Middle-income Countries Research Articles

The impact of COVID-19 on dengue cases in low- and middle-income countries: a systematic review

The WHO declared the COVID-19 pandemic on March 11, 2020, impacting infectious disease surveillance in low-resource, low-income countries, low- and middle-income countries (LMICs). Governments are focusing on COVID-19 reduction, including healthcare workers and epidemiological teams. A comprehensive literature review was conducted to assess this impact. After examining over 19,000 studies, only six were found to provide relevant data. Our analysis revealed that the pandemic substantially affected dengue incidence. The total number of articles obtained was 19,382. Out of the 136 articles screened based on their abstracts, only six were selected for data extraction. The databases utilized in this article were Pubmed and NCBI. Based on the chosen papers, we discovered that the COVID-19 pandemic has had a notable impact on the occurrence of dengue compared to the period before the pandemic emerged. The occurrence of dengue varied in several nations, such as Peru, Brazil, Sri Lanka, India, and Malaysia. This variation can be attributed to factors such as reliance on traditional approaches, for example community health volunteers in epidemiological investigations. Additionally, misdiagnoses by healthcare professionals due to the similarity of symptoms with COVID-19 have been reported during the pandemic. While the prevalence of dengue fever cases has generally declined in low- and middle-income countries (LMICs), one country has experienced an increased case. This trend is possibly linked to heightened pandemic surveillance and changes in mosquito populations. To improve monitoring and surveillance, a digital approach is proposed.

Advancing research on greenspace and climate-sensitive adverse birth outcomes for equity and impact.

Environmental epidemiologists are increasingly evaluating whether and how human exposure to vegetation (greenspace) can benefit health. Relatedly, scientists and policymakers have highlighted the need to integrate efforts to address the dual crises of accelerating climate change and rapid loss of biodiversity, including nature-based solutions. Greenspace is one solution that can protect humans from climate-related exposures, including heat, air pollution, and flooding. However, most environmental epidemiology research on greenspace occurs in high-income countries, and adverse birth outcomes, previously associated with greenspace, disproportionately occur in low- and middle-income countries (LMICs). Although epidemiology research using existing survey or administrative data and satellite imagery is important for documenting broad patterns, such research is lacking in LMICs. Further, complementary, community-engaged research to inform interventions and policies is needed so that nature-based solutions with co-benefits for climate mitigation and health are adopted effectively and equitably. We provide suggestions for future research that would increase impact and call for better representation of LMICs and vulnerable communities within high-income countries in research and action on greenspace and climate-sensitive birth outcomes.

Later-life social network profiles of male war survivors in Vietnam: Implications for health behaviors.

Emerging research emphasizes early-life war exposure as a key determinant of later-life health in older adults from low- and middle-income countries (LMICs). Yet, the linkages between war exposure, social networks, and later-life health behaviors have received little attention. Using data from the 2018 Vietnam Health and Aging Study, we investigate how early-life war experiences relate to the social networks and health behaviors of 1195 Vietnamese men aged 60+ who survived the Vietnam War (1965-1975). We utilize latent class analysis to identify men's network types and examine the associations between military service, war trauma, PTSD, and later-life network profiles. Furthermore, we assess the linkages between war experiences and risky health behaviors (physical inactivity, frequent alcohol and tobacco consumption) and the moderating effect of social networks on these behaviors. Our findings reveal that exposure to wartime malevolent living conditions, as opposed to direct war violence, and recent PTSD symptoms are linked to lower support levels in respondents' network profiles. Moreover, although diverse and supportive networks correspond to a reduced risk of physical inactivity, they are associated with higher risks of frequent alcohol consumption and are marginally associated with tobacco use. Importantly, social network profiles moderate the relationship between PTSD symptoms and the risk of frequent alcohol consumption. This evidence underscores the need for policymakers to consider the historical and social contexts of LMICs when deploying social support as a health intervention.

