Middle-income Countries Research Articles

Long-term symptoms in children after a Cryptosporidium hominis outbreak in Sweden: a 10-year follow-up.

In 2010, a Cryptosporidium hominis outbreak resulted in 27,000 clinical cryptosporidiosis cases (45% of the population) in Östersund, Sweden. Long-term abdominal and joint symptoms are common following cryptosporidiosis in adults, and it can affect the development of children in low-income countries. We investigated the potential consequences for children in a high-income setting. In 2011, we prospectively surveyed 600 randomly selected children aged 0-5 years from Östersund. Cases were defined as respondents reporting new episodes of diarrhoea during the outbreak. After 10 years, respondents received a follow-up questionnaire about long-term symptoms (n = 423). We used X2 and Mann-Whitney U tests to assess between-group differences in demographics and the mean number of symptoms. Logistic regressions adjusted for sex, age, and prior issues with loose stools were used to examine associations between case status and symptoms reported at follow-up. We retrieved data on healthcare visits from patient records. In total, 121 cases and 174 non-cases responded to the follow-up questionnaire (69.7%). Cases reported 1.74 (median 1.00, range 0-14) symptoms and non-cases 1.37 (median 0.00, range 0-11) symptoms (p = 0.029). Cases were more likely to report joint symptoms (aOR 4.0, CI 1.3-12.0) and fatigue (aOR 1.9, CI 1.1-3.4), but numbers were generally low. We found no between-group differences in abdominal symptoms, healthcare utilization, or disease diagnoses. Children aged 0-5years from high-income countries may experience long-term symptoms after cryptosporidiosis, but may not be affected to the same extent as adults or their peers living in low-income countries.

Distribution of informal caregiving for older adults living with or at risk of cognitive decline within and beyond family in rural South Africa.

Aging populations will increasingly need care, much of this provided informally particularly in rural areas and in low and middle-income countries. In rural South Africa, formal support is severely limited, and adult children are frequently unavailable due to morbidity, early mortality, employment and migration. We describe how care is shared within and between households. We conducted quantitative interviews with 1,012 household members and non-household caregivers of 106 older adults (age ≥54) living with or at risk of cognitive decline in rural Mpumalanga, South Africa. Using descriptive statistics and regression analysis, we described how care is shared, with particular attention to generational patterns of care. Spouses, the majority women, commonly considered themselves primary caregivers. informal care was spread among family, friends, and neighbors, most commonly by unemployed female relatives one or two generations younger than the recipient. A small number of paid caregivers, also mostly female, provided the most intensive care. Informal care for older adults was spread widely, predominantly from co-resident family but with important contributions from others. Family commitment to care reflected shared history, reciprocal relationships, and easy access to care tasks within the household. A deeper understanding of how informal care for older adults is shared is essential for developing targeted interventions.

Delayed Surgery Increases the Rate of Infection in Closed Diaphyseal Tibial and Femoral Fractures.

Although delays in musculoskeletal care in low- and middle-income countries (LMICs) are well documented in the open fracture literature, the impact of surgical delays on closed fractures is not well understood. This study aimed to assess the impact of surgical delay on the risk of infection in closed long-bone fractures treated with intramedullary nailing in LMICs. Using the SIGN (Surgical Implant Generation Network) Surgical Database, patients ≥16 years of age who were treated with intramedullary nailing for closed diaphyseal femoral and tibial fractures from January 2018 to December 2021 were identified. Infection was diagnosed based on the assessment by the treating surgeon. A logistic regression model, adjusting for potential confounders, was used to analyze the association between delays to surgery (in weeks) and infection. Of the 9,477 closed fractures that were included in this study, 58% were femoral fractures and 42% were tibial fractures. The mean age was 35 years, and 76.2% of the patients were men. The mean delay to surgery was 10.5 days, and the median delay to surgery was 6 days. The overall infection rate was 3.1%. The odds of developing an infection increased by 9.2% with each week of delayed surgical treatment (odds ratio,1.092; 95% confidence interval, 1.042 to 1.145). Increasing delays were also associated with longer surgery duration and higher rates of open reduction. Surgical delays in LMICs were associated with an increased risk of infection in closed long-bone fractures. This study quantified the increased risk of infection due to delays in receiving care, highlighting the importance of timely surgery for closed fractures in LMICs. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Behavioural interventions targeting the prevention and treatment of young children's mental health problems in low- and middle-income countries: a scoping review.

