Medium-income Countries Research Articles

The Aristotelian model of friendship and the IU-Kenya Partnership

Disparity in economic development between high-income countries (HICs) and low- and medium-income countries (LMICs) has necessitated collaborations, some in health-related activities. Globalisation frameworks indicate that, in fair collaborations, the ultimate aim should be to improve the situation in LMICs. In this paper we present the findings of a research study in which we used Aristotle's concept of friendship among unequal parties as an analytic framework to engage with the issue of inequality in an existing international partnership in health, the Indiana University-Kenya Partnership (IU-Kenya Partnership). This is a collaborative health programme involving a consortium of North American universities and schools of the Moi University College of Health Sciences in Kenya. We carried out in-depth oral interviews and focus group discussions with a sample of 41 partners of various IU-Kenya Partnership programmes. We did a comparison of obtained themes to the Aristotelian pointers of aspects of friendship among unequal parties. We eventually identified good and bad aspects of North-South partnerships as perceived in the IU-Kenya Partnership restricted to the Aristotelian model. Key terms: health research collaborations, HICs-LMICs Partnerships, IU-Kenya Partnership, inequality, good and bad partnership, Aristotelian model.

A qualitative study on perspective of parents of children with autism on the nature of parent-professional relationship in Kerala, India.

This study explored the nature of relationship between parents of children with autism and professionals who provide therapy-based services for autism in Kerala, India. Given the shortage of professionally qualified therapists and educators (particularly in the case of autism) in low- and medium-income countries, parent-mediated interventions where professionals and parents work as partners are recommended as an effective means to meet the demand. However, for parent-mediated interventions to be effective, we first need to understand the customary nature of parent-professional relationship and develop the intervention accordingly. It is within this context that parents of 21 children with autism whose age ranged between 5.8 and 17.3 years were interviewed in order to understand the customary nature of parent-professional relationship. There was a dearth of scheduled, in-depth, and personalized one-on-one interaction between the parent and the professional. Though parents were involved hands on in their child's training under professional direction, they remained mere information providers in decision making. The parent-professional relationship did not nurture parent's self efficacy. This led to parents feeling inadequate to provide for their child's developmental needs and being apprehensive about adulthood. The customary nature of parent-professional relationship observed may be a reflection of the collectivist culture in India. The findings suggest that parent-mediated interventions will need to focus on enabling parents to break cultural barriers that might be holding them back from partnering with professionals as equals.

Potencial De La Educación a Distancia Para Reducir Brechas De Aprendizaje En Educación Superior: Una Mirada Al Caso Colombiano

ABSTRACT One of the main needs of Latin America, besides education coverage, is to reduce learning gaps in higher education. In order to respond to such need, many strategies have been designed, worldwide, to impact the demand and provision of higher education programs. Among these strategies we can find grants and scholarships, financial aids, and others. Many have been the options that have been proposed to raise the provision of higher education programs, such as offering technology-supported education modalities like blended-learning, Massive Open Online Courses (MOOCs), and distance and online education. This paper aims to explore the potential of the provision of distance education programs to close learning gaps in Colombia’s higher education. In order to do so, we present an estimatation of the effects that students and programs characteristics can have on the results of the test “Saber PRO” (a Colombian standardized test that measures the level of competences developed by students in different higher education programs). This estimation was done applying a mixed model (Hierarchical Linear Modeling-HLM) based on the information of 451,358 students who were assessed in their last phase of their university major. Data were collected from 2016 to 2018. The econometrics estimations show that controlling individuals’ backgrounds and the characteristics of different academic programs, the variables that were highly associated with the reduction of learning gaps among individuals registered in distance programs compared to face-to-face programs are the students’ age and their cognitive backgrounds (grades in standardized tests taken before their undergraduate studies). The results show that we could expect distance education to become an efficient mechanism to contribute to the reduction of learning gaps in higher education. The quantitative findings suggest a series of research questions that invite to reflect about the potential of distance education in medium-income countries.

