Low-income Environments Research Articles

The COVID-19 restrictions, child services and the well-being of children in South Africa

Covid-19 posed little danger to children. Nevertheless, the South African government imposed lockdown measures that impeded children’s education, play and food. Schools were closed, feeding schemes were halted and organised sports were banned. In this study of South African children’s experience during the 2020–22 pandemic, we use the capabilities approach, particularly Nussbaum’s ten capabilities, to assess how the lockdown measures affected their development. The one-dimensional nature of the government response was evident in its focus on physical health and safeguarding adults and the health system, at the expense of children’s well-being. Children were masked and their voices were not heard. Despite being far less at risk of illness or death than adults, children and young people were disproportionately affected by government regulations. Children from low-income environments were particularly severely affected.

Disruptive innovation capability in resource-constrained environments: The role of strategic posture and human capital

The disruptive innovation framework has been suggested to enhance new venture sustainability in resource-constrained contexts. This paper explores the role of human capital and strategic posture on disruptive innovation capability in low-income and resource-constrained environments. Using a generic qualitative inquiry strategy, we develop propositions tested by 20 in-depth interviews with entrepreneurs and industry role players in the South African startup incubation sector. Data from the interviews were analyzed through thematic analysis with constant comparison. The findings suggest that adopting an emerging market orientation and taking strategic risks assists in identifying the right consumer target market. Innovativeness is linked to effective product development processes, and a learning orientation contributes to the development of the skills and capabilities required for successful innovation in resource-constrained environments. Additionally, the findings emphasize prior founder knowledge and industry experience in shaping the strategic posture of entrepreneurs. Resource-constrained contexts vary significantly across regions. Our study contributes to the body of knowledge on disruptive innovations and small business sustainability in resource-constrained environments by investigating entrepreneurial dynamics in South Africa.

Association between breastfeeding duration and BMI, 2009-2018: a population-based study.

In the 21st century, childhood overweight and obesity have become major public health issues worldwide. Previous studies have shown that breastfeeding helps prevent overweight or obesity in children. Despite the significant advantages of breastfeeding, the global exclusive breastfeeding rate for infants under 6 months old is only 40%, while in the United States, the rate is only 25%. The aim of this study is to explore the relationship between breastfeeding duration and BMI in children aged 2 to 6 in the United States, and to raise awareness of breastfeeding. A cross-sectional study included 2,769 participants between the ages of 2 and 6 from a sample that represented the entire NHANES 2009-2018. Data was analyzed using EmpowerStats, (www.empowerstats.com) linear regression as well as Chi-square test, t-tests, multivariate regression analysis and smooth cure fitting were done. Breastfeeding duration long-term group exhibited a statistically significant negative association with BMI, with a regression coefficient of -0.21 (P < 0.05). The continuous analysis of breastfeeding duration by tertile also demonstrate a statistically significant negative association with BMI. Subgroup analysis revealed that the potential benefits of breastfeeding on BMI were more obvious in low-income environments and maternal age 18 to 35 years, with a regression coefficient of -0.57 and -0.24, respectively (all P < 0.05). The findings emphasize the importance of breastfeeding in reducing childhood overweight/obesity and preventing associated diseases, both in clinical and public health settings.

Analisis Pengembangan Usaha Kecil dan Menengah di Lingkungan Berpenghasilan Rendah

This study aims to analyze the challenges and development strategies of micro, small, and medium enterprises (MSMEs) located in low-income areas in Indonesia. MSMEs play an important role in the Indonesian economy, but in areas with low income levels, MSMEs face various constraints, such as difficulties in accessing adequate capital, technology, and management skills. To conduct this study, the researchers used a qualitative approach by collecting data from various sources of relevant scientific literature. The results showed that MSMEs in low-income settings face several key constraints, including difficulty accessing formal sources of financing, limited use of information technology, and low implementation of good business management practices, such as in marketing and financial record-keeping. To be able to develop MSMEs in low-income environments, comprehensive efforts are needed, such as facilitating MSME access to official funding sources, providing training and assistance in the use of information technology, and improving MSME skills in implementing good business management practices. In addition, the availability of skilled human resources, as well as innovation and creativity are also important factors in supporting the growth of MSMEs in low-income areas. By paying attention to these various aspects, it is expected that the development of MSMEs in low-income environments can run effectively and provide optimal benefits to the regional and national economy, through collaboration and synergy between MSMEs, government, financial institutions, and other stakeholders.