Globally, 10% of children and adolescents live with mental health problems and often lack high-quality care. Over 80% of people facing mental health issues reside in low- and middle-income countries (LMICs). Failing to address children's mental health may prolong these challenges into adulthood, impeding their chances for a healthy life. This scoping review aims to describe the types, implementation strategies, effectiveness, and gaps of existing interventions for preventing and treating mental health problems in early childhood (<10 years) in LMICs. The study employed a scoping review of experimental studies published 2007-2023. Major databases including PubMed, Embase, Web of Science, and PsycINFO were searched using key terms related to the population (children), intervention (mental and/or behavioural health programmes), and outcome (mental health problems). Three authors independently conducted search strategy, article screening, data extraction, and quality assessment. The findings were presented using descriptive analysis and narrative synthesis. Of 39 499 identified articles, 33 were included in the study, covering 7629 children and published between 2009-2022. Seventeen studies (51.5%) were from upper-middle-income countries, 13 (39.4%) were from lower-middle-income, and three (9.1%) were from low-income countries. Enrolment was community-based in 23 studies and health-facility based in 10 studies; the majority (79%) focused on children aged 3-8 years old. Almost two-third (63.6%) of studies were conducted in urban settings. Programmes encompassed various interventions such as parenting programmes (33.3%). A majority of studies (57.5%) employed group therapy for delivering the programme, with mental health professionals (21.2%) acting as the primary intervention providers. Interventions were primarily received by children (39.4%), followed by mothers/caregivers (33.3%). Most studies explored disruptive disorders (20 studies), social and behavioural problems (16 studies), and anxiety disorders (12 studies). Statistically significant intervention effects on child mental health outcomes were reported for 90% of published studies. Diverse behavioural programmes that improve the mental health of young children are available and effective in LMICs. Most interventions were delivered in urban settings and focus was on the use of health care professionals. Diverse intervention approaches, including parenting programmes and group therapy, were effective in addressing various mental health issues among young children.

Anesthesia Trauma Guidelines: A Systematic Review of Global Accessibility and Quality.

This systematic review describes the available clinical practice guidelines (CPGs) for the anesthetic management of trauma and appraises the accessibility and quality of these resources. This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted across 8 databases (MEDLINE, Embase, Web of Science, CABI Digital Library, Global Index Medicus, SciELO, Google Scholar, and National Institute for Health and Care Excellence) for guidelines from 2010 to 2023. Two independent reviewers assessed guideline eligibility and extracted data, which were audited by a third reviewer. Data regarding author demographics, accessibility, clinical topics, and quality were collected. The quality of guidelines was evaluated according to the National Guideline Clearinghouse Extent Adherence to Trustworthy Standards (NEATS) Instrument. A total of 2426 articles were identified, of which 165 met eligibility criteria and were included. Guidelines were developed by 122 professional societies and authors from 51 countries. By region, Europe contributed with the most authors (61%), while Africa had the fewest (4%). Most CPGs were developed by authors from high-income countries (HIC) and only 12% had a first or last author from low- and middle-income countries (LMIC). The United States was the country with the most guideline authors. While 70% were open access, the average cost for paid access was US$36.61. Among the 8 languages identified, English was the most common. The most common topics were blood and fluid management, shock, and airway management. The overall quality of included guidelines was considered moderately high, with an average NEATS score of 3.13 of 5. Quality scores were lowest for involvement of patient perspectives, plans for updating, and presence of a methodologist. On logistic regression analysis, the involvement of a methodological expert was the only predictor of having a high-quality NEATS score, with no association observed with open accessibility, English language, society endorsement, first author from a HIC, or a multidisciplinary group composition. Though many countries and societies have contributed to the development of anesthesia CPGs for trauma, there has been a disproportionate lack of representation from LMICs, where the burden of trauma mortality is highest. In this study, we identify barriers to accessibility and areas for improving future guideline quality. We recommend ongoing efforts to incorporate perspectives from diverse settings and to increase the availability of high-quality, open-access guidelines to improve worldwide health outcomes in trauma.