Carriage of Neisseria Meningitidis in Low and Middle Income Countries of the Americas and Asia: A Review of the Literature.

IntroductionMeningococcal colonization, or carriage, can progress to invasive meningococcal disease, a serious public health concern, with rapid progression of disease and severe consequences if left untreated. Information on meningococcal carriage and epidemiology in low/middle income American and Asian countries remains sparse. These data are crucial to ensure that appropriate preventive strategies such as vaccination can be implemented in these regions. The goal of this study was to summarize the Neisseria meningitidis carriage literature in low and middle income countries of the Americas and Asia.MethodsTarget countries were categorized as low and middle income according to the International Monetary Fund classification of low income/developing economies and middle income/emerging market economies, respectively. A PubMed search identified English-language publications that examined carriage in these countries. Studies reporting the epidemiology of N. meningitidis carriage or assessing risk factors for carriage were included.ResultsFourteen studies from the Americas [Brazil (n = 7), Chile (n = 3), and Colombia, Cuba, Mexico, and Paraguay (n = 1 each)] and nine from Asia [China (n = 2), India (n = 3), and Malaysia, Nepal, Philippines, and Thailand (n = 1 each)] were identified; an additional Cuban study from the authors’ files was also included. Studies were not identified in many target countries, and substantial diversity was observed among study methodologies, populations, and time periods, thereby limiting comparison between studies. The carriage rate in the Americas ranged from 1.6% to 9.9% and from 1.4% to 14.2% in Asia. Consistent risk factors for carriage were not identified.ConclusionsThere is a lack of comprehensive and contemporary information on meningococcal carriage in low and medium income countries of the Americas and Asia. Future carriage studies should incorporate larger representative populations, a wider age range, and additional countries to improve our understanding of meningococcal epidemiology and disease control.Electronic supplementary materialThe online version of this article (10.1007/s40121-020-00291-9) contains supplementary material, which is available to authorized users.

Prevalence of preeclampsia and eclampsia in adolescent pregnancy: A systematic review and meta-analysis of 291,247 adolescents worldwide since 1969

ObjectiveHypertensive disorders are among the main causes of maternal and perinatal morbidity and mortality, and the findings regarding the occurrence of preeclampsia (PE) and eclampsia (E) in adolescent pregnancy are conflicting. We performed a systematic review and meta-analysis aimed to determining the prevalence of PE and E in adolescent pregnancy considering socioeconomic and temporal characteristics. Study designMEDLINE, EMBASE and SciELO databases, with no time span restrictions. Studies that reported the occurrence of PE and E in adolescent pregnancy. Study selection, data extraction and bias assessment were performed by three independent investigators. Meta-analysis techniques comprised random-effects model and double-arcsine transformation; χ1 and I2 tests were used to assess heterogeneity. Meta-regression used Hunter-Schmidt model; publication bias were assessed by funnel and Baujat plots. ResultsSeventy studies were included, ranging from 1969 to 2019 and comprising 30 countries and 291,247 adolescents. The overall prevalence rate of PE/E was 6.7 % (95 % CI = 5.8–7.6). Subgroup analysis revealed association of PE/E (P = 0.050) and E (P = 0.0113) with country income, and the highest prevalences were found in low-and medium-income country groups (11.5 %, 95 % CI=7.8–15.8 and 10.6 %, 95 % CI=6.05–16.2). Association of PE with publication year (P = 0.0022) was also found with an observable reduction in prevalence rate across the years. ConclusionsThe findings seem to confirm that socioeconomic and demographic characteristics play a role for the risk of PE/E in adolescent pregnancy. Although the occurrence of PE has declined worldwide, the problem has broader dimensions beyond health issues.

The Consortium on Vulnerability to Externalizing Disorders and Addictions (c-VEDA): an accelerated longitudinal cohort of children and adolescents in India.

