Low Middle-income Countries Research Articles

The cost effectiveness of a multidomain intervention on physical, cognitive, vascular, dietary and psychosocial outcomes among community dwelling older adults with cognitive frailty in Malaysia: The AGELESS Trial

BackgroundCognitive frailty (CF) in older adults is a potentially reversible syndrome that may benefit from lifestyle-based multidomain interventions. This study assessed the AGELESS intervention’s impact on cognitive, physical, vascular, dietary, and psychosocial outcomes, along with its cost-effectiveness, in a Low-Middle-Income Country (LMIC).MethodsThe AGELESS randomized controlled trial recruited 106 older adults (above 60 years) from Klang Valley, Malaysia, with (pre)-CF (≥ 1 Fried’s criteria and Clinical Dementia Rating scale = 0.5). Participants were randomly assigned to a 24-month multidomain intervention (physical activity, cognitive training, nutritional and psychological counselling, cardiovascular care) or control group (educational module). Primary outcomes, assessed at baseline, 12 and 24 months, included the modified Neuropsychological Tests Battery (mNTB) and physical performance measures. Intervention costs were calculated to determine Incremental Cost-Effectiveness Ratios (ICERs). An intention-to-treat analysis was conducted to account for attrition.ResultsThe trial occurred during the COVID-19 pandemic. Despite a 50% dropout rate, adherence among remaining participants was over 50% for all intervention components (range 53%-91%). The intervention led to significant improvements in selected parameters of cognitive function, physical performance, anthropometry, and dietary patterns (for all parameters, p < 0.05 for interaction time*group in repeat-measures ANOVA). The cost per participant was RM 1592.74 (≈USD 355.05) in the multidomain arm, and RM 488.21 (≈USD 108.83) in the control arm. The ICER computation indicated the 2-min step test as the most cost-effective measure (ICER RM 149.19 ≈USD33.26).ConclusionThe AGELESS trial demonstrates that a multidomain, lifestyle-based intervention can improve cognitive and physical function in older adults with (pre)-CF. This cost-effective approach highlights CF as a modifiable health condition and supports its potential inclusion in health policy to promote healthy aging and reduce health risks in LMICs, where there is a larger prevention potential due to prevalent lifestyle-related risk factors.

Severe outcomes and risk factors of non-neutropenic fever episodes in hospitalized children with cancer in Kenya

IntroductionCompared to febrile neutropenia (FN), non-neutropenic fever (NNF) episodes in children with cancer have not been associated with severe outcomes. Risk factors for severe outcomes in FN and NNF episodes in children with cancer from low-middle-income countries (LMIC) are incompletely described.MethodsA prospective, observational cohort study was conducted at a tertiary public referral hospital in western Kenya. Inclusion criteria were age ≤14 years, cancer diagnosis, hospitalized, fever &amp;gt;38.5°C or persistently &amp;gt;38°C. Neutropenia was an absolute count (ANC) &amp;lt;500 K/µL. Severe outcomes were BSI or death. Statistical analysis detected significance between groups and a univariate analysis was conducted.ResultsOf the 99 fevers, 54.5% were NNF episodes. Over 66% of NNF episodes were in patients with solid tumors. More severe outcomes were observed in NNF episodes compared to FN [BSI: 7.4% (4/54) vs. 4.4% (2/45); death: 7.4% (4/54) vs. 4.4% (2/45)], yet no deaths occurred in episodes with BSI. Acute leukemia not in remission (OR= 8.67, 95% CI [CI: 2.3-32.62]; p= 0.002) and concern for disease relapse (OR= 14.17, 95% CI [2.08-96.3]; p= 0.012) were significantly associated severe outcomes. Time to antibiotic administration (9 hours) did not differ by ANC. Under half (45.5%) of fever episodes had a blood culture ordered, with 93.9% obtained after administration of antibiotics.DiscussionNon-neutropenic fever episodes had more severe outcomes. Prompt fever management is recommended in all children with cancer treated in an LMIC setting. Pediatric oncology treatment centers in LMICs should rigorously evaluate their fever management clinical practice. Clinical risk factors were identified, but a risk-stratified approach in an LMIC setting is not recommended. Urgent attention is needed to identify areas of clinical improvement.

