Middle-income Countries Research Articles

The prevalence and determinants of unmet healthcare needs in Bulgaria

Self-reported unmet healthcare needs are a useful indicator of access to healthcare, but there is little research from low- and middle-income countries. This study sought to investigate the prevalence and determinants of unmet needs arising from wait times, distance/transportation and financial affordability in Bulgaria using European Health Interview Survey data. We explored associations between individual characteristics and the probability of reporting unmet need by fitting logistic regression models to the data. Unaffordability-related unmet needs were the most cited barrier to access. The largest proportion of people reported unmet dental care needs (14%) or unmet needs due to unaffordability of medicines (8%); distance/transportation problems were the least cited reason (3%). People with poor physical and mental health had a substantially higher probability of experiencing unmet needs. Those with a disability, less disposable income, less social support and lower educational attainment were also more likely to report unmet healthcare needs. People who lived in rural areas experienced specific barriers to access, most notably from distance or transportation issues. Unmet healthcare needs lead to inefficiencies for the healthcare system and are more prevalent among already disadvantaged societal groups. Ensuring better access to healthcare is therefore important from both the efficiency and equity perspectives.

Factors associated with teenage pregnancy among refugees in Palabek refugee settlement, Northern Uganda

BackgroundGlobally, teenage pregnancy is a public health problem. Low- and middle-income countries in the Sub-Saharan region are more affected with teenage pregnancy. It is worse with teenage girls who have other vulnerabilities like living in refugee camps. However, there is little information about teenage pregnancy in refugee camps especially in resource limited areas like Northern Uganda.ObjectiveTo determine the prevalence and the factors associated with teenage pregnancy among refugees in Palabek refugee settlement, Northern Uganda.MethodsThis was a cross-sectional study conducted among teenage girls in Palabek refugee settlement in Northern Uganda. The study estimated a total sample size of 316 teenage girls and they were sampled using systematic random sampling. Data was collected using researcher administered questionnaire. Conditional logistics regression was employed to identify the associated factors for teenage pregnancy.ResultsA total of 306 teenagers participated in the study with a response rate of 98.6%. The study showed that the prevalence of teenage pregnancy among teenage girls in Palabek refugee settlement, Northern Uganda was 41.2%. The factors associated with teenage pregnancy among teenage girls in Palabek refugee settlement included: being in the 15–19 years age group (AOR = 6.3, 95%CI: 1.8–22.8), not being in school (AOR = 5, 95%CI: 2.3–10.9), not being married (AOR = 0.2, 95%CI: 0.1–0.5), delayed sexual debut (AOR = 2.4, 95%CI: 1.1–5.5), having multiple sexual partners (AOR = 0.3, 95% CI: 0.1–0.7), alcohol use (AOR = 6.7, 95%CI: 2.2–18.4), being aware of sexual reproductive health services (AOR = 0.4, 95%CI: 0.2–0.9), and having divorced families (AOR = 2.4, 95% CI: 1.2–4.9).ConclusionStudy results reveal that 4 in 10 teenage girls in Palabek, Northern Uganda, are pregnant, influenced by individual, community, and health system factors. This highlights vulnerabilities in refugee camps, urging prioritization of sexual and reproductive health for adolescent girls in refugee camps.

Validating the Child Behavior Checklist 1.5-5 as a screening tool for autism spectrum disorder.

Early identification of Autism Spectrum Disorder is very important, especially in low and middle-income countries, where access to resources is often limited. The Child Behavior Checklist 1.5-5 is a tool that has been used to help identify children with autism spectrum disorder through specific behavior patterns. However, its effectiveness in low- and middle-income country settings has not been thoroughly studied. This research focused on evaluating the Child Behavior Checklist 1.5-5 as a screening tool for autism spectrum disorder among Brazilian children. The study involved 1292 children aged 3-5 years from the general population and 70 children with autism spectrum disorder aged 1-5 years. Using advanced statistical methods, the study tested how well the Child Behavior Checklist identified children with autism spectrum disorder and how reliable it was in this context. The findings showed that the Child Behavior Checklist 1.5-5 performed well in identifying autism spectrum disorder, with high reliability and consistency in the results. Although one item in each of the autism spectrum problems and withdrawn syndrome subscales did not perform as strongly, the overall tool was effective. In summary, the Child Behavior Checklist 1.5-5 proves to be a reliable and valid tool for early autism spectrum disorder screening in Brazilian children. This can help ensure that more children in low- and middle-income country settings are identified early and receive the necessary support and interventions to help them thrive. Future research should continue to test this tool in different contexts to confirm its usefulness across various populations.

