Middle-income Countries Research Articles

Examining The Impact of Macroeconomics Factors on Carbon Emissions in Selected 7-ASEAN Members: A Panel Data Analysis

This study investigates the relationships between urbanization, economic growth, energy consumption, transportation, and carbon emissions in seven ASEAN countries from 2011 to 2022. As released by the World Health Organization (WHO), more than 80 percent of the world’s population living in urban areas were exposed to air quality levels that were above the WHO limits. The region that is most affected comes from those nations categorized as low to middle-income countries. Hence, it is best to examine why these 7 ASEAN nations categorized from the lower to upper-middle income countries are not able to control the increase in the level of their carbon emissions. The analysis would also identify the appropriate empirical model suitable for the data. Using panel data analysis applying econometric modeling which are the Pooled Ordinary Least Square, Fixed Effects Model, and Random Effects Model, the findings support the Environmental Kuznets Curve hypothesis, revealing that urbanization and economic growth significantly increase carbon emissions. The study emphasizes the need for renewable energy adoption and sustainable urban planning to reduce carbon footprints. Key recommendations include enhancing energy efficiency and promoting cleaner transportation technologies to achieve sustainable economic growth in the ASEAN region.

Dynapenic abdominal obesity and activities of daily living disability among older adults residing in low- and middle-income countries

BackgroundDynapenic abdominal obesity (DAO) may be associated with an increased risk of disability. However, to date, this has not been investigated in low- and middle-income countries (LMICs), while the mediators are largely unknown.AimsTherefore, we aimed to investigate the association between DAO and activities of daily living (ADL) disability, and to identify potential mediators among older adults from six LMICs.MethodsCross-sectional, nationally representative data from the WHO Study on global AGEing and adult health were analyzed. Data on 20,198 adults aged ≥ 60 years were analyzed [mean (SD) age 69.3 (13.1) years; 54.1% females]. Dynapenia was defined as handgrip strength of < 26 kg for men and < 16 kg for women. Abdominal obesity was defined as waist circumference of > 88 cm for women and > 102 cm for men. DAO was defined as having both dynapenia and abdominal obesity. Disability was defined as severe or extreme difficulty in conducting at least one of six types of ADL. Multivariable logistic regression and mediation analysis were conducted.ResultsCompared to no dynapenia and no abdominal obesity, DAO was significantly associated with 2.08 (95%CI = 1.37–3.17) times higher odds for ADL disability Mediation analysis showed that diabetes (mediated percentage 4.7%), hypertension (7.2%), and angina (7.7%) were significant mediators in the association between DAO and ADL disability.ConclusionsDAO was associated with increased odds for ADL disability among older adults from LMICs. Future longitudinal studies are warranted to assess temporal associations, and whether addressing or preventing DAO can impact on future occurrence of disability.

Telemedicine networks for acute stroke: An analysis of global coverage, gaps, and opportunities.

Despite the proven efficacy of telestroke in improving clinical outcomes by providing access to specialized expertise and allowing rapid expert hyperacute stroke management and decision-making, detailed operational evidence is scarce, especially for less developed or lower income regions. We aimed to map the global telestroke landscape and characterize existing networks. We employed a four-tiered approach to comprehensively identify telestroke networks, primarily involving engagement with national stroke experts, stroke societies, and international stroke authorities. A carefully designed questionnaire was then distributed to the leaders of all identified networks to assess these networks' structures, processes, and outcomes. We identified 254 telestroke networks distributed across 67 countries. High-income countries (HICs) concentrated 175 (69%) of the networks. No evidence of telestroke services was found in 58 (30%) countries. From the identified networks, 88 (34%) completed the survey, being 61 (71%) located in HICs. Network setup was highly heterogeneous, ranging from 17 (22%) networks with more than 20 affiliated hospitals, providing thousands of annual consultations using purpose-built highly specialized technology, to 11 (13%) networks with fewer than 120 consultations annually using generic videoconferencing equipment. Real-time video and image transfer was employed in 64 (75%) networks, while 62 (74%) conducting quality monitoring. Most networks established in the past 3 years were located in low- and middle-income countries (LMICs). This comprehensive global survey of telestroke networks found significant variation in network coverage, setup, and technology use. Most services are in HICs, and a few services are in LMICs, although an emerging trend of new networks in these regions marks a pivotal moment in global telestroke care. The wide variation in quality monitoring practices across networks, with many failing to report key performance metrics, underscores the urgent need for standardized, resource-appropriate, quality assurance measures that can be adapted to diverse settings.

