Middle-income Countries Research Articles

South Korea can boost the research potential of low-income countries

South Korea can boost the research potential of low-income countries

Outcomes of external versus internal fixation for traumatic lower limb fractures in low- and middle-income countries

AimsLower limb fractures are common in low- and middle-income countries (LMICs) and represent a significant burden to the existing orthopaedic surgical infrastructure. In high income country (HIC) settings, internal fixation is the standard of care due to its superior outcomes. In LMICs, external fixation is often the surgical treatment of choice due to limited supplies, cost considerations, and its perceived lower complication rate. The aim of this systematic review protocol is identifying differences in rates of infection, nonunion, and malunion of extra-articular femoral and tibial shaft fractures in LMICs treated with either internal or external fixation.MethodsThis systematic review protocol describes a broad search of multiple databases to identify eligible papers. Studies must be published after 2000, include at least five patients, patients must be aged > 16 years or treated as skeletally mature, and the paper must describe a fracture of interest and at least one of our primary outcomes of interest. We did not place restrictions on language or journal. All abstracts and full texts will be screened and extracted by two independent reviewers. Risk of bias and quality of evidence will be analyzed using standardized appraisal tools. A random-effects meta-analysis followed by a subgroup analysis will be performed, given the anticipated heterogeneity among studies, if sufficient data are available.ConclusionThe lack of easily accessible LMIC outcome data, combined with international clinical guidelines that are often developed by HIC surgeons for use in HIC environments, makes the clinical decision-making process infinitely more difficult for surgeons in LMICs. This protocol will guide research on surgical management, outcomes, and complications of lower limb shaft fractures in LMICs, and can help guide policy development for better surgical intervention delivery and improve global surgical care.Cite this article: Bone Jt Open 2024;5(11):1020–1026.

Windows of opportunity for unrelated diversification: a patent data analysis of the field of neurotechnology

PurposeThis study investigates the potential of low-income countries to mitigate technological lock-ins by exploiting windows of opportunity (WOOs). Given their inherent inclination toward path dependency, these countries often face challenges in diversifying beyond their established technological trajectories. We examine the pivotal role of adopting shorter cycle times of technologies (CTTs) in opening technological WOO, triggering unrelated diversification and accelerating technological catch-up.Design/methodology/approachUsing fixed-effect regression models, we analyze country-level patent data within the neurotechnology domain from 1995 to 2021 – a period marked by significant technological change since 2010. Our focus lies in comparing diversification and catch-up trends between low-income and high-income countries, while evaluating the performance of CTT.FindingsOur findings reveal that as low-income countries increase their knowledge complexity (KC), they tend to be locked into existing technological paths. To mitigate lock-in risks, they can strategically adopt technologies with shorter CTTs. These technologies act as catalysts, opening up technological WOOs and stimulating unrelated diversification. KC presents a double-edged sword in the catch-up process, but unrelated diversification can eliminate this dilemma.Practical implicationsOur study introduces the KC-CTT framework, proposing practical strategies to enhance and sustain countries’ competitive advantages.Originality/valueDiversification and catch-up emerge from two separate bodies of literature but present a conceptual overlap. This research bridges the gap between the two literatures by investigating the impact of CTT as their predictor variable.

Celiac disease care differs significantly between high‐ and low‐middle‐income countries: a global survey of celiac experts from 63 countries