Economic Integration and Financial Inclusion: Evidence from Middle-Income Countries

Economic Integration and Financial Inclusion: Evidence from Middle-Income Countries

Behavioral Nudges to Encourage Appropriate Antimicrobial Use Among Health Professionals in Uganda

Background/Objectives: Antimicrobial resistance (AMR) is a global public health concern exacerbated by inappropriate antimicrobial prescribing practices, particularly in low-resource settings such as Uganda. The research aimed to develop a culturally sensitive behavioral intervention, leveraging a “nudge” strategy, to improve healthcare provider adherence to the 2016 Uganda Clinical Guidelines (UCG 2016) in five Ugandan hospitals. This intervention formed part of broader antimicrobial stewardship initiatives led by the United States Agency for International Development Medicines, Technologies, and Pharmaceutical Services Program. Methods: This study employed a mixed-methods approach, combining formative research and behavioral intervention. Guided by the Deloitte Behavioral Insights Framework, the research team conducted key informant interviews to identify prescribing barriers and motivators and developed three suitable behavioral interventions: perceived monitoring, ward leaderboards, and educational workshops. The study evaluated the interventions’ impact through point prevalence surveys (PPS), using the World Health Organization PPS methodology at three stages: pre-intervention, immediate post-intervention, and one-month post-intervention. Results: Key behavioral themes across individual, social, environmental, and organizational elements informed the intervention design and implementation. The behavioral intervention package increased antimicrobial prescription compliance with the UCG 2016 from 27% at baseline to 50% immediately post-intervention, though these effects diminished at one-month post-intervention. Conclusions: Our study addresses an existing gap in behavioral nudges-based operational research on antimicrobial prescribing in low- and middle-income countries. These results showed an immediate improvement in adherence to the UCG 2016 among healthcare providers in Ugandan hospitals, though the effect was attenuated at one-month follow-up. Despite the attenuation, behavior change presents a feasible, cost-effective, and sustainable approach to improving antimicrobial prescribing practices and addressing AMR.

Clinical characteristics of male patients with breast cancer in the Latino population.

Breast cancer is the most prevalent cancer type in Mexico, with male breast cancer accounting for only 1% of all breast cancer cases. A limited number of studies have described the clinical-pathological profiles of males with breast cancer in low- and middle-income countries. This study presents an analysis of patients with breast cancer seen at three different institutions in México. A retrospective review of the medical records was performed to analyze the clinical and pathological characteristics of 49 men diagnosed with breast cancer and their overall survival. The mean age at diagnosis was 64.65years. A significant proportion of patients presented at diagnosis with stage IV disease (n = 11, 22.45%), had triple-negative subtype (n = 6, 12.24%), and nuclear grade III (n = 20, 40.8%). Primary endocrine resistance was observed in 10 patients (31.25%). Genetic analysis was performed on 24 patients (48.9%), revealing a germline BRCA pathogenic variant in 8.33%. Our findings described the clinical and pathological profile of breast cancer in a male cohort in Mexico, with a significantly high proportion of advanced disease, triple-negative subtype, nuclear grade III, and endocrine resistance. Further comprehensive studies, including research into somatic mutations, are needed.