Breathing space in a compact city: Impacts of urban re-densification on Mumbai's low-income housing environment

Redevelopment of low-income settlements by re-densifying cities is a common approach in the Global South to improve living conditions and tackle the housing shortage. However, the effectiveness of the housing design in redevelopment schemes remains to be questioned. This study evaluates a proposed design of a slum redevelopment project in Mumbai, India, by comparing the environmental performance of three design schemes: the existing low-income housing, the redevelopment scheme proposed by the local government and a hypothetical design (modified scheme) that aligns with positive environmental outcomes identified in the current literature. The environmental factors such as the natural airflow, incident solar radiation and daylighting parameters were assessed by computational simulations and validated by a wind tunnel experiment. These factors were associated with direct and indirect density metrics of the three design schemes to inform better policymaking for slum redevelopment projects that seek to re-densify housing for the urban poor. The results indicated that the design performance of the redeveloped scheme is less preferable due to the unclean indoor air and inadequate daylighting conditions requiring large-scale demolition of the existing buildings. The modified plan requires minimal demolishment and demonstrates relatively better environmental performance. The study revealed that indirect density measures - building geometry factors and urban form parameters - are essential in affecting the ecological performance of housing. Considering these factors in design standards and policymaking for high-density redevelopment schemes can enable the “Goldilocks density” that significantly improves the quality of living while densifying the cities.

The role of specific emotion dysregulation facets in the association between child violence exposure and psychopathology.

African Americans living in low-income urban environments are disproportionately exposed to violence compared to other racial groups. Child exposure to community violence is linked to adverse psychological outcomes, including externalizing and internalizing behaviors. Emotion dysregulation may be one psychological process through which externalizing and internalizing behaviors develop in the context of childhood violence exposure. However, limited research exists on how different aspects of emotion dysregulation are affected by community violence exposure in children. The present study examined whether violence exposure was indirectly associated with externalizing and internalizing behaviors via facets of emotion dysregulation in a sample of 94 African American mother-child dyads. Mothers and children completed measures to assess child community violence exposure, externalizing and internalizing behaviors, and emotion dysregulation (anger, sadness, and worry dysregulation). Results indicated that maternal report of child community violence exposure was indirectly associated with externalizing behaviors via anger dysregulation and internalizing behaviors via worry dysregulation. Child report of community violence exposure was also indirectly associated with externalizing behavior via anger dysregulation; however, there were no significant associations with internalizing behavior. These findings suggest that certain components of emotion dysregulation serve as an indirect pathway of influence for community violence exposure on child behavior, and the pathways differ between externalizing and internalizing behavior outcomes. Emotion dysregulation may serve as an important potential treatment target in reducing long-term risks associated with violence exposure in urban communities of color. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Thyroid surgery in a context of scarce resources at Saint Martin de Porres Dominican Hospital (Yaounde, Cameroon)

Surgical campaigns for thyroid surgery in low-income environments are very efficient, but there is little literature reporting results. These campaigns are complex due to multiple particularities: highly evolved cases, the need for professionals to travel or an obvious socio-cultural barrier influence towards the surgical act. We describe a surgical campaign in Cameroon to treat patients with goiter and issue some medical and sociocultural recommendations in view of our experience for its implementation with guarantees. An experienced group carried out an 11-day campaign at the Saint Martin de Porres Dominican Hospital, Yaounde, Cameroon. Demographic data, TSH values, surgery and complications after a 12-month follow-up were analyzed. Thirty-eight patients with goiter were selected for the campaign and 32 patients (mean age, 40-years-old; 30 females) were operated. Bilateral goiter, as assessed with echography, was diagnosed in 13 patients (41%). Ten patients (31%) had a WHO grade II goiter (visible with the neck in a normal position). The surgical procedures were 18 unilateral thyroidectomy with isthmectomie, 13 total thyroidectomy, and 1 totalizing thyroidectomy, due to previous unilateral thyroidectomy (cancer recurrence). A pathological study in 13 patients (40%, extra cost 60 €) showed benign multinodular goiter/thyroid nodule (12 patients) and an extensive papillary carcinoma (one patient). Six months postoperatively, 3 patients had a slight dysphonia and one patient had persistent hypocalcemia. Follow-up was completed in all patients, either face to face (75%, 24 patients) or by phone (25%, 8 patients who failed to have a TSH test because of its cost, 23 €). Surgical campaigns to treat thyroid pathology can be carried out with guarantees if a series of important steps are followed: active participation of the patient's environment, thyroid ultrasound by the surgical team to decide which technique, intense awareness about monitoring and hormone replacement therapy, and the participation of local personnel for long-term follow-up.