Cost-Effectiveness of Perinatal Depression Screening: A Scoping Review.

Perinatal depression (PND) has emerged as a significant public health concern. There is no consensus among countries or organizations on whether to screen for PND. Despite the growing body of evidence regarding the economic value of PND screening, its cost-effectiveness remains inadequately understood due to the heterogeneity of existing studies. This study aims to synthesize the available global evidence on the cost-effectiveness of PND screening compared to routine or usual care to provide a clearer understanding of its economic value. A detailed search strategy was predetermined to identify peer-reviewed publications that evaluated the cost-effectiveness of PND screening. We designed a scoping literature review protocol and searched electronic databases, including MEDLINE, EMBASE, and Web of Science, for studies published from inception to 10 December 2023. We included studies that conducted full economic evaluations comparing PND screening with usual care or other comparators and excluded studies that were not in English or lacked full texts. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to evaluate the reporting quality of the studies. Then, the data regarding costs and effectiveness were extracted and summarized narratively. A total of ten eligible studies were included, all of which were evaluated as being of high reporting quality. Nine of these studies compared the economic value of PND screening with usual care without screening, with eight finding that PND screening was generally more cost-effective. The remaining study evaluated the cost-effectiveness of two psychosocial assessment models and indicated that both effectively identified women "at risk". Across studies, PND screening ranged from being dominant (cheaper and more effective than usual care without screening) to costing USD 17,644 per quality adjusted life year (QALY) gained. Most included studies used decision trees or Markov models to test if PND screening was cost-effective. Although current economic evaluation studies have mostly suggested PND screening could be more cost-effective than usual care without screening, there is high heterogeneity in terms of participants, screening strategies, screening settings, and perspectives across studies. Despite varied settings and designs, most studies consistently indicate PND screening as cost-effective. Further evidence is also required from low- and middle-income countries (LMIC), non-Western countries, and randomized controlled trials (RCTs) to draw a more robust conclusion.

A review of the use of CT pulmonary angiography in pregnant and postpartum women at an academic centre

Background Pulmonary embolism (PE) is a common cause of maternal death during pregnancy and the puerperium yet data on its prevalence in middle-income countries is lacking. Methods We examined the medical records and CTPA (computed tomography pulmonary angiography) images of 67 women in an obstetric high care unit during pregnancy and the puerperium. We aimed to determine the prevalence of PE in a high-risk obstetric population undergoing CTPA, assess associated clinical features in this cohort, and determine the prevalence of alternative CT findings. Results CTPA detected PE in 11 women (16.42%) and alternative CT findings in 46 (68.6%). Women with PE had a lower systolic blood pressure than those without PE ( P = 0.001). Multiple gestation, preterm rupture of membranes, and gestational diabetes were linked to higher PE prevalence. Conclusions This study, set in an upper middle-income country, demonstrated a higher CTPA yield for PE and alternative diagnoses than in international literature, emphasising context-specific assessments.

Assessing the Efficacy of Chlorhexidine in Combating Most Important Causative Agents of Fungal Keratitis: An in Vitro Comparative Study With Seven Antifungal Agents