Prescribing patterns of antihypertensive drugs by clinicians at the National Referral Hospital outpatient department, Thimphu, Bhutan

Introduction: Around 1.28 billion adults aged 30-79 years have hypertension, globally. Of these, two-thirds are in low and middle-income countries, with only 21% having it under control. In Bhutan, there are 362.4 people per 10,000 population with hypertension. Antihypertensive medications must be appropriately prescribed to prevent the complications of hypertension. Methods: A cross-sectional study of the prescriptions of antihypertensive medications at Jigme Dorji Wangchuck National Referral Hospital was undertaken to characterize the current prescribing patterns. Results: Nine monotherapy, 18 dual therapy, 19 triple therapy and 2 multiple combination therapy with antihypertensive drugs were noted during the study period spanning April to December 2023. Nearly half (59.1%) of the hypertensive patients were treated with monotherapy, 36.3% with dual therapy, 4.3% with triple therapy and 0.3% with multiple combination therapy. The proportion of patients who had their blood pressure under control was 42.45%, with females slightly outnumbering males (26.66% versus 15.79%). However, there was no statistically significant difference in blood pressure control between females and males and also between patients who received monotherapy or combination therapy. Conclusion: The study found the prescription of a wide range of drugs, both alone and in combination, to treat hypertension. The proportion of patients with controlled blood pressure was 42.45%.

Drugs for Vector-Borne Protozoal Diseases in a One Health Scenario. A European Perspective.

Vector-borne protozoal diseases (VBPD) represent an enormous health and economic burden, particularly in low- and middle-income countries. Their control requires integrated approaches that consider not only therapeutic interventions for affected human and animal populations but also preventive tools. Environmental contamination can lead to therapeutic ineffectiveness. Effective intervention must consider in-depth knowledge of the environmental factors that regulate the exposure, transmission and pathogenicity of VBPD within a One Health approach. In recent decades, the incidence and prevalence of VBPD have been substantially reduced in many regions of the world, although there are still hot spots and emerging epidemiological cycles. Except for a partially protective vaccine against malaria, vaccination is not available for any other human VBPD, and therefore epidemiological control and chemotherapy are the main control tools. Current therapeutics have several drawbacks, including reduced efficacy, toxicity and high price of safer formulations. In addition, the industrial pipeline is limited, and no therapeutic breakthroughs are expected. Integrated control of VBPD requires multitarget control systems adapted to the disease and region. In this scenario, harmonized surveillance systems, accurate reporting and increased public and private investment will ensure more rational use of the few available and new drugs.

Air pollution and under-5 child mortality: linking satellite and IPUMS-DHS data across 41 countries in South Asia and Sub-Saharan Africa

BackgroundDespite progress, under-five mortality remains high, especially in Sub-Saharan Africa and South Asia, where around 13,400 children die daily. Environmental pollutants, including PM2.5 from outdoor air and household air pollution, significantly contribute to these preventable deaths.MethodsThis cross-country study combined satellite data with 113 surveys from the IPUMS-DHS dataset (1998–2019) to examine under-five child mortality in 41 developing countries. The integration of Global Annual Particulate Matter with a diameter of 2.5 micrometres or less (PM2.5) Grids from Socioeconomic Data and Applications Center (SEDAC) and geospatial data from the DHS Program enabled a focused analysis of the association between indoor and outdoor air pollution, particularly PM2.5, and child mortality rates using both logistic and multilevel logistic regression models, as well as estimating Population Attributable Fractions (PAF) to quantify the mortality burden attributable to these pollutants.ResultsOutdoor air pollution, measured by a one standard deviation increase in PM2.5, significantly increased the risk of child mortality (Odds Ratio [OR]: 1.14; 95% Confidence Interval [CI]: 1.10–1.18; p < 0.001). Moderate and high household air pollution exposure also heightened this risk, with increases of 37% (OR: 1.37; 95% CI: 1.24–1.53; p < 0.001) and 40% (OR: 1.40; 95% CI: 1.26–1.56; p < 0.001), respectively, compared to no exposure. Multilevel models (Models 5a and 10a) produced similar estimates to standard logistic regression, indicating robust associations. Additionally, Population Attributable Fraction analysis revealed that approximately 11.9% of under-five mortality could be prevented by reducing ambient PM2.5 exposure and 12.0% by mitigating household air pollution. The interaction between indoor and outdoor pollution revealed complex dynamics, with moderate and high household exposure associated with a reduction in mortality risk when combined with PM2.5. Geographical disparities were observed, with stronger correlations between outdoor air pollution and child mortality in Africa compared to Asia, and more pronounced impacts in low-income countries. However, household air pollution had stronger association with child mortality in Africa and lower- and middle-income countries.ConclusionsOur findings could serve as a guide for policy development aimed at reducing under-five mortality, ultimately contributing to the attainment of the Sustainable Development Goal (SDGs).

