Low-resource Countries Research Articles

Squamous Cell Carcinoma of the Oral Cavity, Oropharynx, and Larynx: A Scoping Review of Treatment Guidelines Worldwide.

Head and neck cancer (HNC) treatments have been based on single or multimodal therapies with surgery, radiotherapy (RT), chemotherapy, and immunotherapy. However, treatment recommendations among countries may differ due to technological/human resources and usual local practices. This scoping review aims to identify, compare, and map the clinical practice guidelines (CPGs) for treating squamous cell carcinoma (SCC) of the oral cavity, oropharynx, and larynx worldwide. A search strategy on global CPGs for HNC was performed by using five electronic databases and grey literature. CPGs were selected for inclusion using EndNote-20 and Rayyan online software. No language or publication date restrictions were applied. The results were analyzed descriptively considering the most updated CPG version. In total, 25 CPGs covering the head and neck region (10), the larynx (7), the oral cavity (5), and the oropharynx (3), were found in 13 geographical regions, and 19 were developed by medical societies from 1996 to 2023. Surgery and RT remain the main modalities for early-stage HNC, with surgery preferred in low-resource countries, and RT in selected cases, especially in the larynx/oropharynx aiming to achieve a cure with organ preservation. Human papillomavirus infection for oropharyngeal SCC is not tested in some Asian countries and there is still no consensus to treat p16-positive cases differently from p16-negative. Recommendations for larynx preservation vary according to facilities in each country, however, individualized choice is emphasized. Inequality across countries/continents is evident, with a similar pattern of recommendations among developed as well as developing ones. No CPGs were found in Latin America as well as Oceania countries, where the incidence of HNC is high and limitations of access to treatment may be encountered.

Non-adherence to anti-hypertensive medications in a low-resource country Nepal: a systematic review and meta-analysis.

Nepal is a low resource country with cardiovascular diseases being the number one cause of mortality. Despite hypertension being the single most important risk factor for cardiovascular diseases, non-adherence to anti-hypertensive medications has not been assessed systematically. So, this systematic review and meta-analysis aims to analyze the prevalence of non-adherence to anti-hypertensive medications in Nepal. This systematic review and meta-analysis was piloted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Electronic databases of Embase, PubMed, Scopus, Web of Science, Cochrane Library, Cinhal Plus, and Google Scholar were searched from inception till 1 February 2023. The random-effects model with 95% confidence interval (CI) was used to calculate the non-adherence rate. Altogether, 14 studies with a total of 3276 hypertensive patients were included in the meta-analysis. The pooled prevalence of non-adherence to anti-hypertensive medications was 49% (95% CI: 0.37-0.62, I2=98.41%, P<0.001). The non-adherence rate using Morisky Medication Adherence Scale (MMAS) was 55% (95% CI: 0.34-0.76, I2=99.14%, P<0.001), and using Hill-Bone Compliance Scale, the non-adherence rate was 45% (95% CI: 0.37-0.54, I2=84.36%, P<0.001). In subgroup analysis, the non-adherence was higher in rural areas 56% (95% CI: 0.51-0.61, I2=0.0%, P=0.46) compared to urban areas 42% (95% CI: 0.31-0.54, I2=96.90%, P<0.001). The trend of non-adherence was increasing after 2020. Additionally, forgetfulness, carelessness, cost of medications, number of comorbidities, and using an alternate form of medication were common factors associated with non-adherence. This meta-analysis showed that half of the hypertensive population of Nepal are non-adherent to their anti-hypertensive medications, thereby posing a significant long-term cardiovascular consequence among Nepali population.

Importance of measuring student experience in a short online course for educators