Purpose Fungal keratitis (FK) is a difficult condition to treat, particularly in underdeveloped nations. The study aimed to compare the in vitro activity of chlorhexidine (CHX) and seven antifungal agents against a collection of fungi recovered from FK patients. Methods Seventy-three fungi were collected from patients with FK included in study. The antifungal agents tested were fluconazole, voriconazole, posaconazole, miconazole, natamycin, amphotericin B, and caspofungin. The concentration range for CHX was 1–1024 μg/mL. Assessments of antifungal susceptibility were conducted using the EUCAST broth microdilution reference method. Results The findings demonstrated the beneficial in vitro inhibition of filamentous and yeast fungi by CHX. CHX demonstrated efficacy against Fusarium spp., Aspergillus spp., Candida spp., S. apiospermum and dematiceous fungi at concentrations of 4–64, 32–64, 4–32, 8, and 4–16 µg/mL respectively. The median MICs and MIC distributions of CHX showed no significant differences among the evaluated spp. (p > 0.05). The most effective antifungal drug was posaconazole, which was followed by voriconazole, caspofungin, and amphotericin B. Conclusion In situations where access to a range of antifungal medications and microbiological facilities is limited, CHX should be further investigated as a potential treatment for FK. It might be able to treat the condition as an inexpensive topical treatment.

Electrochemical Immunosensor for the Sensitive Determination of Human Papillomavirus (HPV) 16 L1 Capsid Protein: A Leap in Cervical Cancer Diagnosis

Human Papillomavirus (HPV) is the principal cause of cervical cancer, which is still a prime universal health concern, especially in underdeveloped nations where access to advanced screening techniques is often restricted. Herein, we propose an electrochemical immunosensor for the determination of HPV 16 L1 protein, a key biomarker associated with cervical carcinogenesis. The developed immunosensor, employing glassy carbon electrode (GCE) enhanced with gold nanoparticles, provides a highly sensitive, specific, and cost-effective approach for early screening of cervical cancer. An optimized stepwise fabrication process which includes electrode surface modification and antibody immobilization, was used to enhance sensor performance. Characterization studies confirmed the effective modification of electrodes and the selectivity of immunoreactions. With an impressive limit of detection (LOD) of 0.033 fg mL−1, the immunosensor showed a linear response to L1 protein concentrations ranging from 0.1 fg mL−1 to 1 ng mL−1. Additionally, the immunosensor exhibits excellent specificity, stability, reproducibility, and regeneration capabilities. The performance of the immunosensor was compared with the enzyme-linked immunosorbent assay (ELISA) by analyzing clinical samples (positive: n = 12; healthy: n = 5) showed satisfactory results. The findings indicated that the proposed sensing platform has the potential to be utilized for the early diagnosis of cervical cancer.

Applicability of heart failure clinical practice guidelines in low- and middle-income countries.

Clinical practice guidelines are commonly written by professional societies in high-income countries (HIC) with limited anticipation of implementation obstacles in other environments. We used heart failure (HF) guidelines as a paradigm to examine this concern, by conducting a survey to understand clinicians' ability to implement HF guidelines and their perceptions of the current HF guideline applicability in low- and middle-income countries (LMIC). An online survey of physicians in the database of the Translational Medicine Academy who treat HF patients was offered by email from 5 October to 27 November 2023, inquiring of participants' demographic information, experience, and views of HF guidelines as related to their practice. Of 2622 participating clinicians, 1592 partially completed, and an additional 1030 fully completed the survey. Participants were from 138 countries; 668 practiced in HIC, and 1954 in LMIC. Those from LMIC regarded HF guidelines to be less applicable in their country than did those from HIC (p = 0.0002). Of all those responding, 75.3% indicated that it was somewhat or mostly true that the HF guidelines were mostly applicable to HIC. Those from LMIC, but not HIC indicated that the greatest implementation obstacle was that the guidelines were for HIC (51.3% vs. 43.1%; p = 0.0387). A significantly higher proportion of respondents from LMIC indicated that resources for caring for their patients were somewhat or mostly limiting in most cases, than did those in HIC (41.6% vs. 32.5%, p = 0.0068). This survey examined the widely-held thought that HF guidelines are broadly applicable to all regions of the world, concluding that such a perception is incorrect. Clinicians from LMIC view the absence of consideration of local resource limitations as the greatest obstacle for guideline implementation. The results regarding HF guidelines likely also have implications for other guidelines and resultant patient outcomes.

