Low- And Middle-income Countries Countries Research Articles

Integration of livelihood support with MHPSS in rehabilitation of torture survivors in LMICs: Addressing poverty and mental health dynamics.

The integration of livelihood support with mental health and psycho-social support (MHPSS) seems crucial for the rehabilitation of torture survivors in low- and middle-income countries (LMICs). This study aimed to explore the intersec-tionality of poverty and mental health, and the integration of livelihood support with-in MHPSS frameworks related to the rehabilitation of torture survivors in LMICs. A cross-sectional study was conducted using a semi-structured questionnaire distributed to members of the International Rehabilitation Council for Torture Victims (IRCT) in LMICs (n=25). The questionnaire explored the perception of IRCT centres in LMIC countries regard-ing the extent to which poverty contributes to poor mental health outcomes among torture sur-vivors and the effectiveness of integrating livelihood support into MHPSS interventions. The study highlighted the significant economic challenges faced by torture survivors, indicating a high prevalence of extreme poverty among this group. The study found that 92% of respondents believed that poverty and mental health outcomes of torture survivors are strongly linked. Eco-nomic and social inequalities were identified as key determinants of mental health, emphasizing the need to address these inequalities in rehabilitation programs for torture survivors. The study underscores the critical connection between poverty, mental health, and the experience of torture. In the view of most IRCT centres, the integration of livelihood support with MHPSS is essential for addressing economic disparities and promoting long-term resilience among survivors. The results highlight the need to conduct long-term longitudinal studies that provide support to this perception. The study recommends enhancing coordination among stakeholders, addressing cultural and social barriers, securing sustainable funding, and developing strategies to integrate livelihood support with MHPSS for torture survivors. According to participants, rehabilitation programmes should include economic empowerment, mental health support, and social integration, to contribute to a holistic recovery, long-term resilience, and overall well-being.

Global disparities in cancer supportive care: An international survey.

The global cancer burden is rising, particularly in low- and middle-income countries (LMIC), highlighting a critical research gap in understanding disparities in supportive care access. To address this, the Multinational Association of Supportive Care in Cancer (MASCC) Health Disparities Committee initiated a global survey to investigate and delineate these disparities. This study aims to explore and compare supportive care access disparities between LMIC and High-Income Countries (HIC). An online cross-sectional survey was conducted among active members of MASCC. Members, representing diverse healthcare professions received email invitations. The survey, available for 3 weeks, comprised sections covering (1) sociodemographic information; (2) clinical service/practice-related disparities in their region/nation; (3) population groups facing disparities within their region or country. Chi-squared or Fisher's exact test for cross-sectional analyses, and a multivariable logistic regression model was employed for statistical analysis. A total of 218 active members participated, with one-quarter (26.6%) from LMIC and 18.4% ethnic minorities, timely cancer care (43.7%) and timely supportive care (45.0%) emerged as the most pressing disparities globally. Notably, participants from LMIC underscored cancer drug affordability (56.4%) and supportive care guideline implementation (56.4%) as critical issues. Economically disadvantaged populations were noted as more likely to face disparities by both LMIC and HIC (non-US-based) respondents, while US-based respondents identified racial/ethnic minorities as facing more disparities. This global survey reveals significant disparities in cancer supportive care between LMIC and HIC, with a particular emphasis on medication affordability and guideline implementation in LMIC. Addressing these disparities requires targeted intervention, considering specific regional priorities.

International Hackathon as a Tool to Augment Education, Collaboration, and Innovation in Global Neurosurgery.