AbstractBackground and AimCeliac disease (CeD) is increasingly diagnosed but significant disparities exist in awareness, practices, resources, and legislation worldwide. We conducted a global online survey with CeD experts to assess this disparity internationally.MethodsA 55 questions survey encompassing nine domains relevant to CeD care (awareness, gluten‐free [GF] foods availability/cost/quality, GF labeling, CeD dietician availability, insurance for CeD patients, medical training, research funding, patient support groups, and unmet needs) was generated and sent to CeD experts worldwide electronically. Countries were stratified based on per capita income as high‐income (HIC) and lower‐income countries (LIC) (including upper‐middle‐, lower‐middle‐, and low‐income countries). Survey responses were summarized as a single score using principal component analysis.ResultsValid responses were obtained from 131(37.4%) [HIC: 71; LIC: 60] of contacted CeD experts from 63 countries. Compared with HIC, LIC experts perceived worse availability (HIC:80% vs LIC: 47%; P < 0.001), quality (52% vs 20%; P < 0.001), and legislation for labeling of GF foods (82% vs 37%; P < 0.001), with unfavorable reimbursement policies (27% vs 12%; P = 0.002), subsidies (32% vs 13%; P < 0.001), and insurance (76% vs 43%; P < 0.001) for CeD patients. LIC also lacked awareness about CeD among general physicians (69% vs 32%; P < 0.001), trained celiac dieticians (39% vs 12%; P = 0.002), and active CeD patient support groups (93% vs 50%; P < 0.001). All experts believed that GF foods were costly (94% vs 87%), frequently contaminated (27% vs 32%), and unfavorably taxed (97% and 93%). The experts agreed on key unmet needs and better research funding. Overall CeD preparedness score (median 58.3 vs 33.0; P < 0.001) was also associated with income.ConclusionsThe present survey highlights the opinion of global experts on the challenges, opportunities, and preparedness related to CeD and differences worldwide by income.

Global Pathology: A Snapshot of the Problems, the Progress, and the Potential

Context.— For equitable global health care, the United Nations has outlined Sustainable Development Goals for health in low-income and middle-income countries (LMICs) with the goal of reaching universal health care by 2030. Currently, 47% of the global population lacks access to basic diagnostics for many common diseases. The need for diagnostic access has never been more critical owing to the dramatic rise of noncommunicable diseases in LMICS. In a recent analysis, The Lancet Commission on Diagnostics estimated that 1.1 million deaths occurring on an annual basis could be avoided if the diagnostic gap were reduced to 10% for only 6 priority conditions. Objective.— To provide a nonexhaustive summary of the progress made to overcome the barriers to adequate access and explore the potential solutions needed to achieve global diagnostic equity. Data Sources.— Several experts in global pathology were interviewed in addition to pathologists working in low-resource settings outside of the United States. Published literature on the topic of global pathology work was analyzed and summarized to provide a cohesive snapshot of the status of global pathology. Conclusions.— Working to increase access to diagnostics in low-resource settings will save millions of lives. The solution to the current inadequate availability of global pathology services will require a global commitment from the entire pathology and laboratory medicine community, government support, and collaboration between the public-private sectors to achieve equitable health care.

Task-sharing to promote caregiver mental health, positive parenting practices, and violence prevention in vulnerable families in Sierra Leone: a pilot feasibility study

Abstract Background The prevalence of household violence in low- and middle-income countries (LMICs) is high, and exposure to violence has significant adverse effects on both mental health and child development across generations. Evidence-based services to improve parenting practices and reduce household violence in LMICs are scarce, particularly across rural regions of West Africa. This study explored the feasibility, acceptability, and potential benefits of an evidence-based home-visiting intervention to promote early childhood development and reduce household violence—the Family Strengthening Intervention for Early Childhood Development and Violence-Prevention (FSI-ECD + VP)—among vulnerable families in rural regions of Sierra Leone. Methods Eighty dual-caregiver households in the Makeni region of Sierra Leone were included in the study (N = 160 caregivers; 73% female). Eligibility criteria included having at least one child aged 6–36 months and elevated scores (> 62.5) on the Difficulties in Emotion Regulation Scale (DERS). Community Health Workers (CHWs) employed in the Makeni region completed a 3-week FSI-ECD + VP training. Families were randomized to receive either the FSI-ECD + VP or treatment as usual (TAU). Research assistants blinded to treatment assignment assessed caregiver mental health, caregiver-child interactions, and household violence at baseline, post-intervention, and 3-month follow-up time points. Results Triangulation of quantitative and qualitative data showed that caregivers, CHWs, and supervisors generally perceived the intervention as beneficial, feasible, and acceptable. Mixed effects models showed that caregivers who received the FSI-ECD + VP had significantly improved caregiver-child relationship outcomes compared to TAU as assessed by the Home Observation for Measurement of the Environment and the Observation of Caregiver-Child Interactions at post-intervention. Preliminary data also suggests that caregivers receiving the FSI-ECD + VP were less likely to have experienced intimate partner physical violence during the post-intervention period, and had lower symptoms of anxiety and depression at 3-month follow-up. Conclusions FSI-ECD + VP delivery by CHWs in Sierra Leone may be feasible and acceptable; it may also help improve caregiver-child interactions and reduce the likelihood of household violence among vulnerable families with young children. Task-sharing approaches may help increase acceptability and access to evidence-based behavioral interventions that promote early childhood development and violence prevention among families in rural regions of Sierra Leone and other similar settings. Trial registration The study is registered in clinicaltrials.gov (NCT 03045640; 07/22/2020). This study follows the Consort 2010 guidelines for reporting of clinical trials.