The effectiveness of self-help interventions in the treatment of depressive symptoms in low-and-middle-income countries (LMICs): a meta-analysis

Background Self-help psychological interventions show great potential to close the treatment gap for depressive symptoms in low-and middle-income countries (LMICs). The current meta-analysis investigated the pooled effect of self-help interventions for people with depressive symptoms in LMICs and moderators of these psychological interventions. Method PubMed, Cochrane Register of Randomized Controlled Trials, PsychInfo, Embase, and Sabinet databases were searched between June 2021 and December 2022 to select studies that met pre-defined inclusion criteria. A coding protocol was used to retrieve and code relevant data from selected studies. We measured publication bias and assessed the study quality using the Cochrane Risk of Bias tool. The program ‘Comprehensive Meta-Analysis’ (CMA) was used for the data analysis. Overall effect sizes were calculated to assess the effectiveness of self-help programs for depression. Results Eighteen studies were included in the meta-analysis. Self-help interventions were found to have a medium positive effect on depressive symptoms at post-test (Hedges’ g = 0.74) and at follow-up (Hedges’ g = 0.82). There was evidence for publication bias. Larger effects were found for studies that were conducted in lower-middle income countries, had at least mild depression as inclusion criterion, reported less than 30% attrition, did not use relaxation techniques, had a low or medium risk of bias, and that used a booklet form of intervention. Conclusion This meta-analysis suggests that self-help interventions have a positive effect on people with depressive symptoms in LMICs. The findings could inform the design and implementation of mental health interventions that could prevent or treat depression.

Menstrual hygiene practices, determinants, and association with reproductive tract infection in India: a large repeated cross-sectional analysis (2015-2021).

The promotion of menstrual health and hygiene globally, especially in lower-middle-income countries (LMICs), is a major public health imperative. The primary study objective was to ascertain the change in the patterns of menstrual hygiene practices and their sociodemographic determinants amongst adolescent girls and young women in India. The present study analyses data from the Indian National Family and Health Survey (NFHS), round 4 (2015-2016) and round 5 (2019-21). Women in the age group 15-24 years (n = 241,180) were interviewed regarding their menstrual hygiene practices. The proportion of women using sanitary napkins as absorbent during menstruation increased from 41.8% (NFHS-4) to 64.1% (NFHS-5), with more than six in ten adolescent girls and young women in India using sanitary pads during menses, although the socioeconomically vulnerable more likely to lack access. The higher age group (20-24 years), rural residence, lower wealth quintile, absence of schooling, absence of flush toilets, and lack of exposure to media were factors that were independently associated with the use of cloth as menstrual absorbent. Vaginal discharge was reportedly higher among women using unhygienic products, however, on adjusted analyses, no statistically significant association was observed with the type of absorbent used. The transition from cloth to sanitary pads has nearly doubled on average in the states implementing free and subsidised government pad distribution schemes during the same period.

Exploring Maxillofacial Indicators of Cardiovascular Disease: A Cross-sectional Study

Background Cardiovascular disease (CVD) is a leading cause of disability and death worldwide, particularly in lower-middle income countries like India. This study investigates Fordyce granules (FGs) as a potential marker for hyperlipidemia, alongside diagonal earlobe creases (DELC) and corneal arcus as indicators of coronary artery disease, aiming to enhance cardiovascular risk assessment in the Indian population. Objective To evaluate the association between cardiovascular conditions and maxillofacial markers, including corneal arcus, DELC, and FGs. Materials and Methods This cross-sectional study involved 60 participants: 30 CVD patients (Group I) and 30 non-CVD patients (Group II). The presence of DELC, FGs, and corneal arcus was recorded for each group. Results In Group I (CVD patients), prevalences were 40% for DELC, 66% for corneal arcus, and 6% for FGs. In Group II (non-CVD patients), prevalences were 3% for DELC, 10% for corneal arcus, and 30% for FGs, with significant differences between the groups. A significant association was found between DELC and corneal arcus ( p &lt; .01) and FGs ( p = .02), emphasizing their link to cutaneous oral signs in CVD patients. Conclusion DELC, FGs, and corneal arcus may serve as valuable markers for early CVD detection in dental patients.

Neuroimaging and neuromonitoring access in Mexico, where to focus?

