People In Low- And Middle-income Countries Research Articles

Pharmacovigilance in Pregnancy Studies, Exposures and Outcomes Ascertainment, and Findings from Low- and Middle-Income Countries: A Scoping Review.

Pharmacovigilance (PV), or the ongoing safety monitoring after a medication has been licensed, plays a crucial role in pregnancy, as clinical trials often exclude pregnant people. It is important to understand how pregnancy PV projects operate in low- and middle-income countries (LMICs), where there is a disproportionate lack of PV data yet ahigh burden of adverse pregnancy outcomes. We conducted a scoping review to assess how exposures and outcomes were measured in recently published pregnancy PV projects in LMICs. We utilized a search string, secondary review, and team knowledge to review publications focusing on therapeutic or vaccine exposures among pregnant people in LMICs. We screened abstracts for relevance before conducting a full text review, and documented measurements of exposures and outcomes (categorized as maternal, birth, or neonatal/infant) among other factors, including study topic, setting, and design, comparator groups, and funding sources. We identified 31 PV publications spanning at least 24 LMICs, all focusing on therapeutics or vaccines for infectious diseases, including HIV (n = 17), tuberculosis (TB; n = 9), malaria (n = 7), pertussis, tetanus, and diphtheria (n = 1), and influenza (n = 3). As for outcomes, n = 15, n = 31, and n = 20 of the publications covered maternal, birth, and neonatal/infant outcomes, respectively. Among HIV-specific publications, the primary exposure-outcome relationship of focus was exposure to maternal antiretroviral therapy and adverse outcomes. For TB-specific publications, the main exposures of interest were second-line drug-resistant TB and isoniazid-based prevention therapeutics for pregnant people living with HIV. For malaria-specific publications, the primary exposure-outcome relationship of interest was antimalarial medication exposure during pregnancy and adverse outcomes. Among vaccine-focused publications, the exposure was assessed during a specific time during pregnancy, with an overall interest in vaccine safety and/or efficacy. The study settings were frequently from Africa, designs varied from cohort or cross-sectional studies to clinical trials, and funding sources were largely from high-income countries. The published pregnancy PV projects were largely centered in Africa and concerned with infectious diseases. This may reflect the disease burden in LMICs but also funding priorities from high-income countries. As the prevalence of non-communicable diseases increases in LMICs, PV projects will have to broaden their scope. Birth and neonatal/infant outcomes were most reported, with fewer reporting on maternal outcomes and none on longer-term child outcomes; additionally, heterogeneity existed in definitions and ascertainment of specific measures. Notably, almost all projects covered a single therapeutic exposure, missing an opportunity to leverage their projects to cover additional exposures, add scientific rigor, create uniformity across health services, and bolster existing health systems. For many publications, the timing of exposure, specifically by trimester, was crucial to maternal and neonatal safety. While currently published pregnancy PV literature offer insights into the PV landscape in LMICs, further work is needed to standardize definitions and measurements, integrate PV projects across health services, and establish longer-term monitoring.

Violence Against Children, Self-Harm, and Suicidal Behaviors: A Pooled and Country-Specific Analysis of Eight Low- and Middle-Income Countries

PurposeThis study assessed associations between experiences of physical or sexual violence in childhood and self-harm, suicidal ideation, and suicide attempts among young people in low- and middle-income countries (LMICs) and whether these associations varied by sex and perpetrator identity. MethodsWe used nationally representative data from the Violence Against Children and Youth Surveys in eight LMICs (2017–2019). The analytic sample included 33,381 young men and women (ages 13–24 years). Multivariable logistic regressions with country-fixed effects were used to estimate the associations between childhood physical and sexual violence and the three outcomes. Stratified analyses were performed by country, participant's sex, and type of perpetrator (parent/caregiver, other adults, peers, and intimate partner). ResultsAbout 40% of the participants reported physical childhood violence, and 10% experienced childhood sexual violence. Childhood violence was associated with increased odds of self-harm (physical violence: adjusted odds ratio [aOR]: 2.2, 95% confidence interval [CI]: 2.0–2.4; sexual violence: aOR: 2.7, 95%, CI: 2.3–3.0), suicidal ideation (physical: aOR: 3.0, 95% CI: 2.7–3.3; sexual: aOR: 4.0, 95%, CI: 3.6–4.5), and suicide attempts (physical: aOR: 3.6, 95% CI: 3.2–4.1; sexual: aOR: 4.9, 95%, CI: 4.3–5.7). Consistent findings were observed in country-specific analyses. The odds of all outcomes were highest among those who experienced childhood physical violence by intimate partners and childhood sexual violence by parents or caregivers. Young women who experienced childhood sexual violence had higher odds for all outcomes than young men. DiscussionViolence prevention and mental health programs for young people in LMICs should consider the types of violence experienced, the perpetrator, and the sex of the survivor.