Artificial intelligence for low income countries

The global adoption rate of artificial intelligence (AI) is rising, indicating its transformative potential. However, this adoption is far from uniform, with low-income countries (LICs) trailing behind significantly. Despite needing AI for development, LICs face multiple challenges in harnessing its benefits, exacerbating existing global disparities in technology adoption. In spite of the potentially important role that AI can play in the development of LICs, AI literature overlooks these countries, with research predominantly focused on more advanced economies. This lack of inclusivity contradicts the principles of distributive justice and global equity, prompting us to explore the importance of AI for LICs, offer a theoretical grounding for AI catch-up, identify effective AI domains, and propose strategies to bridge the AI gap. Drawing insights from the leapfrogging and absorptive capacities literature, our position paper presents the feasibility of AI catch-up in LICs. One crucial finding is that there is no one-size-fits-all approach to achieving AI catch-up. LICs with strong foundations could favor leapfrogging strategies, while those lacking such foundations might find learning and acquisition prescriptions from absorptive capacity literature more relevant. The article also makes policy recommendations that advocate for the swift integration of AI into critical LIC domains such as health, education, energy, and governance. While LICs must address challenges related to digital infrastructure, human capital, institutional robustness, and effective policymaking, among others, we believe that advanced AI economies and relevant international organizations like UNESCO, OECD, USAID, and the World Bank can support LICs in AI catch-up through tech transfer, grants, and assistance. Overall, our work envisions global AI use that effectively bridges development and innovation disparities.

Perspectives of psychiatric nurses on the stigmatization of mental healthcare in Ghana: a qualitative study.

Stigma surrounding mental illness has been identified as a major bane of psychiatric care in many low- and middle-income countries. Mental illness stigma affects both the sufferer and their care providers, including families and psychiatric care providers. In Ghana, attention toward psychiatric care is limited. This article provides qualitative insights on interpersonal and structural stigma experiences of psychiatric nurses from the Ankaful Psychiatric Hospital, Ghana, and the impact of these stigmas on psychiatric care provision in Ghana. The article addresses relevant gap in the literature on the impact of mental illness stigma experiences among psychiatric nurses in low- and middle-income countries. Using a qualitative research approach, this study draws from the experiences and perspectives of stigma among psychiatric nurses from the Ankaful Psychiatric Hospital. Fourteen registered psychiatric nurses were recruited and interviewed using semi-structured interviews with open-ended questions. A thematic analysis approach was adopted to analyze the data. Coding and analysis were done in NVivo 12, aiding in the analysis of major themes and subthemes that emerged from the data. The study was conducted remotely due to the COVID-19 pandemic travel restrictions. Themes identified include social and structural stigmas toward psychiatric nurses and the impact of these stigmas on mental healthcare in Ghana. While social stigma makes psychiatric nursing a difficult career choice for many, structural stigma-resulting from governmental neglect and lack of material resource provision-presents difficulties for nurses and other psychiatric care providers in the exercise of their care duties, which negatively impacts care provision for persons with mental health issues. The relevance of the experiences and perspectives of psychiatric nurses on mental illness stigma cannot be overlooked in the effort to promote mental illness advocacy, treatment seeking, and improve psychiatry. This article provides insights into the stigma experiences of psychiatric nurses and the impact of these stigmas on mental healthcare provision in Ghana. The study contributes to efforts to improve mental healthcare policymaking and advocacy.

Strengthening uptake of breast cancer screening services in Tanzania; re-visiting the breast cancer screening messages

