Low- And Middle-income Research Articles

Collaborative networking and support for medical physics development in low and middle income (LMI) countries.

Medical physics is one of the key aspects of contemporary medicine, primarily focused on the safe and effective use of medical imaging and radiotherapy equipment. The number of medical physicists and their activities are directly related to the national/regional healthcare provision. The distribution of the medical physics workforce however is still very uneven—more than 70% of all medical physicists are in North America and Europe, serving the healthcare provision of about 1 billion people. The remaining 30% of medical physicists serve the healthcare provision of the rest of the world—serving about 6.5 billion people. A number of activities were taken by various teams and organisations to address this issue. The increase of quality of healthcare and the effectiveness of medical technology usage, lie in adequate education and training for medical physicists and engineers, who are the front-liners when it comes to dealing with technology in healthcare. To help LMI countries professional growth in the field of medical physics and technology, we developed an education and capacity building strategy, based on the revolutionary application of digital resources combined with experience sharing through large international network.

1076Spatial modelling on maternal and child health: a scoping review

Abstract Background The Sustainable Development Goals brought attention to the lack of geographically disaggregated data in low- and middle-income (LMIC) countries as national health surveys are generally not designed to provide estimates beyond the first administrative level. Advances on small area estimation methods have allowed for more granular estimates which support targeting and implementation of local health interventions. This study aims to summarize literature on the advances in spatial modelling of reproductive, maternal, newborn and child health (RMNCH). Methods We carried out a comprehensive literature search in five databases to identify studies that: 1) performed small area estimation; 2) were carried out in LMIC settings; 2) focused on RMNCH outcomes; 3) were based on national health surveys. Studies modelling travel time were not considered. Results We included 70 out of 4266 studies. The state-of-art approach to small area estimation has been through a Bayesian framework with INLA for administrative level or up to 5x5 km estimates. Malaria and child mortality outcomes are predominant, closely followed by anthropometry, vaccination and contraceptives use. Conclusions Spatial modelling has become a suitable approach for local estimates where data at finer resolutions is not available. However, there is not a consensus on how to report and interpret uncertainties. Key messages Local estimates are essential to identify and act on the most disadvantaged areas. Properly communicating uncertainty is a big challenge for researchers and they must accompany estimates to avoid misinterpretation.

BRIEF REPORT: PREVENTING LATE-LIFE DEPRESSION IN LOW – AND MIDDLE – INCOME COUNTRIES (LMICS)

As the number of older adults in low- and middle- income (LMIC) countries is expected to grow substantially over the next several decades, it is important to develop programs for the prevention of major depression in later life. These programs should be flexible enough to be adjusted to the needs of poorly resourced LMICs. The current report provides an overview of a “depression in later life” (DIL) study in Goa, India, as a promising and effective mental health prevention program, with the potential for implementation in other LMICs. DIL study uses unspecialized physicians and lay health counselors (LHCs) to deliver both scalable psychological intervention and low-intensity intervention, consistent with Institute of Medicine’s (IOM, 1994) indicated prevention approach. DIL intervention led to reduced incidence of Major Depressive Disorder in DIL-randomized participants and as such it is important in meeting the 2016-2030 United Nations Sustainable Development Goal of “Ensuring healthy lives and promoting the well-being for all at all ages."

Depressive and anxiety symptoms and COVID-19-related factors among men and women in Nigeria.

Despite the greater adverse economic impacts in low and middle-income (LAMI) compared to high-income countries, fewer studies have investigated the associations between COVID-19-related stressor and mental health in LAMI countries. The objectives of this study were to determine the associations between COVID-19-related stressors and anxiety and depressive symptoms while controlling for known risk and protective factors and to investigate any sex differences. An online survey was carried out to assess sociodemographic, psychosocial (previous mental health conditions, sexual orientation, intimate partner violence and perceived social support) and COVID-19-related variables. Hierarchical linear regression was carried out with anxiety and depressive symptoms as separate outcomes. Of the COVID-19-related factors, testing positive for COVID-19 infection, having COVID-19 symptoms, having other medical conditions, self-isolating due to COVID-19 symptoms, worry about infection, perception of the pandemic as a threat to income and isolation during the lockdown were significantly associated with higher anxiety and depressive symptoms. Of these, worry about infection, isolation during lockdown and disruption due to the pandemic retained independent associations with both outcomes. The variance in anxiety and depressive symptoms explained by COVID-19-related factors was larger in women (11.8%) compared to men (6.1% and 0.8% respectively). COVID-19-related stressors are associated with higher anxiety and depressive symptoms, with these effects being larger in men compared to women. Enhancing social support can be an affordable strategy to mitigate this risk but this needs to be investigated using appropriate designs.