This case study discusses the importance of measuring student satisfaction in online teaching. Student satisfaction is a crucial metric for any educational institution, regardless of whether it offers face-to-face, conventional education or open, distance and e-learning (ODeL). It is essential that students feel engaged and supported in their learning journey to ensure the best possible outcomes, especially in low-resourced countries such as Eswatini. ODeL have each been shown to provide unique advantages when it comes to student satisfaction due to their flexibility and convenience. However, it is important to note that wanting to recommend a course to someone does not necessarily mean that they were completely satisfied with all aspects of the course. For example, a student may have found a course to be very challenging but still found it valuable and would recommend it to others who are interested in the subject matter. Early on in research on blended and e-learning, it was highlighted that the quality of the instructors and the appropriate design and good facilitation of online learning activities are important determinants that influence student learning and satisfaction. Satisfaction is possibly the most accepted measure of teaching/learning quality and effectiveness. In addition, relevant and appropriate support services (quality) are seen by a substantial body of literature on education as a key factor and great predictor of student satisfaction in a blended/online learning environment. Therefore, measuring student satisfaction can help maintain quality teaching and learning by identifying areas for improvement. The case study also provides best practices for measuring student satisfaction in online teaching. These include using surveys or questionnaires that cover various aspects such as course content, instructor support, technical support, communication channels, assessment methods, among others. It is important to use validated instruments or develop customised ones based on specific needs. Furthermore, it is recommended to collect data at different points during the course delivery to capture changes in student satisfaction over time. The data collected should be analysed and used to inform decision making and improve the quality of teaching and learning. In conclusion, measuring student satisfaction in online teaching is crucial for maintaining quality teaching and learning. OSeL have unique advantages when it comes to student satisfaction, but it is important to ensure that students feel engaged and supported throughout their learning journey. Best practices for measuring student satisfaction include using validated instruments, collecting data at different points during course delivery, analysing data and using it to inform decision making.

Neonatal Seizure Pattern, Outcome, and its Predictors Among Neonates Admitted to NICU of Ayder Comprehensive Specialized Hospital, Mekelle, Tigray, Ethiopia.

Seizure is the most frequently observed symptom of neurological disorders and an important determinant of outcome during neonatal period. In clinical practice, it is prevalent and observed in neonates admitted to hospital in low-resources countries, but due to the paucity of studies in these regions, little is known about its pattern, clinical outcomes of hospitalization, and its predictors. Therefore, aims to evaluate seizure patterns, clinical outcomes, and its predictors among neonates admitted to the NICU of ACSH, Mekelle, and Tigray. A hospital-based cross-sectional study design was conducted among neonates with neonatal seizures admitted to NICU of Ayder Comprehensive Specialized Hospital. Data collection was done from record reviews. SPSS Version 25 was used. Descriptive statistics and bivariate logistic regressions where a p-value of <0.05 is considered statistically significant. Out of 1622 NICU admissions, 155 (9.6%) were cases of neonatal seizure. The most frequently observed types of seizure in this study were subtle 70 (45.1%) and tonic 49 (31.6%) respectively. At the end of hospitalization 70.3% of neonates were discharged improved, 21.3% of neonates died and 8.4% of neonates had severe neurologic deficits. Poorly controlled seizures (AOR 4.8, 95% CI 2.6-9.2), prolonged duration of labor (AOR 4.3, 95% CI 2.2-8.8) and seizure onset <72 hours (AOR 3.7, 95% CI 1.6-8.5), respectively, were found to be independent predictors of poor neonatal outcome. Of all neonatal admissions, neonatal seizure was observed in close to 9.6%. The most frequently observed type of seizure was subtle. Of those admitted neonates, 30% had poor outcomes following the end of their hospitalization or when they leave against medical advice for lack of improvement). Poorly controlled seizures, prolonged duration of labor, and seizure onset <72 hours were independent predictors of poor neonatal outcomes.

Forty Years of Care and Research – The Intertwining

Translation of research findings to actual clinical practice, now called translational research, is critical in low-resource settings and countries. In India, we have very few centers offering research training and even fewer agencies funding mental health research. It was in this context that the Schizophrenia Research Foundation (SCARF) based in Chennai used many of the research findings and processes to improve clinic and community-based care of persons with mental disorders. Based on 40 years of our experience of working in the community, this article provides an overview of our major research projects and the ways in which the findings that emanated were used in the promotion of better care.

Assessing potential surge of COVID-19 cases and the need for booster vaccine amid emerging SARS-CoV-2 variants in Indonesia: A modelling study from West Java

ObjectivesPrimary and booster vaccinations are crucial in COVID-19 control. This study aimed to assess the minimum booster coverage to hamper potential surge of COVID-19 cases in 2023 in Indonesia, a low-resource setting country. MethodsWe used a modified SEIR compartment model to assess different scenarios in booster coverage across West Java population: 35%, 50%, and 70%. We fitted the model, then we calculated the potential active cases in 2023 if each scenario was met before 2022 ends. A heat map of predicted cases from various booster coverages and time frames was produced and matched with vaccination rate's function to determine feasible time frames. ResultsA minimum of 70% booster coverage in West Java is needed to reduce 90% of potential COVID-19 cases and avert possible surge in 2023. The booster doses should be distributed before February 2023 to achieve its optimum preventive effect. Delays in achieving minimum booster coverage is acceptable, but higher booster coverage will be required. ConclusionsFor better COVID-19 control in Indonesia, booster vaccination is warranted, as presented by a case study in West Java. Sufficient vaccine supplies, infrastructure, and healthcare workers should be ensured to support a successful booster vaccination program.