ASPRONET: A facilitated online education project for radiation therapists in the Asia-Pacific region

In 2019, the International Atomic Energy Agency approved a technical co-operation project, aimed at supporting clinical decision making and continuing professional education of radiation oncologists, medical physicists and radiation therapists (RTs) in Low-and-Middle Income Countries (LMICs) in the Asia Pacific region. From this, the Asia-Pacific Radiation Oncology Network (ASPRONET) was formed in 2020.An RT co-ordination group administered 16 online, one-hour seminars between December 2021 and November 2023 for an RT audience. Analysis of online registration and attendance data from each seminar was used to co-ordinate group review meetings, improve seminar proceedings, and promote attendance and engagement.772 attendees from 20 different countries were recorded in total across the seminars. Gathered data and observations indicated the success of the seminars and supported their continuation.

Dilemmas of care: Healthcare seeking behaviours and antibiotic use among women in rural communities in Nam Dinh Province, Vietnam

Antimicrobial resistance is a silent pandemic to cause an estimated ten million deaths by 2050. Self-medication with antibiotics in low- and middle-income countries has been identified as a driver of antibiotic resistance. Interventions targeting solely individual behaviour change around antibiotic practices are often unsuccessful as they fail to address socio-cultural and structural causes of the problem. Understanding the context of antibiotic use in communities will better inform interventions addressing the misuse and overuse of antibiotics. Vietnam faces a growing threat of antimicrobial resistance due to inappropriate use of antibiotics in the healthcare system, farming and food production, and in the community. To understand the roots of this problem, we conducted qualitative research in 2020, with one component focusing on the community. This included fifteen in-depth interviews with women and four months of participant observation in three districts in Nam Dinh Province to explore the healthcare seeking practices and perceptions of medicine and antibiotic use. We argue that even when participants understood antibiotic resistance and were willing to adjust their care practices with antibiotics, there were cultural and structural challenges demotivating changes. The participants faced what we term “dilemmas of care”. For example, while public health messaging promoted appropriate antibiotic practices, the healthcare system did not provide a suitable environment to support appropriate use. Besides, the introduction of biomedicines into the long-standing traditional medical system caused confusions in community health practices, leading to issues such as poor adherence to treatment. At an individual level, participants faced challenges in accessing healthcare knowledge, adhering to social expectations surrounding care, and financial issues. We argue that the misuse of medicines and antibiotics in communities are responses to a deficient healthcare system and unequal access to quality healthcare.

Toward zero traffic deaths and disabilities with active and passive safety technologies in the association of southeast Asian nations

Road traffic crashes caused more than 108,000 deaths and 6,200,000 injuries resulting in 7.7 million disability-adjusted life years (DALYs) lost in the Association of Southeast Asian Nations (ASEAN) in 2019. This study estimates that 59 % of these casualties could have been avoided if all vehicles were designed to provide crash protection equivalent to that of the best vehicle safety design in their class and all road users adhered to safety best practices. Results of comparative risk assessments indicate that the application of safety technologies that are considered high priority by the United Nations (anti-lock braking, electronic stability control, occupant restraints, frontal and side airbags, crashworthiness, side-door beam, side structure and padding, and helmets) can save 34,373 lives and avert 2.5 million DALYs annually in ASEAN. While implementing Autonomous emergency braking and lane keeping assistance systems would provide additional reductions estimated at 13,077 fewer deaths and 1,021,220 fewer DALYs, speed-limitation systems would have a larger additional benefit, estimated at 21,394 lives saved and 1,382,530 fewer DALYs. The investigated technologies can be among the best approaches toward zero traffic deaths and can elevate public health burdens in low and middle-income countries.