The global burden of disease attributable to externalizing disorders such as alcohol misuse calls urgently for effective prevention and intervention. As our current knowledge is mainly derived from high-income countries such in Europe and North-America, it is difficult to address the wider socio-cultural, psychosocial context, and genetic factors in which risk and resilience are embedded in low- and medium-income countries. c-VEDA was established as the first and largest India-based multi-site cohort investigating the vulnerabilities for the development of externalizing disorders, addictions, and other mental health problems. Using a harmonised data collection plan coordinated with multiple cohorts in China, USA, and Europe, baseline data were collected from seven study sites between November 2016 and May 2019. Nine thousand and ten participants between the ages of 6 and 23 were assessed during this time, amongst which 1278 participants underwent more intensive assessments including MRI scans. Both waves of follow-ups have started according to the accelerated cohort structure with planned missingness design. Here, we present descriptive statistics on several key domains of assessments, and the full baseline dataset will be made accessible for researchers outside the consortium in September 2019. More details can be found on our website [cveda.org].

Breast Cancer Care in Jordan.

Breast cancer is the most common malignancy in Jordan and the third leading cause of cancer death after lung and colorectal cancers. Although the incidence of breast cancer in Jordan is lower than that in industrialized nations, the number of new cases has been significantly increasing, and women present with breast cancer at a younger age and with more advanced disease than women in Western countries. Jordan is a medium-income country with limited resources and a young population structure. Therefore, breast cancer poses a particularly challenging burden on the country’s health care system. Despite ongoing endeavors to improve breast cancer care at both public and private levels, more work is needed to achieve downstaging of the disease and improve access, awareness, and participation in early detection. Multimodality treatment facilities and supportive care are available; however, the quality of care varies widely according to where the patient is treated, and most treatment facilities remain located centrally, thus, creating access difficulties. The King Hussein Cancer Center, the only comprehensive cancer center in Jordan, has changed the practice of oncology in the country via implementation of a multidisciplinary approach to treatment, monitoring of treatment outcomes, and investments in ongoing cancer research. However, there remains no national system for ensuring provision of high-quality cancer care nationwide. Here, we review the epidemiology of breast cancer and the current status of breast cancer care in Jordan, we compare our treatment outcomes with international ones, and we highlight challenges and improvement opportunities.

Competencies for respectful maternity care: Identifying those most important to midwives worldwide.

A respectful, person-centered philosophy of maternity care has been emerging over several decades. Research conducted on behalf of the International Confederation of Midwives (ICM) to identify essential competencies for midwifery practice also identified the knowledge, skills, and professional behaviors that should be hallmarks of respectful maternity care practices among the global community of midwives. A three-round, online, modified Delphi survey was conducted between April 2016 and October 2016. A total of 895 individuals from 90 of the then-current 105 ICM member countries participated, with good representation across English, French, and Spanish speakers, high-income, medium-income, and low-income countries, and educators and clinicians. A total of 115 respectful maternity care (RMC)-related items were endorsed by participants in Round 1 or 2. These items received average scores of between 90.24% and 99.10%, well above the 85% threshold required to be identified as within the scope of global midwifery practice. These items were compared with the 12 domains of RMC identified by Shakibazadeh and colleagues that defined respectful care during childbirth in health facilities globally, and with similar RMC frameworks, and were found to be highly congruent, thus demonstrating the high value of RMC within the core of midwifery practice. ICM survey items were endorsed across all 12 RMC domains proposed by Shakibazadeh et al, and the findings affirmed that across ICM countries and regions, the philosophy of RMC was integrally related to the knowledge, skills, and professional behaviors that emerged as essential for basic midwifery practice.

#SoMe4Surgery: from inception to impact

Objectives and settingThe aim of this study was to create a hashtag #SoMe4Surgery on the social network application Twitter, and to examine the natural history of the resulting online community.Design...

A MULTIVARIATE PROGNOSTIC SCORE FOR PREDICTING MORTALITY OF ACQUIRED IMMUNODEFICIENCY SYNDROME PATIENTS WITH HYPOXEMIC RESPIRATORY FAILURE AND PNEUMOCYSTIS JIROVECI PNEUMONIA.

