% CI 1.13–2.18] whereas, among private patients, the mean number of hospital visits was 1.70 times more in higher educational status [IRR: 1.70; 95%CI 1.01–3.69]. The mean number of medicines taken per day was higher among patients attending private hospitals.ConclusionOur findings suggest that, multimorbidity is being more reported in public primary care facilities. The pattern and health care utilization in both types of settings are different. A comprehensive care approach must be designed for private care providers.

The Aristotelian model of friendship and the IU-Kenya Partnership.

Disparity in economic development between high-income countries (HICs) and low- and medium-income countries (LMICs) has necessitated collaborations, some in health-related activities. Globalisation frameworks indicate that, in fair collaborations, the ultimate aim should be to improve the situation in LMICs. In this paper we present the findings of a research study in which we used Aristotle's concept of friendship among unequal parties as an analytic framework to engage with the issue of inequality in an existing international partnership in health, the Indiana University-Kenya Partnership (IU-Kenya Partnership). This is a collaborative health programme involving a consortium of North American universities and schools of the Moi University College of Health Sciences in Kenya. We carried out in-depth oral interviews and focus group discussions with a sample of 41 partners of various IU-Kenya Partnership programmes. We did a comparison of obtained themes to the Aristotelian pointers of aspects of friendship among unequal parties. We eventually identified good and bad aspects of North-South partnerships as perceived in the IU-Kenya Partnership restricted to the Aristotelian model. Key terms: health research collaborations, HICs-LMICs Partnerships, IU-Kenya Partnership, inequality, good and bad partnership, Aristotelian model.

The Aristotelian model of friendship and the IU-Kenya Partnership

Disparity in economic development between high-income countries (HICs) and low- and medium-income countries (LMICs) has necessitated collaborations, some in health-related activities. Globalisation frameworks indicate that, in fair collaborations, the ultimate aim should be to improve the situation in LMICs. In this paper we present the findings of a research study in which we used Aristotle's concept of friendship among unequal parties as an analytic framework to engage with the issue of inequality in an existing international partnership in health, the Indiana University-Kenya Partnership (IU-Kenya Partnership). This is a collaborative health programme involving a consortium of North American universities and schools of the Moi University College of Health Sciences in Kenya. We carried out in-depth oral interviews and focus group discussions with a sample of 41 partners of various IU-Kenya Partnership programmes. We did a comparison of obtained themes to the Aristotelian pointers of aspects of friendship among unequal parties. We eventually identified good and bad aspects of North-South partnerships as perceived in the IU-Kenya Partnership restricted to the Aristotelian model. Key terms: health research collaborations, HICs-LMICs Partnerships, IU-Kenya Partnership, inequality, good and bad partnership, Aristotelian model.

Mapping Evidence of Experiential learning for Primary Health Care Workers in Low-and-Middle-Income Countries: A Scoping Review

Background: Improving equity of healthcare is one of the main global health priorities, particularly in low and medium-income-countries (LMICs). However, most LMICs still struggle to achieve equity in healthcare provision. One of the major contributing factors to achieving health equity in these settings include low levels of healthcare competency among primary healthcare workers. Experiential learning has been shown to contribute effectively to healthcare curriculum delivery. The purpose of this study was to systematically map evidence of experiential learning training programs for PHC workers with a focus on quality improvement in LMICs.&#x0D; &#x0D; Findings: Of the 240 022 articles retrieved from database search, 129 studies were found to be eligible for inclusion in abstract screening following title screening. Subsequent to abstract screening, 29 articles were eligible for inclusion in full article screening. Full article screening resulted in four articles found eligible for inclusion for data extraction and quality appraisal. Included studies were conducted in the following Countries: South Africa, China and Brazil. The following themes emerged: The utility, efficiency and acceptability of experiential learning approaches to PHC workers and Reflection. Experiential learning through various approaches was shown to have the potential to provide an important practical aspect on curriculum delivery not easily taught in lecture-based learning. Skills developed by PHC students in LMICs included communication, empathy, creativity and critical-reflexive skills. The reflection step of experiential learning was shown to be a useful tool to identify root causes of health systems inefficiencies and to inform policy making. The quality of included studies was found to range from above average to high quality.&#x0D; &#x0D; Conclusion: Limited research on the utility, efficiency and acceptability of experiential learning approaches to PHC-based professionals as well as on the impact of these approaches to the provision of quality services was found. Research focused on the development and piloting of experiential learning approaches to determine feasibility and to ensure effectiveness of interventions towards continuous professional development and life-long learning of PHC nurses in rural clinics is recommended.

Pertussis in Low and Medium Income Countries: A Pragmatic Approach.