Assessing public a priori acceptance of fully automated vehicles using an extended technology acceptance model and importance-performance analysis

Fully automated vehicles (FAVs) are anticipated to enter the passenger vehicle market soon. Given the uncertainties surrounding user adoption of this emerging technology, research is needed to understand their user acceptance. While most studies on the acceptance of automated vehicles have been conducted in upper-middle-income or high-income developed countries, similar research in middle-income countries is limited. This study aims to evaluate a priori acceptance of FAVs in a middle-income developing country by extending the Technology Acceptance Model (TAM). Trust, subjective norms, perceived safety risk and four decision-making styles (Thoroughness, Hesitancy, Social resistance, and Perfectionism) were included in the extended model. This study aims to evaluate a priori acceptance of FAVs in a middle-income developing country by extending the Technology Acceptance Model (TAM). Trust, subjective norms, perceived safety risk and four decision-making styles (Thoroughness, Hesitancy, Social resistance, and Perfectionism) were included in the extended model. Structural Equation Modeling was applied to confirm model validation by using data from 1026 drivers from different cities in Iran. A multi-group analysis was conducted to assess whether the relationships between model constructs vary across different demographic and background groups. Additionally, an importance-performance analysis was performed to gain a deeper understanding of the factors influencing behavioral intention. The findings of the model highlighted that beyond the original TAM scales, subjective norms were the strongest predictor in explaining drivers' intentions to use FAVs. Initial trust also moderately contributed to explaining user acceptance of FAVs. The results also revealed that among decision-making styles, thoroughness positively affected behavioral intention through trust, while social resistance had an indirect negative effect on intention. The findings showed that effect of the perceived safety risk on behavioral intention through the initial trust was confirmed; however, importance-performance map analysis revealed that a significant improvement was observed in the safety area that could still be obtained. It is suggested that policymakers start promoting the usefulness and ease of use of FAVs through advertisements, social media, public campaigns and autonomous vehicle test ride events to facilitate the adoption of FAVs when available in countries with similar sociocultural contexts.

Teaching Quality and Student Achievement Inequalities in Low- and Middle-income Countries: A Hierarchical Linear Model Analysis

Teaching quality is associated with student achievement, though the strength of this association may vary. This study employs hierarchical linear modeling using PISA-D data to examine the association between teaching quality (teacher support, classroom management, and cognitive support) and mathematics achievement, while disaggregating the analysis by student gender and socioeconomic status (SES). Our findings indicate that cognitive support is negatively associated with student achievement in Ecuador, with no significant association in Cambodia, Guatemala, Honduras, Paraguay, Senegal, or Zambia. Additionally, we found a positive association between classroom management and mathematics in Cambodia, Ecuador, Honduras, and Zambia, but no association in other countries. Similarly, teacher support showed a negative association with mathematics in Ecuador and Honduras, but no significant association in other countries. Beyond these direct associations, our findings suggest that the influence of teaching quality may vary across student gender and SES. We also discuss the policy implications of these findings.

The future of personal electric mobility in emerging economies: A survey of e-moto users in Vietnam

Decarbonizing private transport is crucial in the highly polluted cities of low- and middle-income countries, such as Vietnam. In motorcycle-dominated megacities, this means gradually converting the conventional motorcycle fleet into e-motos. In this study set in Hanoi, we examined the factors that explain existing e-moto riders' attachment to this mode. For this purpose, we built a novel theoretical framework called VEMM (Values and Expectations in Mobility Model), which combines the constructs of the Expectation Confirmation Model (ECM) and the Value-Based Adoption Model (VBAM). Survey data collected from 481 e-moto users in Hanoi were analysed by applying a Partial Least Squares Structural Equation Model (PLS-SEM). We find that the enduring intention to use e-motos is positively related to perceived value, user satisfaction, and perceived usefulness. We controlled for riders' gender, age, education, and living area but only education was statistically significant. Overall, we found that the perceived value of e-motos owes more to the perceived benefits (usefulness, enjoyment, and eco-friendliness) than the perceived costs (risk, price, technicality, habit, and stigma) of this mode. Based on these findings, we recommend that manufacturers consider the critical role of values when designing and promoting e-motos.