Transition to Value-Based Care IoT Wearable Devices in Maternity Healthcare for Low-Resource Countries

Transition to Value-Based Care IoT Wearable Devices in Maternity Healthcare for Low-Resource Countries

Exploring the challenges and roles of nurses in delivering palliative care for cancer patients and co-morbidities in Ghana

BackgroundPatients suffering from chronic and life-threatening diseases receive inadequate palliative care in low-income countries, eventually leading to poor quality of life for these patients. Little is known about the experience of delivering palliative care in a low-resource country such as Ghana in comparison to higher-income countries. This study, therefore, aimed to assess the roles and challenges of nurses providing palliative care services for patients with cancer and life-limiting conditions at tertiary Hospitals in Ghana.MethodsThirty oncology nurses at a tertiary Hospital in Ghana participated. All nurses were providing end-of-life care to patients with cancer. A qualitative exploratory-descriptive design and a semi-structured interview guide developed by the researchers were used. Interviews lasted on average forty minutes to 1 h were audio-recorded, and transcribed verbatim. Content analysis was carried out to generate themes and sub-themes.FindingsParticipants were between the ages of 25 and 40 years. A higher percentage of females (n = 17, 57%) participated in the study than males (n = 13, 43%). Two main themes were generated which were the delivery of palliative care and the provision of home care services. The current roles of nurses were centered around pain management, home care services, spiritual needs, and psychological care. Challenges that hindered the implementation of palliative care included distress over expected and unexpected patient mortality, difficulty delivering bad news to patients and families, and frustration with health system resource shortages that negatively impacted patient care.ConclusionPalliative care is one of the essential services provided for patients with life-limiting conditions, and nurses play an active role in the provision of this care. Further research is needed to determine the most effective ways to deliver this care, particularly in developing nations like Ghana.

Effects of Communicable Diseases on Maternity services in selected MNCH priority counties’ Public Health facilities in Kenya: A Case of COVID-19.