Understanding the Determinants Influencing Self-Medication with Antibiotics Among Malaysian Residents: A Qualitative Study to Inform Preventive Public Health Strategies

Introduction: Self-medication with antibiotics (SMA)—the use of these drugs without a physician’s diagnosis, supervision, or a medical prescription—has emerged as a significant crisis in many societies, being a particular concern in low- and middle-income countries. SMA practices hinder global efforts to reduce antibiotic consumption in the human health sector and to control antimicrobial resistance (AMR). The aims of the study were to explore the motivations, perspectives, and personal experiences of the Malaysian population related to SMA, analyzing their subjective viewpoints, attitudes, and behaviors. Methods: The present qualitative study applied an interpretivism paradigm to explore the complex topic of SMA; the interview questions were developed and confirmed by experts in AMR and pharmacy practice. Qualitative data analysis was carried out through a thematic approach. Results: Out of twenty-seven (n = 27) eligible individuals, eleven (n = 11) agreed to participate in in-depth interviews. Three main themes and seven subthemes were identified. Participants revealed directly purchasing antibiotics from pharmacies, due to doctors prescribing similar medications for comparable illnesses in the past. Trust issues related to physicians prescribing unnecessary additional medications and suspected personal motives were revealed. Budgetary constraints, timesaving, and aspects of self-care were identified as some of the key drivers for SMA. Conclusions: The current study’s findings contribute to the understanding of the complexities surrounding SMA and provides insights into the public perceptions and behaviors regarding unregulated antibiotic use in Malaysia. Understanding these dynamics may inform targeted public health interventions to address SMA to mitigate the development of AMR.

Barriers and Facilitators to Cervical Cancer vaccination Among Young Females in Chennai: A Cross-Sectional KAP Study

Cervical cancer develops in the cervix, primarily caused by persistent infection with high-risk types of human papilloma virus (HPV). It is one of the most common cancers in women, especially in low- and middle-income countries. While most HPV infections resolve naturally, some persist and can lead to cervical cancer over time. Aim: This study aims to evaluate the knowledge, attitudes, and practices (KAP) of young women in Chennai regarding cervical cancer, screening, and prevention, and to identify barriers and facilitators influencing participation in screening programs. Methodology: A cross-sectional study was conducted from January to May 2024 among 222 young females, aged 13 and above.. A semi-structured questionnaire assessed their KAP towards cervical cancer. Responses were analyzed using descriptive statistics, and Bloom’s taxonomy was applied to categorize knowledge and attitude. Chi-square tests were used to determine statistical significance, with a p-value < 0.05. Results: Although 78.2% of participants were aware of cervical cancer, knowledge of preventive measures was low—only 25.2% knew about the HPV vaccine, and 44% understood the correct Pap test frequency. Attitudes toward screening were mostly positive, with 73.2% agreeing that free screening reduces cervical cancer risk. However, actual preventive practices were limited—only 9% had undergone a Pap smear, and 10% had received the HPV vaccine. Statistical analysis showed no significant differences in KAP between groups (p > 0.05), except for medical students, who demonstrated significantly higher knowledge levels. Conclusion: Despite positive attitudes toward cervical cancer screening, there were notable gaps in knowledge and preventive practices among young women in Chennai. The findings underscore the need for targeted educational interventions, particularly on HPV vaccination and routine screening, to bridge these gaps.