A quality of life for patients with diabetes

Introduction and purpose: Diabetes mellitus (DM) is a metabolic disease caused by a chronic state of hyperglycemia, which results from a defect in the function or secretion of endogenous insulin. It is a disease that leads to serious complications such as blindness, lower limb amputation, ischemic heart disease or ischemic strokes. Description of the state of knowledge: The World Health Organization has identified diabetes mellitus as a global epidemic. Between 1980 and 2014, the number of people with diabetes increased from 108 million to over 422. Between 2000 and 2016, more than 7 million deaths from diabetes were reported in 108 countries, but this is an under-number due to the fact that many patients are not diagnosed with diabetes. The prevalence of diabetes in recent years is also higher in low and middle income (LMIC) countries than in high income (HIC) countries. DM also places a significant financial burden on the healthcare budget. Despite relatively large investments in medical care, clinical trials and public health interventions do not reduce the rate of increase in incidence. In the United States, annual healthcare expenditure for people with diabetes is 2.3 times greater than for people without diabetes.Summary: It is well known that diabetes significantly reduces patients' quality of life. It is influenced by both severe complications related to DM and adherence to strict medical recommendations. The low quality of life of diabetic patients contributes to depression, which is associated with not compliance with medical recommendations and increased mortality.

Understanding the maternal and child health system response to payment for performance in Tanzania using a causal loop diagram approach

Payment for performance (P4P) has been employed in low and middle-income (LMIC) countries to improve quality and coverage of maternal and child health (MCH) services. However, there is a lack of consensus on how P4P affects health systems. There is a need to evaluate P4P effects on health systems using methods suitable for evaluating complex systems. We developed a causal loop diagram (CLD) to further understand the pathways to impact of P4P on delivery and uptake of MCH services in Tanzania. The CLD was developed and validated using qualitative data from a process evaluation of a P4P scheme in Tanzania, with additional stakeholder dialogue sought to strengthen confidence in the diagram. The CLD maps the interacting mechanisms involved in provider achievement of targets, reporting of health information, and population care seeking, and identifies those mechanisms affected by P4P. For example, the availability of drugs and medical commodities impacts not only provider achievement of P4P targets but also demand of services and is impacted by P4P through the availability of additional facility resources and the incentivisation of district managers to reduce drug stock outs. The CLD also identifies mechanisms key to facility achievement of targets but are not within the scope of the programme; the activities of health facility governing committees and community health workers, for example, are key to demand stimulation and effective resource use at the facility level but both groups were omitted from the incentive system. P4P design considerations generated from this work include appropriately incentivising the availability of drugs and staffing in facilities and those responsible for demand creation in communities. Further research using CLDs to study heath systems in LMIC is urgently needed to further our understanding of how systems respond to interventions and how to strengthen systems to deliver better coverage and quality of care.

Anticonvulsant Activity of 80% Methanol Leaf Extract and Solvent Fractions of Buddleja polystachya Fresen. (Buddlejaceae) in Mice