Covid-19 is a rapidly evolving pandemic which has affected both developed and developing countries. Maternity services in low resource countries are adapting to provide antenatal and postnatal care midst a rapidly shifting health system environment due to the COVID-19 pandemic. Over the years there has been progress in reducing maternal and new-born mortality and stillbirths in Kenya and the globe. However, in the wake of covid-19 pandemic, perinatal women and their frontline health services providers especially nurses and midwives have been cited to bear the brunt of the pandemic. This has largely been linked to the limited access to Personal Protective Equipment (PPE) requirements and the fear of contracting the disease within health services delivery points. There have been adverse effects of maternal and new-born care outcomes due to coronavirus disease. The objective of this study was to determine the effect of coronavirus disease (COVID 19) to maternity services in selected levels III and IV public health facilities within five (5) Counties in Kenya. The five MNCH priority counties selected included Nairobi, Migori, Kilifi, Isiolo and Garissa. A two-stage sampling approach was used to select health facilities in the 5 MNCH priority counties with the sampling frame comprising all MNCH priority counties in Kenya. The study employed cross-sectional and observational retrospective approaches. Data was collected from the midwifery managers and maternity registers in a total of 28 levels III and IV facilities. Open Data Kit (ODK) formatted tools were used to collect data from maternity services facility managers and maternity registers in the selected facilities. Data collected from maternity registers covered the period of four months before covid-19 pandemic and four months during the covid-19 pandemic. A two-days training programme comprising of introduction to study objectives and instruments as well as review of the instruments, practice interviews and data collection was conducted. Data was analysed using STATA Version 15. Descriptive statistics and measures of central tendencies were used to analyse the demographic details of the respondents and health related variables of interests. Chi-square test and fishers exact test were used to find association between facilities that had diagnosed COVID-19 cases and their demographic characteristics. For all tests, a p-value &lt; 0.05 was taken as statistically significant. A total of 31 midwifery managers were interviewed and a total of 801 maternity records (400 before COVID and 401 during COVID-19 pandemic) were obtained from levels 3 III (66%) and IV (34%) facilities across 5 MNCH priority counties in Kenya [Nairobi (27%), Garissa (10%), Isiolo (20%), Kilifi (23%) and Migori (20%)]. On Overall representation, Level III facilities were slightly over half (51.6%) and level IV facilities had 48.4% representation. Most of the maternity services managers interviewed (48.4%) had worked for less than 3 years in their respective stations and the majority (67.7%) had a diploma in either Nursing or midwifery as their highest level of professional education. Overall, the managers indicated that ANC visits had reduced (67.9%), referrals of mothers with complications got delayed (29%), mothers feared delivering in hospitals (64.5%) and possibly some mothers were delivering with the assistance of TBAs (45.2%). The managers reported that New-born care services were the most affected by the pandemic (54.8%) followed by ANC services (45.2%). Immunization services were the least affected (35.5%). The managers (41.9%) reported reduced uptake of FP commodities and a reduction in exclusive breastfeeding (12.9%). Majority (51.6%) of the managers confirmed there was an increase of unplanned pregnancies (90.4) during the pandemic period with limited opportunity to educate ANC clients (74.2%). It was observed that 48% of the facilities surveyed had diagnosed a covid-19 case yet only 61.3% and 54.8% of the facilities had access to masks and hand sanitizers respectively. Facility records indicated a 19% higher ANC attendance before COVID than during COVID-19 pandemic period. Neonatal deaths increased significantly during Covid-19 period ((P=0.010) by 38%. Live births significantly increased by 15% during the pandemic (p&lt;0.0001). Other significant increases were observed in mothers with labour complications (p=0.0003) and number of mothers that underwent caesarean sections(p&lt;0.001) during the pandemic period. There was no sufficient statistical evidence on whether the uptake of FP commodities, post-partum complications, immunizations and maternal mortalities were affected by the covid-19 pandemic. The Covid-19 pandemic caught maternity service providers and the local health systems unaware. The fear of the pandemic had a cross-cutting effect on utilisation of maternity services. Continuous training of health services providers on emergency response to pandemics and health system preparedness is vital in order to have resilient service delivery points.

Point-of-Care Molecular Test for the Detection of 14 High-Risk Genotypes of Human Papillomavirus in a Single Tube.

Cervical cancers constitute a large disease burden in developing countries, with the human papillomavirus (HPV) being responsible for most cervical lesions. Many regions in low-resource countries lack adequate access to sensitive point-of-care (POC) screening tools, preventing timely diagnosis and treatment. To reduce screening barriers, we developed a POC HPV molecular test that detects 14 high-risk HPV types in 30 min in a single assay. We introduced innovations to the underlying amplification (recombinase polymerase amplification) and detection methodologies such as improved probe design, reagent lyophilization, and pipette-less processing to increase sensitivity while enabling minimally trained personnel to conduct reproducible testing. Based on 198 clinically derived samples, we demonstrated a sensitivity of 93% and a specificity of 73% compared to an FDA-approved polymerase chain reaction-based clinical method. Our modified pipette-less simplified assay had a sensitivity of 96% and a specificity of 83%. The application of our assay is intended as a near-patient screening tool with further evaluation by a clinician for confirmation.

Improving data use in decision-making and utilization of maternal healthcare services through a data-informed platform for health approaches in districts of the Gedeo Zone, southern Ethiopia, 2023: a cluster-randomized control trial.

In low-resource countries such as Ethiopia, the utilization of local data for planning and decision-making health systems was frequently constrained. In addition, despite several government initiatives, maternal health services were not completely utilized. On the other hand, efforts to effectively utilize the local data available to improve the utilization level of maternal healthcare services were insufficient, necessitating the need for a different approach. This implementation study aims to test and validate the effectiveness of a data-informed platform for health (DIPH) strategies on data use for decision-making and utilization of maternal health services in districts of the Gedeo Zone, southern Ethiopia. A two-arm parallel group, type II hybrid, cluster-randomized control trial design has been implemented to conduct the study between 1 September 2022 and 29 February 2024. Six woredas/districts have been assigned to the intervention arm and the other six to the control arm. Baseline and end-line data have been collected from 120 eligible health management staff (from both intervention arm and control arm). In the intervention arm, district health management staff have been given specialized training and continuous technical assistance as a package called the DIPH strategy by embedding it with the district's current decision-making platform such as Performance Review Team meetings. The DIPH strategy has mainly focused on five-step approaches such as situational assessment, stakeholder engagement, defining/setting priorities, planning, and follow-up. Health management staff in the control arm have performed their regular daily activities. The χ2 and t-tests have been used to check the effect of the intervention. In addition, difference-in-differences estimates have been calculated because the change may inherently occur over time. A P-value of <0.05 and a 95% confidence interval have been used to declare the significance of the intervention. The findings of this study were supposed to give insights into implementation strategies that improve data use in decision-making and utilization of maternal healthcare services at the woreda level and uncover contextual factors that boost the response of these strategies.