Health care providers' exposure to global surgical disparities is limited in current nursing and/or medical school curricula. For instance, global health is often associated with infectious diseases or maternal health without acknowledging the growing need for surgical care in low- and middle-income countries (LMICs). We propose an international virtual hackathon based on neurosurgical patient cases in under-resourced settings as an educational tool to bring awareness to global surgical disparities and develop relationships among trainees in different countries. Participants were recruited through email listservs, a social media campaign, and prize offerings. A 3-day virtual hackathon event was administered, which included workshops, mentorship, keynote panels, and pitch presentations to judges. Participants were presented with real patient cases and directed to solve a barrier to their care. Surveys assessed participants' backgrounds and event experience. The hackathon was executed through Zoom at Harvard Innovation Lab in Boston, MA, on March 25 to 27, 2022. Participants included medical students, with additional participants from business, engineering, or current health care workers. Three hundred seven applications were submitted for 100 spots. Participants included medical students, physicians, nurses, engineers, entrepreneurs, and undergraduates representing 25 countries and 82 cities. Fifty-one participants previously met a neurosurgeon, while 39 previously met a global health expert, with no difference between LMIC and high-income countries' respondents. Teams spent an average of 2.75 hours working with mentors, and 88% of postevent respondents said the event was "very" or "extremely conducive" to networking. Projects fell into 4 categories: access, language barriers, education and training, and resources. The winning team, which was interdisciplinary and international, developed an application that analyzes patient anatomy while performing physical therapy to facilitate remote care and clinical decision-making. An international virtual hackathon can be an educational tool to increase innovative ideas to address surgical disparities in LMICs and establish early collaborative relationships with medical trainees from different countries.

Causes of preventable death among children of female sex worker mothers in low- and middle-income countries: A community knowledge approach investigation.

Female sex workers (FSW) in low- and middle-income countries (LMIC) are disproportionately vulnerable to poor health, social, and economic outcomes. The children of female sex workers (CFSW) experience health risks based on these challenging circumstances and the unique conditions to which they are exposed. Although country child mortality data exist, little is known about the causes of death among CFSW specifically, thereby severely limiting an effective public health response to the needs of this high-risk group of children. The Community Knowledge Approach (CKA) was employed between January and October 2019 to survey a criterion sample of 1280 FSW participants across 24 cities in eight LMIC countries. Participants meeting pre-determined criteria provided detailed reports of deaths among the CFSW within their community of peers. Newborn deaths were gleaned from FSW maternal death reports where the infants also died following birth. Of the 668 child deaths reported, 589 were included in the analysis. Nutritional deficiencies comprised the leading cause of mortality accounting for 20.7% of deaths, followed closely by accidents (20.0%), particularly house fires, overdoses (19.4%), communicable diseases (18.5%), and homicides (9.8%). Other reported causes of death included neonatal conditions, respiratory illnesses, and suicides. The causes of CFSW death in these eight countries are preventable with improved protections. Governments, intergovernmental organisations like the United Nations, nongovernmental stakeholder organisations (e.g. sex worker organisations), and funders can implement targeted policies and programmes to protect CFSW and assist vulnerable FSW who are pregnant and raising children. Further research is needed to identify effective child welfare safeguards for CFSW.

Cross-sectional associations between fruit and vegetable intake and successful ageing across six countries: findings from the WHO Study on global AGEing and adult health (SAGE).

This study develops successful ageing profiles across six low- and middle-income countries (LMIC) and examines associations with fruit and vegetable (F&V) intake. A cross-sectional analysis was conducted in mid-aged and older adults from the WHO Study of Global Ageing. Participants without chronic disease, cognitive impairment, depression or disability and with good physical, cardiovascular and respiratory function were considered to have successfully aged. Associations between F&V intake (serves/d) and successful ageing were examined using log-binomial regression adjusting for key confounders. China, Ghana, India, Mexico, Russia and South Africa. A total of 28 785 men and women aged 50 years and over. Successful ageing ranged from 4 % in Mexico to 15 % in China. After adjustment, only Ghana showed an association between fruit intake and successful ageing, with an inverse association identified (prevalence ratio (PR) = 0·87, 95 % CI 0·78, 0·98). An inverse association between vegetable intake and successful ageing was found in China (0·97, 0·95, 0·98) but no other country. An inverse association was shown for both China (0·98, 0·96, 0·99) and Ghana (0·92, 0·84, 1·00) when considering fruit and vegetables combined. Associations between F&V intake and successful ageing are inconsistent. Further studies on LMIC countries are needed to meet the challenges of the ageing population.