Undernutrition in young children with congenital heart disease undergoing cardiac surgery in a low-income environment

BackgroundMalnutrition (undernutrition) in children with congenital disease (CHD) is a notable concern, with preoperative and persistent growth failure post-cardiac surgery contributing to poorer outcomes. Poor growth in children with CHD in low-income environments is exacerbated by feeding difficulties, poverty, delayed diagnosis, and late corrective surgery. This study describes and compares the growth of young children with CHD undergoing cardiac surgery in central South Africa from before to 6-months after cardiac surgery.MethodsChildren 30 months and younger, with their mothers, were included in this prospective observational descriptive study. Weight- height-, and head circumference-for-age z-scores were used to identify children who were underweight, stunted and microcephalic. Z-scores for growth indices were compared from baseline to 3-months and 6-months post-cardiac surgery. Changes in growth over time were calculated using a 95% confidence interval on the difference between means. Linear regression was used to determine the association between growth and development, health-related quality of life and parenting stress respectively.ResultsForty mother-child pairs were included at baseline. Most children (n = 30) had moderate disease severity, with eight children having cyanotic defects. A quarter of the children had Down syndrome (DS). Twenty-eight children underwent corrective cardiac surgery at a median age of 7.4 months. Most children (n = 27) were underweight before cardiac surgery [mean z-score − 2.5 (±1.5)], and many (n = 18) were stunted [mean z-score − 2.2 (±2.5)]. A quarter (n = 10) of the children had feeding difficulties. By 6-months post-cardiac surgery there were significant improvements in weight (p = 0.04) and head circumference (p = 0.02), but complete catch-up growth had not yet occurred. Malnutrition (undernutrition) was strongly associated (p = 0.04) with poorer motor development [Mean Bayley-III motor score 79.5 (±17.5)] before cardiac surgery. Growth in children with cyanotic and acyanotic defects, and those with and without DS were comparable.ConclusionMalnutrition (undernutrition) is common in children with CHD in central South Africa, a low-income environment, both before and after cardiac surgery, and is associated with poor motor development before cardiac surgery. A diagnosis of CHD warrants regular growth monitoring and assessment of feeding ability. Early referral for nutritional support and speech therapy will improve growth outcomes.

Scalability and Sustainability of a Surgical Infection Prevention Program in Low-Income Environments

Surgical infections are a major cause of perioperative morbidity and mortality, particularly in low-resource settings. Clean Cut, a 6-month quality improvement program developed by the global nonprofit organization Lifebox, has demonstrated improvements in postoperative infectious complications. However, the pilot program required intense external programmatic and resource support. To examine the improvement in adherence to infection prevention and control standards and rates of postoperative infections in hospitals in the Clean Cut program after implementation strategies were updated and program execution was refined. This cohort study evaluated and refined the Clean Cut implementation strategy to enhance scalability based on a qualitative study of its pilot phase, including formalizing programmatic and educational materials, building an automated data entry and analysis platform, and reorganizing hospital-based team composition. Clean Cut was introduced from January 1, 2019, to February 28, 2022, in 7 Ethiopian hospitals that had not previously participated in the program. Prospective data initiated on arrival in the operating room were collected, and patients were followed up through hospital discharge and with 30-day follow-up telephone calls. Implementation of the refined Clean Cut program. The primary outcome was surgical site infection (SSI); secondary outcomes were adherence to 6 infection prevention standards, mortality, hospital length of stay, and other infectious complications. A total of 3364 patients (mean [SD] age, 26.5 [38.0] years; 2196 [65.3%] female) from 7 Ethiopian hospitals were studied (1575 at baseline and 1789 after intervention). After controlling for confounders, the relative risk of SSIs was reduced by 34.0% after program implementation (relative risk, 0.66; 95% CI, 0.54-0.81; P < .001). Appropriate Surgical Safety Checklist use increased from 16.3% to 43.0% (P < .001), surgeon hand and patient skin antisepsis improved from 46.0% to 66.0% (P < .001), and timely antibiotic administration improved from 17.8% to 39.0% (P < .001). Surgical instrument (38.7% vs 10.2%), linen sterility (35.5% vs 12.8%), and gauze counting (89.2% vs 82.5%; P < .001 for all comparisons) also improved significantly. A modified implementation strategy for the Clean Cut program focusing on reduced external resource and programmatic input from Lifebox, structured education and training materials, and wider hospital engagement resulted in outcomes that matched our pilot study, with improved adherence to recognized infection prevention standards resulting in a reduction in SSIs. The demonstration of scalability reinforces the value of this SSI prevention program.