BackgroundBreast Cancer remains among the top five cancers responsible for morbidity and mortality globally. For many years, infectious (communicable) diseases were a primary concern in low- and middle-income countries (LMICs) compared to higher-income countries, where non-communicable diseases (NCDs) were already a major concern. However, starting from the early 2000s, the LMICs including Tanzania has witnessed an epidemiological transition being equally affected by NCDs, and breast cancer, is among the prevalent NCDs. While the evidence is vast on the role of breast cancer screening messages in promoting screening, debunking myths, and addressing barriers to the uptake of breast cancer services, context-specific messages are limited. Amidst the changing technology, growth of social media and cultural dynamics, context-specific breast cancer screening messages are needed. We aimed to analyze the breast cancer screening messages from the experiences of women seeking care at Ocean Road Cancer Institute in Tanzania.MethodsAn exploratory qualitative case study adopting in-depth interviews (IDI) and focused group discussion (FGD) was carried out among purposefully selected women aged from 18 years to 65 years seeking care from Ocean Road Cancer Institute in Dar es Salaam, Tanzania. Eighteen women participated in the IDIs, and 16 women participated in FGD. Data analysis followed inductive qualitative content analysis.FindingsThree main categories emerged: the existence of multiple sources of breast cancer screening messages, the strengths and weaknesses of breast cancer screening messages, and clients’ mixed perceptions of breast cancer screening messages.ConclusionThe findings of this study depict that although breast cancer screening promotion messages are regarded as a source of information about cancers, they fall short of completeness and relevance to the otherwise at-risk population and trigger negative perceptions toward screening. Therefore, this study advocates revisiting the breast cancer screening messages, employing participatory approaches to tailor the screening messages and communication media to fit specific audiences. This calls for re-designing both the content of the messages and means of delivery; thus, collaborative efforts are needed.

Cholera outbreak in diyala province

Background: Vibrio cholerae is a primary cause of severe dehydrating diarrhea and remains a serious public health problem in low- and middle-income countries (LMICs) with insufficient water, sanitation, and hygiene. Cholera remains a public health threat the worldwide, mainly in countries with poor access to safe water and sanitation facilities. According to estimates, there are 21,000–143,000 deaths and 1.3–4 million cases of cholera annual. Objective: This study aims to carry out an analysis of the available information on cholera outbreaks in Diyala province, 2022. Patients and Methods: A descriptive study conducted in the department of public health using the data of cases reported from eight sectors in province. The data was collected from the surveillance unit, communicable control division of the public health department in Diyala province, IRAQ in 2022. Results: The total number of confirmed cases of cholera was (n = 139), female (72) 52 % and male (67) 48%, death reported for two of these cases. According to the date of onset, the registration of cases began from July 19 to October 25, 2022. However, the case fatality ratio (CFR) was 1.4%, while the attack rate in the governorate is 7.6 per 100,000 populations during 2022, the highest attack rate in Khanaqin district was (77 cases) 46, while the lowest attack rate in Baldruze, Al-Mansuria, and Al-Khalis districts was (1 case) 0.3,0.6, and 0.8 respectively. The age mean of patients was (38.7 ± 17.14 years) and the occurrence of the disease is more incidence in the age group 30-44 and females more than males. Conclusion: Occurrence Cholera outbreak during year 2022 without confirmed cases recorded since 2015 and the occurrence of cholera cases in governorate is greater during the months of August and September and most of the cases were from Khanaqin district.

Analysis of implementation science strategies to train laparoscopic surgical skills among Liberian surgeons using ALL-SAFE.

Significant disparities exist in laparoscopic training opportunities for surgeons in low- and middle-income countries (LMICs). ALL-SAFE is an innovative, low-cost training system for LMIC surgeons' laparoscopic development. However, strategies to implement and scale ALL-SAFE are unstudied. We aimed to assess the impact of implementation science strategies on ALL-SAFE uptake in Liberia, a novel and low-resource context. This study used implementation science approaches to evaluate ALL-SAFE uptake in three Liberian hospitals: John F. Kennedy Medical Center, Phebe, and ELWA. Five validated implementation strategies of program orientation, local champions, network weaving, feedback mechanisms, and practical supervision were piloted. All five strategies were implemented at two hospitals, while four strategies, excluding clinician supervision, were implemented at the final site as a pseudo-control, to evaluate the impact of resource-intensive supervision. Participants included surgical consultants, residents, and medical students. Engagement was assessed with mixed methods including participant number, practice hours, module completion rates, and strategy feasibility through end-user interviews. Across three hospitals, 33 participants used ALL-SAFE for 87.8 total training hours (5,268min). Participant numbers varied across sites (NJFK = 20, 80%; NPhebe = 7, 88%; NELWA = 6, 86%), as did practice times (TotalJFK = 3,060min, Median time/ParticipantJFK = 103min; TotalPhebe = 1,434min, Median time/ParticipantPhebe = 126min; TotalELWA = 774min, Median time/ParticipantELWA = 100min). Sites with practical supervision demonstrated higher engagement than those without (P = 0.042). Interviews (n = 8) revealed positive perceptions toward program orientation, practical supervision, and network weaving. Participants recommended thirteen additional strategies for sustainability including translating ALL-SAFE skills to patient care. Our study is one of the first to evaluate implementation science strategies for laparoscopic training in sub-Saharan Africa. The implementation bundles of five validated strategies were considered feasible by Liberian surgeons in both urban and rural hospitals. Mixed methods suggested a positive association between engagement and the resource-intensive practical supervision strategy. Future studies should focus on quantifying individual strategy contributions with rigorous implementation designs and assessing sustainability strategies.