Understanding the trends of maternal mental health research in India through bibliometric analysis

Pregnancy-related mental health issues are more common in low and middle‐income countries (LMICs). Common mental health disorders are more prevalent among women than men. In LMIC countries, the prevalence of mental health disorders is higher, estimated at 15.6% among pregnant women and 19.8% among postpartum women. According to the studies, Antenatal depression prevalence in India ranged from 9.8% to 36.7%, while antenatal anxiety prevalence was 55.7%. This study performed bibliometric profiling to shed light on maternal mental health research conducted in India since 1979 and to present the research output in the field of maternal mental health in India. SCOPUS databases have been chosen for data retrieval due to their extensive coverage, high-impact journal inclusion and ease of access to quality publications. In total, 146 publications were found in the field. Maternal mental health research increased significantly in 2022. The peak number of publications occurred in 2022.There has been a lot of focus on maternal mental health. This is evidenced by the fact that there has been a significant increase in the number of scientific publications in India since 1979. The bibliometric indicators provided important information on the research contributions from different institutes and authors. The results of this study can serve as a reference for researchers and policymakers to plan future research.

Trends in child marriage, sexual violence, early sexual intercourse and the challenges for policy interventions to meet the sustainable development goals

IntroductionChild marriage remains a prevalent issue in low- and middle-income countries (LMIC) despite global declines. Girls are disproportionately affected, facing health risks, limited education, and restricted decision-making power. We aim to provide insights for child marriage prevalence across LMIC from 1990 to 2020, with a focus on sexual violence and early sexual intercourse for public health policy interventions.MethodsThis study used World Bank datasets to assess progress in addressing child marriage in LMIC countries. Statistical analyses, including trend analysis and compound annual growth rate (CAGR), were conducted to evaluate indicators of first marriage, sexual violence, and sexual intercourse. Countries with sufficient data were categorized based on prevalence rates and trends, and detailed analysis focused on significant indicators.ResultsWhile significant reductions were observed in the prevalence of child marriage before the age of 15 and 18 and early sexual intercourse in most countries, few countries show increasing trends, and others could not demonstrate statistical trends due to data limitations, such as scarcity of data for boys. Overall, many countries showed a decline in sexual violence and early sexual intercourse before the age of 15, but some exhibited increasing trends. For instance, Zambia and Senegal showed a decreasing trend of sexual violence, while Nigeria exhibited an increasing trend. Notably, Uganda, Cameroon, and Sierra Leone for women, and Namibia, Zambia, and Kenya for men, experienced substantial decline in early sexual intercourse.ConclusionThere is a decline in child marriage, sexual violence, and early sexual intercourse in most countries independent from the income group. Only a few countries show slight increasing trends. The improvements confirm that policies that address education, employment, and deep-rooted gender inequality at the societal level seem to be effective and help reach the SDG. However, better data are needed to enhance the understanding of the development of child marriage in these countries to improve the effectiveness of policy intervention. Therefore, we recommend that policymakers not only include existing evidence that continues progress but also increase and improve the monitoring of relevant indicators.

Improvement in operator safety for low- and middle-income countries: A user-friendly, consistent risk assessment and mitigation process

Abstract Ensuring operator safety when handling and applying chemical pesticides is an important aspect of pesticide registration. A risk-based approach to assess if operators can safely apply a pesticide product is usually conducted in countries with a regulatory infrastructure to support the relatively complex process for risk assessment. However, most low- and middle-income countries (LMIC) have limited expertise and/or resources for conducting sophisticated operator risk assessments. The FAO Pesticide Registration Toolkit was developed to support regulators from countries with limited resources to conduct operator risk assessments for national/regional pesticide registration processes. The two operator exposure models referenced in the FAO toolkit for agricultural use, based primarily on studies conducted in Europe and the United States, focus more on mechanical-assisted spray equipment prevalent in those regions. The models for hand-held application technology are based on a rather limited dataset. The applicability of the models for scenarios prevalent in the country and complexity of the risk assessment process are the two key challenges LMIC countries face in using the models referenced in the toolkit. A global initiative that builds on existing expertise and available studies is underway to develop a global database and operator exposure model for handheld application scenarios prevalent in most LMICs. The goal is to develop a user-friendly risk assessment and mitigation tool to be proposed for inclusion in the FAO toolkit. This article provides a brief overview of risk assessment and examines factors that contribute to the accuracy and consistency of exposure models and risk mitigation measures to ensure operator safety. It also proposes suggestions that can serve as the basis for a user-friendly risk assessment and risk mitigation tool based on a global database for handheld applications