Awareness, experiences, and beliefs related to ultra-processed foods among young people in Cebu, Philippines

Ultra-processed food (UPF) intake is rising in low- and middle-income countries, where non-communicable diseases are now the leading contributor to disease burden. The purpose of this study was to assess awareness and knowledge of UPFs, factors that influence consumption of UPFs, and beliefs about the relationship between UPF intake and health among young people (18-20 years old) in a metropolitan area of the Philippines, a lower middle-income country. We conducted eight focus group discussions across four strata defined by gender and urban-rural neighborhood designation. We applied deductive and inductive codes to transcripts and organized codes into themes. Sixty participants were included in the study. Although most were unfamiliar with the concept of UPFs, participants demonstrated an intuitive understanding of the meaning of the term. Vendors in or around schools were commonly reported as a source of UPFs, though most participants reported consuming UPFs at home as well. Factors that were reported as having influence over participants’ UPF intake included taste, convenience, cost, influence from parents, peers, and others, and health knowledge and status. Participants expressed various beliefs about the link between overconsumption of UPFs and risk of multiple health outcomes, including diabetes, hypertension, and kidney disease. Some males, but not females, believed that some UPFs were neutral or beneficial with respect to health. Commonly cited sources of information about UPFs and their link to health included parents, schools, and social media. This study provides important insights into the factors that drive UPF consumption among young people in a lower middle-income country and should inform efforts to reduce UPF intake among young people in this and similar settings.

Patients' Experiences, Satisfaction and Quality of Life With Physiotherapy Follow-Up After Total Knee Arthroplasty: A Phenomenological Qualitative Study Protocol.

Available quantitative studies indicate that patients who have undergone Total Knee Arthroplasty (TKA) experience dissatisfaction. There is a lack of comprehensive information on the experiences, satisfaction, and quality of life of patients after TKA. Hence, there is a need to explore the patients' perspective about the satisfaction and experiences undergoing rehabilitation and to explore the factors influencing quality of life with physiotherapy after 1st and 3rd months of TKA. 35 patients with post TKA, aged from 45years, will participate in semi-structured face-to-face or telephone interviews. The participants will be recruited using criterion-based purposive sampling. The interviews will be audio-recorded and transcribed. NVivo 14V software and Braun and Clarke thematic analysis will be used. Credibility, transferability, dependability, and confirmability will be ensured. The transcribed verbatim transcript will be analysed to generate sub-themes and themes using thematic analysis. Irrespective of the responses received from male or female patients' data would be analysed using inductive qualitative analysis to explore their perspectives. This study is the first qualitative study from lower- and middle-income country that aims to investigate the satisfaction and experiences of patients after undergoing TKA rehabilitation. The efficacy of the data and subsequent suggestions would rely on the insights generated from the qualitative study, which would support the rehabilitation of patients in their later years.

The goal-oriented collaborative approach with postural management strategies intervention via telehealth for children with non-ambulant cerebral palsy: Feasibility randomized clinical trial protocol

IntroductionChildren with non-ambulant Cerebral Palsy (CP), have limitations in terms of self-mobility and require the use of assistive technology with extensive adaptations. However, purchasing assistive technology equipment is expensive and difficult to access in low- and middle-income countries, like Brazil. Guidelines recommend a postural management program to children with CP and emphasize the need for high doses of practice to achieve functional goals. Furthermore, collaborative practices are recommended, with active parental participation in the intervention. AimsThis study describes a protocol for assessing the feasibility of a future randomized clinical trial using a goal-oriented collaborative approach with postural management strategies via telehealth for non-ambulant children with CP. MethodsEighteen children (1–5 years) with CP and their families will be randomized into two groups for 12 weeks: (A) goal-oriented collaborative approach with postural management strategies intervention via telehealth associated with conventional physical therapy or (B) conventional physical therapy. Feasibility measures will be verified, and outcomes will include parents' perceptions of performance and satisfaction, gross motor function, postural control, goal achievement and participation at home, preschool, and community. ImplicationsThe findings will inform the planning and preparation of a future randomized clinical trial of interventions for non-ambulant CP children via telehealth.