Severe hypoxemic respiratory failure (SHRF) due to Pneumocystis jiroveci pneumonia (PJP) in AIDS patients represents the main cause of admission and mortality in respiratory intensive care units (RICUs) in low- and middle-income countries. The objective of this study was to develop a predictive scoring system to estimate the risk of mortality in HIV/AIDS patients with PJP and SHRF. We analyzed data of patients admitted to the RICU between January 2013 and January 2018 with a diagnosis of HIV infection and PJP. Multivariate logistic regression and Kaplan-Meier method were used in data analysis. The RICU and inhospital mortality were 25% and 26%, respectively. Multivariate analysis identified four independent predictors: body mass index, albumin, time to ICU admission, and days of vasopressor support. A predictive scoring system was derived and validated internally. The discrimination was 0.869 (95% confidence interval: 0.821-0.917) and calibration intercept (α) and slope (β) were 0.03 and 0.99, respectively. The sensitivity was 47.2%, specificity was 84.6%, positive predictive value was 89.2%, and negative predictive value was 82.6%. This scoring system is a potentially useful tool to assist clinicians, in low- and medium-income countries, in estimating the RICU and inhospital mortality risk in patients with HIV/AIDS and SHRF caused by PJP.

Study of microalbuminuria in acute ischemic stroke and its correlation with severity

Introduction: With the rising incidence of noncommunicable diseases such as stroke in low- and medium-income countries like India, it has become imperative to identify the potentially modifiable risk factors and focus on prevention. Microalbuminuria (MA) is now gaining recognition as an independent risk factor for ischemic stroke. It has also been studied as a prognostic marker for acute ischemic stroke. Thus, it was intended to study MA in acute ischemic stroke and its correlation with stroke severity. Methods: A single-center case–control study was done after enrolling seventy cases of ischemic stroke with age between 40 and 65 years, satisfying inclusion and exclusion criteria during a span of 2 years. Fifty patients in the age group of 40–65 years with no history of stroke and transient ischemic attack and fulfilling the exclusion criteria were taken as control. All cases were subjected to detailed history, systemic clinical examination, and biochemical and radiological investigations with assessment of National Institutes of Health Stroke Scale (NIHSS) for grading of severity of ischemic stroke with semi-quantitative measurement of MA (urinary albumin: creatinine ratio). Results: Hypertension (62.86%), diabetes mellitus (34.29%), and smoking (27.14%) were found to be the major risk factors for acute ischemic stroke. MA was present in 48.57% of cases, whereas in the control group, MA was present only in 18% of patients. Our study showed MA as an independent risk factor for acute ischemic stroke. On multivariate logistic regression analysis of risk factors of acute ischemic stroke, odd ratio for MA was 4.312 with P = 0.005. In our study, cases with mean NIHSS 17.71 and median NIHSS 18 were positive for MA, while cases with mean NIHSS 13.03 and median NIHSS 12 were negative for MA, that is, cases with higher mean and median NIHSS were positive for MA. This association of MA with NIHSS was statistically significant (P = 0.036). Conclusion: MA was found in approximately half of the patients studied with acute ischemic stroke, and there was a significant association between MA and higher NIHSS.

Pulmonary tuberculosis in young people

Tuberculosis is a global health problem and the main cause of death in the whole world. Young individuals are significantly affected in the low- and medium income countries. The children are more often infected by close contact with familiar adults at home, and lung tuberculosis with cavities plays a major role in environmental contamination. Their primary infection may evolve to primary tuberculosis without specific manifestations. The diagnostic challenges may be solved by higher clinical suspicion index associated with complementary investigation tools including tuberculin skin test and chest X-rays. These comments aim to enhance the awareness of lung tuberculosis at younger ages.