Synthesizing the Evidence Base to Enhance Coordination between Humanitarian Mine Action and Emergency Care for Casualties of Explosive Ordnance and Explosive Weapons: A Scoping Review.

Humanitarian mine action (HMA) stakeholders have an organized presence with well-resourced medical capability in many conflict and post-conflict settings. Humanitarian mine action has the potential to positively augment local trauma care capacity for civilian casualties of explosive ordnance (EO) and explosive weapons (EWs). Yet at present, few strategies exist for coordinated engagement between HMA and the health sector to support emergency care system strengthening to improve outcomes among EO/EW casualties. A scoping literature review was conducted to identify records that described trauma care interventions pertinent to civilian casualties of EO/EW in resource-constrained settings using structured searches of indexed databases and grey literature. A 2017 World Health Organization (WHO) review on trauma systems components in low- and middle-income countries (LMICs) was updated with additional eligible reports describing trauma care interventions in LMICs or among civilian casualties of EO/EWs after 2001. A total of 14,195 non-duplicative records were retrieved, of which 48 reports met eligibility criteria. Seventy-four reports from the 2017 WHO review and 16 reports identified from reference lists yielded 138 reports describing interventions in 47 countries. Intervention efficacy was assessed using heterogenous measures ranging from trainee satisfaction to patient outcomes; only 39 reported mortality differences. Interventions that could feasibly be supported by HMA stakeholders were synthesized into a bundle of opportunities for HMA engagement designated links in a Civilian Casualty Care Chain (C-CCC). This review identified trauma care interventions with the potential to reduce mortality and disability among civilian EO/EW casualties that could be feasibly supported by HMA stakeholders. In partnership with local and multi-lateral health authorities, HMA can leverage their medical capabilities and expertise to strengthen emergency care capacity to improve trauma outcomes in settings affected by EO/EWs.

Out of pocket costs and financial hardships among breast cancer patients in Egypt: a pilot study

ABSTRACT Breast cancer shows high global prevalence with high mortality rates and hence high financial burden specifically in low and middle-income countries (LMICs). This pilot study took place in Egypt to quantify the out-of-pocket expenses and analyze the financial burden faced by breast cancer patients under the governmental reimbursement system. The study took place at the Center of Clinical Oncology and Nuclear Medicine, Cairo University. We collected data on out-of-pocket costs, subjective financial burden and disease coping strategies through an interviewer-administered questionnaire. Then, we used descriptive statistics and Pearson correlations for analysis and the results were presented in Egyptian pound (EGP) and dollars (USD). The study included 60 breast cancer patients from Cairo University's oncology center, aged 27–75 years. The average direct medical costs, including medications, diagnostics, and medical care outside the center was 1096 EGP (35.47 USD) per month. Non-medical costs, such as food and travel, cost an average of 381 EGP (12.33 USD) per month and indirect costs of 1160 EGP (37.47 USD) per month. The total out of pocket costs of breast cancer showed an average of 2637 EGP (85.34 USD) per month. Around 32% of patients experienced catastrophic financial burden. Coping strategies included medication adjustments and lifestyle changes due to financial constraints. There was moderate positive correlation (r = 0.7) between the perceived financial burden and the number of adopted strategies. Breast cancer patients face financial challenges that may lead to impoverishment due to the excessive direct and indirect expenses associated with treating the disease. Therefore, we recommend disease screening, early detection, and facilitated access to subsidized healthcare.

A paper-based HPV E7 oncoprotein assay for cervical precancer detection at the point of care.