Evaluation of job satisfaction among pharmacists working in public health facilities

BackgroundThe decline in healthcare workforce is a global trend that is alarming in low and middle-income countries (LMIC) in LMIC and many countries worldwide, pharmacists plays critical role in healthcare, many of which are not limited to patient care, research and development, health promotion. However, growing dissatisfaction among pharmacists working in public health facilities has become increasingly common and can have severe public health consequence. Job dissatisfaction ranks among the most significant factors influencing healthcare employees to seek career changes, reduce productivity, and possibly migrate to more promising opportunities, thereby posing a public health threat in the region.' Furthermore, healthcare professionals are crucial to the functionality of a healthcare system, with human resources standing as a critical element ensuring organizational success vis-a-vis other dependent factors to optimize efficiency and effectiveness. ObjectivesTo examine the job satisfaction of pharmacists working in public health facilities in Nigeria. MethodA descriptive, cross-sectional study on pharmacists' job satisfaction was carried out between march and July 2023, to determine the job satisfaction of pharmacists working in primary, secondary, and tertiary healthcare facilities in Nigeria. Data were gathered using an anonymous online validated questionnaire adapted from the Minnesota questionnaire short form and the Job Description Index (JDI) (Measuring Job Satisfaction - Tools, Scales, and Methods). ResultsThe study identified an overall low job satisfaction level of 65%. Major influencers included facility conditions, co-worker relations, and remuneration. The demographic data revealed a dominance of female pharmacists in general hospital settings, with a significant proportion aged between 23 and 36 years. Remuneration emerged as a universal concern across different age groups, reflecting Nigeria's prevailing economic challenges. Interestingly, satisfaction with the working facility decreased with age, suggesting that enthusiasm and optimism wane over time. Relationship dynamics with co-workers showed positive progression with age, whereas satisfaction with pay remained universally low. ConclusionThe study underscores the need for a comprehensive strategic review in the health sector, focusing on remuneration, working conditions, and inter-personal relationships to boost job satisfaction and retention. Further research might delve deeper into specific allowances and the impact of home ownership on satisfaction.

Radiotherapy Access and Treatment in Rwanda: Demographics and Clinical Characteristics of Cervical Cancer Patients

Nearly all cervical cancer deaths occur in low- and middle-income countries (LMIC), and in Rwanda, cervical cancer is the leading cause of cancer mortality among women. In 2018, Rwanda Cancer Center (RCC) opened as the first place to offer radiotherapy (RT) for cervical cancer treatment in the country. This study aims to characterize patient demographic and clinical characteristics, access to care, and predictors associated with treatment initiation. This study was conducted at RCC in Kigali. Between 2019 and 2022, patients who received radiotherapy were included; data were extracted from electronic medical records, including demographics, medical history, cancer information, pre-RT imaging, RT information, and toxicities. Descriptive statistics were used to summarize patient characteristics; chi-square and t-tests were used to test any distribution differences. Time to treatment initiation (TTI, time from biopsy to first RT session) was dichotomized as ≤45 vs. >45 days) and multivariable logistic regression was used to find predictors of TTI. Of the 620 women who presented with cervical cancer, 428 (69%) were treated with radiotherapy (External Beam Radiotherapy using Volumetric Modulated Arc Therapy). The average patient's age was 55.4 years (+/-11.4), and the median distance traveled was 87.7 km (IQR: 37.0-140.0). Nearly 88% used community-based (government) insurance (CBHI, either 0% and 10% copay category); 21.9% were known to be living with HIV. 66.9% of patients presented with stage 3 or 4 disease. Of the patients receiving RT, 357 (83%) received chemotherapy. Predictors of TTI (≤45 days) were travel distance and insurance type. The odds of early TTI (≤45 days) decreased by 27% per 1 log kilometer increase. Patients using CBHI insurance had 54% lesser odds of early TTI than others. RCC has built a capacity to provide advanced radiation treatment to cancer patients in Rwanda and surrounding LMIC countries. Despite the COVID-19 pandemic, RCC has treated nearly 500 patients already. This study is the first to document these patient characteristics; results suggest that longer travel distance and public insurance are major factors for longer treatment initiation. Strategies to identify barriers to screening for early cancer detection and expediting treatment initiation are ongoing.