Prevalence and Factors of Pregnancy Termination Among Reproductive-Aged Women: Evidence from the Bangladesh Demographic and Health Survey.

Pregnancy termination (PT) is a major public health concern in low-and middle-income countries like Bangladesh. This cross-sectional study aimed to determine the prevalence and factors of PT using the nationally representative Bangladesh Demographic and Health Survey data 2017-2018. A weighted population-based sample of 8759 ever-married reproductive-aged women (15-49 years) was included in the study. The outcome variable was PT in any of the following forms: miscarriage, induced abortion, and stillbirth. A univariate analysis for mean, frequency, and percentage and multiple logistical regression were used to determine the factors associated with PT. Around 18% of the women were found to have PT. The mean age of the women in the study was 25.79 years; 65.1% lived in the rural areas, and the majority of them were Muslims. Advanced age of the women (AOR:3.49, p = 0.004), residence in the countryside (AOR:0.81, p = 0.002), higher education (AOR:0.72, p = 0.027), not being a Muslim (AOR:0.74, p = 0.010), higher socio-economic status (AOR:1.28, p = 0.027), having a job (AOR:1.15, p = 0.041), being married at the age of >22 years (AOR:0.71, p = 0.036), and using a mobile phone (AOR:1.22, p = 0.002) were significant factors of PT. This study did not find any association between PT and contraceptive use. Age, living region, education, religion, wealth index, working status, marital age, and mobile phone use are the determinants of PT. Interventions including these factors need to be made to reduce PT in Bangladeshi women. These findings could be helpful in undertaking further epidemiological studies to understand the actual causes of PT in various rural and urban settings among different socio-demographic groups in Bangladesh.

Opportunities to advance cervical cancer prevention and care

Cervical cancer (CaCx) is a major public health issue, with over 600,000 women diagnosed annually. CaCx kills someone every 90 s, mostly in low- and middle-income countries. There are effective yet imperfect mechanisms to prevent CaCx. Since human papillomavirus (HPV) infections cause most CaCx, they can be prevented by vaccination. Screening methodologies can identify premalignant lesions and allow interventions before a CaCx develops. However, these tools are less feasible in resource-poor environments. Additionally, current screening modalities cannot triage lesions based on their relative risk of progression, which results in overtreatment. CaCx care relies heavily on genotoxic agents that cause severe side effects. This review discusses ways that recent technological advancements could be leveraged to improve CaCx care and prevention.

Intraoperative Anesthesia-Related Critical Events in Low-Resource Hospitals During Short-Term Surgical Missions in Tanzania and Democratic Republic of the Congo: An Observational Study.