Oral Arsenic Trioxide in Front Line Therapy for Acute Promyelocytic Leukemia. A Prospective Costa Rican Study

KEY WORDS: Acute Promyelocytic Leukemia, oral Arsenic Trioxide, ATRA, Front Line Therapy. CONTEXT: Studies showed the combination of all-trans-retinoic acid (ATRA) with Arsenic trioxide (ATO) as an effective treatment of patients with newly diagnosed Acute Promyelocytic Leukemia (APL), permitting a chemotherapy-free treatment approach. Oral formulations of ATO were developed with similar efficacy compared to the IV formulation, and a slightly safer profile. OBJECTIVE:To determine the effectiveness and safety of a locally produced oral ATO with ATRA as a first line therapy in APL. DESIGN:We designed the LPCR05 protocol based on established treatment protocols. Treatment regimen: Induction phase: all patients received ATRA (45 mg/m2 daily) and an locally produced oral formulation of ATO (10 mg daily), with a dose of Idarubicin (12 mg/m2 on days 1,3,5 and 7, if older than 60 years only given on day 1) added only to the high-risk patients. Consolidation Phase: 3 cycles of ATO + ATRA for 30days every 6 weeks. Maintenance Phase: 4 Cycles of ATRA+ATO daily for 15 days every 3 months. Oral formulation for ATO is prepared by the Laboratory of Pharmaceutical Products from our Social Security System according to the literature and approved by local health and pharmaceutical regulators. RESULTS: We report data on our first 26 APL patients enrolled on the LPCR05 protocol. Six patients were classified as high risk, eighteen intermediate and two low risk (Table 1). One high risk patient discontinued after first consolidation because of lost follow up. The median follow up is 12.5 months. Hematological complete remission was obtained after 30 days of treatment in all 26 patients. Molecular complete remission in 22 evaluated patients after first and third consolidation was achieved in 95% and 100% respectively (Table 2). None of the patients have relapsed. There were no withdrawals of the protocol because of side effects and no induction deaths because of coagulopathy. No severe cardiac or neurological toxicity was found. Grade 3 hepatic toxicity was seen in two patients, in both cases, temporary discontinuation of ATRA and ATO resolved the side effect. One patient developed non treatment related grade 3 renal toxicity and other one developed a probably related grade 3 skin toxicity. Severe infectious complications were seen in three patients, two had pneumoniae (one death) and one enteritis (Table 3). Patients are managed in the ambulatory setting, with fewer hospitalizations (mean hospitalization days per patient of 38,1 with ATRA + chemotherapy vs 14,1 with oral ATO and ATRA), and therefore the cost is three times lower (US$65 208 vs US$24 195) than our previous approach with ATRA + chemotherapy protocol. CONCLUSION: Our data demonstrate both efficacy and safety of oral ATO with ATRA as front line therapy in all risk groups. This strategy also demonstrated lower operational costs, fewer hospitalization days, and improved convenience for patients. We expect longer follow-up will confirm that treatment with oral ATO and ATRA is a curative therapeutic strategy for patients with APL that is particularly attractive for use in low and medium income countries. Disclosures No relevant conflicts of interest to declare.

Identifying biological markers for improved precision medicine in psychiatry

Mental disorders represent an increasing personal and financial burden and yet treatment development has stagnated in recent decades. Current disease classifications do not reflect psychobiological mechanisms of psychopathology, nor the complex interplay of genetic and environmental factors, likely contributing to this stagnation. Ten years ago, the longitudinal IMAGEN study was designed to comprehensively incorporate neuroimaging, genetics, and environmental factors to investigate the neural basis of reinforcement-related behaviour in normal adolescent development and psychopathology. In this article, we describe how insights into the psychobiological mechanisms of clinically relevant symptoms obtained by innovative integrative methodologies applied in IMAGEN have informed our current and future research aims. These aims include the identification of symptom groups that are based on shared psychobiological mechanisms and the development of markers that predict disease course and treatment response in clinical groups. These improvements in precision medicine will be achieved, in part, by employing novel methodological tools that refine the biological systems we target. We will also implement our approach in low- and medium-income countries to understand how distinct environmental, socio-economic and cultural conditions influence the development of psychopathology. Together, IMAGEN and related initiatives strive to reduce the burden of mental disorders by developing precision medicine approaches globally.