Epilepsy is a chronic non-communicable disease characterized by recurrent seizures. According to 2019 WHO report, it affects about 50 million people globally and nearly 80% of them live in low-and middleincome countries. Current antiepileptic drugs have several limitations including lack of response in significant number of patients and intolerable adverse drug reactions. Buddleja polystachya Fresen. (Buddlejaceae) is a medicinal plant used for the treatment of epilepsy in Ethiopian traditional medicine, where the dried leaves are crushed, mixed with local alcoholic beverage and taken orally. Thus, this study was conducted to evaluate the anticonvulsant activity of the 80% methanol leaf extract and solvent fractions of B. polystachya in mice models of seizure. The dried and powdered leaves of B. polystachya were extracted using cold maceration with 80% methanol (1:5 w/v), and the resulting crude extract was fractionated using chloroform and n-butanol to get chloroform, n-butanol and aqueous fractions. Anticonvulsant activities of B. polystachya crude extract and solvent fractions at doses of 100, 200 and 400 mg/kg were evaluated using pentylenetetrazol (PTZ) and maximal electroshock (MES)–induced seizures in mice (n = 6). In addition, motor coordination effects were assessed using rotarod test. Sodium valproate (200 mg/kg), phenytoin (25 mg/kg) and diazepam (5 mg/kg) were used as standards for PTZ, MES and rotarod tests, respectively. Distilled water or 2% tween 80 was used as negative control. All doses of the crude extract exhibited a significant (p < 0.001) anticonvulsant property in both PTZ and MES tests compared with negative control. Similarly, the n-butanol fraction exerted significant (p < 0.001) anticonvulsant effects in both seizure models. However, the chloroform fraction (200 and 400 mg/kg) showed a significant (p < 0.001) anticonvulsant effect in only PTZ-induced seizure model. The aqueous fraction was devoid of any anticonvulsant activity in both models. The crude extract and fractions did not exert any significant changes in motor coordination. Preliminary phytochemical screening of the crude extract and solvent fractions revealed the presence of flavonoids, phenols, tannins, steroids, terpenoids and saponins. In conclusion, the results of this study indicated that the plant has a promising anticonvulsant activity and could be considered as a potential source to develop new anticonvulsant drug.

Training Global Health Leaders: A Critical Review of Competency Gaps.

Background:Global health leadership training seeks to strengthen the existing global health workforce to build leaders that have the necessary knowledge, attitudes, and skills to deliver a vision for public health and healthcare delivery. In order to develop impactful training curricula, there is a greater need to understand the areas of focus required to strengthen the global health workforce.Objectives:This paper seeks to present a critical analysis of the competency gaps among participants of a single global health training program.Methods:This is a cross-sectional observational study conducted during the implementation of the Sustaining Technical and Analytical Resources (STAR) project from May 1, 2018 to May 31, 2020. We utilized descriptive statistics to analyze the baseline competency assessment of STAR participants using a customized framework that was developed for the program.Findings:Among the 74 individuals enrolled in the study, we identified that there were significant differences in milestone achievement across participant types for all eight competencies (p < 0.001). Overall, US-based fellows reported higher perceived competency levels than low- and middle-income (LMIC)-based fellows in all categories except Capacity Strengthening (4, 23.5% leading vs. 12, 63.5% leading). LMIC fellows reported lower achieved milestones in Gender Equity (only 6, 31.5% at practicing) and Development Practice (only 6, 31.5% at practicing).Conclusions:Our study identified critical needs in the domains of public health ethics, health equity, and social justice and gender equity. Further emphasis on these domains in global health curricula and other professional development is critical to strengthen the knowledge and skills of individuals who are well-placed to advance the development of an equitable global health workforce.

Adolescent suicide and suicidal behavior: a review

Suicide among adolescent has emerged as a major public health issue in many low and middle-income (LAMI) countries. Suicidal behavior including ideation and attempt are the most important predictors of completed suicide and offer critical points for intervention. This article reviews recent population and national data based studies of adolescent suicide and suicide attempters for analyzing risk factors for adolescent suicide and suicidal behavior. According to WHO estimates, 800,000 suicide deaths occurred worldwide in 2016 and it is the third leading cause of death for 15-19 year olds. The suicide rate in Bangladesh was 5.9 per 100,000 population in 2016 (4.7 for males and 7.0 for females). Approximately, 90 percent of suicide cases meet criteria for a psychiatric disorder, particularly major depression, substance abuse and prior suicide attempts are strongly related to adolescent suicides. The relationship between psychiatric disorders and adolescent suicide is now well established. Factors related to family adversity, social alienation and precipitating problems also contribute to the risk of suicide. The main target of effective prevention of adolescent suicides is to reduce suicide risk factors. Recognition and effective management and control of psychiatric disorders, e.g. depression, are essential in preventing adolescent suicides. Research on the treatment of diagnosed depressive disorders and of those with suicidal behavior is reviewed.