Cost-effectiveness of HARNESS-MRI protocol in focal drug-resistant epilepsy in a limited-resources country: An Egyptian study

ObjectivesThe international league against epilepsy (ILAE) recommended the harmonized neuroimaging of epilepsy structural sequences (HARNESS-MRI) to improve the detection of epileptogenic lesions in patients with focal drug-resistant epilepsy (DRE). The application of this protocol is still limited in low-resource countries, mainly due to apparent high costs. We aimed to evaluate the cost-effectiveness of the HARNESS-MRI protocol in Egypt and highlighted our experience. MethodsPatients diagnosed with focal DRE at Cairo University epilepsy clinic underwent both conventional MRI (c-MRI) and HARNESS-MRI. Electro-clinical data were collected and analyzed. After the radiologists' initial diagnosis, a multidisciplinary team re-evaluated the MRI. Lesion detection rate and cost for detecting an extra lesion by HARNESS-MRI protocol were calculated. ResultsThe study included 230 patients with focal DRE (146, 62% males and 91, 38% females), with a mean age of 20.5 years. Epileptogenic lesions detected by c-MRI and HARNESS-MRI before and after the board meeting were 40, 106, and 131 lesions, respectively (P < 0.001). Sixty-nine percent of the lesions detected by HARNESS-MRI were missed on c-MRI; most commonly were mesial temporal sclerosis (MTS) and Malformations of cortical development (MCDs). Thirty-seven MTS and 32 MCDs were detected with HARNESS-MRI, compared to only 6 and 3, respectively, detected on c-MRI (P < 0.001). HARNESS-MR protocol is more cost-effective than c-MRI in detecting MRI lesions; it can save about 42$ for detecting an extra lesion in MRI. ConclusionThe HARNESS-MRI protocol was cost-effective and highly recommended even in limited-resource countries for patients with focal DRE.

A STUDY TO ASSESS THE EFFECTIVENESS OF BENSON’S RELAXATION THERAPY IN ANXIETY BETWEEN PRE-TEST TO POST-TEST AMONG EXPERIMENTAL AND CONTROL GROUPS WITH HIGH-RISK ANTENATAL MOTHERS AT SELECTED HOSPITALS IN WARANGAL, TELANGANA

In 2017, every day approximately 808 women died due to pregnancy complications. Most of the deaths occurred in low-resource countries. The primary causes of maternal deaths are hemorrhage, hypertension, infections, and indirect causes like accidental or incidental causes. Mostly due to interactions between medical conditions and pregnancy complications. A quantitative research approach was adopted for this study. The research design used for the present study was quasi experimental, non-equivalent group design. The population included in this study was high-risk antenatal mothers with anxiety at selected hospitals, in Warangal, Telangana. Government Maternity Hospital at Warangal, Telangana. Kalyani Nursing Home at Warangal, Telangana. Sri Laxmi Maternity Hospital, Warangal, Telangana. had been selected for undertaking this look at. Hospitals have nicely prepared and established specialized separate Obstetrics and Gynaecological department with close to 100 Outpatient go to in line with day, nearly general a hundred of inpatient bed satisfy through ordinary admission and nearly greater than 100 affected persons visit hospital for regular consultancy in OPD in line with day. The sample size consist of 500 high risk antenatal mothers with anxiety at selected hospitals, Warangal, Telangana. Non probability Convenience sampling technique was used for this study.