Consensus guidelines for the management of HR-positive HER2/neu negative early breast cancer in India, SAARC region and other LMIC by DELPHI survey method

BackgroundPrecise prognostication is the key to optimum and effective treatment planning for early-stage hormone receptor (HR) positive, HER2/neu negative breast cancer patients. Differences in the breast cancer incidence and tumor anatomical features at diagnosis, pharmacogenomics data between Western and Indian women along with the vast diversity in the economic status and differences in insurance policies of these regions; suggest recommendations put forward for Western women might not be applicable to Indian/Asian women. Opinions from oncologists through a voting survey on various prognostic factors/tools to be considered for planning adjuvant therapy are consolidated in this report for the benefit of oncologists of the sub-continent, SAARC and Asia’s LMIC (low and middle-income countries).MethodsA three-phase DELPHI survey was conducted to collect opinions on prognostic factors considered for planning adjuvant therapy in early-stage HR+/HER2/neu negative breast cancer patients. A panel of 25 oncologists with expertise in breast cancer participated in the survey conducted in 2021. The experts provided opinions as ‘agree’ or disagree’ or ‘not sure’ in phases-1 and 2 which were conducted virtually; in the final phase-3, all the panel experts met in person and concluded the survey.ResultsOpinions on 41 statements related to prognostic factors/tools and their implications in planning adjuvant endocrine/chemotherapy were collected. All the statements were supported by the latest data from the clinical trials (prospective/retrospective). The statements with opinions of consensus less than 66% were disseminated in phase-2, and later in phase-3 with supporting literature. In phase-3, all the opinions from panelists were consolidated and guidelines were framed.ConclusionsThis consensus guideline will assist oncologists of India, SAARC and LMIC countries in informed clinical decision-making on adjuvant treatment in early HR+/HER2/neu negative breast cancer patients.

Healthcare Cost and Outcomes Associated With Surgical Site Infection and Patient Outcomes in Low- and Middle-Income Countries.

Surgical site infection (SSI) is a growing global concern. The principal explanation for this is its adverse clinical outcomes, such as morbidity and mortality. However, the link between the economic burden of SSIs and patient outcomes needs to be sufficiently characterized. This review aims to describe the financial implications of SSIs on patient outcomes in low- and middle-income countries (LMIC). Despite the heterogeneity in study designs from multiple LMIC countries, there is a significant correlation between SSI-associated healthcare costs from increased length of stay (LOS), readmissions, reoperations, and adverse patient outcomes. This varies based on the size, degree of infection, or other patient comorbidities. SSIs are much more prevalent in LMICs. The additional financial burden incurred in managing SSIs reinforces the need to prioritize practicing interventions to prevent this complication, which resource-limited health institutions are unequipped to do and consequently have significant adverse patient outcomes.

Developing a capacity building training model for public health managers of low and middle income countries.

The challenges faced by the low and middle-income countries (LMIC) in the field of public health management calls for the capacity building of qualified and trained public health managers in order to improve the effectiveness and efficiency of the health care delivery system. Most of the existing training programs for public health management are based in the settings of developed countries, which hinders their application in LMIC countries. The objective of this paper is to document the process of development and evaluation of a capacity building program for public health managers of various LMICs. A training program was developed using Kern's six-step framework with several innovative learning and assessment methodologies and evaluation using Kirkpatrick training evaluation model. Delphi technique was used for program development. This five to ten-day partly/fully funded six International Public Health Management Development Programs (IPHMDP) programs was conceptualized which enrolled 178 participants from 42 countries between years 2016 and 2019. Based upon the elaborative discussion in four rounds of Delphi technique, the problem and challenges faced by public health mangers and eight key competencies (viz. Leadership and governance, Project/ program planning, financial management, supply chain management, quality management, Human Resource management, monitoring and evaluation, and communication.) were identified. The group consensually agree upon a blended teaching methodology comprising of chalk and talk approach, inquiry based learning, participatory student based learning, small group instructions, gamification, project-based learning and field-based learning. There was a significant increase in participants' knowledge score (P<0.0001) after all programs especially in the competencies of monitoring and evaluation, followed by project/ program planning, supply chain management and quality management. The majority (90%) submitted their action plan one week following the program, out of which 64% implemented their action plans within six months. A majority (54.7%) of participants were able to implement their learning once they went back by conducting similar training/ workshop/webinars in their settings. The comprehensive public health management program in LMIC settings strengthens the competencies of public health managers which can be replicated in similar settings across LMIC to mitigate diverse challenges in public health management.

