Middle-income Countries Research Articles

Parental involvement in infection prevention and control in low- and middle-income country neonatal units: a scoping review protocol

IntroductionNeonatal sepsis is a key contributor to neonatal mortality worldwide, and low- and middle-income countries (LMIC) are disproportionately affected. With antimicrobial resistance challenging effective treatment of neonatal sepsis, it is...

Protein-specific immune response elicited by the Shigella sonnei 1790GAHB GMMA-based candidate vaccine in adults with varying exposure to Shigella.

Shigella is a leading cause of diarrheal morbidity and mortality in young children from low- and middle-income countries. Here, we aimed to verify the ability of the generalized modules for membrane antigens (GMMA)-based Shigella sonnei candidate vaccine 1790GAHB to elicit an anti-protein antibody response. Serum samples from previous clinical trials in adults (a dose-escalation study and its extension in France, a vaccine efficacy study after human challenge in the United States, and a study in Kenya) were investigated using pan-proteome microarrays consisting of 3,150 full-length or fragmented Shigella proteins. Pre-/post-vaccination comparisons identified subsets of proteins that were highly immunoreactive and largely overlapped across all trials; the T3SS lipochaperone family protein (expressed on GMMA) was the most reactive in all studies. Responses to several microarray antigens correlated well with S. sonnei LPS serum IgG antibody levels. Overall, we confirmed the ability of GMMA to elicit an anti-protein IgG/IgA response; however, no association with protection against shigellosis was identified. In the challenge study, IgG response to seven antigens (IpaC, IpaB, IpaA, IpaD, IpaH, IpgC, and MxiD; not expressed on GMMA) was associated with a decreased risk of shigellosis. These antigens were observed to also have high IgG responses at baseline in individuals naturally exposed to Shigella and could constitute targets for future vaccine development.IMPORTANCEShigella remains a major cause of diarrheal disease, especially in children aged under 5 years from low-to-middle-income countries. No vaccine against shigellosis is yet widely available despite the high public health need. An ideal vaccine would provide protection against the most prevalent species, Shigella flexneri and Shigella sonnei; therefore, it could be relevant to identify common antigens. We developed a microarray containing 3,150 full-length or fragmented proteins selected across Shigella species. Sera collected in four clinical trials conducted in three countries of varying endemicity to evaluate a S. sonnei GMMA-based candidate vaccine were tested against these proteins. We identified several Shigella proteins (IpaC, IpaB, IpaA, IpaD, IpaH, IpgC, MxiD) that induced robust antibody response following experimental challenge or natural infection. These proteins correlated with a reduced risk of shigellosis after the S. sonnei challenge. We found no apparent role for anti-GMMA proteins' IgG or IgA response in protection against shigellosis.

Developing a new pragmatic tool for assessing contextual fit and feasibility of evidence-based interventions towards effective implementation in global health

IntroductionUnderstanding the contextual fit and feasibility of evidence-based interventions (EBIs) constitutes an important aspect of implementation research to inform policy decisions for their uptake and sustainability in any given context...

Nurturing Leaders in Community-Based, Primary Healthcare Services for People with Disabilities in Low- and Middle-Income Countries

Nurturing Leaders in Community-Based, Primary Healthcare Services for People with Disabilities in Low- and Middle-Income Countries

Stroke Outcomes in a Population-Focused Urban Hypertension Program in Brazil and Senegal.

Stroke is one of the major causes of death worldwide, mainly in low- and middle-income countries. The implementation of multifaceted strategies aiming at blood pressure control may change the global burden of stroke. We evaluated the impact of a multisector urban cardiovascular health initiative (CARDIO4Cities) on stroke outcomes in Dakar, Senegal, and São Paulo, Brazil. Data covered preintervention, intervention, and follow-up periods with ongoing intervention from 2016 to 2021. An interrupted time series analysis and a segmented regression approach were used to evaluate temporal trends. The relative risk of stroke hospitalization was analyzed with a generalized linear model. In São Paulo, data could also be compared between intervention and control districts. A total of 3445 stroke hospitalizations were analyzed in Dakar and 4491 in São Paulo. In both cities, age-standardized stroke hospitalization rates (Dakar: -26%; São Paulo: -54% on average across 2 districts) and the risk of death from stroke declined over the intervention period. In São Paulo, the baseline risk of stroke hospitalization was comparable across the city. In the follow-up period, the risk was 24.5% lower in the intervention districts compared with the rest of the city (P<0.05). The COVID-19 situation did not change this dynamic. The implementation of the multisectoral CARDIO4Cities initiative correlated with positive trends in stroke outcomes. Interventions to reduce cardiovascular risk and improve hypertension management at population level appear to rapidly translate into reduced stroke-related hospitalizations and mortality.