Sensitivity and specificity of microscopic and molecular techniques for the diagnosis of taeniasis

Background and ObjectivesThe diagnostic challenges associated with T. solium continue to hamper control efforts of the world's most significant foodborne parasite and leading cause of epilepsy in low and middle-income countries. This study aimed to validate two conventional PCRs for taeniasis and estimate the diagnostic performance of microscopic and molecular tools. MethodsFormalin and ethanol-fixed samples were tested by formalin-ethyl acetate concentration technique (FECT), Malachite smear, McMaster2 method, rrnS PCR and cox1 PCR. Initial validation of PCR methods was completed on 45 microscopy positive individuals. After validation, the performance of microscopic methods and the rrnS were estimated using samples from 1,156 individuals in Laos. Bayesian latent class models (BLCMs) and a composite reference standard were used to estimate diagnostic sensitivity and specificity. ResultsOn preliminary validation the rrnS was able to detect 27/45 (60.00%) infections whereas the cox1 detected 21/45 (46.67%). As a result, the cox1 was excluded from further performance analysis. Microscopy methods and the rrnS were highly specific with estimates above 99.02% regardless of analytical method. The rrnS was the most sensitive test by informed BCLM (91.45%, CrI: 73.41–99.52%) followed by the FECT (71.20%, CrI: 50.53–85.48%), McMaster2 (51.31%, CrI: 32.00–71.29%) and Malachite smear (32.23%, CrI: 15.40–54.47%). DiscussionThe inability to validate the cox1 PCR suggests that it may not be suitable in its current form for routine characterisation of Taenia spp. detected by microscopy. The rrnS presents a suitable alternative to the cox1, however, requires its products to be sequenced. Given the low prevalence of taeniasis in most populations, this should be a feasible approach that may be able to be integrated with existing soil-transmitted helminth surveys that often use FECT for microscopic diagnosis.

Clinical and lifestyle predictors of loneliness: a two-year longitudinal study

BackgroundWhile loneliness is a global public health problem, the literature lacks studies assessing loneliness predictors in low- and middle-income countries. Therefore, we aimed to analyze clinical and lifestyle predictors of loneliness. MethodsWe conducted a 2-year longitudinal study in Brazil based on a snowball sample and online surveys (baseline: May 6 to June 6, 2020). We assessed clinical and lifestyle predictors of loneliness using multiple regression models. The analyses were adjusted for several sociodemographic variables and weighted for attrition and sampling procedures. ResultsThe study included a nationwide sample of 473 participants (18-75 years; 87.1% females). After adjusting for sociodemographic factors, we identified as risk factors: depressive symptoms (RR: 1.214; 95%CI: 1.08-1.36; p=0.001), anxiety symptoms (RR:1.191; 95%CI: 1.04- 1.35; p=0.007), alcohol abuse (RR: 1.579; 95%CI: 1.32- 1.88; p<0.001), and cannabis use (RR: 1.750; 95%CI: 1.25- 2.39; p<0.001). More than 150 min/week of physical activity (RR: 0.177; 95%CI: 0.07- 0.34; p<0.001) and good/excellent quality of family relationships (RR: 0.73; 95%CI: 0.60- 0.87; p<0.001) and sleep (RR: 0.483; 95%CI: 0.39- 0.59; p<0.001) were protective factors. ConclusionSeveral clinical factors (depression, anxiety, alcohol, and cannabis) have been identified as risk factors for loneliness, while lifestyle factors (physical activity, better quality of sleep, and family relationships) have been associated with a lower incidence of loneliness. Addressing clinical and lifestyle factors may therefore be essential to preventing loneliness.