Deploying Electronic Immunization Information Systems in Low and Middle Income Countries in Response to COVID-19: Systematic Review of Best Evidence Practices

Background: Electronic Immunization information Systems (IISs) have been recognized as crucial in the response to COVID-19. For low and middle income (LMIC) countries, establishing an effective IIS or expanding existing IISs for mass vaccination needs may be challenging. This systematic review aimed to highlight some of the best evidence practices around IISs benefiting LMICs in its pandemic response as well as in strengthening routine immunization settings. Methods: In this systematic review, we searched PubMed and IEEE Explorer as well as selected peer reviewed journals and grey literature for studies around health information systems published from 2011 to 2021. We used a search phrase consisting of keywords information system, vaccine registry, vaccine, immunization, electronic, mobile and e-registry linked with Boolean operators. Selected publications were screened for its relevance before applying a thematic analysis technique to identify the key themes emerging from these studies. Findings: We identified 405 studies and 131 were selected for the full text review. There were case studies(n=26), cross-sectional studies(n=13), randomized control trials(n=7), experimental studies(n=6), system reviews(n=4), cohort studies(n=3) and 17 other studies belonging to 12 study types. Five key themes were identified and these were scope of IISs (n=15), immunization related functionality(n=48), socio-technicality of IISs(n=29), scalability of IISs(n=19), and quality enhancement(n=8). We have used these themes to present the most notable elements or areas of interest around IISs. Interpretation: We highlight the scope of IIS, key elements related to functionality, socio technicality, scaling and quality enhancement of IISs that need focus when such systems are implemented, particularly in LMICs. We believe these elements help overcome IIS related inter-connected concerns of user expectations, technology readiness, and the need for citizen participation in a particular context. Registration Details: The protocol for this study was published in PROSPERO (Reg. No: CRD42021229030) prior to commencement of review. Funding Information: No funding to declare. Declaration of Interests: No competing interests to declare.

Psychometric properties of instruments to measure parenting practices and children\u2019s movement behaviors in low-income families from Brazil

BackgroundChildhood obesity has increased remarkably in low and middle-income (LMIC) countries. Movement behaviors (physical activity, screen time, and sleep) are crucial in the development of overweight and obesity in young children. Yet, few studies have investigated the relationship between children’s movement behaviors and parenting practices because validated measures for use among families from LMIC are lacking. This study evaluated the psychometric properties of previously validated measures of young children’s physical activity, screen time, and sleep and parenting practices, translated and culturally adapted to Brazilian families.MethodsA total of 78 parent-child dyads completed an interviewer-administered survey twice within 7 days. Child physical activity, sedentary time and sleep were concurrently measured using a wrist-worn accelerometer. Internal consistency and test-retest reliability was assessed using McDonald’s Omega and Intraclass Correlation Coefficients (ICC’s). Concurrent validity was evaluated by calculating Spearman correlations between parent reported child behaviors and accelerometer measured behaviors.ResultsSeventeen of the 19 parenting practices scales exhibited acceptable internal consistency reliability (Ω ≥ 0.70). Test-retest reliability ICC’s were acceptable and ranged from 0.82 - 0.99. Parent reported child physical activity was positively correlated with objectively measured total movement (rho= 0.29 - 0.46, p < .05) and energetic play (rho= 0.29 – 0.40, p < .05). Parent reported child screen time was positively correlated with objectively measured sedentary time; (rho = 0.26, p < .05), and inversely correlated with total movement (rho = - 0.39 – - 0.41, p < .05) and energetic play (rho = - 0.37 – - 0.41, p < .05). Parent reported night-time sleep duration was significantly correlated with accelerometer measured sleep duration on weekdays (rho = 0.29, p < .05), but not weekends.ConclusionsMeasurement tools to assess children’s movement behaviors and parenting practices, translated and culturally adapted for use in Brazilian families, exhibited acceptable evidence of concurrent validity, internal consistency, and test-retest reliability.

