Middle-income Countries In Asia Research Articles

Advances in Research on COVID-19 Vaccination for People Living with HIV.

Advances in Research on COVID-19 Vaccination for People Living with HIV.

Mental health gaps characteristics in the management of schizophrenia in a developing upper middle-income South-East Asian country

The Mental Health Gap Action Program (mhGAP) was launched by the World Health Organization (WHO) in 2008 to address the lack of care of people in low and middle-income countries The purpose of this narrative review is to examine Mental Health Gaps in the management of Schizophrenia in Malaysia. A search was conducted using the five keywords in the following databases: Embase, MEDLINE, Web of Science, PubMed and Google Scholar. A review of the mental health system in Malaysia was conducted through the lens of the mhGAP context with a particular focus on Schizophrenia. Gaps in service delivery and lack of fidelity to evidence-based practices to this population of patients are examined in context of social security and health coverage, evidenced-based practices in Schizophrenia and health and allied delivery systems. and Implications for Practice: Mental health service delivery and associated systems in Malaysia are found wanting in several aspects of mental health management of schizophrenia. There is an urgent need for a thorough review and realignment of the management of Schizophrenia by all stakeholders involved in the multi-sectoral inter-system delivery of services to people with schizophrenia i.e. Mental health professionals, Social Welfare officers, policy makers, local and federal government agencies involved in education, employment, transport and housing.

Opportunities and challenges for advance care planning in strongly religious family-centric societies: a Focus group study of Indonesian cancer-care professionals

BackgroundMost studies on advance care planning in Asia originate in high-income Asian countries. Indonesia is a middle-income Asian country characterized by its religious devoutness and strong family ties. This study aims to explore the perspectives and experiences of Indonesian healthcare professionals on advance care planning for cancer patients.MethodsFocus-group discussions were conducted in July and August 2019 and were analysed using thematic content analysis enhanced by dual coding and exploration of divergent views. Purposive sampling of physicians and nurses actively engaged in cancer care in a national cancer centre and a national general hospital.ResultsWe included 16 physicians and 16 nurses. These participants were open to the idea of advance care planning. We further identified four aspects of this planning that the participants considered to be important: 1) the family’s role in medical decision-making; 2) sensitivity to communication norms; 3) patients’ and families’ religious beliefs regarding the control and sanctity of life; and 4) the availability of a support system for advance care planning (healthcare professionals’ education and training, public education, resource allocation, and formal regulation). Participants believed that, although family hierarchical structure and certain religious beliefs may complicate patients’ engagement in advance care planning, a considerate approach to involving family and patients’ religious perspectives in advance care planning may actually facilitate their engagement in it.ConclusionIndonesian healthcare professionals believed that, for culturally congruent advance care planning in Indonesia, it was essential to respect the cultural aspects of collectivism, communication norms, and patients’ religious beliefs.

Factors explaining pedestrian-involved fatality crashes on National Highways in India

Pedestrians continue to face high risk of getting involved in fatal and serious injury crashes all over the world. In many high-income countries, pedestrian involvement in fatal crashes occur mostly in urban areas. However, in many low- and middle-income countries in Asia and Africa, pedestrian involvement in fatal crashes occur on intercity highways too. This research analyses fatal pedestrian crash characteristics, and identifies probable contributory factors to pedestrian involvement in fatal crashes using logistic regression for two-, four-, and six-lane National Highways. The fatal pedestrian crash density is found to be the highest at 1.37 crashes/km/year on six-lane divided NH-1. The binary logistic regression estimation results for pedestrian involvement in the fatal crash model revealed that the predictors: “number of lanes” and “time of crash” are found to be significant at 95% level. The model results for the variable “number of lanes” highlights the need to study pedestrian crossing behaviour on highways in detail. The design standards for pedestrian crossing facilities in urban areas may not be suitable for National Highways in particular multi-lane highways. In-depth research is required to understand the suitability of various traffic calming measures and other possible interventions which can ensure pedestrian safety on highways.

Correlates of sedentary behavior in Asian preschool-aged children: A systematic review.