Injury epidemiology and emergency department length of stay in trauma hospital in Addis Ababa, Ethiopia

Background Injuries are a major cause of health problems in low- and middle-income countries than in high-income nations. This study aimed to describe injuries and identify factors associated with the emergency department (ED) length of stay (LoS). Methods This study was conducted at the Addis Ababa Burn, Emergency, and Trauma (AaBET) hospital in Addis Ababa, Ethiopia. All injured patients who visited the ED between April 1, 2021, and March 30, 2022, were included in the study. Data were collected through a retrospective medical record review. Descriptive statistics were used to present the data and a multivariable binary logistic regression model was used to assess factors associated with LoS in the ED. Results A total of 6991 (86.8%) injured patients were studied out of 8055 patients who visited the ED. The majority of the patients were male, 5184 (74.2%), and aged between 18–44 years, 4368 (62.4%). The most common mechanism of injury was road traffic accidents, 2693 (38.5%), followed by falls, 1523 (21.8%). The most commonly reported injured body parts were the head (2179, 31.2%). Of the total injured patients, 101 (1.8%) died. The LoS in the ED was greater than 24 hours for 24.4% (95% CI: 23.3–25.5) of the injured patients, with a mean duration of 2.51 (SD = 5.18) days. Factors significantly associated with a prolonged LoS (>24 hours) in the ED included being residing in outside Addis Ababa in Oromia [AOR: 1.61, 95% CI (1.38–1.88)], Amhara [AOR: 1.56, 95% CI (1.14–2.14)] and other [AOR: 3.93, 95% CI (2.73–5.64)], male [AOR: 1.30, 95% CI (1.09–1.54)], aged 60 years or older [AOR: 1.38, 95% CI (1.03–1.85)]; sustaining injuries from road traffic accident [AOR: 2.43, 95% CI (1.19–4.94)], being triaged to orange [AOR: 3.03, 95% CI (2.40–3.83)] and red zones [AOR:3.37, 95% CI (2.65–4.28)]; having fracture injuries [AOR: 1.95, (1.34–2.83)]; and experiencing contusions and crushing injuries [AOR: 2.63 (1.57–4.42)]. Conclusions Injuries are the major share of cases among ED patients at AaBET hospital. Patients were staying in the ED for longer than the recommended 24 hours by the Ethiopian health system. Intervention measures focusing on injury prevention are necessary to reduce the patient burden on the hospital and strengthen the hospital’s capacity to reduce prolonged LoS.

ASSESSMENT OF NITRIC OXIDE METABOLISM, MALONDIALDEHYDE, SIALIC ACIDS , AND ENOS GENE VARIANTS (RS1799983) IN NEWBORNS WITH HYPOXIC-ISCHEMIC ENCEPHALOPATHY FOLLOWING L-CARNITINE ADMINISTRATION

In Ukraine, conditions arising during the perinatal period accounted for 57.9% of infant mortality under 1 year of age in 2021, compared to 55.6% in 2017. Hypoxic-ischemic encephalopathy (HIE) remains a leading cause of neurological complications and disability, particularly in low-income countries, where its incidence reaches 10-20 cases per 1,000 newborns. Despite advances in medical care, the risk of irreversible brain damage from HIE remains high. The processes associated with HIE are marked by oxidative stress and disrupted ionic homeostasis, leading to neuroapoptosis and necrosis of brain cells. Objective: to investigate metabolic changes in newborns with HIE by assessing nitric oxide, malondialdehyde, sialic acids, eNOS gene variants, and the impact of L-carnitine on metabolite concentrations. Materials and Methods. The study included 30 neonates. The main group consisted of 16 children with HIE, monitored in an outpatient follow-up clinic and receiving levocarnitine. The comparison group included 14 randomly selected relatively healthy neonates without HIE. Levels of nitrites, nitrates, malondialdehyde, and sialic acids in urine were assessed during the early neonatal period and at 6-9 months of age in children with HIE. In the comparison group, metabolite levels were measured at 6-9 months of age. Results. The study revealed increased nitrite (1.71 vs. 2.7; p=0.003) and nitrate (3.72 vs. 5.42; p=0.010) levels in newborns with HIE, indicating activation of nitric oxide metabolism. Malondialdehyde levels decreased following L-carnitine treatment, suggesting reduced oxidative stress. Genetic analysis showed a higher frequency of the 894GT genotype in the eNOS gene among newborns with reduced sialic acid concentrations (0.2 vs. 0.59; p=0.008). Conclusion. L-carnitine shows potential neuroprotective effects in the treatment of HIE by stabilizing mitochondrial function and reducing oxidative stress. Further studies are needed to optimize therapeutic strategies.