Morbidity and mortality in tuberculosis associated immune reconstitution inflammatory syndrome in children living with HIV: A narrative review

Tuberculosis-associated immune reconstitution syndrome (TB-IRIS) is an increasingly recognized complication of children living with HIV who are receiving treatment for active tuberculosis (TB). The purpose of the study was to appraise available evidence of morbidity and mortality related to TB IRIS among the paediatric population. A non-systematic review of the literature was conducted by retrieving records from Scopus, PubMed and Google Scholar). Four specific research questions assessing the risk factors (age, undernutrition, extrapulmonary TB and degree of immunosuppression) for TB-IRIS were discussed. The search yielded 370 articles, subsequently screened for eligibility according to the inclusion criteria. The majority of the articles were adult studies. Six studies were identified: Three retrospective and three prospective studies. The majority of the studies were conducted in TB/HIV-endemic countries. Only one study addressed mortality due to TB-IRIS as an outcome. A total of 6 mortalities related to TB-IRIS were reported. Advanced immunosuppression is universally agreed as an established risk factor for mortality in TB-IRIS in children. The severe presentation was more common in children with extrapulmonary tuberculosis. There is a paucity of data available on mortality in HIV-infected children with TB-IRIS. Future research is needed to assess the predictive factors of morbidity and mortality in HIV-infected children with TB-IRIS especially in low resource and high endemic countries.

Knowledge, Attitude and Practices on the Use of Uterine Tamponade in the Management of Severe Postpartum Hemorrhage in Public Health Facilities of Niger State

Background: Obstetric hemorrhage is a contributor to worldwide maternal morbidity and mortality in low-resource countries. The aim of this study was to assess knowledge, attitude and practices on the use of uterine tamponade in managing severe postpartum hemorrhage (PPH) by healthcare personnel.&#x0D; Method: The study was descriptive and cross-sectional. A self-administered, structured questionnaire was used to collect data on uterine tamponade from untrained and trained health workers who take deliveries in labour wards of selected health facilities. Respondents were selected by cluster sampling technique. Data was analyzed using SPSS version 20. Frequencies were determined and chi-square was used to test the hypothesis. A p-value of &lt;0.05 was considered statistically significant.&#x0D; Results: The mean age of the respondents was 35 years ± 11.7. Slightly less than half of the respondents 62 (42.5%) had poor knowledge of uterine tamponade. The majority of respondents 120 (82.2%) had positive attitudes about uterine tamponade. This was associated with point of service, professional group, and previous training on uterine tamponade insertion (p&lt;0.05). About 70% (46; 69.7%) of respondents who had managed cases of refractory postpartum hemorrhage, had never conducted uterine tamponade. Reasons include inadequate knowledge (29; 63.0%) and unavailability of the commodities (9; 19.6%)&#x0D; Conclusion: Though knowledge about uterine tamponade was poor, attitude towards uterine tamponade in managing severe post- partum hemorrhage was good. However, this did not translate to good practices on the use of uterine tamponade in managing severe PPH. Training and re-training on the application of uterine tamponade should be conducted and commodities made available in every health facility.

Accuracy of Low-Cost, Smartphone-Based Retinal Photography for Diabetic Retinopathy Screening: A Systematic Review.

Diabetic retinopathy (DR) is a leading cause of blindness. Early DR screening is essential, but the infrastructure can be less affordable in low resource countries. This study aims to review the accuracy of low-cost smartphone-based fundus cameras for DR screening in adult patients with diabetes. We performed a systematic literature search to find studies that reported the sensitivity and specificity of low-cost smartphone-based devices for fundus photography in adult patients with diabetes. We searched three databases (MEDLINE, Google Scholar, Scopus) and one register (Cochrane CENTRAL). We presented the accuracy values by grouping the diagnosis into three: any DR, referrable DR, and diabetic macular oedema (DMO). Risk of bias and applicability of the studies were assessed using QUADAS-2. Five out of 294 retrieved records were included with a total of six smartphone-based devices reviewed. All of the reference diagnostic methods used in the included studies were either indirect ophthalmoscopy or slit-lamp examinations and all smartphone-based devices' imaging protocols used mydriatic drops. The reported sensitivity and specificity for any DR were 52-92.2% and 73.3-99%; for referral DR were 21-91.4% and 64.9-100%; and for DMO were 29.4-81% and 95-100%, respectively. Sensitivity available low-cost smartphone-based devices for DR screening were acceptable and their specificity particularly for detecting referrable DR and DMO were considerably good. These findings support their potential utilization for DR screening in a low resources setting.