This systematic review aims to identify the multilevel correlates of sedentary behavior (SB) and its sub-domains among preschool-aged children aged 0-7years in Asia. We systematically searched for studies published from 2000 onwards using terms related to SB correlates and Asia in six databases. Eligible studies were observational and used quantitative methods to examine correlates of total, and domain-specific SB (screen viewing [SV] and non-screen-based SB) in Asian children living in Asia. Two reviewers independently screened identified references. Following quality assessment of included studies, we performed narrative synthesis to summarize the evidence on the intrapersonal, interpersonal, environmental correlates of total and domain-specific SB (PROSPERO: CRD42018095268). Twenty-two studies from 4 regions and 12 countries/territories were included. Out of the 94 correlates explored, the following associations were consistent: older age, being a boy, non-Chinese ethnicity (Southeast Asia), younger maternal age, higher maternal and paternal television-viewing time with higher SV; higher SV at earlier age with higher SV and total SB; and presence of TV/computer in the bedroom with higher leisure-time SB. We encourage more studies from low- and middle-income Asian countries with an increased focus on different SB domains, further exploration of environmental correlates, and the use of objective measurements to capture SB.

Psychological and Social Impact of HIV on Women Living with HIV and Their Families in Low- and Middle-Income Asian Countries: A Systematic Search and Critical Review.

Human Immunodeficiency Virus (HIV) infection adds a significant burden to women in Low- and Middle-Income Countries (LMICs), often leading to severe detrimental impact, not only on themselves, but also on their families and communities. Given that more than half of all people living with HIV globally are females (53%), this review seeks to understand the psychological and social impact of HIV infection on Women Living with HIV (WLHIV) and their families in LMICs in Asia, and the interrelationships between one impact and another. A systematic review was conducted to find literature using the following databases: Medline, PsycINFO, CINAL, Emcare, Scopus and ProQuest. Research articles included in this review were selected based on the following inclusion criteria: conducted in LMICs in Asia, published in English language between 1 January 2004 and 31 December 2021, had full text available, involved WLHIV (married and unmarried) and explored the psychological and social impacts of HIV on these women and their families. Critical appraisal tools developed by Joanna Briggs Institute (JBI) were used to assess the methodological quality of the studies, and thematic narrative synthesis was used to analyse the findings. A total of 17 articles met the inclusion criteria. The review showed that HIV has a range of negative psychological consequences on WLHIV, such as stress, fear, worry, anxiety and depression, as well as social impacts on the women and their families, including stigma, discrimination and family separation. The findings indicate the need for targeted interventions—specific to WLHIV—that address the psychological challenges, stigma and discrimination these women and their families face. These interventions should also incorporate education and sustainable support structures for WLHIV and their families.

Impact of Time Trend and Heterogeneity on EKC in Asian Countries

The basic objective of the study is to investigate the shape of EKC for 39 Asian countries and income groups during the period of 1990-2015 with and without the use of a linear time trend variable. The study tests the validity condition of the mathematical model depicting an ‘N’ shaped EKC. Besides, the status of each country group is compared as per the expected emissions of GHG. The empirical investigation reveals that for both the overall and the high-income Asian group, the presence of a linear time trend variable renders EKC to be inverted U-shaped. However, eliminating the effect of time, the EKC becomes an ‘N’ shaped curve in agreement with a valid mathematical model. The middle-income Asian countries follow a monotonic increasing EKC relationship both in the presence and absence of a linear time trend. The computation of expected emissions of GHG demonstrates that the lower-middle-income group is expected to emit more among the three income groups followed by the high-income group and the upper-middle-income group.