Global Air Quality Enhancement Pathways to Health Benefits and Environmental Justice

Nowadays, air pollution has emerged as a critical global health and environmental justice issue, with a stark contrast in exposure and management between high-, middle-, and low-income countries. This study synthesizes satellite-derived data with Global Burden of Disease insights, examining the spatiotemporal trends of PM2.5 and O3 exposures and their health impacts from 1998 to 2019. Despite a reversal in the global upward trend of PM2.5 exposure post-2011, O3 levels persist, highlighting a geographical disparity in health benefits due to air quality policies. The study reveals that while a reduction in indoor PM2.5 pollution has led to significant health gains, the rise in outdoor PM2.5 and O3 pollution continues to escalate the global death toll. The research underscores the urgent need for tailored governance strategies to address the primary pollution conditions in various income-level regions, advocating for environmental justice and equality. The findings suggest that targeted air pollution management could not only mitigate the health risks but also enhance life expectancy, emphasizing the potential for substantial health benefits through improved air quality regulations.

Can high-profile endorsements improve COVID-19 vaccine uptake and reduce hesitancy in Pakistan?

BackgroundWhile low- and middle-income countries continue to struggle to secure adequate COVID-19 vaccine supply, a potentially greater challenge is to induce adequate demand to overcome widespread vaccine hesitancy; vaccination uptake has historically been a contentious political issue in Pakistan. High-level endorsements by trusted actors are one way to potentially increase public vaccine confidence. Methods: Employing a four-armed randomized trial with 2,026 participants in June 2021, we examine whether endorsements by different actors (Prime Minister, prominent religious leader, doctors) influenced participants’ willingness to register for the COVID-19 vaccine. ResultsWe find high levels of vaccine hesitancy with nearly 35% of participants reporting that they do not intend to vaccinate against COVID-19. Endorsements failed to influence participants' desire to register for vaccination, and only 37% agreed to register on spot. However, we find that higher trust in government, male gender, and higher income/wealth were associated with participants' willingness to register. A follow-up phone survey was consistent with the main results. DiscussionOur study finds that endorsements appear to have little effect on people’s immediate willingness to register for vaccination. Our findings suggest messaging on its own may be insufficient to overcome widespread social and structural barriers to vaccine uptake.

Enhancing flood forecasting accuracy in Data-Scarce regions through advanced modeling approaches

Flood forecasting in data-scarce regions poses significant challenges due to irregular rainfall patterns and limited hydrological monitoring networks, particularly in semi-arid regions in Africa, South America, and Asia. However, despite significant efforts and advancements, there remains a substantial gap in the accurate prediction of flood events necessary for effective risk management and mitigation, evidenced by the recurrence of devastating floods in middle to low-income countries in recent years. Here, we address this problem by testing advanced modeling techniques in a local African case, using a combination of statistical methods for extreme event prediction, hydrodynamic modeling, and remote sensing data, to recommend the most adapted and accurate approach under a variety of settings. Our case study is an emerging urban area in Northern Morocco, situated in a triangular plain interposed between adverse geomorphological and precipitation settings, and unregulated expansion flow, creating an exceptionally overwhelming context for disastrous floods. In the absence of previous studies, we integrate frequency distribution analysis to predict extreme rainfall events and flood flow modeling to simulate floodplain inundation. Data sources included high-resolution remote sensing, local hydrological measurements, fine topographical data, and interviews with stakeholders. We found the Pearson Type 3 distribution to be the most suitable for modeling extreme precipitation in coastal areas, whereas the Generalized Extreme Value (GEV) distribution better fits inland areas. For flood flow assessment, the Gradex method proved to be the most accurate, while other empirical methods outlined critical limitations. Findings reveal that advanced hydrodynamic models significantly enhance flood hazard assessments, even in regions with limited data, showing outstanding correlations with previous flood records and stakeholder feedback. The outcomes carry critical implications for highlighting the importance of selecting appropriate models based on geographical and climatic conditions to inform more resilient urban planning and disaster management practices. We anticipate that these insights will support local decision-makers and urban planners in developing strategies that enhance community resilience and reduce the adverse impacts of flooding. Our work contributes to the broader field of flood risk management, providing a foundation for future developments and practical applications in similar regions worldwide.