Critical incidents and mortality related to anesthesia are more frequently observed in low- and middle-income countries in comparison to high-income countries. The difficulties linked to anesthesia in rural areas of the Democratic Republic of the Congo (DRC) and Tanzania have limited documentation. The aim of this study was to comprehensively document anesthesia-related critical events that occurred during surgical missions organized by the nongovernmental organization 2nd Chance in hospitals in DRC and Tanzania. Data were collected during 6 surgical missions in 3 hospitals in the DRC and 1 in Tanzania. All scheduled surgery patients were included. Anesthesia was administered by a local Non-Physician Anesthesia Provider (NPAP), using local resources, under the supervision of an anesthesiologist from the association. The anesthesiologist reported critical events and collected data. Local teams managed critical events initially, with intervention by the anesthesiologist from 2nd Chance on the local team's request, according to preestablished protocol or if the situation was considered dangerous. Critical incidents associated with anesthesia, including bradycardia, hypoxemia, airway management failure, and equipment problems, were documented from induction of anesthesia until discharge from the recovery room. We recruited 201 patients, of whom 192 were evaluated, with 9 patients dropping out due to protocol noncompliance. All patients were American Society of Anesthesiologists (ASA) I (62%; n = 120) or ASA II (38%; n = 72). Among them, 104 individuals (54%) experienced at least 1 critical event, totaling 202 critical events. Hypoxemia emerged as the most common event, affecting 29% of the patients (n = 55) with at least 1 episode. Equipment problems (oxygen supply and/or anesthesia machine failure) occurred in 24% of cases (n = 46), airway management issues in 23% (n = 44), and bradycardia in 6% (n = 12). Hypotension and hypertension were not documented due to the lack of monitoring. The majority of these events (over 60%) required intervention by the anesthesiologist. The occurrence of critical events related to anesthesia appears to be high in this study. Due to numerous limitations, these results cannot be generalized to all hospitals in Tanzania and the DRC. However, this study underscores the challenges faced by anesthesia teams, encompassing inadequate resources, equipment deficiencies, and varying levels of expertise among anesthesia personnel. The research further stresses the significance of addressing these challenges to enhance patient safety.

The Impact of Climate Change on the Mental Health of Populations at Disproportionate Risk of Health Impacts and Inequities: A Rapid Scoping Review of Reviews

The impacts of climate change on mental health are starting to be recognized and may be exacerbated for populations at disproportionate risk of health impacts or inequalities, including some people living in low- and middle-income countries, children, indigenous populations, and people living in rural communities, among others. Here, we conduct a rapid scoping review of reviews to summarize the research to date on climate impacts on the mental health of populations at disproportionate risk. This review highlights the direct and indirect effects of climate change, the common mental health issues that have been studied related to climate events, and the populations that have been studied to date. This review outlines key gaps in the field and important research areas going forward. These include a need for more systematic methodologies, with before-and-after comparisons or exposure/non-exposure group comparisons and consistent mental health outcome measurements that are appropriately adapted for the populations being studied. Further research is also necessary in regard to the indirect effects of climate change and the climate effects on indigenous populations and populations with other protected and intersecting characteristics. This review highlights the key research areas to date and maps the critical future research necessary to develop future interventions.

Determinants of micronutrient supplementation during pregnancy among women in three sub-Saharan African countries: a multilevel logistic regression model.

Poor maternal nutrition during pregnancy is a common cause of poor maternal and infant outcomes. Micronutrient deficiencies are common among pregnant women in low- and middle-income countries, including sub-Saharan Africa. Pregnant women are recommended to take micronutrients like iron or folic acid and deworming medication during pregnancy. Therefore, this study was conducted to assess micronutrient intake and its associated factors among pregnant women in three countries using the most recent demographic and health survey. We used data from the most recent demographic and health surveys, which were carried out between 2019 and 2022 in three sub-Saharan African countries. The study included a weighted sample of 13,568 reproductive-age women who had given birth within the five years prior to the survey. Utilizing multilevel logistic regression, the factors associated with the dependent variable were identified. Model comparison and fitness were assessed using the deviance (-2LLR), likelihood ratio test, median odds ratio, and intra-class correlation coefficient. Ultimately, factors were deemed statistically significant if they had a p-value less than 0.05. The pooled prevalence of micronutrient intake among pregnant women during pregnancy of last birth was 77.56% (95% CI: 76.85%-78.25%). Factors like age [AOR = 1.78; 95% CI (1.14, 2.77)], educational status [AOR = 1.49; 95% CI (1.23, 1.79)], marital status [AOR = 0.66; 95% CI (0.58, 0.75)], working status [AOR = 1.17; 95% CI (1.01, 1.34)], media exposure [AOR = 1.20; 95% CI (1.05, 1.38)], preceding birth interval [AOR = 1.17; 95% CI (1.01, 1.34)], number of ANC visits [AOR = 1.65; 95% CI (1.29, 2.10)], and residence [AOR = 1.19; 95% CI (1.03, 1.37)] were significantly associated with micronutrient intake among pregnant women. More than three-fourths of the study subjects were micronutrient supplemented during their pregnancy. Improving women's education, disseminating nutrition information through media, providing more attention to young pregnant women who live in rural areas, increasing the number of ANC visits, and women's empowerment are strongly recommended.