Whole-genome sequencing of Mycobacterium tuberculosis from Cambodia

Cambodia has one of the highest tuberculosis (TB) incidence rates in the WHO Western Pacific region. Remarkably though, the prevalence of multidrug-resistant TB (MDR-TB) remains low. We explored the genetic diversity of Mycobacterium tuberculosis (MTB) circulating in this unique setting using whole-genome sequencing (WGS). From October 2017 until January 2018, we collected one hundred sputum specimens from consenting adults older than 21 years of age, newly diagnosed with bacteriologically confirmed TB in 3 districts of Phnom Penh and Takeo provinces of Cambodia before they commence on their TB treatment, where eighty MTB isolates were successfully cultured and sequenced. Majority of the isolates belonged to Lineage 1 (Indo-Oceanic) (69/80, 86.25%), followed by Lineage 2 (East Asian) (10/80, 12.5%) and Lineage 4 (Euro-American) (1/80, 1.25%). Phenotypic resistance to both streptomycin and isoniazid was found in 3 isolates (3/80, 3.75%), while mono-resistance to streptomycin and isoniazid was identical at 2.5% (N = 2 each). None of the isolates tested was resistant to either rifampicin or ethambutol. The specificities of genotypic prediction for resistance to all drugs tested were 100%, while the sensitivities of genotypic resistance predictions to isoniazid and streptomycin were lower at 40% (2/5) and 80% (4/5) respectively. We identified 8 clusters each comprising of two to five individuals all residing in the Takeo province, making up half (28/56, 50%) of all individuals sampled in the province, indicating the presence of multiple ongoing transmission events. All clustered isolates were of Lineage 1 and none are resistant to any of the drugs tested. This study while demonstrating the relevance and utility of WGS in predicting drug resistance and inference of disease transmission, highlights the need to increase the representation of genotype–phenotype TB data from low and middle income countries in Asia and Africa to improve the accuracies for prediction of drug resistance.

Impact of Patient Navigation on Timeliness of Diagnosis and Treatment, and Adherence to Treatment in Middle Income Asian Country

PURPOSE Women in low to middle-income countries (LMICs), such as in Malaysia, face complex barriers to healthcare because of social, economic, geographic, and other interrelated factors, which can limit their access to timely, affordable, and effective breast cancer care. Patient Navigation has emerged as a cost-effective and impactful approach to enable women to access care. METHODS We have established a hospital-based partnership model between a non-profit organization and national healthcare service to address the barriers faced by low-income women to improve the timeliness of diagnosis and treatment and reduce poor adherence to treatment. The navigation team provides resources required to overcome financial and logistic barriers, counseling to address knowledge and emotional needs and to ensure treatment adherence. RESULTS To determine the effectiveness of the program, timeliness of diagnosis and treatment, and rates of treatment adherence were compared with a historical cohort from the same hospital. The proportion of patients who met the healthcare system's targets for timeliness to cancer diagnosis increased from 50.4% to 67.3% ( P < .05) and that for initiation of primary treatment increased from 36.5% to 49.5% ( P < .05). The overall treatment default rates reduced from 8.6% to 2.6% ( P < .05). CONCLUSION In summary, Patient Navigation is feasible and potentially effective for addressing barriers to cancer care and could be a key element of cancer control in LMICs.

Attitudes and training needs of oncologists and surgeons in mainstreaming breast cancer genetic counseling in a low-to-middle income Asian country.

With the advent of poly-ADP-ribose polymerase inhibitor (PARPi) therapies, the focus of genetic testing for breast, ovarian, and other cancers has shifted from risk management to treatment decision-making in high-resource settings. Due to the shortage of genetic counselors worldwide, alternative ways of delivering genetic counseling have been explored, including training nongenetics healthcare professionals (NGHPs) to provide genetic counseling. However, little is known about the feasibility of adopting such models in healthcare settings with insufficient specialists, where population health literacy is low and where access to new therapies may be limited. In this study, we evaluated the attitudes, considerations, and self-efficacy of oncologists, breast surgeons, and general surgeons in mainstreaming breast cancer genetic counseling in Malaysia, a middle-income Asian country with a universal healthcare system. We developed a 32-item survey via a modified Delphi method, which was then distributed via a purposive and network sampling approach. While 77% of respondents expressed interest in providing breast cancer genetic counseling, 85% preferred to refer patients directly to genetic services for genetic counseling and testing. The main considerations for mainstreaming were the cost of genetic testing and PARPi therapy, as well as the availability of support from genetics professionals. Respondents reported a lack of confidence in communicating genetic risk, particularly to patients with poor health literacy, and in the clinical management of patients with variants of uncertain significance. Our results highlight the urgent need to train more NGHPs in providing genetic counseling and testing in low-to-middle income countries, and suggest that the mainstay for genetic counseling in this setting may be for risk management rather than access to PARPi therapy.