Public Administration "Changing Paradigms of Public Administration in Facing the Global Health Crisis: Lessons from the Pandemic"

The COVID-19 pandemic has changed the paradigm of public administration in dealing with the global health crisis by emphasizing the importance of multilateralism and cross-border cooperation. The government now plays the role of a facilitator that integrates health and political policies to respond more effectively. The study identifies countries with swift and transparent leadership, such as Vietnam, that are better able to respond to the pandemic, while also exposing global inequalities in low-income countries that need international support. Public administration has a crucial role in designing effective policies, providing resources, and implementing measures such as social distancing, with transparent communication to build public trust. The digitization of public services and evidence-based collaboration between governments and scientists have become important pillars in responding to people's needs. This study uses a descriptive-qualitative approach with case studies and comparative analysis of policies in various countries. The results show that adaptation and innovation in public administration, including increasing digital literacy and community participation, are critical to building health system resilience to future crises. This research is expected to contribute to public administration theory and relevant policy recommendations to face similar challenges in the future.

“I beat my wife to correct her…” perpetration of intimate partner violence by men in low-income settings of Ibadan municipality: a qualitative exploration

BackgroundGlobally, intimate partner violence (IPV) is a major public health problem. Recent studies have focused on women’s experience of abuse. However, only few studies have documented men’s perpetration of abuse in low-income countries. This study describes male perpetrated IPV and triggers of IPV among men in low-income communities of Ibadan, Nigeria.MethodsThis qualitative study adopted a descriptive phenomenology method to understand the lived IPV experience of men in Ibadan, southwest, Nigeria. The study was conducted in five communities selected by simple random sampling from a list of low-income communities within Ibadan municipal. Fourteen In-Depth Interviews (IDI) were conducted among eligible men aged 26 to 50 years, selected by convenience sampling. Interviews were transcribed verbatim. Thematic analysis was done to generate themes and sub-themes using NVIVO software.ResultsThe forms of male perpetrated IPV included: physical, emotional, economic and controlling behaviour. Respondents also reported using money to control their wives. Sexual violence (marital rape) was not recognized as a form of IPV by the men interviewed. Participants disagreed that marital rape exist, because they believe that sex is an obligation of the wife to the husband. IPV was fostered by traditional marital expectations and ideals, norms that supported patriarchy, ‘wife’s disobedience’, domestic financial challenges.ConclusionMen perpetrated different forms of violence against their partners. IPV perpetration was encouraged by men’s beliefs as well as the social norms. Interventions to educate men on the consequences of IPV on individuals, families and communities are recommended.

Development of a triplex endpoint PCR assay for the detection of SARS-CoV-2: insights on cost-efficiency and method design.

Lower respiratory tract infections, including COVID-19, have a substantial global impact, making the development of diagnostic tests crucial. The study aimed to develop a new, accurate, fast, and cost-effective PCR-based detection method for SARS-CoV-2, applicable in limited settings and capable of detecting all current variants and potential future pathogens. The study was conducted between 2020 and 2022 at the molecular biology department of Mures County Clinical Hospital, Romania. Initially, pharyngeal and nasal secretions were collected and processed using the real-time qRT-PCR method for routine COVID-19 diagnosis. Ninety-two samples were randomly selected to develop the assay, including samples from different infection periods and negative controls. Complementary DNA (cDNA) was prepared from the selected samples, and the presence and integrity of the extracted RNA were evaluated by amplifying the GAPDH housekeeping gene. Primers for three specific viral genes (N, ORF1ab, and S) were designed, and their efficiency was evaluated using endpoint PCR and sequencing. Finally, the method was optimized and implemented as a one-step triplex PCR assay for routine diagnostic use. The molecular laboratory at the Mures County Clinical Hospital (MCCH) analyzed a total of 41,818 samples between June 2020 and December 2022. Among these samples, 26.15% tested positive for SARS-CoV-2, while 70.9% were negative and 2.95% were inconclusive or invalid. Three peaks of positive tests were observed in November 2020, April 2021, and February 2022. The study selected 92 preserved RNA samples for triplex-PCR assay development, validating the primers' specificity and confirming the quality of the nucleic acids. The comparative analysis showed the efficiency and accuracy of the endpoint reverse-transcription triplex-PCR method (RT-PCR), indicating its potential as a cost-effective alternative to real-time reverse-transcription PCR (qRT-PCR) in low-income countries with limited infrastructure for COVID-19 testing. This method has the potential to facilitate large-scale diagnosis of SARS-CoV-2 infections, allowing for rapid and appropriate therapeutic management and ongoing monitoring of patients. Additionally, the method can be easily adapted for the detection of other pathogens.