Long-term Immunity of a Microneedle Array Patch of SARS-CoV-2 S1 Protein Subunit Vaccine Irradiated by Gamma Rays in Mice.

COVID-19 vaccines effectively prevent symptomatic infection and severe disease, including hospitalization and death. However, unequal vaccine distribution during the pandemic, especially in low- and middle-income countries, has led to the emergence of vaccine-resistant strains. This underscores the need for alternative, safe, and thermostable vaccine platforms, such as dissolved microneedle array patches (MAP) delivering a subunit vaccine, which eliminate the need for cold chain and trained healthcare personnel. This study demonstrates that the SARS-CoV-2 S1 monomer with RS09, a TLR-4 agonist peptide, serves as an optimal protein subunit immunogen. This combination stimulates a stronger S1-specific immune response, resulting in binding to the membrane-bound spike on the cell surface and ACE2-binding inhibition, compared to the monomer S1 alone or trimer S1, regardless of RS09. MAP delivery of the rS1RS09 subunit vaccine elicited higher and longer-lasting immunity compared to conventional intramuscular injection. S1-specific IgG levels remained significantly elevated for up to 70 weeks post-administration. Additionally, different doses of 5, 15, and 45 μ g of MAP vaccines induced robust and sustained Th2-prevalent immune responses, suggesting a dose-sparing effect and inducing significantly high neutralizing antibodies against the Wuhan, Delta, and Omicron variants at 15 and 45 μ g dose. Moreover, gamma irradiation as a terminal sterilization method did not significantly affect immunogenicity, with irradiated vaccines maintaining comparable efficacy to non-irradiated ones. The stability of MAP vaccines was evaluated after long-term storage at room temperature and refrigeration for 19 months, showing minimal protein degradation. Further, after an additional one-month of storage at elevated temperature (42°C), rS1RS09 in both non-irradiated and irradiated MAP degraded less than 3%, while the liquid subunit vaccine degraded over 23%. Overall, these results indicate that gamma irradiation sterilized MAP-rS1RS09 vaccines maintain stability during extended storage without refrigeration, supporting their potential for mass production and widespread use in global vaccination efforts.

Evaluation of Multi-antibiotic Resistance Index (MAR) and Molecular Characterization of Pseudomonas aeruginosa Isolated in Pathological Products from Chad

Pseudomonas aeruginosa is a bacterium present in several ecological niches causing opportunistic infections in humans. In developing countries like Chad, this bacteria is responsible for various human pathologies. High-priority pathogens, such as Salmonella and Shigella, represent a particularly heavy burden in low- and middle-income countries, as do Pseudomonas aeruginosa and Staphylococcus aureus, which pose serious problems in health centers. The objective of this study was to evaluate the multi-antibiotic resistance index and to carry out a molecular characterization of Pseudomonas aeruginosa isolated in pathological products from Chad using by rep-PCR (GTG)5. Antibiotic resistance phenotypes were obtained by interpreting the results of our previous study on antimicrobial resistance of Pseudomonas aeruginosa isolated from human infections in N'Djamena, Chad. In this study, two phenotypes were obtained that is XDR and MDR. Thus, 24/36 of strains came from urine and 29/36 strains were MDR. The multi-antibiotic resistance (MAR) indexes varied from 0.33 to 0.86. The rep-PCR allowed good discrimination of Pseudomonas aeruginosa strains in this study. These isolates were grouped based on characteristic bands appearing in their genetic fingerprint profiles. In this study, Pseudomonas aeruginosa strains isolated from urinary tract infections and pus were classified as XDR and MDR type strains.