Cervical cancer, while preventable through screening and treatment of cervical precancer, remains a global challenge with a disproportionately high burden of disease in resource-limited settings, especially in low- and middle-income countries (LMICs). Lack of affordable, easy-to-use screening and diagnostic tests contributes to this disparity. Most commercially available tests are not appropriate for use in LMICs due to resource constraints. Specifically, HPV mRNA and oncoprotein tests that have high specificity for cervical precancer and cancer require complex sample preparation protocols and expensive instrumentation. To address these limitations, an HPV E7 oncoprotein assay for HPV16, 18, and 45 was developed that is appropriate for use at the point of care. The assay is paper-based, involves only five simple steps, and does not require instrumentation. A clinically relevant limit of detection was demonstrated with cellular samples. Additionally, clinical performance was demonstrated with a small pilot study (n = 19), in which the HPV E7 paper-based assay was found to have 95% accuracy when compared to histopathologic diagnosis of cervical intraepithelial neoplasia grade 2 or more severe (CIN2+). With further clinical validation, this assay could enable highly specific point-of-care testing for cervical precancer and cancer that is instrumentation-free, affordable, and ideal for use in resource-limited settings.

Impact of nocturnal road traffic noise and annoyance on self-reported insomnia symptoms: policy intervention in noise-polluted environments.

Chronic exposure to traffic noise is associated with increased stress and sleep disruptions. Research on the health consequences of environmental noise, specifically traffic noise, has primarily been conducted in high-income countries (HICs), which have guided the development of noise regulations. The relevance of these findings to policy frameworks in low- and middle-income countries (LMICs) remains uncertain. To investigate the relationship between road traffic noise exposure and annoyance on insomnia symptoms, a questionnaire survey was administered to 5408 randomly selected participants residing in Srinagar, India. Sleep quality was assessed using a standardized sleep disturbance score, along with self-reported annoyance levels related to road traffic noise at the participants' residences. Nighttime road traffic noise was modeled using Sound PLAN 8.2 software to generate noise contour maps, enabling the spatial evaluation of noise levels along roadways near residential areas. A total of 79.3% of the 5408 respondents were exposed to noise levels exceeding 45 Lnight dB(A). Statistically significant associations were observed between traffic noise exposure and all insomnia symptoms, with difficulty falling asleep showing the strongest association (OR = 1.53; 95% CI = 1.12-2.09) within the study sample. Compared to males, females exhibited higher insomnia symptoms (OR = 1.68; 95% CI = 1.35-2.08). The results indicated that insomnia was strongly correlated with an increased odds of traffic noise annoyance (OR = 2.39; 95% CI = 1.73-3.76) (p = 0.029). Finally, this study advocates for a robust regulatory framework to incorporate noise pollution mitigation strategies into the public health action plans of developing nations.

Associations of macrosomia with sociodemographic, anthropometric, lifestyle factors and perinatal outcomes in Southwest Nigeria.

Currently, macrosomia contributes to maternal and neonatal morbidity and mortality in low-and middle-income countries because of changes in maternal lifestyle. Reliable data are needed for its prevention, early detection, and management. This study assessed the associations between sociodemographic, anthropometric, maternal lifestyle, perinatal outcomes, and macrosomia in Southwest Nigeria. We used the Ibadan Pregnancy Cohort Study (IbPCS) data, which investigated maternal obesity, lifestyle factors and the associated pregnancy outcomes among 1745 antenatal care attendees in Southwest Nigeria. This study examined the 1200 women who were not lost to follow-up, had health facility deliveries and the infants' birthweight records. Outcome variables were macrosomia (birthweight ≥ 4kg) and perinatal outcomes. Explanatory variables were sociodemographic, anthropometric, and maternal lifestyle factors. Maternal blood glucose and lipids were assessed between 24 and 28 weeks' gestation. Bivariate and multiple logistic and Poisson regression analyses examined the associations at a 5% level of statistical significance. The prevalence of macrosomia was 72 (6%) [95% CI: 4.66-7.35]. On bivariate analysis parity (p = 0.009), maternal age (p = 0.012), history of macrosomia (0.021), consumption of protein-rich diets with non-alcoholic beverages (p = 0.021), sex of infants (p = 0.018), and engagement in physical activity (p = 0.036) were significantly associated with macrosomia. The mean maternal glucose levels were significantly higher among mothers with macrosomic babies compared with those without macrosomia: FPG: 4.72 ± 2.32 vs. 4.32 ± 0.9 mmol/l (p = 0.035), 1-hour plasma glucose: 8.80 ± 3.77 vs. 6.97 ± 1.93 mmol/l (p < 0.001), 2-hour plasma glucose: 7.16 ± 3.20 vs. 6.25 ± 1.73 mmol/l (p = 0.008). The predictors of macrosomia include a history of macrosomia [AOR = 2.057, 95% CI: 1.009-4.191), maternal obesity [AOR = 1.883, 95% CI: 1.027-3.451], and male infants [AOR = 1.847, 95% CI: 1.016-3.357) were more likely to have macrosomia compared to female infants. Furthermore, Emergency Cesarean section was a significant outcome of macrosomia [RR = 1.675, 95% CI: 1.068-2.627]. Macrosomia was common among our study population. This study identified common modifiable risk factors for foetal macrosomia,its mechanistic pathways and suggested prevention and control strategies for macrosomia among pregnant women.