Association of gestational weight gain rate with infant birth weight and cesarean delivery: A prospective cohort study in Nepal

Gestational weight gain (GWG) is linked to pregnancy outcomes, such as birth weight and delivery mode, though research in low-income countries like Nepal is limited. We examined the association of GWG rate with infant birth weight and cesarean delivery in a prospective cohort of 191 pregnant women in Nepal, using data collected from August 2018 to August 2019 at a peri-urban hospital in Dhulikhel. Participants included women with singleton, full-term live births, with GWG rate calculated from weight gain between the second and late pregnancy stages, divided by the weeks in between. GWG rate categories—adequate, inadequate, or excessive—were defined by pre-pregnancy Body Mass Index (BMI) specific to GWG recommendations from the 2009 Institute of Medicine report. Ethical approval was obtained from Institutional Review Board of Kathmandu University and Rutgers University. Statistical analyses in SPSS and Stata revealed that 52.4% of mothers exceeded the recommended GWG rate, particularly among overweight and obese women (0.4 ± 0.2 kg/week and 0.5 ± 0.2 kg/week, respectively). The average birth weight was 2964.9 ± 407.0 grams, with 12% of infants classified as low-birth-weight. Cesarean delivery was recorded in 45% of the women. After controlling for factors like age, education, ethnicity, occupation, parity and BMI, each 1 kg/week increase in GWG from the second to third trimester correlated with a 392-gram increase in birth weight (β = 391.9, 95%CI = 67.2–716.7, p = 0.01), while excessive GWG rate led to a 148-gram increase over adequate GWG rate (β = 148.1, 95%CI = 8.7–287.5, p = 0.03). However, GWG rate was not significantly linked to cesarean delivery. These findings suggest that maternal GWG rate positively affects infant birth weight but not cesarean delivery, underscoring the need for larger studies to explore GWG rate’s effects on maternal and neonatal outcomes.

Financial Challenges Faced by IELTS Test-Takers in Sylhet, Bangladesh: An Exploration of Family Support and Assistance

This study explores the sources of financial assistance available to IELTS test-takers, the motivating factors for taking the test, and the influence of family background on these decisions. The research has adopted a tabular analysis study design to collect the required data and information about IELTS test-takers. Quantitative techniques were applied to gather the necessary primary data and information. This study also adopted In-depth Interview (IDI), Case Studies, and Document Review techniques. Data were collected in Sylhet through coaching centers and an online Google form between June and October 2024, specifically from six centers in Modina Market, Amborkhana, Zindabazar, and Uposhohor. The questionnaire was distributed to 190 individuals, comprising 132 participants currently preparing for a retake. After excluding data of 14 participants due to missing information, 176 responses were analyzed. MS Excel and STATA were employed for data classification and interpretation. Authors used MS Excel for data entry, data cleaning, and tabular analysis and STATA-16 for summary statistics. Female participation in IELTS test preparation is impressive and closely comparable to that of male participants. Additionally, a higher number of students take the IELTS exam in Sylhet district compared to the other three districts. Most of the time, 76.70% of the participants’ family (Parents/Brother/Sister) covered their whole cost of IELTS test and Family members often play a key role in encouraging individuals to pursue the test. IELTS test-takers from low-income families face significant difficulties in covering tuition fees and other expenses related to their preparation, coaching such as the cost of academic materials and center fees. The findings reveal that many test-takers struggle to afford the costs of preparing for the exam. As a student in a low-income country, Bangladesh, many individuals face challenges in covering expenses beyond necessities like food and shelter. Therefore, the study recommends scholarship opportunities and special consideration for participants who are facing financial challenges. The researchers and policy makers of IELTS test, should give a focus to their test fee which will be helpful for students of a developing country.