Managing less influence with a better understanding: the benefit for low-income countries of understanding distance as a field

Purpose In international business research, distance connotes unfamiliarity and misunderstanding. This paper aims to theorize the distance between low-income and higher-income countries, taking as point of departure that low-income countries are generally unimportant business partners of high-income countries, but dependent on the goods, services and markets of many of them. Design/methodology/approach Because low-income countries are dependent upon higher income countries, they have a greater incentive to understand high-income countries than the reverse. Higher income countries not only know little about low-income countries, but among themselves also have varied and often competing interests and concerns. This changes how low-income countries, actors with little influence, make sense of distance. The authors use literature on psychic distance and institutional fields to develop this argument. Findings Rather than managing a series of dyadic distances, low-income countries seek to situate themselves optimally vis-à-vis the range of higher income countries with which they interact. By developing a holistic view of the entire transnational institutional field, they can better navigate and strategically position themselves amongst the more influential high-income countries. Research limitations/implications This work is conceptual, and the authors recommend future research to empirically test their propositions. Social implications This work explains why low-income countries do not necessarily seek aligned interests among higher income counterparts. Originality/value Distance is rarely researched from the perspective of low-income countries. Building on the psychic distance literature, the authors argue that low-income countries have asymmetrically greater motivation and opportunities to overcome distance. This understanding of distance represents a resource for them in conducting business internationally.

Leveraging artificial intelligence in the prediction, diagnosis and treatment of depression and anxiety among perinatal women in low- and middle-income countries: a systematic review

AimThe adoption of artificial intelligence (AI) tools is gaining traction in maternal mental health (MMH) research. Despite its growing usage, little is known about its prospects and challenges in low-...

Barriers to and facilitators of clinician acceptance and use of artificial intelligence in healthcare settings: a scoping review

ObjectivesThis study aimed to systematically map the evidence and identify patterns of barriers and facilitators to clinician artificial intelligence (AI) acceptance and use across the types of AI healthcare application...

Genomic analysis of carbapenemase-encoding plasmids and antibiotic resistance in carbapenem-resistant Klebsiella pneumoniae isolates from Vietnam, 2021.

Carbapenem resistance in gram-negative rods is increasing in low- and middle-income countries. We conducted a single-center study to identify carbapenemase-encoding plasmids in carbapenem-resistant Klebsiella pneumoniae isolates causing human infections in Vietnam. The secondary objective was to investigate the prevalence of multidrug-resistant (MDR) and hypervirulent K. pneumoniae in this setting. Our genomic analysis study characterized 105 of 245 clinical K. pneumoniae isolates at the 108 Military Hospital in Hanoi, Vietnam, collected from intensive care unit and regular wards between 1 January 2021 and 31 December 2021. All isolates were characterized using long- and short-read sequencing, followed by hybrid assembly. Comprehensive genomic analysis was performed to identify carbapenemase-encoding plasmids, complemented by extended antibiotic susceptibility testing for commonly used and novel antibiotics. We observed a high prevalence of NDM-4-related carbapenem resistance (30.5%, 32/105) mostly carried by a specific 83-kb IncFII plasmid co-carrying the blaTEM-1 (46.9%, 15/32). The genomic content of the blaNDM-4-harboring plasmids is highly variable. While blaOXA-181 and blaOXA-48 were predominantly located on an IncX3 and an IncL plasmid, respectively, the majority of plasmids harboring blaKPC-2 were not related to any named Inc-type. All isolates exhibited the MDR phenotype; however, the majority remained susceptible to the siderophore-cephalosporin cefiderocol (79%, 83/105). All isolates were susceptible to aztreonam/avibactam. In addition, we identified a hypervirulent, carbapenem-resistant K. pneumoniae ST23 strain, confirmed through both in vitro and in vivo experiments. Our study provides insights into plasmids harboring the carbapenemases New Delhi metallo-β-lactamase, oxacillinase-48 like, and K. pneumoniae carbapenemase-2 circulating in Vietnam.IMPORTANCECarbapenem resistance in Klebsiella pneumoniae is a major public health threat, especially in low- and middle-income countries. This study examined resistant strains from a hospital in Vietnam to understand how they spread and which antibiotics might still work. We found that a significant number of these bacteria carried resistance genes on different types of plasmids. Despite their resistance to many antibiotics, most strains remained susceptible to newer substances like cefiderocol and aztreonam/avibactam. Alarmingly, we also identified a hypervirulent strain that is carbapenem resistant, potentially posing an even greater risk to patients. This research provides insight into the epidemiology of the carbapenemase gene-harboring plasmids in a Vietnamese hospital. Understanding these resistance patterns can help guide antibiotic use and policy decisions to combat the growing threat of multidrug-resistant infections in Vietnam.