The first 1000 days: the price of inequalities in high and middle-income countries.

The first 1000 days of human life start from conception until the child turns 2 years of age. This is a unique period in which the foundations of a child's lifelong health are built. Disadvantaged socioeconomic circumstances and limited access to health care services can globally affect a child's health outcomes and educational and vocational potential. This article discusses health inequalities over the first 1000 days of life and possible mitigation programs. Governments and politicians should promote fairer health interventions and pediatric healthcare workers should be aware of the main health determinants to advocate for more equitable and child-focused resource allocation. Therefore, the main approaches to contrast health inequalities include cooperation between governments and public health professionals, removing barriers to accessing medical care, and raising staff awareness about health determinants. Finally, pro-equality interventions should include providing services commensurate with the level of need, in adherence to the principle of social justice. IMPACT: This review aims to elicit a detailed understanding of how inequalities affect early childhood development in different socio-economic contexts, focusing on both the short and long-term consequences. The greatest impact comes precisely from providing valuable tools for both clinicians and public health practitioners to understand and read, in daily practice, the effects produced by health determinants and health inequalities.

Where is Batho Pele? The perspective of child and adolescent mental health service users in the Western Cape Province of South Africa.

Mental health disorders of children and adolescents represent a key area of concern, yet child and adolescent mental health services (CAMHS) are neglected, especially in low- and middle-income countries. There is a clear need to provide services that are relevant to the needs of service users, but little research to date has explored their needs and experiences of services, or to identify their recommendations for service strengthening. In 1997 the South African Government introduced the "Batho Pele" ('People First') initiative in all public sector services, with the aim of putting the voices of service users at the centre of decision-making of policy development and implementation. This study sought to explore user perspectives about CAMHS in the Western Cape, one of the nine provinces of South Africa. Using focus group discussions and semi-structured interviews, qualitative data were collected from purposively sampled CAMHS users (caregivers and adolescents) across the Western Cape Province. Data were entered into NVivo, and thematic analysis was performed by two independent raters. Results highlighted slow, inappropriate and unacceptable CAMHS at primary level of care, and lack of dedicated CAMH resources and staff rudeness at primary and secondary levels of care. Only one positive theme was identified about a new service initiative at primary care. Only specialist CAMHS (tertiary level) were regarded as well-organised. To improve CAMHS, users recommended that the processes and procedures should be restructured to become child- and family-friendly, separate CAMHS should be developed at primary and secondary levels, CAMHS should be prioritized to provide equitable services to young people with mental health disorders, and better communication and information, including formal psychoeducation should be provided to caregivers. The data from this study provided very little support for the "Batho Pele" principles and highlighted a clear need for CAMHS strengthening in the Western Cape, and in South Africa as a whole. These findings may be similar in other low-resource settings and highlight the importance of putting "people first" by listening to their voices on an ongoing basis and at all levels of service and systems strengthening.

Amoebas: the omnipotent organism and silent assassin.