Neuromonitoring plays an integral part of neurocritical care decision making in patients with acute brain injury, as it facilitates detection of physiological changes with the goal to mitigate further neurological deterioration and prevent secondary brain injury. There are increasing efforts being made to understand how the care of neurocritical patients is delivered globally, but there is little information about the use of neuroimaging and neuromonitoring in Lower Middle-Income Country. We aimed to investigate the availability of different neuromonitoring tools in intensive care units in Mexico. This was a prospective observational survey focused on gathering current neuroimaging and neuromonitoring practices in Mexico. We used a web-based survey using Google Forms (©2024 Google) to query practicing intensive care physicians in all states in Mexico. The questionnaire consisted of two sections with 27 questions. A total of 66 responses were included in the final analysis, that represent 65% of the states in Mexico (21 out of 32 states). Most ICUs reported not having access to a neurointensivist (79%, 52/66). Computed Tomography (CT) was available around the clock in 97% of ICUs (64/66), while CT angiography (CTA) was available 24/7 in 20% of ICUs (13/66) with only daytime availability in 35% (23/66) of ICUs. The most available invasive monitor in Mexico was the jugular bulb oximetry, which was available in 62% of ICUs (41/66). One third of ICUs (34%, 29/66) reported the use of invasive ICP monitoring. Of those, ventriculostomy was the most commonly use type of catheter, followed by the intraparenchymal ICP monitor, epidural and subdural ICP monitors. Brain tissue oxygen monitor (pbtO2) was only available in less than third of ICUs, 14% (5/66). Only 62% percent (41/66) of hospitals had 24/7access to a neurosurgeon. The availability of neuroimaging and neuromonitoring is limited in ICUs in Mexico, despite a sizeable proportion of neurocritical care patients. This may be in part driven by resources constraints, as well as lack of neurocritical care and neurosurgical access in many centers. There is an unmet need for recruiting and training in neurocritical care and neurosurgery.

Revolutionizing chronic rhinosinusitis treatment with functional endoscopic sinus surgery: Insights from a low-middle income country.

Chronic rhinosinusitis is a common condition that significantly affects quality of life, and functional endoscopic sinus surgery (FESS) has emerged as a widely used, minimally invasive procedure for its treatment. This retrospective study aimed to analyze the symptom patterns and variations in surgical approaches during FESS for treating chronic rhinosinusitis. The study included 110 patients who underwent FESS at a tertiary care center of eastern Nepal between January 2021 and December 2022. Of the participants, 51.81% were male, and 48.18% were female, with a mean age of 32.92 years for males and 29.03 years for females. Preoperative assessments included nasal endoscopy and computed tomography scans, followed by detailed counseling on surgery and potential complications. The most common symptom among the patients was nasal obstruction, while anosmia was the least prevalent. Nasal polyposis was diagnosed in 61 patients. The surgical approaches varied: 27.27% of patients underwent full house FESS, 48.18% had medial maxillary antrostomy with spheno-ethmoidectomy, and 24.54% had medial maxillary antrostomy with ethmoidectomy. Additionally, 93.63% of patients had endoscopic septoplasty, and 37.27% underwent turbinate reduction. Follow-ups were conducted at 3 months, 6 months, and 1 year, with outcomes evaluated through nasal endoscopy. The study reported minimal complications, including 1 case of minor bleeding and 5 cases of middle turbinate lateralization. The findings suggest that FESS is an effective treatment for chronic rhinosinusitis, with precise sinus opening, polyp removal, and mucosal preservation, combined with appropriate surgical planning, significantly improving symptoms and reducing the risk of recurrence.

Delay in diagnosis and treatment of childhood cancers in a developing country: A cross-sectional patient-based survey at country’s largest pediatric oncology center

Background &amp; Objectives: Pediatric cancers have a huge survival gap between the high-income and the low-middle-income countries (LMICs). Despite various other causes, the advanced stage of presentation is a major contributing factor but limited data is available from developing countries in this regard. This study aimed to identify delay in treatment and factors associated with it in our setup. Methods: This was a Cross-Sectional survey conducted at the department of pediatric hematology-oncology Children Hospital Lahore using a questionnaire-based interview of parents of all newly diagnosed cases of pediatric cancers presenting to Pakistan’s largest public-sector specialized center at the Children’s Hospital Lahore, over two months, i.e. from December 1, 2023 to January 31, 2024. The data was analyzed using SPSS version 23.0. Results: A total of 119 new patients presenting to the hospital were included. The median total delay in treatment of children with cancer was 63 days which is less than comparable LMICs, but physician and healthcare system delay that makes up the major portion of the total delay is equivalent to some low-income countries. The patient delay was negligible. The statistically significant factors associated with delay were gender, age of the patient; and type of cancer. Whereas, the distance from the specialized center and the socio-economic status of the family did not contribute significantly. Conclusions: Healthcare system delay is a major contributor therefore strengthening the existing medical services, development of medical referral systems, and medical professional awareness and education can improve delays in treatment and outcomes in our setup. doi: https://doi.org/10.12669/pjms.41.5.9663 How to cite this: Rahat Ul Ain, Rahman AA, Tariq A, Faizan M. Delay in diagnosis and treatment of childhood cancers in a developing country: A cross-sectional patient-based survey at country’s largest pediatric oncology center. Pak J Med Sci. 2025;41(5):1267-1273. doi: https://doi.org/10.12669/pjms.41.5.9663 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Does peak technology combat energy poverty in developing countries?