Practical Clinical Consensus Guidelines for the Management of Cancer Associated Anemia in Low- and Middle-Income Countries.

Purvish M. ParikhCancer-associated anemia (CAA) remains a major unmet need that compromises overall survival (OS) and quality of life (QoL). Currently, available guidelines do not take into consideration the unique challenges in low- and middle-income countries (LMIC). Our CAA patients have to battle preexisting impaired nutritional status, depleted body iron stores, financial limitations, and difficulty in having easily accessible affordable healthcare. Hence, we fulfilled the need of guidelines for LMIC. A group of subject experts were put together, given background literature, met in a face-to-face discussion, voted using Delphi process, and finally agreed on the contents of this guideline document. As many as 50% of cancer patients will have significant anemia (hemoglobin < 10 g/dL) at initial diagnosis. It is most commonly seen with gastrointestinal malignancies, head and neck cancers, and acute leukemias. The hemoglobin falls further after initiation of cancer directed therapy, due to chemotherapy itself or heightened nutritional deficiency. Its evaluation should include tests for complete blood count, red blood cell morphology, reticulocyte count, Coombs test, and levels of vitamin B12 and folic acid. Iron status should be monitored using test to measure serum iron, total iron binding capacity, transferring saturation, and serum ferritin levels. A minimum of 50% of cancer patients with anemia require iron supplements. The preferred mode of therapy is with intravenous (IV) iron using ferric carboxymaltose (FCM). Most patients respond satisfactorily to single dose of 1000 mg. It is also safe and does not require use of a test dose. Significant anemia is found in at least half of all cancer patients in India, South Asian Association for Regional Cooperation region, and other LMIC countries. Its awareness among healthcare professionals will prevent it from remaining undiagnosed (in up to 70% of all cancer patients) and adversely affecting OS and QoL. The benefits of treating them with IV iron therapy are quick replenishment of iron stores, hemoglobin returning to normal, better QoL, and avoiding risk of infections/reactions with blood transfusions. Many publications have proven the value of single-dose FCM in such clinical situations. CAA has been proven to be an independent prognostic factor that adversely affects both QoL and OS in cancer patients. Use of FCM as single IV dose of 1000 mg is safe and effective in the majority of patients with CAA.

The Current Status and Challenges of Prehospital Trauma Care in Low- and Middle-Income Countries: A Systematic Review

Background This review aims to understand the present circumstances on the provision of prehospital trauma care in low- and middle-income countries (LMICs), particularly scoping the challenges experienced by LMICs in this regard. The objective is to systematically evaluate the currently available evidence on this topic. Based on the themes and challenges identified in the provision of prehospital trauma care in LMICs, we provide a series of recommendations and a knowledge base for future research in the field. Methods A systematic database search was conducted of original articles that explored and reported on prehospital trauma care in LMIC in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to March 2022. All original articles reporting on prehospital trauma care from 2010 to 2022 in LMICs were assessed, excluding case reports, small case series, editorials, abstracts, and pre-clinical studies; those with data inconsistencies that impede data extraction; and those with study populations fewer than ten. Results The literature search identified 2,128 articles, of which 29 were included in this review, featuring 27,848 participants from LMICs countries. Four main areas of focus within the studies were identified: (1) exploring emergency service systems, frameworks, and interconnected networks within the context of prehospital trauma care; (2) transportation of patients from the response site to hospital care; (3) medical education and the effects of first responder training in LMICs; and (4) cultural and social factors influencing prehospital trauma care-seeking behaviors. Due to overarching gaps in social and health care systems, significant barriers exist at various stages of providing prehospital trauma care in LMICs, particularly in injury identification, seeking treatment, transportation to hospital, and receiving timely treatment and post-intervention support. Conclusion The provision of prehospital trauma care in LMICs faces significant barriers at multiple levels, largely dependent on wider social, geographic, economic, and political factors impeding the development of such higher functioning systems within health care. However, there have been numerous breakthroughs within certain LMICs in different aspects of prehospital trauma care, supported to varying degrees by international initiatives, that serve as case studies for widespread implementation and targets. Such experiential learning is essential due to the heterogenous landscapes that comprise LMICs.