Amoebas are characterized by their unique ability to exist both as free-living organisms and, occasionally, as parasites within host tissues, earning them the designation 'amphizoic amoebae'. While amoebic infections are less prevalent, their health impact can be tremendous, leading to several diseases. In low-income countries, poor sanitation and socioeconomic conditions significantly increase the risk of amoebic infections, particularly E. histolytica, which affects up to 50 million people and causes over 100,000 deaths each year. Diagnostic methods, including microscopy, serological tests, polymerase chain reaction, and the loop-mediated isothermal amplification assay, have improved the accuracy and timeliness of amoeba diagnosis. However, these methodologies are often cost-prohibitive for developing countries. Conversely, current treatments involve aggressive protocols using antibiotics, antifungals, and anticancer agents. However, the prognosis for severe infections such as Primary Amoebic Meningoencephalitis and Granulomatous Amebic Encephalitis remains poor. Despite advancements, effective treatments, and new low-cost therapeutic options are still being researched. Thus, the current review sought to provide a description of molecular aspects such as amoeba virulence factors and invasion processes, focusing on recent advances in the detection, identification, and treatment of associated diseases.

Pandemic preparedness in Vietnam: a review of health system resilience and areas for improvement.

In this viewpoint, we explore Vietnam's health system vulnerabilities and its national response to the COVID-19 pandemic, as well as critical areas of health system resilience, including health financing, workforce distribution, information systems, and governance. While Vietnam achieved early success through strong governance and mass vaccination campaigns, the pandemic revealed weaknesses in resource procurement, workforce imbalance, and limitations of its health information system. There are challenges in ensuring the rapid disbursement of financial resources and reliance on imported medical supplies, which delayed response times. Uneven healthcare workforce distribution, particularly in rural areas, further strained the health system. Although telemedicine and digital health solutions were implemented, weak digital infrastructure and inadequate information technology literacy hindered their effectiveness. Governance efforts, while generally strong, highlighted the need for better coordination and role clarity during health emergencies. Our findings identify areas for improvement, including effective resource mobilisation and allocation, enhanced digital infrastructure, expanded telemedicine access, and better support for healthcare workers. Governance enhancements, such as improved priority setting and interagency coordination, were also critical. These insights offer valuable guidance for strengthening Vietnam's health system and ensuring greater preparedness for future pandemics, but could also help other low- and middle-income countries facing similar challenges.

Neonatal near miss and associated factors among neonates delivered at East Gojjam zone public health hospitals, Northwest Ethiopia.

Neonatal mortality and morbidity is a significant public health issue globally, particularly in low-income countries including Ethiopia. This study aimed to determine the proportion and associated factors of neonatal near misses among newborns delivered at public hospitals in the East Gojjam zone of Northwest Ethiopia. A facility-based cross-sectional study was conducted from April 21 to June 20, 2023, among 560 newborns and their mothers in randomly selected five public hospitals. Data was collected using an interviewer-administered questionnaire, medical record review, and a standard checklist with a systematic random sampling technique in each proportionally allocated hospital. The data was entered using 4.6 Epi-data software and exported to SPSS version 25. Bivariable and multivariable logistic regression analyses were performed using a backward stepwise approach method, and statistical significance was declared at a 95% confidence interval with a p-value < 0.05. A total of 552 participants responded to the study, with a response rate of 98.6%. The prevalence of neonatal near miss was 41.3% with a 95% confidence interval of 37.1-45.3. Unplanned pregnancy (AOR = 4.91, 95% CI: 2.43-9.94), current obstetric complications at birth (AOR = 5.48, 95% CI: 2.92-10.27), pregnancy-induced hypertension (AOR = 2.75, 95% CI: 1.23-6.12), premature rupture of membrane (AOR = 3.40, 95% CI: 1.71-6.78), mother referred from other healthcare facilities (AOR = 7.12, 95% CI: 4.01-12.63), delivered on-duty time (AOR = 5.04, 95% CI: 2.94-8.65), less than three ultrasound scans (AOR = 3.71, 95% CI: 2.11-6.53), and no ultrasound scan (AOR = 9.44, 95% CI: 2.55-34.99) were significantly associated with neonatal near miss. The prevalence of neonatal near-misses was 41.3% (95% CI: 37.1%, 45.3%). Unplanned pregnancy, obstetric complications at birth, ultrasound scan, premature rupture of membrane, pregnancy-induced hypertension, and mothers referred from other healthcare facilities, and delivered on-duty time were significant factors associated with neonatal near misses.

A cross-sectional survey of psychiatrists' experiences of using telepsychiatry during the COVID-19 pandemic and the relationship with burnout in selected high, middle, and low-income countries.