Skill bias in the labour market: Evidence from Iran

Purpose ― Most global economies are dealing with the issue of skill bias. In developing and underdeveloped countries, skill bias poses a problem by preventing the educated from participating in the economy's production function, especially in the long run. This paper expands on the skill-wage relationship and investigates this issue in the case of Iran from 1981 to 2021.Methods- Applying Impulse Responses from VECM and the Structural VAR model separates the relationship between skill and wage into short- and long-term effects. The structural wage model was estimated using the structural vector auto-regression model.Findings ― The results show that skill played a significant role in wage determination only for three periods in the short run, and the effect was neutral in the long run. This means that skill accumulation through advancement in graduate and postgraduate study is unlikely to increase wages in the long run.Implication ― According to the findings, skill bias implies that education attainment in the Iranian labour market can only improve wages to a minimum extent. This also proves that factors other than education determine wage growth in the economy. Originality ― The skill-wage relationship has not been a focus of studies in education outcome fields. Moreover, in the case of Iran, this investigation is novel, and there is a lack of studies on the relationship between compensation and skill.

Analysis of the Tourism Revenue Sharing Status at the Aksu-Zhabagly Nature Reserve of Kazakhstan

Sharing tourism-generated revenues with local people has become a popular strategy for implementing sustainability in nature-based tourism destinations globally. Although the local people have received some economic gains from tourism development, there are still some limitations to fair income sharing. These limitations are evident in many underdeveloped countries and lead to a passive situation of local community participation in tourism development. The primary purpose of this article is to determine the level of tourism revenue sharing in the Aksu-Zhabagly tourist destination and, at the same time, to make appropriate recommendations on the remaining issues. To understand the status of tourism revenue sharing, we surveyed the perceptions of 44 nature reserve employees and 66 travel company workers, respectively. The survey results show that although the business operations of tourism organizers do not harm the living environment of the local population, they usually do not spend part of the income from tourism on the common good of the local population. Most residents are unsatisfied with tourism development, and their participation in tourism is also comparatively low. The results also reveal that the comparatively low level of sharing the tourism-associated revenue with local development is the leading indirect cause of residents’ dissatisfaction with the development of the tourism industry. In conclusion, we believe that the results of this study and our recommendations help local authorities understand the importance of removing constraints in the fair distribution of tourism revenues in this tourist destination.

Evaluating the relationship between climate change, food prices, and poverty: empirical evidence from underdeveloped countries

Evaluating the relationship between climate change, food prices, and poverty: empirical evidence from underdeveloped countries

Emerging Issues of IPR in Developing and Under Developed Countries

Intellectual Property Rights (IPR) are pivotal in driving innovation, creativity and economic growth globally. However, they also pose significant challenges, particularly for developing and underdeveloped nations. IPR can hinder access to essential goods, such as medications, educational materials, and agricultural technologies, exacerbating inequalities and stifling innovation. The monopolistic control of IPR by developed countries often leads to economic dependency and limits knowledge sharing crucial for addressing global challenges like climate change and public health. To mitigate these issues, a multifaceted approach is required, including strengthening legal framework, empowering communities, promoting technology transfer, and fostering international cooperation. Reforming the current IPR regime to ensure equitable access and benefit-sharing can harness the potential of intellectual property for sustainable development and global prosperity.