Application of ecological dynamics principles to drowning prevention

Drowning has been identified as the cause of over 2.5 million preventable deaths globally in the past decade. Lower- and middle-income countries in Asia have recorded the highest numbers of drowning worldwide and children seem particularly vulnerable. Drowning is a complex phenomenon informed by multiple interacting factors, and the majority of deaths occur in natural environments such as ponds, ditches, rivers and oceans. Any potential drowning prevention strategy should acknowledge the important relationships that are created between individuals and their environment in water safety education. In this article, we share how the ecological dynamics theoretical perspective can help inform our understanding of drowning prevention. First, we review recent drowning prevention recommendations provided by the World Health Organization (WHO). Next, we discuss how well WHO's recommendations align with the principles of ecological dynamics. It is acknowledged that in many Asian countries, there are considerable challenges to delivering WHO's drowning prevention interventions. Teaching children basic swimming, water safety and self-rescue skills remains the most practical means to prevent drowning. The relevant scale of analysis for understanding behaviour is the individual-environment relationship. Specifically, the relative fit between these components may dictate how well water safety skills are learnt. Considerations such as installing barriers and adequate supervision around water can be scaffolded alongside an understanding of affordances in the context of water safety. We conclude that water safety education informed by an ecological dynamics approach is an effective partnership to help tackle the drowning pandemic.

Quality of Life of the Elderly during the COVID-19 Pandemic in Asian Countries: A Cross-Sectional Study across Six Countries.

Background: Few studies have explored the determinants of health-related quality of life (HRQoL) in the elderly during the COVID-19 pandemic. Identifying these factors may help implement appropriate policies to enhance HRQoL in the elderly. Therefore, we aimed to identify the predictors of physical and mental component summary (PCS and MCS) scores of HRQoL in selected six low- and middle-income Asian countries. Methods: We conducted an online survey of older people aged ≥55 years in six countries: Bangladesh, Iran, Iraq, Malaysia, Palestine, and Sri Lanka. The Stark QoL questionnaire was used to measure the PCS and MCS scores. Univariate and multiple variable analyses after adjusting for confounders were performed to identify the possible predictors of PCS and MCS. Results: A total of 1644 older people (69.1 ± 7.8 years, range 55–97 years, Female: 50.9%) responded to the survey. We documented age, country of residence, marital status, number of male children, current employment status, and health insurance, ability to pay household bills, frequency of family members visits and receiving support during COVID-19 pandemic predicted both PCS and MCS. However, gender, residence, and number of female children were associated with PCS only (all p < 0.05). Conclusion: Socio-demographic factors such as age, country of residence, marital status, number of male children, current employment status, health insurance, ability to pay household bills, frequency of family members visiting family members, and receiving support during the COVID-19 pandemic affecting both physical and mental quality of life. These results can guide formulating health care planning policies to enhance QoL during COVID-19 and future pandemics in the elderly.

Prevalence of chronic kidney disease stages 3-5 in low- and middle-income countries in Asia: A systematic review and meta-analysis.

Chronic kidney disease (CKD) is a major public health problem in low- and middle-income countries (LMICs). Although CKD prevalence has been rapidly increasing in LMICs, particularly in Asia, quantitative studies on the current epidemiology of CKD in this region are limited. This study aimed to identify the prevalence of CKD stages 3–5 in LMICs in Asia, by subregion, country economy classification, identification of CKD, traditional and non-traditional risk factors. A systematic review and meta-analysis of observational studies was conducted through a literature search of seven electronic databases and grey literature search published until November 2021. The Newcastle-Ottawa quality assessment scale (NOS) was used to assess the risk of bias of each study. A random-effects model was used to estimate pooled prevalence. The protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42019120519). Of 4,548 potentially relevant records, 110 studies with moderate and high quality were included with 4,760,147 subjects. The average prevalence (95% CI) of CKD stages 3–5 in 14 LMICs in Asia was 11.2% (9.3–13.2%). The prevalence of CKD stages 3–5 was varied among subregions and country economic classification. CKD prevalence was 8.6% (7.2–10.2%) in east Asia, 12.0% (7.7–17.0%) in south-east Asia, 13.1% (8.7–18.2%) in western Asia, and 13.5% (9.5–18.0%) in south Asia. CKD prevalence was 9.8% (8.3–11.5%) in upper-middle-income countries and 13.8% (9.9–18.3%) in lower-middle-income countries. Prevalence of CKD stage 3–5 in LMICs in Asia is comparable to global prevalence. High level of heterogeneity was observed. Study of factors and interventions that lead to the delay of CKD progression is needed.