Exploring determinants of, and interventions for, delayed presentation of women with breast symptoms: A systematic review.

Behaviour change interventions are more likely to be effective if they are sensitive to contextual determinants of behaviour. Delayed presentation of women with breast symptoms is a concern for both high-income and low- and medium-income countries. Our aim was to integrate evidence on determinants of time to presentation of women with breast symptoms with complementary evidence on interventions for promoting early presentation. A systematic review was conducted according to PRISMA guidelines. Ten electronic databases were searched for relevant articles published between 1985 to May 2019. Pre-defined selection criteria were applied to retrieved records. Evidence on interventions, and on determinants were integrated through sequential explanatory synthesis design. Of the 4185 documents retrieved, 11 intervention studies and 10 determinants studies were included in the synthesis. Overall, evidence on interventions is of low quality, while that on determinants is of medium quality. Intervention studies were mostly individual-level with almost exclusive focus on breast cancer awareness among postmenopausal women in high-income countries. Synthesis of evidence on determinants resulted in 10 domains. Juxtaposing the evidence on determinants of time to presentation of women with breast symptoms with that of the interventions to promote early presentation shows a mismatch between them. Whilst there is strong evidence that women with breast symptoms face multi-level influences to presentation, current interventions have focused almost exclusively on breast cancer awareness in high-income countries. High quality multi-level interventions are required to promote early presentation of symptomatic women in different socio-cultural and economic settings.

Overview of Meta-Analyses: The Impact of Dietary Lifestyle on Stroke Risk.

A stroke is one of the most prevalent cardiovascular diseases worldwide, both in high-income countries and in medium and low-medium income countries. The World Health Organization’s (WHO) report on non-communicable diseases (NCDs) indicates that the highest behavioral risk in NCDs is attributable to incorrect nutrition. The objective of our work is to present an overview of meta-analyses that have investigated the impact of different foods and/or drinks in relationship with the risk of stroke events (ischemic/hemorrhagic). The papers to be included in the overview were found in MEDLINE, EMBASE, Scopus, Clinicaltrials.gov, Web of Science, and Cochrane Library and were selected according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow chart. Quality assessment were made according to the AMSTAR 2 scale. This overview shows that all primary studies came from countries with high income levels. This evidence shows that many countries are not represented. Therefore, different lifestyles, ethnic groups, potentially harmful or virtuous eating habits are not reported. It is important to underline how the choose of foods may help reduce the risk of cardiovascular diseases and stroke in particular.

Factors associated with burnout amongst healthcare workers providing HIV care in Malawi.

ContextHigh rates of burnout have been reported in low and medium income countries and can detrimentally impact healthcare delivery. Understanding factors associated with burnout amongst health care workers providing HIV care may help develop interventions to prevent/treat burnout.ObjectivesWe sought to understand factors associated with burnout amongst health care workers providing HIV care in Malawi.MethodsThis was a sub-study of a larger cross-sectional study measuring burnout prevalence amongst a convenience sample of healthcare workers providing HIV care in 89 health facilities in eight districts in Malawi. Burnout was measured using the Maslach Burnout Inventory. Anonymously administered surveys included questions about sociodemographics, work characteristics (work load, supervisor support, team interactions), depression, life stressors, assessment of type D personality, and career satisfaction. We performed univariable and multivariable regression analyses to explore associations between variables and burnout.ResultsWe received 535 responses (response rate 99%). Factors associated with higher rates of burnout on multivariable regression analyses included individual level factors: male gender (OR 1.75 [CI 1.17, 2.63]; p = 0.007), marital status (widowed or divorced) (OR 3.24 [CI 1.32, 7.98]; p = 0.011), depression (OR 3.32 [CI 1.21, 9.10]; p = 0.020), type D personality type (OR 2.77 [CI 1.50, 5.12]; p = 0.001) as well as work related factors: working at a health center vs. a rural hospital (OR 2.02 [CI 1.19, 3.40]; p = 0.009); lack of a very supportive supervisor (OR 2.38 [CI 1.32, 4.29]; p = 0.004), dissatisfaction with work/team interaction (OR 1.76 [CI 1.17, 2.66]; p = 0.007), and career dissatisfaction (OR 0.76 [CI 0.60, 0.96]; p = 0.020).ConclusionThis study identified several individual level vulnerabilities as well as work related modifiable factors. Improving the supervisory capacity of health facility managers and creating conditions for improved team dynamics may help reduce burnout amongst healthcare workers proving HIV care in Malawi.