Determinants of dietary diversity and drivers of food choice among low-income consumers in urban Kenya, Malawi and Zimbabwe.

Rapid urbanisation affects lifestyle and eating habits, predominantly causing a dietary shift that adds challenges to meet dietary recommendations within a complex food system. This research investigated dietary diversity and food choice drivers among low-income consumers in three urban settlements (Nairobi, Kenya; Bulawayo, Zimbabwe and Lilongwe, Malawi, representing rapid, moderate and slow urban growth patterns, respectively) as a first step towards improving diets across cultures and geographies. Mixed methods data collection was employed for this study. Qualitative methods such as rapid foodscape appraisal workshops and food stories in selected low-income settlements in Nairobi, Bulawayo and Lilongwe were utilised to collect information on the food environments (food balances, infrastructure, safety, policies and institutions). Quantitative data such as socio-demographic characteristics and dietary diversity were collected via structured questionnaires using Cognitive Edge's SenseMaker® (n = 890, 450 and 440 for Nairobi, Bulawayo and Lilongwe, respectively). The dietary intake of respondents was assessed using a 24-h recall, which was then converted to the food group diversity score (FGDS). Different levels of compounded stress affected dietary diversity and quality, including high food prices, concerns about sanitation and hygiene and the role of food standards regulation bodies. The mean FGDS across all locations was lower than the recommended cut-off of 5 (4.5, 2.8 and 2.6 across Nairobi, Zimbabwe and Lilongwe, respectively). Additionally, in Nairobi, there were gender differences in diet diversity, with men having a higher dietary diversity score than women (4.6% vs. 4.3%; p = 0.004). The majority of respondents in Lilongwe (65%) reported price as the most important driver of food choice, compared to 38% in Nairobi and 42% in Bulawayo. Our observation of poor-quality diets provides further evidence of the need for food policies that are cognisant of the nutrition and health of the growing population of the urban poor. Such policies would focus on lowering the costs of nutritious foods as well as ensuring food safety within the complex food system observed in the urban low-income environment.

A stochastic model of group wealth responses to insurance mechanisms in low-income communities

This study addresses the group-based nature of financial vulnerability in the low-income environment. Adopting a highly flexible stochastic dissemination model, we assess the impact of insurance on the resilience of a low-income group to wealth shocks. For this purpose, the transient wealth of a group of interacting uninsured and insured agents is considered. The model is extended to capture four types of transaction events: external arrivals, internal redistributions, wealth losses and premium payments. Risk-sharing mechanisms, mitigating the impact of financial losses that are otherwise uninsured, are widespread in low-income communities. Our modelling of redistribution events captures the wealth transactions associated with these mechanisms, alongside the purchase of commodities and services from within the group. Through this set-up, we present a method for incorporating the high level of wealth interaction characteristic of the low-income setting in the assessment of the effectiveness of insurance. The model is underlined by an exogenously evolving Markov background process that represents the state of the economy. To analyse the distribution of wealth jointly with the state of the background process, a system of coupled differential equations for the joint transient distribution of agent wealth is derived, and is reduced to a linear system of differential equations through consideration of the moments of agent wealth. Sensitivity analysis is performed to establish the impact of the system's structure and stochastic dynamics on the wealth of the group. The probability of falling below the poverty line is then determined through application of a normal approximation and the impact of insurance in reducing this probability considered under varying levels of subsidisation.