The regulation of healthcare professions and support workers in international context

BackgroundThe objective of this paper is to outline and compare the regulation of paid healthcare professions and associated support workers in international context, bringing out the lessons to be learned as appropriate. Modern neo-liberal societies have sought to enhance healthcare through greater professional regulation, albeit in different ways and at variable pace. This general trend is illustrated with reference to medicine in the UK. However, although such reforms have helpfully cascaded to other health professions, government policy in high-income countries has not yet adequately regulated the interrelated group of non-professionalised health support workers who form the largest and least recognised part of the workforce. Nonetheless, in low- and middle-income (LMIC) countries—aside from the greater need for regulation of health professions—there is even more of an imperative to regulate the disparate, largely invisible support workforce.MethodsWith reference to existing studies of the medical and wider health professions in the UK and selected other higher income societies, the importance of health professional regulation to the public is underlined in the Global North. The larger gap in the regulation of support workers in modern neo-liberal countries is also emphasised on a similar basis, with an increasingly ageing population and advances in healthcare. It is argued from the very limited patchwork of secondary literature, though, that policy-makers may want to focus even more on enhancing regulation of both the professional and non-professional workforce in LMIC societies centred mainly in the Global South, drawing on lessons from the Global North.Results/conclusionsEfforts to reform health professional regulatory approaches in more economically developed countries, while needing refinement, are likely to have had a positive effect. However, even in these societies there are still substantial shortfalls in the regulation of health support workers. There are even larger gaps in LMICs where there are fewer health professional staff and a greater dependence on support workers. With higher rates of morbidity and mortality, there is much more scope here for reforming health regulation in the public interest to extend standards and mitigate risk, following the pattern for healthcare professions in the Global North.

Health systems strengthening to arrest the global disability burden: empirical development of prioritised components for a global strategy for improving musculoskeletal health

IntroductionDespite the profound burden of disease, a strategic global response to optimise musculoskeletal (MSK) health and guide national-level health systems strengthening priorities remains absent. Auspiced by the Global Alliance for...

PSY10 Global and Regional Prevalence and Incidence of LUPUS in Low and-Middle Income Countries: A Systematic Review and Meta-Analysis

The aim of this study was to systematically summarise the prevalence and incidence of SLE in low and-middle income countries (LMICs). A systematic search of MEDLINE, CINHAL, Web of Science and Global Index Medicus was carried out using keyword search terms for SLE combined with prevalence, incidence and epidemiology. The search was to identify papers addressing SLE in LMICs and published up to September 1, 2020. The prevalence and incidence of SLE were pooled through random effect model. Pooled estimates were expressed with 95% confidence intervals. Out of 1757 papers, 16 studies were included. The mean age at diagnosis ranged from 25.5 to 45.8 years. The included studies were conducted in Argentina (n = 2), Brazil (n = 3), China (n = 2), Colombia, Greece, India, Malaysia, Pakistan, Venezuela, Zimbabwe and French Guiana. The SLE prevalence and incidence varied from 3.2 to 159 per 100,000 and 1.4 to 8.7 per 100,000 population, respectively. In the random effects meta-analysis (n = 8), the pooled prevalence of SLE was 120 (95% confidence interval [CI]:100 – 200) per 100,000. Meta-analysis of data from six incidence studies revealed an incidence of 4 cases per year (95% CI: 2 – 6) per 100,000. According WHO regions, the pooled prevalence of American and Western Pacific regions was 300 (95% CI -200 – 900) and 36 (95% CI 35 – 37) per 100,000, respectively. The pooled incidence of the American region was 10 (95% 0 – 14) per 100,000 population. Our findings provide a comprehensive and up-to-date summary of the prevalence and incidence of SLE in LMICs. As SLE is an important threat to the population, health professionals and policymakers needs to put in place appropriate programmes to reduce the burden of SLE in LMICs.

Sexual and reproductive health “Train The Trainer” programs in low- and middle-income countries: a scoping review

Background Universal access to reproductive health care including family planning and sexual health care are recognised as human rights and are a key contributor to the United Nations’ (UN) Sustainable Development Goals, yet many people across the globe have limited access to information and services to protect their sexual and reproductive health (SRH). Universal access cannot be achieved without a skilled health workforce. ‘Train the Trainer’ (TTT) approaches are commonly advocated as cost-effective and sustainable options for building health capacity through up-skilling health workforces. Methods A scoping review was undertaken to identify the type and extent of the available literature on sexual and reproductive health TTT programs in low- and middle-income (LMI) countries, in order to gain insights to inform practice and fill the knowledge gaps to inform future research. Six databases were used as the source of information (CINAHL, EMBASE, ERIC, Global Health, Medline and Scopus). Results A systematic search returned a total of 700 studies. After duplicate removal, 487 studies were screened by year, title and abstract, and 39 studies were identified for full text review. After the full text review, 16 studies were deemed to meet the criteria for final inclusion. Findings show that much of the published literature on SRH TTT programs reports on HIV training in African countries. Thematic analysis revealed a wealth of practical considerations for practitioners wishing to implement SRH TTT programs in LMI country settings. Conclusions This scoping review identified a paucity of recent peer-reviewed literature available on SRH TTT programs in LMI country settings. Despite this, a number of practical considerations remain, relating to TTT methodology and design; factors that support or inhibit implementation; and sustainability and scaling up were identified. Future research should focus on adopting stronger outcome evaluation methodology to determine effectiveness of TTT programs; and investigate the application of TTT models across a range of SRH topics in a diverse range of LMI countries.