Health-Related Quality of Life of People with Chronic Kidney Disease in Low- and Middle-Income Countries: A Literature Review

Complications of chronic kidney disease (CKD) impair cardiovascular health and quality of life. Health-related QoL (HRQoL) is influenced by cultural perspectives, social environment and health behaviors that vary across countries with varying income. Therefore, present review aims to report HRQoL in people with CKD and factors influencing HRQoL in low and middle-income countries (LMIC). Fifty relevant studies were reviewed following literature search in Cochrane Library, Pub Med, Google Scholar and CINAHL databases using keywords: Quality of life, chronic kidney disease and LMIC. HRQoL was poor in people with CKD compared to healthy individuals. QoL was positively influenced by younger age, male gender, higher socioeconomic and status of employment. Presence of comorbidities, anemia and low hemoglobin levels were associated with poor QoL. Intrinsic and extrinsic factors influencing HRQoL were similar in people with CKD in LMIC and high-income countries. However, overall HRQoL and mental-health scores were lower with reference to high-income countries. Therefore, a multipronged approach designed towards prevention of kidney disease, early detection and management to delay end-stage kidney disease through health education, modification of risk factors, accessible and affordable comprehensive management of kidney disease is necessary. In resource constrained settings of LMIC, strategic investment in planning and implementation of prophylactic and monitoring measures will help to reduce huge financial costs necessary for management and improvement of HRQoL of people with CKD.

The Scope, Growth, and Inequities of the Global Neurosurgery Literature: A Bibliometric Analysis

Here, we evaluate the evolution and growth of global neurosurgery publications over time, further focusing on the contributions and impact of authors in low- and middle-income countries (LMICs). In this systematic bibliometric analysis, we conducted a two-stage blinded screening process of global neurosurgery publications from 5 databases from inception through July 2021. Articles involving multi-national/multi-institutional research collaborations, detailing any area of global neurosurgery collaboration, or influencing global neurosurgery practice were included. Statistical hypothesis testing was conducted to analyze trends and hypotheses of LMIC authorship contributions. The number of global neurosurgery publications has soared in the last decade. Overall, authors from HIC countries were most commonly from the US (41.1%), Canada (4.0%), and the UK (3.9%), while authors from LMIC countries were most commonly from Uganda (4.2%), Tanzania (2.6%), Cameroon (1.8%), and India (1.8%). Over a quarter (28%) of publications had no LMIC authors, while only 11% had 3 or more LMIC authors. The proportion of LMIC authors (LMIC-R) was not correlated with the citation rate of individual articles or with the year of publication, and a positive trend emerged when the LMIC-R of top-publishing LMICs was individually examined and compared to the year of publication. Despite recent growth, the number of global neurosurgery publications arising from LMICs pales in comparison to those from HICs. Collaborative efforts between certain HICs and LMICs have likely contributed to the observed increase in LMIC author independence over time.

The Case for Integrating Health Systems to Manage Noncommunicable and Infectious Diseases in Low- and Middle-Income Countries: Lessons Learned From Zambia.

Noncommunicable diseases (NCDs) are the leading cause of death in the world, and 80% of all NCD deaths occur in low- and middle-income countries (LMICs). The COVID-19 pandemic has demonstrated that patients with NCDs are at increased risk of becoming severely ill from the virus. Disproportionate investment in vertical health programs can result in health systems vulnerable to collapse when resources are strained, such as during pandemics. Although NCDs are largely preventable, globally there is underinvestment in efforts to address them. Integrating health systems to collectively address NCDs and infectious diseases through a wide range of services in a comprehensive manner reduces the economic burden of healthcare and strengthens the healthcare system. Health system resiliency is essential for health security. In this article, we provide an economically sound approach to incorporating NCDs into routine healthcare services in LMICs through improved alignment of institutions that support prevention and control of both NCDs and infectious diseases. Examples from Zambia's multisector interventions to develop and support a national NCD action plan can inform and encourage LMIC countries to invest in systems integration to reduce the social and economic burden of NCDs and infectious diseases.