Beneficiary Expectation from Low-Income Housing Projects: A Post-Occupancy Evaluation Study from Punjab, Pakistan

The Pakistani government has been promoting affordable housing projects for low-income households for the last thirty years. It is important to appraise the low-income housing projects from the perceptions of beneficiaries being the ultimate users of such facilities in urban settings. This paper presents an analytical study on the experiences of beneficiaries from the application process to possession of housing units in two different models of affordable housing in the Punjab region, Pakistan. It is challenging to link their experiences as post occupancy evaluation (POE) regarding the application process, living experience, and governance of such housing projects. Analysis was done using inductive reasoning by data collection through focus group discussions. The findings show and confirm that quality of life in a low-income housing environment is a combination of multiple factors which influence the mind of households from the inception of projects till the possession and continue in the post-occupancy phase as well. The funding and execution of projects need to consider the end user demand by the inclusion of targeted beneficiaries in the planning, design, and regulation of the housing projects to ensure the resident’s housing satisfaction in terms of provision of all allied facilities, infrastructure, experience, and quality of living.

Low length-for-age Z-score within 1 month after birth predicts hyperdynamic circulation at the age of 21 years in rural Malawi

Low birth weight predisposes to the development of hypertension in middle- and high-income countries. We examined the relation of early life length-for-age score (Z-score) on cardiovascular function in young adults in Malawi, a low-income country. Capture of supine, seated, and standing brachial pulse waveforms (Mobil-O-Graph) were performed in 223 females and 152 males (mean age 21 years), and analyzed according to the length-for-age Z-score tertiles during the first month of life. Plasma LDL cholesterol in young adulthood was slightly lower in the lowest versus highest tertile. Otherwise, blood hemoglobin and plasma chemistry were similar in all tertiles. Irrespective of posture, blood pressure, forward and backward wave amplitudes, and pulse wave velocity were corresponding in all tertiles. In the three postures, the lowest tertile presented with 4.5% lower systemic vascular resistance than the highest tertile (p = 0.005), and 4.4% and 5.5% higher cardiac output than the middle and highest tertiles, respectively (p < 0.01). Left cardiac work was 6.8% and 6.9% higher in the lowest tertile than in the middle and highest tertiles, respectively (p < 0.01). To conclude, in a low-income environment, low length-for-age Z-score after birth predicted hyperdynamic circulation at 21 years of age without changes in blood pressure and metabolic variables.

Transforming Impossible into Possible (TIP) for Financial Capability: Application of Practice-Based Program Theory and Measures in Intervention Design

Purpose: Financial knowledge often does not translate into financial well-being. This study looks at how knowledge might be converted to well-being for people living in low-income environments, based on a theory called Financial PSS. Methods: The study tests the validity of the two scales that make up Financial PSS: Perceived Financial Barriers and Financial Hope. Then it examines how these measures along with an intervention measure called TIP are associated with financial capability. Results: Results validated the Perceived Financial Barrier Scale and Financial Hope Scale. Next, the study found that the Perceived Financial Barriers Scale and the Financial Hope Scale are associated with financial capability, as is the TIP score. Conclusions: The study concludes that Financial PSS as a newly applied practice-based theory should be further tested. Workforce providers could integrate financial education and empowerment-based F-PSS process models and see a positive impact on their placement and retention outcomes.

Prevalence of Schistosoma mansoni, soil-transmitted helminths and intestinal protozoa in orphans and street children in Mwanza city, Northern Tanzania.