Giardia lamblia risk factors and burden in children with acute gastroenteritis in a Nicaraguan birth cohort

Background Giardia lamblia is an intestinal protozoan estimated to cause ~200 million symptomatic infections annually, mainly in children in low- and middle-income countries associated with intestinal damage, increased permeability, and malabsorption. Methods and results We describe here the epidemiology, incidence, clinical characteristics, and risk factors of acute gastroenteritis episodes (AGE) with G. lamblia detection (GAGE) using a birth cohort of 443 Nicaraguan children followed weekly until 36 months of life. From June 2017 to July 2021, 1385 AGE samples were tested by qPCR. G. lamblia was detected in 104 (7.5%) of AGE episodes. In all, 69 (15.6%) children experienced at least one GAGE episode, and 25 of them (36.2%) experienced more than one episode. The incidence rate of the first episode of GAGE was 6.8/100 child-years (95% CI, 4.5–9.1). During GAGE, bloody stools, vomiting, and fever were uncommon, and children were less likely to be treated at a primary care clinic, suggesting that GAGE is typically mild and most cases did not receive medical attention, which could facilitate higher parasite loads with increased possibilities of establishing chronic carriage. GAGE was more common in children 12–24 months of age (13.9/100 child-years [95% CI, 10.7–17.1]) as compared to other age groups. In our birth-cohort, children living in a home with an indoor toilet (aHR, 0.52 [95%CI, 0.29–0.92]), and being breastfed in the first year of life (aHR: 0.10 [95%IC, 0.02, 0.57]) had a lower incidence of GAGE. In contrast, being breastfed for ≤ 6 months was associated with a higher incidence if the children were living in houses without indoor toilets and earthen floors (HR, 7.79 [95% CI, 2.07, 29.3]). Conclusion Taken together, GAGE is more frequent under poor household conditions. However, breastfeeding significantly reduces the incidence of GAGE in those children.

End-of-life care awareness in a low–middle-income country: a plea for improvement

End-of-life care awareness in a low–middle-income country: a plea for improvement

QLTI-09. CLINICAL TRIALS IN NEURO-ONCOLOGY: DESIGN, LOGISTICS, CHALLENGES, AND PRACTICAL CONSIDERATIONS

Abstract Timely, secure and reliable transportation, precise handling and storage of biological specimens are critical for the success of clinical research. Research in neuro-oncology often involves complex assays such as next-generation sequencing where the integrityof brain tumor specimens is paramount. These challenges are pronounced in most Lower Middle-Income Countries (LMIC), due to climatic factors and infrastructure limitations, necessitating stringent measures to preserve sample quality and their genetic data integrity for downstream analysis. In this study, we conducted extensive cohort analysis on 80 tissues randomly picked samples of the 3600 samples collected across India to assess the impact of collection protocols, transportation logistics, and long-term storage on the genetic material of tissues. The quality and quantity of the isolated nucleic acids was determined by BioAnalyzer and Qubit parameters. Tissue samples were collected and stored at -80°C in RNAstable® within 4-12 hrs of collection. The DNA and RNA obtained from tissue samples stored for over one year was found to be of good quality with corresponding DNA Integrity Number (DIN) and RNA Integrity Number (RIN)between 7-9. Also, optimum quantity of DNA and RNA was obtained for whole exome and transcriptome sequencing. Upon sequencing, these samples showed good read coverage of 100X or more. These findings provide critical insights into the measures necessary for optimizing sample preservation and transportation to ensure accurate research outcomes. The results indicate that appropriate sample collection, transportation, and long-term storage of bio-specimens can be used effectively for future research. Additionally, the outcome underscores the potential for long-term studies in neuro-oncology using archived biological samples without compromising data integrity.

Understanding the COVID-19 vaccine uptake, acceptance, and hesitancy in Ethiopia and Tanzania: a scoping review