Retinoblastoma outcomes: a global perspective

Retinoblastoma outcomes: a global perspective

Evaluation of Urban Design Qualities across Five Urban Typologies in Hanoi

Urban design has been shown to play a vital role in promoting the health and wellbeing of urban citizens. However, studies of microscale urban design are underrepresented in comparison with macroscale urban design, especially from low- and middle-income countries in Asia, where urban forms are traditionally compact, complex and with multiple layers and varied urban typologies. The study evaluated microscale urban design qualities of streets (n = 40) across five urban typologies in Hanoi—a typical city in a low- and middle-income country in Asia. The study found that urban typologies and their characteristics have particular impacts on urban design qualities. Old and high-density urban typologies tend to report higher urban design qualities than modern and low-density typologies. Urban design qualities are also significantly associated with the number of pedestrians on the streets. Compared to Western cities, the urban design qualities in Hanoi are substantially different, especially in terms of imageability and complexity, reflecting the differences in urban design and cultural context between cities from various regions. Overall, the study contributes to our understanding of urban design circumstances in Hanoi, providing policymakers, planners, urban designers and architects with important insights for sustainable urban design policies, strategies and interventions.

Education and training opportunities for local and indigenous social workers: case studies in disability-related fields from an international development perspective

ABSTRACT Many ‘non-professional’ and ‘non-certified’ social workers seem to conduct indigenous social work practices in low- and middle-income countries in Asia. From the perspective of international developmental social work, this case study explores the education and training opportunities for local and indigenous social workers in disability related fields. The data was mainly obtained through field work and practice conducted by the author, whose positionality was considered an international social worker in Sri Lanka and Mongolia. The field data was supplemented by literature. The findings reveal that some local workers in government and non-government sectors, who might not have received professional social work education, engage in practices that can be considered a part of social work using their indigenous and local knowledge and skills. In some cases, these workers also use their knowledge of international concepts and frameworks. Additionally, this study presents some instances of knowledge exchange between domestic and international stakeholders through dialogue-based practices and training in the field. The findings suggest that international social workers are required to explore reflective practice and collaborative knowledge creation with domestic stakeholders, including indigenous social workers and disabled people, through dialogue in the field.

A Synthesis of Findings from 'Rapid Assessments' of Disability and the COVID-19 Pandemic: Implications for Response and Disability-Inclusive Data Collection.

Introduction: People with disabilities are disproportionately impacted by disasters, including health emergencies, and responses are not always inclusive or accessible. Disability-inclusive response and recovery efforts require rapid, contextually relevant data, but little was known about either the experience of people with disabilities in the first phase of the COVID-19 pandemic, or how rapid needs assessments were conducted. Methods: We reviewed the available results from rapid assessments of impacts of COVID-19 on people with disabilities in low- and middle-income countries in Asia and the Pacific. Rapid assessment methods and questions were examined to describe the current approaches and synthesise results. Results: Seventeen surveys met the inclusion criteria. The findings suggest that people with disabilities experienced less access to health, education, and social services and increased violence. The most rapid assessments were conducted by or with disabled person’s organisations (DPOs). The rapid assessment methods were varied, resulting in heterogeneous data between contexts. Efforts to standardise data collection in disability surveys are not reflected in practice. Conclusions: Persons with disabilities were disproportionately impacted by the ‘first wave’ of the COVID-19 pandemic. Despite complex implementation challenges and methodological limitations, persons with disabilities have led efforts to provide evidence to inform disability-inclusive pandemic responses.

Community first responders: A missing key to reducing the impact of injury and illness in low- and middle-income countries in the Western Pacific?

This perspective article discusses the potential role community first responders could play in reducing injury and illness in low- and middle-income countries in the Western Pacific. Community first responders are reportedly making a difference in low- and middle-income countries in Asia and Africa in reducing injury and illness, and in disease surveillance and reporting. Efforts must be made to explore the appropriate and effective introduction of locally tailored community first responder programs in the Western Pacific.