The association between asthma emergency department visits and satellite-derived PM2.5 in Lima, Peru

BackgroundAsthma affects millions of people worldwide. Lima, Peru is one of the most polluted cities in the Americas but has insufficient ground PM2.5 (particulate matter that are 2.5 μm or less in diameter) measurements to conduct epidemiologic studies regarding air pollution. PM2.5 estimates from a satellite-driven model have recently been made, enabling a study between asthma and PM2.5. ObjectiveWe conducted a daily time-series analysis to determine the association between asthma emergency department (ED) visits and estimated ambient PM2.5 levels in Lima, Peru from 2010 to 2016. MethodsWe used Poisson generalized linear models to regress aggregated counts of asthma on district-level population weighted PM2.5. Indicator variables for hospitals, districts, and day of week were included to account for spatial and temporal autocorrelation while assessing same day, previous day, day before previous and average across all 3-day exposures. We also included temperature and humidity to account for meteorology and used dichotomous percent poverty and gender variables to assess effect modification. ResultsThere were 103,974 cases of asthma ED visits during the study period across 39 districts in Lima. We found a 3.7% (95% CI: 1.7%–5.8%) increase in ED visits for every interquartile range (IQR, 6.02 μg/m3) increase in PM2.5 same day exposure with no age stratification. For the 0–18 years age group, we found a 4.5% (95% CI: 2.2%–6.8%) increase in ED visits for every IQR increase in PM2.5 same day exposure. For the 19–64 years age group, we found a 6.0% (95% CI: 1.0%–11.0%) increase in ED visits for every IQR in average 3-day exposure. For the 65 years and up age group, we found a 16.0% (95% CI: 7.0%–24.0%) decrease in ED visits for every IQR increase in PM2.5 average 3-day exposure, although the number of visits in this age group was low (4,488). We found no effect modification by SES or gender. DiscussionResults from this study provide additional literature on use of satellite-driven exposure estimates in time-series analyses and evidence for the association between PM2.5 and asthma in a low- and middle-income (LMIC) country.

Sustainable Business Models for Informal Charcoal Producers in Kenya

The sustainable business model (SBM) concept requires enterprises to integrate sustainability aspects in their planning and operations. Although 60% of the global working population make their living in the informal sector mostly in low-and middle income countries, the potential for SBMs has rarely been analyzed for this category. This study explores the SBMs of informal charcoal-producing enterprises in coastal Kenya. It describes key business-model components: value proposition, value creation and delivery, and economic value capture. Impact and dependency on sustainability-related indicators were also studied. Data were obtained through individual interviews, focus-group discussions, and workshops for charcoal producers and other relevant stakeholders. Findings demonstrated that charcoal enterprises, despite their informal status, adopt elaborate business models. The incomes positively affect several Sustainable Development Goals (SDGs) by reducing, if not eradicating, poverty and supporting basic livelihood needs. Examples of negative impacts on some SDG include the activity’s contribution to forest degradation. Feedback impacts, where SDG status influence the informal enterprises’ opportunities were also identified. The SBM model contributes to the development of a balanced sustainability transition of the charcoal sector. We suggest further analyses of the role of informal enterprises in the bioenergy sector for sustainable development and how their SBMs could be improved.

Mobile Health Interventions Addressing Childhood and Adolescent Obesity in Sub-Saharan Africa and Europe: Current Landscape and Potential for Future Research.