Effects of the simulation pedagogy utilization in undergraduate nursing and midwifery students' skill development, in low- and middle-income countries: A systematic review

Objective: The development of a body of knowledge in simulation pedagogy is a source of enrichment of teaching methods, beneficial for the professional training of nurses and midwives. This review synthesized the effects of the simulation pedagogy utilization in undergraduate nursing and midwifery students' skill development in low- and middle-income countries (LMICs).Methods: The search for primary research papers was conducted in PubMed, CINAHL, ERIC, and EMBASE. For additional papers, hand-searching was performed in key journals. All studies published in the English language between 2011 and 2020 were included. Titles and abstracts were screened after removing duplicates and then full texts of the remaining studies. Thirteen research studies were initially selected for a full review, with fifteen studies that fulfilled inclusion criteria included in the final analysis. The quality of studies was appraised using the Mixed Methods Appraisal Tool. A narrative approach was used for synthesizing data. Results: Of the fifteen primary studies included in the review, there are three qualitative studies, ten quantitative studies, and two mixed methods studies. Among these studies, five were conducted in Turkey, three in South Africa, two in Ethiopia, one in Jordan, one in Kenya, one in Zambia, one in Brazil, and one in China. Student-level outcomes measured included knowledge, attitudes, skill performance, and satisfaction. Most of the outcomes at the reaction level demonstrated students’ satisfaction. At the learning level, outcomes involve knowledge (knowing), attitudes (feeling), and skills (doing).Conclusions: Educators and researchers in undergraduate education programs need evidence to inform best practice strategies for students’ skill development. This research presents preliminary evidence of the effects of the simulation pedagogy utilization in undergraduate nursing and midwifery students' skill development on satisfaction, knowledge, attitudes, and skills. In addition, it could enlighten policymakers, managers and educators in LMICs countries on the need to use simulation pedagogy in nursing and midwifery professional training institutes.

Quality of routine health facility data used for newborn indicators in low- and middle-income countries: A systematic review

BackgroundHigh-quality data are fundamental for effective monitoring of newborn morbidity and mortality, particularly in high burden low- and middle-income countries (LMIC).MethodsWe conducted a systematic review on the quality of routine health facility data used for newborn indicators in LMIC, including measures employed. Five databases were searched from inception to February 2021 for relevant observational studies (excluding case-control studies, case series, and case reports) and baseline or control group data from interventional studies, with no language limits. An adapted version (19-point scale) of the Critical Appraisal Tool to assess the Quality of Cross-Sectional Studies (AXIS) was used to assess methodological quality, and results were synthesized using descriptive analysis.ResultsFrom the 19 572 records retrieved, 34 studies in 16 LMIC countries were included. Methodological quality was high (>14/19) in 32 studies and moderate (10-14/19) in two. Studies were mostly from African (n = 30, 88.2%) and South-East Asian (n = 24, 70.6%) World Health Organization (WHO) regions, with very few from Eastern Mediterranean (n = 2, 5.9%) and Western Pacific (n = 1, 2.9%) ones. We found that only data elements used to calculate neonatal indicators had been assessed, not the indicators themselves. 41 data elements were assessed, most frequently birth outcome. 20 measures of data quality were used, most along three dimensions: 1) completeness and timeliness, 2) internal consistency, and 3) external consistency. Data completeness was very heterogeneous across 26 studies, ranging from 0%-100% in routine facility registers, 0%-100% in patient case notes, and 20%-68% in aggregate reports. One study reported on the timeliness of aggregate reports. Internal consistency ranged from 0% to 96.2% in four studies. External consistency (21 studies) varied widely in measurement and findings, with specificity (6.4%-100%), sensitivity (23.6%-97.6%), and percent agreement (24.6%-99.4%) most frequently reported.ConclusionsThis systematic review highlights a gap in the published literature on the quality of routine LMIC health facility data for newborn indicators. Robust evidence is crucial in driving data quality initiatives at national and international levels. The findings of this review indicate that good quality data collection is achievable even in high-burden LMIC settings, but more efforts are needed to ensure uniformly high data quality for neonatal indicators.