Parasitic infections are highly prevalent in low-income environments worldwide. While orphans and street children represent a particularly vulnerable population group, they are often exempt from preventive interventions such as Mass Drug Administration. In part, this could be due to a lack of data showing the burden of disease in this group. This study aims to address this gap. For this cross-sectional study, 144 orphans and 112 street children were screened for Schistosoma mansoni(S. mansoni), Schistosoma haematobium(S. haematobium), soil-transmitted helminths and intestinal protozoa using POC-CCA testing, urine filtration, and Kato-Katz technique. Nutritional status, water- and washing patterns were determined using a standardised questionnaire. Ultrasonography was performed to screen for organ abnormalities. The prevalence of S. mansoni determined by POC-CCA-test was 65.9% for orphans and 94.5% for street children. 19.2% of the orphans tested positive for S. mansoni in Kato Katz. Of the street children, 77.1% showed positive test results in Kato-Katz. Only 1.3% of the orphans stated in the questionnaire that they use the lake to wash, whereas 91.1% of the street children named the lake as at least one of their options for washing. Microscopy showed positive results for Giardia intestinalis(G. intestinalis) in 8.2% and for Entamoeba histolytica/dispar (E. histolytica/dispar)in 23% of orphans and 8.1% for G. intestinalis, and 23.8% for E. histolytica/dispar in street children. In the ultrasonography, we did not observe patterns that indicate severe periportal fibrosis. The results indicate a significantly higher rate of infections with S. mansoni in street children compared with orphans. This might be explained by the lack of access to adequate sanitation for street children as well as regular contact with the water of Lake Victoria. However, we did not find similar results concerning infection rates with protozoa. The study results show overall inadequate living conditions in this study population, which could be addressed by public health interventions.

Endoscopic Third Ventriculostomy with Choroid Plexus Cauterization in Infantile Hydrocephalus: An Experience from Mali

Introduction: Pediatric hydrocephalus is a common disease in sub-Saharan Africa. In Mali, 350–400 new cases are diagnosed in our center yearly. With a total land mass of 1,241,000 km², patients in remote areas must travel up to 1,500 km to access neurosurgical care. Hence, treatment and follow-ups of “shunted” patients are difficult. In this context, endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) provides an opportunity for an affordable and less constraining treatment for hydrocephalus children under 12 months of age. Methods: We performed a retrospective analysis of ETV/CPC performed on infants from July 2013 to January 2015. Patients were followed postoperatively on day 15, month 6, and month 12. Statistical analysis was conducted using Prism 9 GraphPad software. ETV successes were categorized according to the patient’s age into 3 groups: ≤3 months, 3–6 months, and 6–12 months. Statistical significance was defined at p < 0.05. Results: During the study period, 199 patients were included with 40% of patients aged between 0 and 6 months. The head circumference ranged from 35 cm to 79 cm. The etiology was congenital malformation in 55%. ETV/CPC was a success in 69% of 6- to 12-month-old patients, 54% in the 3- to 6-month-old patients, and 29% in ≤3-month-old patients. Overall, 94 (47%) patients were successfully treated without a shunt. The postoperative infection rate was 1% and mortality at 12 months was 8%. Conclusion: In a low-income environment such as Mali, ETV/CPC stands as a viable and alternative treatment option for pediatric hydrocephalus patients; our findings suggest that age is an important factor in predicting ETV success.

Can Ordering Groceries Online Support Diet Quality in Adults Who Live in Low Food Access and Low-Income Environments?

During the COVID-19 pandemic, U.S. food assistance programs allowed the use of program benefits to order groceries online. We examined relationships between the food environment, food assistance, online grocery ordering, and diet quality among adults from one low-income, low food access community in Northeastern Connecticut during the pandemic. Via online survey, adults (n = 276) reported their perceived home and store food environments, food assistance participation, whether they ordered groceries online, and consumption frequency and liking of foods/beverages to calculate diet quality indices. Those who ordered groceries online (44.6%) were more likely to participate in food assistance programs and report greater diet quality. Perceived healthiness of store and home food environments was variable, with the ease of obtaining and selecting unhealthy foods in the neighborhood significantly greater than healthy foods. Healthier perceived home food environments were associated with significantly higher diet qualities, especially among individuals who participated in multiple food assistance programs. Ordering groceries online interacted with multiple measures of the food environment to influence diet quality. Generally, the poorest diet quality was observed among individuals who perceived their store and home food environments as least healthy and who did not order groceries online. Thus, ordering groceries online may support higher diet quality among adults who can use their food assistance for purchasing groceries online and who live in low-income, low-access food environments.