Survey of postgraduate medical physics programmes in the Asia-Oceania region

The increased use of medical imaging and radiation therapies has resulted in a high demand for medical physicists. Although medical physics programmes are well established in advanced countries, the same cannot be said for many low- and medium-income countries. In some countries, there may be huge variations in the graduates' skill and quality, which pose a problem in ensuring patient safety, providing quality assurance in treatments, optimisation of protocols and standardisation of quality. It also makes any yet-to-be-established regional peer recognition efforts problematic. In order to understand the depth of this problem, a survey was carried out as part of the home-based assignment under the RAS 6088 IAEA programme. A large diversity in terms of course content, duration, clinical training and student profile could be observed across the Asia-Oceania universities surveyed. Out of 25 programmes, only six received recognition from professional bodies, and they were mostly in Australia and New Zealand. Hence, to ensure quality education, a regional curriculum model needs to be developed to harmonise standards. And there is still a long way to go towards standardizing medical physics education and clinical training in the region.

Determination of carotenoids in sweet potato (Ipomoea batatas L., Lam) tubers: Implications for accurate provitamin A determination in staple sturdy tuber crops

Vitamin A deficiency (VAD) is a global health problem, which despite significant financial investments and initiatives has not been eradicated. Biofortification of staple crops with β-carotene (provitamin A) in Low Medium Income Countries (LMICs) is the approach advocated and adopted by the WHO and HarvestPlus programme. The accurate determination of β-carotene is key to the assessment of outputs from these activities. In the present study, HPLC-PDA analysis displayed superior resolving power, separating and identifying 23 carotenoids in the orange sweet potato (Ipomoea batatas) variety used, including only eight carotenoids with provitamin A properties. Additionally, the results evidently displayed that the use of lyophilised material facilitated the extraction of twice the amount of pigments compared to fresh material, which impacts the precise calculation of the provitamin A content. These results highlight that yellow to orange starchy edible crops produce a wide array of carotenoids in addition to β-carotene. Biosynthetically it is clear from the intermediates and products accumulating that the β-branch of the carotenoid pathway persists in sweet potato tuber material. Collectively, the data also have implications with respect to the determination and biosynthesis of provitamin A among staple crops for developing countries.

Regulating human interventions in Colombian coastal areas: Implications for the environmental licensing procedure in middle-income countries

Although anthropogenic impacts could be assessed in any environment, coastal areas pose a particular challenge because of their special nature as the interface between land and sea. Therefore, this study evaluates the environmental regulatory framework for coastal interventions in Colombia, as an archetype of medium income countries (MICs), to derive implications for the environmental licensing procedure (ELP). The methods comprised two simultaneous pathways: a. An inventory of human interventions at the large scale area of the Colombian Caribbean Coast, with an estimation of the overall environmental impact; b. An analysis of the ELP in Colombia during the last 25 years. The study evidences several weaknesses, such as a consistent reduction in the number of works and activities covered in each new legislative. Moreover, the Colombian ELP currently regulates only four of the ten types of interventions with greater effect in its coastal zones. The discussions highlight some policy implications for the ELP in MICs, mainly based on how the impact of a type of intervention can be magnified in proportion to its frequency of occurrence, and the need to articulate instruments of environmental management and territorial planning. At last, the need to evolve the impact assessment of human interventions from environmental factors toward socio-natural processes is evidenced and further addressed, by the introduction of a susceptibility approach inspired on geomorphological processes. Overall, this study highlights important gaps of the Colombian ELP for coastal environments, which entails valuable lessons for MICs.