BackgroundThe development and implementation of COVID-19 vaccines have been a breakthrough in controlling the pandemic. However, the vaccination coverage in most low-income countries remains very low due to critical vaccine shortage and profound hesitancy. In this scoping review, we aimed to assess COVID-19 vaccine uptake, acceptance, and hesitancy in Ethiopia and Tanzania.MethodsThe search was made in PubMed, Scopus, Embase, and Web of Science. Only original research articles focusing on vaccine acceptance and hesitancy were included. The studies selected for a full read were analysed using a thematic analysis approach.FindingsA total of 76 articles were included in the study, with 74 of them coming from Ethiopia. The study found an increasing trend in vaccine uptake over time. However, there was also an increase in hesitancy and a decline in willingness to receive the vaccine. The willingness to receive the COVID-19 vaccine in Ethiopia ranged from 18.5 to 88%. The main reasons for "vaccine hesitancy" included fear of side effects, concerns about long-term safety, doubts about vaccine effectiveness, lack of information, vaccine fast-tracking, and religious beliefs. The study also found that younger individuals, females, and pregnant women were less willing to receive the vaccine. The adverse events reported among vaccinated individuals were mostly mild. Most of the studies operationalised vaccine acceptance-hesitancy as dichotomous variables. However, the historical, political, and socio-cultural context in which vaccine acceptance and hesitancy occur was not given any attention. While there is a good amount of data from Ethiopia describing patterns of vaccine acceptance and hesitancy among different populations over time, there is limited information from Tanzania due to the late arrival of the vaccine and limited published articles.ConclusionWe have observed a paradox involving two seemingly conflicting trends: an increase in vaccination rates/coverage and "anti-vax." Most studies have simplified vaccine acceptance-hesitancy as an “either-or” incident, without considering its dynamic nature and occurrence within a broader political, social, and cultural context. Therefore, it is crucial to explore approaches that can enhance our understanding of the vaccine acceptance-hesitancy phenomenon, in order to improve vaccine trust and uptake.

Phase II study on the safety and immunogenicity of single-dose intramuscular or intranasal administration of the AVX/COVID-12 “Patria” recombinant Newcastle disease virus vaccine as a heterologous booster against COVID-19 in Mexico

BackgroundThe global inequity in the distribution of COVID-19 vaccines underscores the urgent need for innovative and cost-effective vaccine technologies to address access disparities and implement local manufacturing capabilities. This is essential for achieving and sustaining widespread immunity, and for ensuring timely protection of vulnerable populations during future booster campaigns in lower- middle income countries (LMICs). MethodsTo address this need, we conducted a phase II clinical trial to evaluate the safety and immunogenicity of the locally manufactured AVX/COVID-12 “Patria” (AVX) vaccine as a booster dose. The vaccine was administered either intramuscularly (IM) or intranasally (IN) to participants who had previously completed a vaccination regimen for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using adenoviral vector, inactivated virus, or mRNA-based vaccines. Participants with initial anti-spike IgG titers below 1,200 U/mL were included, allowing us to observe the booster effect induced by vaccination. ResultsBoth IM and IN immunization with AVX were found to be safe and well-tolerated. The vaccine induced a significant (>2.5-fold) increase in neutralizing antibodies against the ancestral Wuhan strain and variants of concern (VOCs), including Alpha, Beta, Delta, and Omicron (BA.2 and BA.5). This immune response was further supported by increased cellular production of interferon-gamma (IFN-γ), demonstrating a robust and multifaceted immune reaction. ConclusionsThe administration of AVX as a booster dose, whether through IM or IN routes, was safe and well-tolerated. The vaccine extended immune responses not only against the ancestral Wuhan-1 strain but also against various VOCs. Its ability to enhance preexisting immune responses suggests a potential contribution to expanding and sustaining herd immunity within the population.

The reliability and validity of a novel clinical tool for distributing rehabilitation patients: a multicenter cross-sectional study in China

This study aimed to assess the reliability and validity of a novel clinical tool for distributing rehabilitation patients (DRP) for measuring a population of rehabilitation patients based on first-hand data from the field survey in China. A multi-stage sampling scheme was used to select 2512 rehabilitation outpatients from 21 medical institutions in seven cities in China. The evaluation indicators of the DRP tool consisted of five clinical indexes on multiple dysfunctions, self-care ability, vital signs, disease status, and disease course. The evaluation of rehabilitation ways of the DRP tool mainly included outpatient rehabilitation treatment, admission to primary healthcare, admission to secondary hospitals, and admission to tertiary hospitals. The mean age of participants was 54.22 years (SD:17.91), and nearly half (48.68%) were male. The majority (70.15%) were diagnosed with orthopaedic disorders. The Cronbach’s alpha (0.66), the Kendall test (Kendall coefficient = 0.86; P < 0.001), and the Kappa test (Kappa = 0.83; Agreement: 90.48%; P < 0.001) reflected acceptable consistency reliability for the indexes on multiple dysfunctions, self-care ability, vital signs, disease status, and disease course in DRP tool. The modified confirmatory factor analysis (CFA) showed the indexes of multiple dysfunctions (β = 0.31; 95%CI = 0.20–0.43), self-care ability (β = 0.99; 95%CI = 0.65–1.33), disease status (β = 0.11; 95%CI = 0.06–0.16), disease course (β = 0.15; 95%CI = 0.09–0.21), and vital signs (β = 0.15; 95%CI = 0.08–0.21) had significantly factor loadings on the rehabilitation ways. The modified CFA exhibited a satisfactory model fit (RMSEA = 0.03; CFI = 0.99; TLI = 0.95; SRMR = 0.01; AIC = 8268.51; BIC = 8373.43). This is the first study to develop a DRP tool using a relatively large sample from seven cities in China. The DRP tool had acceptable reliability and validity in measuring the rehabilitation ways of patients. Our findings provide a starting point for developing a practical tool in rehabilitation clinical practices and could provide advice on building more effective strategies and tools for other low-and middle-income countries that struggle with integrated healthcare.