Design and development of machine vision robotic arm for vegetable crops in hydroponics

Modern agricultural machinery such as harvesting robotic arms are necessary to optimize the semi-automated agricultural processes to meet the ever-growing food needs of the population of the world. Production of low cost and highly efficient robotic arms are needed to meet the needs of the small-scale growers of underdeveloped countries. In this regard, mechanical design, sensor placement, and object identification are essential to optimize the performance of agricultural robots. This research is conducted to design a fully automated robotic arm for fruit picking in hydroponics system and research farm using machine vision to help the smallholders. For this purpose, a robotic arm with 1.3 m in height is designed using aluminum (18-gauge) and mild steel (MS-16) as fabrication material for the mechanical structure. The prototype design is tested for stress estimation at various payloads using SolidWorks simulations. The proposed robotic arm is based on a four degrees of freedom (4-DoF) design with the gripper having an opening range of 5.5 to 12 cm depending upon the task to handle various objects. The robotic arm is installed on an expandable vertical mobile platform that enables an expanded operational workspace with lower energy consumption. The total weight of the robotic arm is 60 kgs housing a payload capacity ranging between 8 and 10 kgs in accordance with industry-standard load-bearing specifications. The inverse kinematic algorithm using DH-table is computed with an accuracy of up to 95 % and target height of gripper is cross checked by mounting the ultrasonic sensor at the base of robotic arm. The YOLOv8 algorithm is used for object detection using the depth sense camera having angle range of 0.3 m to 3 m with the precision of up to 96 %. The time needed for recognition of fruits and pitching was about 15 s, with a success rate of up to 90 %. This research produces a low-cost and efficient solution for stallholders by developing a fully automated robotic arm for fruit picking. It optimizes agricultural productivity through improved mechanical design, sensor accuracy, and object detection which reduces labor costs by increasing efficiency of semi-automated farming systems. Further research is required to optimize the overall weight of the system and automation of the movement of robotic arm system between the consecutive rows to build a fully autonomous fruit picking operation in hydroponics.

Family-based sexual health intervention for adolescents; A systematic review and meta-analysis

Abstract Background Family-based interventions are important in promoting adolescent sexual health outcomes. However, the effectiveness of these interventions in promoting adolescent sexual and reproductive health (ASRH) in Lower and middle-income countries (LMIC) has not been empirically evaluated. This review aimed to summarise the effectiveness of family-based sexual and reproductive health interventions in promoting ASRH in LMIC. Methods We conducted a systematic search for studies published in English from 2000 to October 2023 using MEDLINE, PsyINFO, CINAHL, Web of Science, and EMBASE databases. Studies were included if they involved adolescents aged 10-19 years, included family members in a key intervention component, evaluated the effectiveness of the interventions using an experimental or quasi-experimental design, assessed ASRH outcomes reported by adolescents and were conducted in LMIC setting. Standardized mean difference (SMD) and 95% confidence intervals were computed and meta-analyses were conducted using random effect models. Results Ten articles involving 2,246 participants were included in the review. The studies were nostly conducted in Africa. Across studies, there was no significant impact of family-based interventions in improving adolescent sexual health knowledge (SMD=0.5, 95%CI: -1.98 to 2.98), attitudes (SMD= -0.05, 95%CI: -1.92 to 1.82), practices (SMD=0.53, 95%CI: -0.69 to 1.75), or sexual communication with their family (SMD= 0.14, 95%CI: -0.42 to 0.7). Although individual studies reported a mixed effect of family-based interventions in improving sexual health outcomes, the pooled results from the meta-analysis showed no significant impact of family-based interventions. Conclusions Our review did not find any significant impact of family-based interventions in improving ASRH in LMIC. We recommend interventions using innovative approaches and novel strategies to align with the socio-cultural and economic background of the study setting. Key messages • This study found no significant impact of family-based interventions in improving ASRH in LMIC. • Additional studies, particularly from Asia, using culturally relevant interventions is required in this area.

Perinatal depression and adverse child growth outcomes in low-income and middle-income countries (LMICs): A systematic review and meta-analysis.