Factors predicting poor anticoagulant control on warfarin in a Thai population with non-valvular atrial fibrillation (NVAF): the ACAChE score

BackgroundIn many low- to middle-income countries in Asia, patients with NVAF usually received warfarin for thromboembolic prevention due to cost-effectiveness. The SAMe-TT2R2 score has been proposed to predict TTR in NVAF patients. However, the SAMe-TT2R2 score has not been much validated in Asian population. Interestingly, it may overestimate patients who had TTR < 65% due to regarding being Asians as a risk factor.ObjectivesTo determine the factors predicting poor anticoagulant control on warfarin, create new scoring system, and compare with the SAMe-TT2R2 score in a Thai population with NVAF.MethodsThis is a retrospective study in a tertiary care hospital. We enrolled NVAF patients who received warfarin from January 2014 to December 2018. TTR was calculated based on Rosendaal method. Multiple logistic regression and AUC-ROC curve were used for analysis.ResultsA total of 864 patients were enrolled with mean age of 73.6 ± 11.58 years. The mean TTR was 48.1 ± 25.2%. Using multivariate regression analysis, the predictive factors for TTR < 65% were antiplatelet use (OR 4.49, p ≤ 0.001), LVEF < 40% (OR 1.92, p = 0.037), chronic kidney disease (GFR < 50 ml/min/1.73 m2) (OR 1.68, p = 0.013), history of CHF (OR 1.7, p = 0.047), and age ≥ 75 years (OR 1.4, p = 0.037). Based on the regression coefficients, we developed the new scoring system called ACAChE score [A, antiplatelet use (4 points); C, chronic kidney disease, GFR < 50 ml/min/1.73 m2 (2 points); A, age ≥ 75 years (1 point); Ch, history of CHF (2 points); E, LVEF < 40% (2 points)]. ROC curve showed discrimination performance of the ACAChE score and SAMe-TT2R2 score for prediction of TTR < 65% with the C-statistic of 0.62 (95%CI 0.57–0.65) and 0.54 (95%CI 0.50–0.58), respectively.ConclusionIn Thai NVAF patients, the ACAChE score (antiplatelet use, chronic kidney disease (GFR < 50 ml/min/1.73 m2), age ≥ 75 years, history of congestive heart failure, and LVEF < 40%) has better prediction for TTR < 65% than SAMe-TT2R2 score. Thus, it expected to guide the selection of oral anticoagulation in Asian patients with NVAF.

Physical Activity of Type 2 Diabetes Mellitus Patients and Non-Diabetes Participants in Yangon, Myanmar: A Case-Control Study Applying the International Physical Activity Questionnaires (IPAQ-S).

BackgroundDespite the evidence that physical activity (PA) can prevent type 2 diabetes mellitus (T2DM), limited research investigated the level of PA among diabetes and non-diabetes in Myanmar, where there is the escalating prevalence of diabetes recently. We investigated PA as modified the risk of diabetes, in a case-control study.MethodsWe conducted a case-control study which included 150 cases and 150 controls age 25–74 years (Mean age 43.3±14.7 years) among the cases and (55.1±10.9 years) among the controls, both sex and residence in Yangon. Cases were newly diagnosed with T2DM within six months before data collection, with laboratory-confirmed fasting blood glucose level ≥126mg/dl. Controls were community residents, without diabetes, confirmed with a laboratory test. The IPAQ-S was used to assess the PA level. Multiple logistic regression analysis was applied in STATA 15, using the interaction terms for age and PA, adjusting age, sex and BMI.ResultsIn comparison to controls, cases were older and having less PA knowledge. The levels of vigorous PA were mean 254.9±standard deviations (SD) 845.6 METsmin.wk−1 among controls, 73.06±392.1 cases, moderate PA 631.5±1240.8 METsmin.wk−1 among controls and 1050.9±1601.6 cases and walking PA 569.8±1060 METsmin.wk−1 among controls and 777.4±1249 cases, respectively. The multiple logistic regression analysis showed adjusted odds ratios (aOR) 3.84, 95% confidence interval (CI) 1.18–12.42 (P<0.05) for those aged 40 and older, with moderate PA and aOR 18.01, Cl 6.45–50.26 (P<0.001) for those aged 40 and older, with low PA. Comparing the strength of association, the risk of T2DM among people aged 40 and older with moderate PA is lower than age over 40 with low PA.ConclusionPA lessened the risk of T2DM, posted by increasing age. The findings highlighted the importance of promoting PA to reduce the T2DM prevalence in the context of Yangon, Myanmar, a low- and middle-income Asian country.