Analysis of the United Arab Emirates' contribution to the sustainable development goals with a focus on global health and climate change

PurposeThe world is confronted by various current development challenges, including global health security and climate change. The rapid growth of these challenges warned all nations regardless of their development or geographical position. As an emerging international power, the United Arab Emirates (UAE) was among these nations and is viewed as a proactive key actor.Design/methodology/approachThis review was conducted as a thematic synthesis from 27 studies, reports and publications along with authors' insights. Using MS Word and Excel programs, three stages of data exploration, extraction and synthesis and analysis were applied. Data gathering, analysis and thematization and compilation.FindingsThe UAE is giving significant attention to global health and climate change. Over the past 20 years, multipolicies, strategies and bodies were developed to lead the national, regional and global SDGs. Global health and climate change became the most two notable priorities on the government agenda and its strategic thinking is that both priorities can no longer be overlooked. Nationally, the UAE has made significant economic, scientific, social and health growth. Building a resilient and world-class healthcare system was one of six national priorities of the achieved UAE National Agenda 2021. Globally, UAE has proved its global health leadership by ensuring lasting and collective multilateral partnerships and collaborations that led to remarkable achievements in global health and climate change. Examples on the global scale: partnership with the World Health Organization (WHO) to target billions of people of the world's population and ensure they get Universal Healthcare Coverage (UHC) without financial hardship, the partnership between UAE and Bill and Melinda Gates Foundation to establish the Global Institute for Disease Elimination (GLIDE) to fight diseases and put an end to polio. Additionally, the state's role in the COVID-19 global efforts such as vaccine development, supply chain and distribution targeted low- and middle-income countries (LMIC). The UAE has shown a constant commitment to climate change mitigation and building a sustainable ecosystem by hosting global organizations, leading initiatives, supporting countries and is now organizing the 28th Conference of the Parties (COP28) this year. Great opportunities can be exploited to promote the country's contributions through further investment in cooperation, research and technology for better knowledge, sound policies, and innovative solutions for all regional and global health and climate change challenges. Originality/valueThis review is a fresh evidence-synthesizing attempt to document the role of the UAE. This role is well placed to play an additional major role with all partners to address these pressing challenges by boosting its role, especially in the Middle East region and advancing a new regional-oriented revolutionary expanded developmental plan that centered on low-resource countries empowerment, multilateralism, intersectionality and lasting collaborations.

Ultrasound Findings of Suspected Breast Cancer Lesions in Females Accessing Breast Ultrasound Services in Selected Hospitals in Lusaka, Zambia

Background: Breast cancer is the most common malignancy among women in Zambia. Ultrasound can be a useful tool for early diagnosis of breast cancer based on the breast lesions’ features. However, an overlap in the ultrasound features of malignant and benign breast tumours has been noticed together with a paucity of information on the ultrasound features that are more suggestive of breast cancer. Objective: The purpose of this study was to identify ultrasound features of suspected breast cancer lesions which may assist in ascertaining a high breast cancer or benign breast disease suspicion index, that may be used to prioritise patients requiring further and urgent management for breast cancer. Methods: Systematic random sampling was used for the selection of participants in this study. The selected patients first underwent an ultrasound scan in the Ultrasound department to obtain the breast lesion ultrasound features. The histology results for the same patients were then obtained from the University Teaching Hospital (UTH) histology laboratory or the histology report filed in the patient’s medical file. Results: Irregular shape of breast lesions, vertical orientation of breast lesions, hypoechogenicity of breast lesions, complex echo pattern of breast lesions, irregular or spiculated margin contours of breast lesions, compression of breast lesion surrounding tissue, absence of hyperechogenic spots in breast lesions and a breast lesion boundary with neither a hyperechoic halo nor thin capsule (None) were found to be associated with breast cancer. No breast lesion showed less than 3 ultrasound features suspicious for breast cancer. Hyperechoic spots in breast lesions were found to be associated with non-cancerous breast lesions. Conclusion: Low-resource countries, such as Zambia, where access to imaging diagnostic equipment such as Mammography and Magnetic Resonance Imaging machines (MRI), and histology examinations are scarce, the preceding ultrasound findings .......

Gynecological Malignancies in Albania: The Challenges of Cancer Care in a Low Resource Country

Gynecological Malignancies in Albania: The Challenges of Cancer Care in a Low Resource Country

Child neurodevelopmental disorders in armed conflict country, case of DR Congo: long-term trauma impact on brain development in childhood: review

Child neurodevelopmental disorders in armed conflict country, case of DR Congo: long-term trauma impact on brain development in childhood: review