Perinatal depression (PND), which encompasses the antepartum and postpartum depression (APD and PPD), is a neglected crisis in low-income and middle-income countries (LMICs). We aimed to systematically search and meta-analyze existing evidence to determine whether a mother's PND affects adverse growth outcomes in children in LMICs (PROSPERO protocol: CRD42021246803). We conducted searches, including nine databases (PubMed, EMBASE, Web of Science, CINAHL Plus, Global Health Database, Google Scholar, WHO Regional Databases, PsycINFO, and LILACS) from January 2000 to September 2023. We restricted studies that assessed PND using validated screening tools or clinical interviews during pregnancy or within 12 months postpartum. We included studies that reported four types of adverse child growth outcomes (stunting, wasting, underweight, and overweight/obesity) in children younger than 5 years. We assessed the quality using the Newcastle Ottawa Scale and pooled risk ratios (RRs) and odds ratios (ORs) between PND and each adverse growth outcome using random-effects models. In total, 27 studies met the inclusion criteria for systematic review, with 24 eligible for meta-analysis, spanning data from 15 countries and 26,261 mother-baby pairs. Based on the studies that reported ORs, children below the age of 3 years with mothers experiencing PND had higher odds for stunting (OR 1.63, 95% CI 1.32, 2.02, I2 = 56.0%) and underweight (OR 2.65, 95% CI 1.90, 3.68, I2 = 34.5%) compared to children of mothers without PND. The pooled RRs for stunting and underweight did not show significant differences between mothers with and without PND. Studies on wasting (n = 5) and overweight/obesity (n = 2) were limited, demonstrating inconsistent results across studies. The association between PND and adverse growth outcomes varied according to the measure of association, region, country, PND type, outcome timepoint, and study design. There were limited studies in diverse LMICs, particularly on wasting, or overweight/obesity as an outcome.

Vaccination status and long COVID symptoms among patients hospitalized with COVID-19: the WHF COVID-19 Long-term Study

Abstract Background COVID-19 vaccinations have been found to be effective in reducing the severity of COVID-19 infection and in-hospital deaths; however, insufficient evidence exists about the effect of vaccination on long term morbidity and mortality after hospitalization in patients from low- and middle-income countries. Methods The global WHF COVID-19 Long-Term Follow-up Study recruited 2,504 COVID-19 hospitalized patients from 26 collaborating sites in 16 countries between January 2022 - June 2023. Patients were followed up , at 1, 3, 6, and 9-12 months post-discharge to examine short- and long-term physical and psycho-social outcomes. A standardised questionnaire was used to collect data on demographics, pre-existing comorbidities, COVID-19 symptoms on admission, vaccination status, and outcomes at discharge, including persisting symptoms, new onset hypertension or diabetes, major adverse cardiovascular events (MACE), and mortality. We compared persistent long COVID symptoms, MACE, and mortality outcomes up to one year by COVID-19 vaccination status. Results The majority of study participants were Asians (78%), males (56%) with a mean (SD) age of 59.2 (19.9) years and from low- and middle-income (65%), upper middle-income (20%) and high-income (15%) countries. The most commonly reported comorbidities were hypertension: 54% and diabetes: 38%. Approximately two-thirds of the patients had received at least one dose of COVID-19 vaccination prior to hospitalization. Unvaccinated patients were more likely to present with dyspnea (60% vs 53%, p-value&amp;lt;0.001) and acute respiratory infection (15% vs 9%, p-value&amp;lt;0.001) during hospitalization. Unvaccinated patients also had twice the in-hospital mortality rate, compared with vaccinated patients (6% vs 3%, p-value&amp;lt;0.001). Unvaccinated patients had a greater incidence of MACE (23% vs 18%, p-value=0.016) during hospitalization and across all follow-up visits. Unvaccinated patients also had a higher mortality rate across all follow-up visits (mortality at one year post-discharge 14% vs 10%, p&amp;lt;0.001). At the 9-12 month follow-up, about a quarter of the patients had at least one long COVID symptom, but unvaccinated patients had a higher rate of long COVID symptoms, including fatigue (23% vs 14%, p&amp;lt;0.001), palpitations (17% to 7%, p-value&amp;lt;0.001), and anxiety (13% to 7%, p=0.002). Conclusions Our data highlight the long-term protective effect of COVID-19 vaccination on reducing morbidity and mortality among COVID-19 patients after hospital discharge. However, a substantial proportion of COVID-19 vaccinated patients still showed persistent long COVID symptoms (22%) and mortality (10%). Future research is needed to investigate individual- and health system-level factors contributing to poor health outcomes post-COVID-19 infection.