The COVID-19 pandemic necessitated substantial modifications in the delivery of patient care on a global scale. Telemedicine-based care services were implemented worldwide to maximize access to healthcare systems. This study aimed to investigate the use of and satisfaction with telepsychiatry services implemented during the COVID-19 pandemic by psychiatrists across low, middle, and high income countries, and to assess levels of burnout among psychiatrists providing telepsychiatry services in different settings and countries. We hypothesized that use of telepsychiatry will have increased during the pandemic and is associated with increased risk of burnout. A cross-sectional survey was conducted from October 2020 to June 2021 on psychiatrists practicing in Egypt, United Kingdom, Croatia, Belgium, Indonesia, Italy, and El Salvador. Participants were asked to provide sociodemographic data and to complete a questionnaire developed ad-hoc by the authors on telepsychiatry use, the Modified Arizona Telemedicine Program Satisfaction (MATPS) survey and the Oldenburg Burnout Inventory questionnaire. A total of 347 participants completed the survey. Sixty three percent indicated that they had not utilized teleservices for clinical consultation or academic purposes prior to the COVID-19 pandemic. A substantial shift was observed during the pandemic, with this percentage increasing to 98%. Over two-thirds of psychiatrists expressed satisfaction with the visual (76%) and audio (77%) aspects of teleconsultation. No significant correlation was found between burnout and satisfaction. While older age was negatively correlated with burnout levels, years of experience showed a positive correlation with levels of burnout. While there was an increased acceptance and satisfaction with teleconsultation, a persistent preference for in-person consultations remained. The study did not find a correlation between satisfaction in telepsychiatry and levels of burnout. Moreover, increasing age was correlated with lower burn out rate, whereas a correlation between years of experience and heightened levels of burnout was evident.

Multimorbidity patterns and function among adults in low- and middle-income countries: a scoping review.

To map the scope of available evidence on relationships between multimorbidity patterns and functioning among adults in low- and middle-income countries (LMICs), and describe methods used. Scoping review guided by a five-step methodological framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines. PubMed/MEDLINE, Scopus, EBSCOhost (CINAHL) and Cochrane databases were searched from January 1976 to March 2023, plus reference lists of included studies. Peer-reviewed full-text articles or conference proceedings of any design, published in English or Afrikaans, involving adults (>18 years) with multimorbidity living in LMICs. Studies had to refer to associations between multimorbid patterns of co-occurrence and functioning. Multimorbidity was defined as the coexistence of ≥2 diseases, including any combination of non-communicable, infectious and mental health conditions. Data were extracted independently by two reviewers using a piloted form. Findings were synthesised according to methodological approaches, multimorbidity-pattern epidemiology, evidence gaps/limitations and recommendations for future research. The International Classification of Functioning, Disability and Health framework was used to classify functional problems. Nine studies (total sample size: 62 003) were included, mainly from upper-middle-income Asian countries. Key methodological inconsistencies were identified in defining and operationalising multimorbidity, conditions included in determining patterns, statistical methods for pattern determination and functioning outcome measures. Five main multimorbidity pattern domains emerged: Cardio-Metabolic and Coronary Atherosclerotic, Musculoskeletal, Respiratory and Digestive/Visceral, Degenerative, and Mental Health-Related. Mobility limitations, instrumental activities of daily living, self-care and bowel/bladder problems were consistently linked to all pattern domains. The limited and geographically skewed body of literature, along with methodological inconsistencies, hampers a comprehensive understanding of multimorbidity patterns and associations with functioning in LMICs. Future research should explore context-specific multimorbidity definitions, employ transparent methodologies, use standardised measures and incorporate diverse samples to inform tailored interventions and policies.

Enhancing trauma triage in low-resource settings using machine learning: a performance comparison with the Kampala Trauma Score.