Improvised intracranial pressure monitoring devices for traumatic brain injury management in a low-income environment: A single-centre randomised study demonstrating feasibility

BackgroundThe high cost and non-availability of standard ICP monitoring devices limit their use in low- and middle-income countries like Nigeria. This study aims to demonstrate the use of an improvised intraventricular ICP monitoring device as a feasible alternative. Research questionAre improvised ICP Monitoring devices feasible and effective in resource-constrained settings? Materials and methodsThe study was a prospective single-institution investigation involving 54 adult patients that presented with severe TBI (GCS of 3–8) within 72 ​h of injury and required operative intervention. All patients underwent craniotomy or primary decompressive craniectomy (DC) to evacuate traumatic mass lesions. 14-day in-hospital mortality was used as a primary endpoint of the study. 25 patients had ICP monitoring postoperatively using the improvised device. ResultsThe modified ICP device was replicated using a feeding tube and a manometer with 0.9% saline as a coupling agent. Based on hourly ICP recording (up to 72 ​h), patients were observed as having high ICP (>27 ​cm H2O) and normal ICP (27 ​cm H2O). In the ICP-monitored group, raised ICP was detected more than in the clinically assessed group (84% vs 12% p= <0.001). Discussion and conclusionThere was a 3-time higher mortality rate among the non-ICP monitored participants (31%) compared to the ICP-monitored participants (12%), although this did not reach statistical significance due to the small sample size. This preliminary study has shown that this modified ICP monitoring system is a relatively feasible alternative for diagnosing and treating elevated ICP in severe TBI in resource-constrained environments.

Bridging the know-do gap in low-income surgical environments: Creating contextually appropriate training videos to promote safer surgery in Ethiopia

Although international guidelines exist for the prevention of surgical site infections, their implementation in diverse clinical contexts, especially in low and middle-income countries, is challenging due to the lack of available resources and organizational structure of facilities. The goal of this project was to develop a series of video training aids to highlight best practices in surgical infection prevention in hospitals with limited resources and to provide practical solutions to common challenges faced in these settings.Using the validated Clean Cut education framework for infection prevention developed by Lifebox, a charity devoted to improving surgical and anesthetic safety, we partnered with clinicians in one Ethiopian hospital to create six educational videos giving practical guidelines for infection prevention under resource variable conditions. These include: 1) proper use of the WHO Surgical Safety Checklist, 2) hand and skin antisepsis, 3) confirming instrument sterility, 4) maintaining the sterile field, 5) antibiotic prophylaxis, and 6) gauze counting.Gaps in available online educational materials were identified in each of the six areas. Videos were created providing setting-specific education and addressing gaps in existing materials for each of the infection prevention topics. These videos are now integrated into infection prevention curricula through Lifebox in Ethiopia and ongoing data collection to evaluate acceptability and efficacy is ongoing.Surgical education videos on infection prevention topics addressing location-specific resources and workarounds can be useful to hospitals operating in resource-limited settings for training staff and supporting quality and safety efforts in surgery.

Gender differences in the stress-buffering effects of mindfulness facets on substance use among low-income adolescents

Problematic substance use during adolescence predicts numerous adverse outcomes, including increased risk of substance use disorders in adulthood. Adolescents often use substances to cope with stress, particularly adolescents who have experienced environmental stress in childhood (e.g., low-income environments), but research indicates stress-related substance use disorders may develop differently across gender. This highlights a need to identify coping resources for stress-related substance use and understand whether these coping resources are differentially effective across gender. Mindfulness has garnered evidence as a coping resource for stress-related problematic substance use; however, there is limited research on how specific mindfulness facets (e.g., nonjudgment) may buffer against stress-related substance use among adolescents. This study examined whether overall mindfulness and specific facets buffered the association between stress and substance use differentially across gender in a predominantly low-income, racially-diverse (42 % Black, 24 % White, 15 % Hispanic/Latinx, 13 % Asian, 3 % American Indian/Alaskan Native, and 3 % multiracial) sample of adolescents (n = 212) using moderated moderation models. Girls with lower levels of two mindfulness facets (i.e., acceptance/nonjudgement, decentering/nonreactivity), relative to girls with higher levels, demonstrated a greater probability of substance use with increased stress. Conversely, boys with higher levels of acceptance/nonjudgement and decentering/nonreactivity, relative to boys with lower levels, reported a greater probability of substance use with increased stress. Results suggest that acceptance/nonjudgment and decentering/nonreactivity may be protective against stress-related substance use for girls and potentially contraindicated for boys, indicating that adolescent substance use prevention and intervention efforts may need to be tailored by gender.