Effectiveness of Three Front-of-Pack Food Labels in Guiding Consumer Identification of Nutrients of Concern and Purchase Intentions in Kenya: A Randomized Controlled Trial

Background: Front-of-pack-labels (FOPLs) on packaged foods provide essential information to help consumers make informed dietary choices. However, evidence on their effectiveness, particularly in low- and middle-income countries like Kenya, is limited. Objective: This study assessed the effectiveness of three FOPLs in helping consumers identify nutrients of concern in packaged food products and influencing their purchase intention in Kenya. Methods: A total of 2198 shoppers from supermarkets in Nairobi, Mombasa, Kisumu, and Garissa were randomized into three groups: Red and Green Octagon label (RG), Red and Green Octagon with icons (RGI), and Black Octagon Warning label (WL). In the control phase, participants were shown unlabeled images of packaged foods, followed by questions. In the experimental phase, the same images were presented with one assigned FOPL, and participants responded again to the same set of questions. Differences in correct identification of nutrients of concern and changes in purchase intention were analyzed using frequency tables and Chi-Square tests, while modified Poisson regression assessed FOPL effectiveness. Results: FOPLs significantly improved correct nutrient identification and reduced the intention to purchase unhealthy foods, with the WL proving most effective. Conclusions: These findings highlight the potential of FOPLs, particularly the WL, as an effective regulatory tool for promoting healthier food choices in Kenya.

Outcomes of Congenital Heart Diseases in Duhok, Kurdistan Region of Iraq

Background: Congenital heart diseases (CHD) are the most common birth defects worldwide, significantly impacting morbidity and mortality, especially in low- and middle-income countries where early diagnosis and access to surgical care are limited. In Iraq, congenital heart surgeries are relatively new, and few studies have investigated CHD outcomes in this context. Aim: This study aimed to evaluate the prevalence, distribution, and surgical outcomes of congenital heart diseases among patients treated at the Azadi Heart Center in Duhok, Kurdistan Region of Iraq. Patients and Methods: A retrospective, cross-sectional study was conducted involving 111 patients aged 1-69 years with CHD who underwent surgery at the Azadi Heart Center between March 2019 and March 2024. Data were collected on demographic characteristics, clinical profiles, surgical details, and postoperative complications, including mortality rates. Statistical analysis was performed using Microsoft Excel, with data presented as means, standard deviations, frequencies, and percentages. Results: The average age of patients in the study was 13 years (±16), with congenital heart disease (CHD) being most common among children, who made up 80.18% of cases. Male patients accounted for 54.95%. The most frequent CHD types observed were Tetralogy of Fallot (25%), isolated Ventricular Septal Defect (20%), and Atrial Septal Defect (10%). The surgeries were highly successful, with a 95.5% success rate. However, some patients experienced postoperative complications, such as pneumonia (11.71%), arrhythmias (10.96%), and surgical site infections (5.41%). The overall mortality rate was 10.81%, with infections being a leading cause of death after surgery. Conclusions: CHD is prevalent among young patients in Duhok, with favorable surgical outcomes and acceptable complication rates. These findings highlight the need for early detection, enhanced surgical resources, and continued surveillance to improve outcomes for CHD patients in Iraq.