Platelets indices clinical implications in diabetes mellitus: A broader insight.

Platelet indices (PIs) including high mean platelet volume (MPV), plateletcrit (PLC), and platelet distribution width (PLDW) are associated with poor glycemic control. In addition, they can indicate prothrombotic and procoagulation risk among patients with diabetes. PI measurement is cheap, quick and fits healthcare system needs in remote outreaching areas in low-income countries. However, a broader insight into their clinical implications in diabetes is lacking. To achieve a wider understanding, we reviewed PubMed/MEDLINE, Google Scholar and Cochrane Library for relevant articles investigating the role of PIs in diabetes mellitus. No limitation to the publication date was applied, which included all articles published up to August 17, 2024. The terms used were MPV, PLC, PLDW, platelet large cell ratio, glycated hemoglobin (HbA1c), PIs, platelet activity and diabetes mellitus. Out of the 790 articles retrieved, 187 full texts were reviewed, and 44 were included. PIs, when measurements are done promptly and within 2 h, could be short-term pointers to glycemic control in the life span of the platelets (2 wk). PIs are easy to perform, cheap and useful in remote outreaching areas with limited facilities where measurement of HbA1c is not available or cost-effective. However, PIs are not specific and are affected by demographic factors, such as pregnancy, renal failure, medications, hemoglobin and duration of diabetes. PIs could be implemented with daily blood glucose to inform doctors in low-income countries about their patients' glycemic control and cardiovascular risk. An important application might be when blood glucose control is needed quickly (before elective surgery).

Unlocking the secrets: Exploring the connection between HPV and bladder cancer in Pakistan.

Unlocking the secrets: Exploring the connection between HPV and bladder cancer in Pakistan.

The future of funding for cancer research in lowand middle-income countries

The future of funding for cancer research in lowand middle-income countries

Prevalence and associated factors of obsessive compulsive symptoms among under graduate medical and health science students in Dilla university, Ethiopia: a cross-sectional study

BackgroundObsessive-Compulsive Disorder (OCD) is a debilitating mental health condition characterized by recurrent, intrusive thoughts and repetitive behaviors that significantly disrupt daily life. Medical students may be uniquely susceptible to obsessive compulsive symptoms due to their constant exposure to potential contaminants and infectious diseases during their training. Obsessive Compulsive symptoms among medical students are often overlooked, which can significantly impact their academic performance, well-being, and future career prospects. The prevalence and factors of obsessive compulsive symptom is not widely studied in low and middle income countries and there are limited studies in Ethiopia. Therefore, this study aimed to assess the prevalence and associated factors of obsessive compulsive symptoms among medical students.MethodsThis was a cross-sectional study conducted among 370 students. The outcome variable was assessed using the Obsessive-Compulsive Inventory-Revised scale (OCI-R). The collected data were entered using kobo collect tool box version 1.3 and analyzed using SPSS version 25. Bivariable and multivariable logistic analysis was conducted to identify factors associated with Obsessive Compulsive symptoms and variables with P-values less than 0.05 were considered to have significant association with 95% confidence interval.ResultThe probable prevalence of obsessive-compulsive disorder among medical and health science students was 28% with (95% CI: 26.4–32.7). Being female [AOR = 1.33(95%CI: 1.09, 2.18)], Depressive symptoms [AOR = 2.12(95%CI: 1.95, 4.06)], Maladaptive coping mechanism [AOR = 1.74 (95%CI: 1.23, 2.50)], and Poor sleep quality [(AOR = 1.48(95%CI: 1.08, 2.24)] were significantly associated with obsessive compulsive symptoms.ConclusionObsessive Compulsive Symptom has a high probable prevalence among medical and health science students. Being female, experiencing depressive symptoms, employing maladaptive coping mechanisms, and having poor sleep quality were significantly associated with obsessive-compulsive disorder. Therefore, early detection, screening, and appropriate intervention for obsessive-compulsive symptoms in medical students are crucial.