Purpose The purpose of this study is to highlight the importance of advanced technologies in combating energy poverty. Design/methodology/approach The study focuses on a group of 99 developing countries spanning from 2000–2021. It applies different estimation methods such as OLS with fixed effects, Driscoll-Kraay with fixed effects and generalized least squares (GLS). Findings The main conclusion is that advanced technologies significantly reduce energy poverty in developing countries. Similarly, this effect remains robust by changing the estimation technique, including the generalized method of moments and Tobit models. Furthermore, the impact of advanced technologies on all alternative measures of energy poverty remains robust to the main result. By adding natural resources to the model, it is apparent that natural resources have an inverse impact on energy poverty. By taking into account the heterogeneity of income level, the effect is more important in low-income developing countries, followed by lower middle-income and higher middle-income countries. In high-income countries, there is an inverse impact of technological readiness on the consumption of energy. Policy suggestions are provided. Originality/value The paper complements the existing literature by examining how peak technology influences energy poverty in developing countries.

Elective Laparoscopic Cholecystectomy: A Clean Surgery

Abstract Background: Laparoscopic cholecystectomy (LC) has become the gold standard procedure for treatment of cholelithiasis. It has many advantages over open cholecystectomy in terms of small incision, minimal postoperative pain, shorter hospital stays, better cosmesis and early recovery. The incidence of infectious complications after LC is significantly lower compared with open cholecystectomy. Surgical site infection (SSI), a significant postoperative complication, can lead to considerable morbidity and mortality. One approach to preventing infection is the administration of prophylactic antibiotics. However, in low-risk patients, for clean surgeries antibiotic prophylaxis does not seem to affect the incidence of SSI. In low- risk patients, eliminating the unnecessary use of prophylactic antibiotics would result in a cost reduction: moreover, it would lower the risk of adverse reaction and reduced microbial resistance. This is a prospective study conducted with total of 650 patients undergoing LC. Risk of SSI and cost effectiveness of LC compared among study groups with and without antibiotic prophylaxis and no significant difference in SSI was present in both group so LC without antibiotic prophylaxis found to be a cost-effective method of treatment of gall stone disease in selected population. Methods: After the approval of the hospital ethics committee, the observational case control study was conducted at the Dept. of Surgery, for 24 months from Sept 2022 to Aug 2024 with 650 patients. After randomization, LC have been done with antibiotic prophylaxis in control group whereas case group has not received any antibiotic prophylaxis. Patient followed up on day three, seven, days 14 and day 28 postoperatively for development of SSI. Results: There is no significant difference in SSI rate among the case and control groups and avoiding unnecessary use of antibiotics is a cost-effective method of treatment. Conclusion: The standardization of international and national guidelines for lower middle-income countries, including India, by carrying out a significant number of clinical trials and establishing recommendations, is required to prevent SSI concerning antibiotic prophylaxis and cost effectiveness of treatment.

Evidence of Coxiella burnetii and Bartonella species infections among patients with persistent febrile illness in four low- and middle-income countries.

Evidence of Coxiella burnetii and Bartonella species infections among patients with persistent febrile illness in four low- and middle-income countries.

A global assessment of urban extreme weather early warning systems and public health engagement.

To assess extreme weather early warning systems in large cities across the world. Among cities with populations above 1million reporting to the Carbon Disclosure Project Cities Adaptation Actions database from 2021 to 2023, we included those providing a description of at least one adaptation action for a climate hazard in at least one year. We identified cities reporting early warning systems using the United Nations Early Warnings for All framework, which includes four pillars: risk knowledge, hazard monitoring and forecasting, warning communication and preparedness. We also tracked public health engagement in these systems. We identified 182 cities, of which 71 described full early warning systems across the four pillars. Cities in high- and upper middle-income countries described early warning systems nearly three times more often than those in low- and lower middle-income countries. Multihazard early warning systems were reported by 35(49%) cities, and many of these involved institutionalized cross-sectoral coordination and funded at least one activity from their own resources. Health was reported as a goal of early warning systems by 58(82%) cities, although just 29(41%) indicated a specific role for public health agencies. These findings suggest that many large cities are not covered by these health-protective systems. We recommend development of a city-specific framework for early warning systems that identifies roles for health, and scaling up of these tools, particularly in cities in low- and lower middle-income countries, to ensure strengthened adaptive urban resilience against climate threats.