The role of regulatory agencies in public health emergencies: A critical review of global approaches and challenges

Regulatory agencies play a pivotal role in public health emergencies by ensuring that medical products, including vaccines, diagnostics, and therapeutics, are rapidly available while maintaining safety and efficacy standards. The COVID-19 pandemic, along with past crises such as the Ebola and Zika outbreaks, exposed both strengths and vulnerabilities in global regulatory frameworks. This paper critically reviews the role of regulatory agencies in public health emergencies, synthesizing existing literature to present new insights into their operational challenges and the reliance strategies employed to bridge capacity gaps. By examining case studies, such as the reliance on the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) by low- and middle-income countries (LMICs), this paper highlights the importance of global cooperation and reliance mechanisms in managing crises. Furthermore, it addresses challenges such as resource constraints, disparities in regulatory capacity, and ethical dilemmas faced when approving products based on limited data. The paper also explores the future direction of regulatory science, emphasizing the need for greater global regulatory convergence, capacity building, and the adoption of innovative digital tools. Ultimately, the paper argues that while reliance strategies are vital, long-term investment in national regulatory systems and global harmonization efforts are essential for a more equitable and effective response to future public health emergencies.

Parasitic intestinal infection in students of disabilities centers in Sanaa governorate, Yemen

Background: Intestinal parasite infections remain prevalent in low-income countries, especially among children, due to poor drinking water quality and insufficient personal and environmental cleanliness. This study sought to diagnose, prevent, and manage intestinal parasites in individuals with special needs in Sanaa Governorate. Method: We collected stool samples from 232 students, aged 1 to 18, of which 143 were male and 89 were female. We collected data using a validated standard questionnaire. We processed and analyzed fecal samples using a wet mount preparation, adhering to the standing concentration technique. Results: We found an overall prevalence of intestinal parasitic infection of 83.6%. E. histolytica (76.7%), G. lamblia (8.6%), A. lumbricoides (0.4%), H. nana (6.5%), S. mansoni (0.4%), Ent. vermicularis (6.5%), and S. stercoralis (2.2%). Conclusions: In children, E. histolytica was the most common intestinal parasite infection. There are few methods of transmission and protection for students with special needs.

Surgery and the first 8000 days of life: a review

Abstract The first 8000 days of life, from birth to adulthood, encompasses critical phases that shape a child's health and development. While global health efforts have focused on the first 1000 days, the next 7000 days (ages 2–21) are equally vital, especially concerning the unmet burden of surgical conditions in low- and middle-income countries (LMICs). Approximately 1.7 billion children globally lack access to essential surgical care, with LMICs accounting for 85% of these unmet needs. Common surgical conditions, including congenital anomalies, injuries, infections, and pediatric cancers, often go untreated, contributing to significant mortality and disability. Despite the substantial need, LMICs face severe workforce and infrastructure shortages, with most pediatric surgical conditions requiring specialized skills, equipment, and tailored healthcare systems. Economic analyses have shown that pediatric surgical interventions are cost-effective, with substantial societal benefits. Expanding surgical care for children in LMICs demands investments in workforce training, infrastructure, and health systems integration, complemented by innovative funding and equitable global partnerships. Prioritizing surgical care within national health policies and scaling up children's surgery through initiatives like the Optimal Resources for Children's Surgical Care can improve health outcomes, align with Sustainable Development Goals, and foster equity in global health. Addressing the surgical care gap in LMICs will reduce preventable mortality, enhance quality of life, and drive sustainable growth, emphasizing surgery as an essential component of universal health coverage for children.