Government purchase of private health services in the Eastern Mediterranean region: opportunities and challenges for stewarding towards a universal health coverage focus

BackgroundProliferation in government purchase of private healthcare requires stewardship support for impactful alignment to Universal Health Coverage (UHC) goals. This paper provides a synthesis of country purchasing initiatives involving the...

Programmes for pathology: improving health outcomes for low- and middle-income countries in the artificial intelligence paradigm.

Programmes for pathology: improving health outcomes for low- and middle-income countries in the artificial intelligence paradigm.

Automatic development of speech-in-noise hearing tests using machine learning

Understanding speech in noisy environments is a primary challenge for individuals with hearing loss, affecting daily communication and quality of life. Traditional speech-in-noise tests are essential for screening and diagnosing hearing loss but are resource-intensive to develop, making them less accessible in low and middle-income countries. This study introduces an artificial intelligence-based approach to automate the development of these tests. By leveraging text-to-speech and automatic speech recognition (ASR) technologies, the cost, time, and resources required for high-quality speech-in-noise testing could be reduced. The procedure, named “Aladdin” (Automatic LAnguage-independent Development of the digits-in-noise test), creates digits-in-noise (DIN) hearing tests through synthetic speech material and uses ASR-based level corrections to perceptually equalize the digits. Traditional DIN tests were compared with newly developed Dutch and English Aladdin tests in listeners with normal hearing and hearing loss. Aladdin tests showed 84% specificity and 100% sensitivity, similar to the reference DIN tests (87% and 100%). Aladdin provides a universal guideline for developing DIN tests across languages, addressing the challenge of comparing test results across variants. Aladdin’s approach represents a significant advancement in test development and offers an efficient enhancement to global screening and treatment for hearing loss.

Ethical implications related to processing of personal data and artificial intelligence in humanitarian crises: a scoping review

BackgroundHumanitarian organizations are rapidly expanding their use of data in the pursuit of operational gains in effectiveness and efficiency. Ethical risks, particularly from artificial intelligence (AI) data processing, are increasingly recognized yet inadequately addressed by current humanitarian data protection guidelines. This study reports on a scoping review that maps the range of ethical issues that have been raised in the academic literature regarding data processing of people affected by humanitarian crises.MethodsWe systematically searched databases to identify peer-reviewed studies published since 2010. Data and findings were standardized, grouping ethical issues into the value categories of autonomy, beneficence, non-maleficence, and justice. The study protocol followed Arksey and O’Malley’s approach and PRISMA reporting guidelines.ResultsWe identified 16,200 unique records and retained 218 relevant studies. Nearly one in three (n = 66) discussed technologies related to AI. Seventeen studies included an author from a lower-middle income country while four included an author from a low-income country. We identified 22 ethical issues which were then grouped along the four ethical value categories of autonomy, beneficence, non-maleficence, and justice. Slightly over half of included studies (n = 113) identified ethical issues based on real-world examples. The most-cited ethical issue (n = 134) was a concern for privacy in cases where personal or sensitive data might be inadvertently shared with third parties. Aside from AI, the technologies most frequently discussed in these studies included social media, crowdsourcing, and mapping tools.ConclusionsStudies highlight significant concerns that data processing in humanitarian contexts can cause additional harm, may not provide direct benefits, may limit affected populations’ autonomy, and can lead to the unfair distribution of scarce resources. The increase in AI tool deployment for humanitarian assistance amplifies these concerns. Urgent development of specific, comprehensive guidelines, training, and auditing methods is required to address these ethical challenges. Moreover, empirical research from low and middle-income countries, disproportionally affected by humanitarian crises, is vital to ensure inclusive and diverse perspectives. This research should focus on the ethical implications of both emerging AI systems, as well as established humanitarian data management practices.Trial registrationNot applicable.