Traumatic injuries are a leading cause of morbidity and mortality globally, with a disproportionate impact on populations in low- and middle-income countries (LMICs). The Kampala Trauma Score (KTS) is frequently used for triage in these settings, though its predictive accuracy remains under debate. This study evaluates the effectiveness of machine learning (ML) models in predicting triage decisions and compares their performance to the KTS. Data from 4,109 trauma patients at Soroti Regional Referral Hospital, a rural hospital in Uganda, were used to train and evaluate four ML models: Logistic Regression (LR), Random Forest (RF), Gradient Boosting (GB), and Support Vector Machine (SVM). The models were assessed in regard to accuracy, precision, recall, F1-score, and AUC-ROC (Area Under the Curve of the Receiver Operating Characteristic curve). Additionally, a multinomial logistic regression model using the KTS was developed as a benchmark for the ML models. All four ML models outperformed the KTS model, with the RF and GB both achieving AUC-ROC values of 0.91, compared to 0.62 (95% CI: 0.61-0.63) for the KTS (p < 0.01). The RF model demonstrated the highest accuracy at 0.69 (95% CI: 0.68-0.70), while the KTS-based model showed an accuracy of 0.54 (95% CI: 0.52-0.55). Sex, hours to hospital, and age were identified as the most significant predictors in both ML models. ML models demonstrated superior predictive capabilities over the KTS in predicting triage decisions, even when utilising a limited set of injury information about the patients. These findings suggest a promising opportunity to advance trauma care in LMICs by integrating ML into triage decision-making. By leveraging basic demographic and clinical data, these models could provide a foundation for improved resource allocation and patient outcomes, addressing the unique challenges of resource-limited settings. However, further validation is essential to ensure their reliability and integration into clinical practice.

Antibiotics for Paediatric Community-Acquired Pneumonia: What is the Optimal Course Duration?

Despite significant global reductions in cases of pneumonia during the last 3 decades, pneumonia remains the leading cause of post-neonatal mortality in children aged <5 years. Beyond the immediate disease burden it imposes, pneumonia contributes to long-term morbidity, including lung function deficits and bronchiectasis. Viruses are the most common cause of childhood pneumonia, but bacteria also play a crucial role. However, the optimal duration of antibiotic therapy for bacterial pneumonia remains uncertain in both low- and middle-income countries and in high-income countries. Knowing the optimal duration of antibiotic therapy for pneumonia is crucial for effective antimicrobial stewardship. This is especially important as concerns mount over rising antibiotic resistance in respiratory bacterial pathogens, which increases the risk of treatment failure. Numerous studies have focused on the duration of oral antibiotics and short-term outcomes, such as clinical cure and mortality. In contrast, only one study has examined both intravenous and oral antibiotics and their impact on long-term respiratory outcomes following pneumonia hospitalisation. However, study findings may be influenced by their inclusion criteria when children unlikely to have bacterial pneumonia are included. Efforts to differentiate between bacterial and non-bacterial pneumonia continue, but a validated, accurate, and simple point-of-care diagnostic test remains elusive. Without certainty that a child has bacterial pneumonia, determining the optimal duration of antibiotic treatment is challenging. This review examines the evidence for the recommended duration of antibiotics for treating uncomplicated pneumonia in otherwise healthy children and concludes that the question of duration is unresolved.

Data Collection Variability Across Neonatal Hypoxic-Ischemic Encephalopathy Registries.

To assess variability among data elements collected among existing neonatal hypoxic-ischemic encephalopathy (HIE) data registries worldwide and to determine the need for future harmonization of standard common data elements. This was a cross-sectional study of data elements collected from current or recently employed HIE registry data forms. Registries were identified by literature search and email inquiries to investigators worldwide. Data elements were categorized by group consensus. A total of 1,281 data elements were abstracted from 22 registries based in 14 countries, including 3 middle-income countries. Registries had a median of 106.5 distinct data elements per registry (range 59-458). The most commonly collected data were related to pregnancy, therapeutic hypothermia, and short-term hospital outcomes. The least consistently collected data were laboratory values other than acid/base status values. Only 4 variables were consistently collected in every registry. Five registries included neurodevelopmental follow-up fields and 5 others linked their data to a separate follow-up registry. Many HIE registries are collecting patient data around the world, but there is considerable variability in the number, type, and format of data collected. Future attempts to develop standard common data elements to harmonize data collection globally will be crucial to facilitate worldwide collaboration and to optimize management and outcome of neonatal HIE.