Pertussis is a vaccine preventable disease since late 1940s. However, it is still endemic in all countries and occurs in epidemic cycles. The number of cases/deaths has decreased during the last decade but a high number of deaths persists in Low and Medium Income Countries (LMIC). The epidemiological situation in LMIC is not precisely known due to lack of surveillance and specific diagnostic tools. A pragmatic approach in these countries should be to establish; (i) a hospital-based surveillance in the largest cities of the country with clinicians and nurses trained to detect clinical symptoms, to obtain biological samples for specific analysis and diagnosis; (ii) a reference laboratory as part of an international network of reference laboratories, under quality assurance, and able to perform at least PCR diagnosis and if possible detection of antibiotic resistance. This surveillance network would allow specific diagnosis of pertussis and facilitate the reporting of cases at national level, thereby improving awareness of the disease at clinician, population and decision maker levels. This network could allow a better evaluation of vaccine coverage, timely vaccination and impacts of modification of national vaccine strategy or type of pertussis vaccine used. Collaboration between this network and basic scientists should be strengthened through translational research projects in order to improve fundamental knowledge on pertussis in LMIC and help clinicians' access to specific diagnostic tools.

Crises in the Aquatic Profession

In this paper, I propose there are several crises in the aquatic profession and I explain what they are and how to address them using research and my own observations. I use an innovative questioning process to do this by asking you the reader a series of questions after which I explain each. The first crisis has to do with the quantity of trained swimming instructors relative to the population that they serve. In many western European and North American high income countries (HICs), the teacher:student ratios are declining and it is getting increasingly difficult to hire trained swim instructors. In low and medium income countries (LMICs), the ratios remain devastatingly low and allow few persons to receive formal swim lessons. The second aquatic crisis I address is the apparent lack of competence and experience of many swim instructors in both HICs and LMICs. Part of the issue appears to be that most novice swim instructors only teach for 1-3 years creating a large turnover in instructors. Due to the lack of experience, the likelihood of new instructors to be highly effective is dramatically reduced. Among many training agencies, public pressure has been to reduce the amount of time and expertise required to become certified. The final crisis relates to the aquatic curricula provided by the primary training agencies (e.g., American Red Cross, YMCA of the USA). For the most part, the validity and reliability of swimming curricula have not been evaluated rigorously. Few if any evaluations of the efficacy of swimming curricula have been regularly conducted. The primary measure of program success continues to be how many students are enrolled in programs rather than how well students had learned to swim. I propose an ongoing need to address each of these crises as a primary way to address the drowning crisis faced worldwide.

Challenges and practical steps to optimizing the utilization of electronic fetal monitoring in low and medium income countries: The UBTH experience

Electronic fetal monitoring with special emphasis on cardiotocography (CTG) has become indispensable in the management of pregnancy and labor, especially in the high-risk parturient. While this is an essential part of the practice in high-income countries, many low- and medium-income countries (LMICs) lack the facilities and skill to deploy the technology in their centers. The reasons for this stem from various issues including lack of knowledge on the significance of the tool, lack of training in the acquisition and interpretation of the trace, inordinate fear of the presumed increase in Caesarean section rate, equipment cost and maintenance, among others. In this commentary, the lessons learnt from the 10-year experience of the implementation of CTG monitoring at the Maternal and Fetal Unit of the Department of Obstetrics and Gynecology of the University of Benin Teaching Hospital, Benin City are shared. The basic steps necessary to commence the service are proposed. The issue of training and retraining is emphasized while also highlighting the necessity of preventive maintenance of the equipment. The challenges of the program and limitations of the report are also brought to the fore. Despite these drawbacks, in the spirit of the peer review system for the introduction and sustenance of contemporary medical technology in LMICs, it is believed that sharing these experiences will help build an enduring system capable of improving service delivery and practice in these regions.

Assessing the Impact of Terrorism in Trade Development in the SADC Region: A Gravity Model Approach

The South African Development Community (SADC) was formed with the objective of achieving development, peace and security, and economic growth but terrorism has been a major obstacle. This paper captured terrorism as a trade cost to bilateral trade in the region. The PPML technique was used for the analyses because of its robustness, consistency and ability to capture zero trades and appropriate fixed effects. Our analyses revealed that, terrorism must have caused an increase in bilateral trade in the region and were dependent on the level of income of trading partners. Trade with low-and medium-income countries were positively influenced by terrorism primarily because their production capacity must have been damaged by terrorism and the only way to augment domestic demand was to depend on international trade. But the region’s trade with high-income countries was negatively affected by terrorism. Partly because their capacity to produce for export must have been affected and raising insurance premiums for goods that are shipped to higher-risk nations may also hinder trade. Based on the coefficients, the impacts of terrorism on bilateral trade appear very small but not negligible.

Towards equity in global health partnerships: adoption of the Research Fairness Initiative (RFI) by Portuguese-speaking countries

Research partnerships between high-income countries (HICs) and low- and medium-income countries (LMICs) often display a set of asymmetries that hinder the development of science, technology and health systems in the...