Long COVID prevalence and risk factors in adults residing in middle- and high-income countries: secondary analysis of the multinational Anti-Coronavirus Therapies (ACT) trials

BackgroundDuring the recent COVID-19 pandemic, reports of long-term persistence or recurrence of symptoms after SARS-CoV-2 infection emerged, which are now collectively referred to as ‘long COVID’. Most descriptions of long...

Etiology and Outcomes of Meningitis among Adults in Three Ugandan Referral Hospitals, 2018-2023: A Prospective Cohort Study in a High-HIV Endemic Setting.

Studies describing the global burden of meningitis often exclude HIV- or tuberculosis (TB)-related etiologies, thereby presenting a limited view of meningitis etiology in low- and middle-income countries. This study provides an updated evaluation of the etiology of meningitis and treatment outcomes in Uganda given advancements in molecular and TB diagnostics. We conducted a prospective observational cohort study from December 2018 to October 2023, for which adults with suspected meningitis were recruited from three referral hospitals in Uganda. We used a comprehensive diagnostic algorithm to determine microbiological etiologies of cases. Participants were followed through hospital discharge, and mortality was summarized by meningitis etiology. We enrolled 1,577 participants with suspected meningitis, of whom 96% (n = 1,511/1,577) had HIV infection and 51% (n = 772/1,577) were antiretroviral therapy naive. The median CD4 cell count was 39 cells/µL (interquartile range: 14-97 cells/µL). Cryptococcal meningitis was the most frequently diagnosed etiology of meningitis (62%) followed by TB meningitis (21%). Inpatient mortality was highest among participants diagnosed with possible TB meningitis (32%) followed by probable TB meningitis (29%) and bacterial meningitis (24%). Among the 4% (n = 66/1,577) of HIV-seronegative participants, TB meningitis was the most frequently (38%) diagnosed cause of meningitis. Despite improvements in access to HIV therapy, cryptococcal meningitis and tuberculous meningitis persist as the most common etiologies of meningitis in Uganda. Improved access to meningitis diagnostics and treatments is critically needed to mitigate the morbidity and mortality, particularly in the resource-limited settings of HIV and TB endemic regions.

Climate-smart approaches for enhancing livestock productivity, human nutrition, and livelihoods in low- and middle-income countries

In low- and middle-income countries (LMIC), particularly in South Asia and sub-Saharan Africa, livestock production is dominated by smallholder production systems characterized by low productivity and high greenhouse gas (GHG) emissions intensity coupled with high vulnerability to climate change-related natural disasters. Yet, these countries lead the world in the future demand for livestock products. For instance, the projected growth in protein demand for red meat between 2020 and 2050 is greatest in south Asia (49%) and sub-Saharan Africa (55%) relative to global estimates (14%). Most LMIC aim to meet the increasing demand for meat and milk by increasing livestock numbers, which perpetuates the high GHG emissions intensity in these countries. Rather, emphasis should be on increasing productivity per animal through increased adoption of climate-smart interventions that sustainably increase productivity, efficiency and resilience. Such interventions must go beyond the current focus on reducing enteric methane emissions from intensive livestock production systems to include interventions that also improve adaptation to climate change, and that are appropriate for extensive smallholder livestock systems. Thus, additional factors such as affordability and socio-cultural appropriateness are particularly important determinants of adoption. We recommend the use of a systems lens to examine existing GHG mitigation strategies in terms of their efficacy as well as their support for adaptation to climate change, socio-cultural acceptability, and promotion of livestock’s contribution to food and nutritional security and livelihoods. Policy changes necessary to foster adoption of such climate-smart livestock production interventions in LMIC are discussed.