Child and adolescent overweight is a growing public health problem globally. Europe and low and middle-income (LMIC) countries in Sub-Saharan Africa provide sufficiently suitable populations to learn from with respect to the potential for mobile health (mHealth) interventions in this area of research. The aim of this paper is to identify mHealth interventions on prevention and treatment of childhood and adolescent obesity in Sub-Saharan Africa and Sweden and report on their effects, in order to inform future research in this area. A search of peer-reviewed publications was performed using PubMed, ScienceDirect, EBSCOhost, and Scopus. The search included all articles published up to August 2019. The search strings consisted of MeSH terms related to mHealth, overweight or obesity, children, adolescents or youth and individual countries in Europe and Sub-Saharan Africa. Second, a combination of free-text words; mobile phone, physical activity, exercise, diet, weight, BMI, and healthy eating was also used. Seven studies were reported from Europe and no eligible studies from Sub-Saharan Africa. The results of this narrative review indicate a lack of research in the development and testing of mHealth interventions for childhood and adolescent obesity. There is a need for an evidence base of mHealth interventions that are both relevant and appropriate in order to stem the epidemic of overweight and obesity among children and adolescents in these countries. Uptake of such interventions is likely to be high as there is high penetrance of mobile phone technology amongst adolescents, even within poor communities in Africa.

Agricultural R&amp;D investment intensity: A misleading conventional measure and a new intensity index

AbstractThe conventional wisdom that developing countries are significantly underinvesting in agricultural research and development (R&amp;D) has been challenged by studies that found that the high rates of return in the literature result from data limitations and inadequate modeling choices. However, evidence of low research effort in developing countries as measured by the intensity ratio (IR)—the percentage of agricultural gross domestic product invested in agricultural R&amp;D—has not been questioned. This article argues that the IR is an inadequate indicator of research effort and proposes an alternative index to measure R&amp;D intensity. Using the proposed index, we find that the investment effort in developing countries is much higher than the one observed when the IR is used, that the contribution of low‐ and middle‐income (LMI) countries to growth in global R&amp;D intensity was higher to that of high‐income (HI) countries in recent years, that the investment gap in LMI countries is close to 50% of R&amp;D investment, and that the proposed development goal of a 1.0% value of the IR is beyond the possibilities of most Asian and African countries.

Study To Evaluate the Performance of a Point-of-Care Whole-Blood HIV Viral Load Test (SAMBA II HIV-1 Semi-Q Whole Blood).

Remote areas of many low and middle income (LMI) countries have poor access to HIV viral load (HIV VL) testing. The SAMBA II (simple amplification-based assay) Semi-Q whole-blood test (Diagnostics for the Real World [DRW], Cambridge, UK) is a point-of-care assay, which uses leucodepletion technology to allow whole-blood testing in remote settings. A total of 1,540 consecutive HIV-positive clinic patients in Cameroon (250), United Kingdom (633), Ukraine (412), and Zimbabwe (245) donated venous blood (all countries) and finger prick blood (all except UK) for testing on SAMBA II. SAMBA II results were compared with simultaneous plasma results on the Abbott RealTime HIV-1 (Abbott Molecular, Des Plaines, IL) viral load assay and interpreted as either <1,000 RNA copies/ml or ≥1,000 RNA copies/ml. For 1,528 venous whole-blood samples tested on SAMBA II, overall percent agreement with the reference test at a cutoff HIV VL of ≥1,000 copies/ml was 96.9% (1,480/1,528; 95% confidence interval [CI], 95.9% to 97.7%), negative percent agreement was 97.7% (1,259/1,289; 95% CI, 96.7% to 98.4%), and positive percent agreement was 92.5% (221/239; 95% CI, 88.4% to 95.5%). For 854 finger prick samples, there was 95.0% (811/854; 95% CI, 93.3% to 96.3%) overall percent agreement, 98.0% (625/638; 95% CI, 96.5% to 98.9%) negative percent agreement, and 86.1% (186/216; 95% CI, 80.8% to 90.4%) positive percent agreement. These rose to 93.5% (82.1% to 98.6%), 97.6% (95.6% to 98.8%), and 95.6% (93.3% to 97.3%) after exclusion of aberrant results from the Ukraine center. These results show a high level of agreement between SAMBA-II and a laboratory-based assay. SAMBA-II has a performance that is suitable to use as a VL point-of-care assay in remote settings.