Evaluation of Organizational Readiness for Simulation in Secondary and Tertiary Care Hospitals in a Low-middle Income Country

Evaluation of Organizational Readiness for Simulation in Secondary and Tertiary Care Hospitals in a Low-middle Income Country

Expression, purification, and immunogenicity study of human papillomavirus type 52 virus-like particles produced in Hansenula polymorpha.

Expression, purification, and immunogenicity study of human papillomavirus type 52 virus-like particles produced in Hansenula polymorpha.

External Validation of CRASH Prognostic Model in an Urban Tertiary Care Public University Hospital.

Trauma represents 9% of global mortality, where traumatic brain injuries are the leading cause in low-middle income countries, most commonly due to road traffic injuries. The multicenter randomized controlled trial CRASH (corticosteroid randomization after significant head injury) published a prediction model to estimate prognosis in traumatic brain injury patients. This prediction model was derived based on data from high-, low-, and middle-income countries. The external validity of this prediction model was not assessed in low and middle-income countries. To fill this gap, we aim to external validate the CRASH prediction model in traumatic brain injury (TBI) patients in India, a lower-middle-income country. We conducted a prospective observational study at the General Surgery department of an urban tertiary care hospital in India. We collected data on the 14-d mortality and 6-mo unfavorable outcomes in patients with TBI. Calibration and discrimination of the CRASH models (basic and computed tomography [CT] model) comparing the observed and predicted outcomes using logistic regression, and area under the curve was analyzed to validate the model. In this study, 417 patients with the median age of 40 y and age range of 18-95y were evaluated. There was no significant difference between the calibration of the models in prediction of a 14-d mortality (basic P=0.082, CT P=0.067) and 6-mo unfavorable outcome (basic P=0.688, CT P=0.204). The area under the receiver operating characteristic curve in basic and CT models in prediction of 14-d mortality were 0.885 and 0.885 respectively. In addition, the area under the receiver operating characteristic curve in basic and CT models in prediction of 6-mo unfavorable outcome were 0.901 and 0.896, respectively. The results of this study showed that the CRASH basic and CT model both accurately predict 14 d mortality and 6 mo unfavorable outcomes of TBI patients in an urban tertiary care public university hospital in India.

Levosimendan Against Conventional Vasoactive Agents for Acute Heart Failure: A Cost-Effectiveness Analysis in a Lower-Middle Income Country

Levosimendan Against Conventional Vasoactive Agents for Acute Heart Failure: A Cost-Effectiveness Analysis in a Lower-Middle Income Country

Identifying the most effective policies for minimising inappropriate use of antibiotics: A replicability study using three WHO datasets.

Identifying the most effective policies for minimising inappropriate use of antibiotics: A replicability study using three WHO datasets.

State-Owned Enterprises, Productivity Loss and Misallocation of Resources in Indonesia amidst the Commodity Boom Era: Evidence from Firm-Level Data

The recent evolution of total factor productivity (TFP) difference across countries has risen significantly, creating a considerable divergence in income per person as a measurement of living standards. However, Indonesia experienced a declining trend in TFP levels persistently. As a lower middle-income country, Indonesia is ambitious to be a high-income country by design, named Indonesia Vision 2045. This study mainly examines the presence of resource misallocation by channel. Higher revenue productivity (TFPR) dispersion leads to inefficiency of allocating resources and causes productivity loss. Secondly, it also examines the source of resource misallocation by observing the relationship between productivity loss and the proxy of policy distortion variables. Furthermore, this study aims to contribute to the misallocation and growth literature by analyzing firm-level data from 2004, 2005, 2012, and 2013. This study assesses the impact of the commodity boom period that spanned between 2002 and 2012–2013, two pivotal events that significantly altered Indonesia’s economic landscape. The TFPR and output productivity (TFPQ) are the dependent variables using large and medium manufacturing annual surveys from the Indonesian Central Bureau of Statistics (BPS). This study discovers that TFPR varied across firms within industries, indicating resource misallocation. Furthermore, equalizing TFPR across sectors would increase aggregate TFP by 122%–133%. Productivity loss relates significantly to ownership, with the elasticity being 1% higher in state-owned enterprises (SOE), equating to a 57.7% increase in the TFPR dispersion. These findings have an important implication for the government policy aligning with the target above. Indonesia should reform SOE to be more productive and profitable while creating a fair playing field. This study also complements by analyzing other policy distortion factors, namely the firm's location and investment type.

Pregnancy and neonatal outcomes of assisted pregnancies in a low-middle income country in South Asia

BackgroundAssisted reproductive techniques are increasingly used to achieve fertility in developing countries in South Asia. However, the data on the outcome of assisted pregnancies are sparse. This study aims to evaluate the pregnancy, delivery and neonatal outcomes and complications of assisted pregnancies in Sri Lanka, a low-middle-income country in South Asia.MethodsWe performed a secondary analysis of the data of the island-wide multi-centre Sri Lanka Birth Weight Study, which recruited all live-born newborns in 13 hospitals covering 20% of all births in the country from 01 August to 30 September 2023. Data on socio-demographic background, type of conception, pre-pregnancy medical, obstetric and delivery complications and immediate neonatal outcomes were collected by interviewing mothers and perusing patient records. Maternal age-, multiple births- and prematurity-adjusted odds ratios were determined by logistic regression analysis.ResultsOf the 8992 pregnancies, 8900 (99.0%) were spontaneous conceptions. The assisted pregnancy rate was 1.0%, with 52 intra-uterine insemination and 40 in-vitro fertilisation pregnancies. The mean ages of mothers who had intra-uterine insemination (31.2 years) or in-vitro fertilisation (38.7 years) were significantly (p < 0.001) higher than the mothers who had spontaneous conceptions (28.6 years). Pregestational diabetes (p = 0.003) and hypothyroidism (p < 0.001) were significantly higher in the assisted pregnancy group compared to the spontaneous conceptions. Regarding pregnancy complications, gestational diabetes (p = 0.001) was higher in in-vitro fertilisation pregnancies and urinary tract infection (p < 0.001) was higher in intra-uterine insemination pregnancies. The multiple births (6.4% vs. 1.2%, p < 0.001) and caesarean section (77.2% vs. 41.8%, p < 0.001) rates were significantly higher among the assisted pregnancy group compared to spontaneous conceptions. Neonates born following assisted pregnancies were significantly more likely to be premature (p < 0.001), low birth weight (p < 0.05), admitted to neonatal intensive care units (p < 0.001) and die within the first day of life (p < 0.05) compared babies born following spontaneous conceptions.ConclusionsThe assisted pregnancy rate in this study was 1%, and assisted pregnancies were more common among women with pregestational diabetes and hypothyroidism. Gestational diabetes and urinary tract infections were more frequent in assisted pregnancies. Neonates born following assisted pregnancies reported significant morbidity and mortality compared to spontaneous conceptions.

Rivaroxaban for Venous Thromboembolism (VTE) in Paediatric Patients: an institutional retrospective observational study from the Low/Middle Income setting in Pakistan

Objectives: To evaluate bleeding events, mortality, recurrence and prescribing practices in paediatric and adolescent patients of venous thromboembolism using direct acting oral anticoagulants (DOACs). Method: The descriptive, retrospective study was conducted from November 2021 to May 2022 at the Aga Khan University Hospital and comprised data from 2017 to 2021 of patients from birth to 18 years who received DOACs for prophylaxis or treatment purposes of venous thromboembolism. Data was analysed using STATA MP.15. Results: Of the 45 patients, 37(82.2%) were males and 8(17.8%) were females. The overall median age was 16 years (interquartile range: 12.5-18 years). Of the total, 33(73.3%) patients were treated for acute venous thromboembolism, while 12(26.7%) received anticoagulants as prophylaxis. Complete thrombus resolution was achieved in 15(45.5%) patients, partial resolution in 3 (9.1%), and no resolution in 4(12.1%). Recurrence of venous thromboembolism occurred in 2(6%) patients. Enoxaparin was prescribed in 24(53.3%) cases, rivaroxaban in 14(31.1%) and heparin in 7(15.6%). There were 13(28.9%) deaths in the cohort. Conclusion: Rivaroxaban may be safe in the management of paediatric venous thromboembolism, with no major bleeding complications observed in our study. Key Words: Rivaroxaban, Direct oral anticoagulants, Paediatric, Low middle-income country.