How does per capita income growth affect bipolar and depression disorders in Africa?

PurposeBipolar and depression disorders are some of the most common mental health disorders affecting millions of people in low-and middle-income countries, including those in Africa. These disorders are therefore major contributors to the burden of diseases and disability. While an enhancement in income is seen as a major approach towards reducing the burden of these disorders, empirical evidence to support this view in the African context is lacking. This study therefore aims to examine the effect of per capita income growth on bipolar and depression disorders across African countries.Design/methodology/approachThe study uses data from secondary sources comprising 42 African countries over the period, 2002–2019, to achieve its objective. The prevalence of bipolar and major depressive disorders (depression) are used as the dependent variables, while per capita income growth is used as the main independent variable. The system Generalised Method of Moments regression is used as the estimation technique.FindingsIn the baseline, the authors find per capita income growth to be associated with a reduction in the prevalence of bipolar (coefficient: −0.001, p < 0.01) and depression (coefficient: −0.001, p < 0.1) in the short-term. Similarly, in the long-term, per capita income growth is found to have negative association with the prevalence of bipolar (coefficient: −0.059, p < 0.01) and depression (coefficient: −0.035, p < 0.1). The results are similar after robustness checks.Originality/valueThis study attempts at providing the first empirical evidence of the effect of per capita income growth on bipolar and depression disorders across several African countries.

Local Sources of Protein in Low- and Middle-Income Countries: How to Improve the Protein Quality?

Protein inadequacy is a major contributor to nutritional deficiencies and adverse health outcomes of populations in low- and middle-income countries (LMICs). People in LMICs often consume a diet predominantly based on staple crops, such as cereals or starches, and derive most of their daily protein intakes from these sources. However, plant-based sources of protein often contain low levels of indispensable amino acids (IAAs). Inadequate intake of IAA in comparison with daily requirements is a limiting factor that results in protein deficiency, consequently in the long-term stunting and wasting. In addition, plant-based sources contain factors such as antinutrients that can diminish protein digestion and absorption. This review describes factors that affect protein quality, reviews dietary patterns of populations in LMICs and discusses traditional and novel small- and large-scale techniques that can improve the quality of plant protein sources for enhanced protein bioavailability and digestibility as an approach to tackle malnutrition in LMICs. The more accessible small-scale food-processing techniques that can be implemented at home in LMICs include soaking, cooking, and germination, whereas many large-scale techniques must be implemented on an industrial level such as autoclaving and extrusion. Limitations and considerations to implement those techniques locally in LMICs are discussed. For instance, at-home processing techniques can cause loss of nutrients and contamination, whereas limitations with larger scale techniques include high energy requirements, costs, and safety considerations. This review suggests that combining these small- and large-scale approaches could improve the quality of local sources of proteins, and thereby address adverse health outcomes, particularly in vulnerable population groups such as children, adolescents, elderly, and pregnant and lactating women.

The economic burden of chronic diseases with co-occurring depression and alcohol use disorder for people in the Western Cape, South Africa

There is limited evidence on the economic burden of chronic diseases with co-occurring depression and alcohol use disorder (AUD) for people in low-and middle-income countries. We describe patient costs related to the utilisation of services and identify factors associated with the economic burden of co-occurring depression and AUD for people with HIV and/or diabetes using government health services in South Africa. We used baseline data from participants enrolled in a cluster randomised controlled trial (RCT). The sample (N = 1340) comprised participants classified as having risk of depression but not AUD (n = 689), risk of AUD but not of depression (n = 221); or risk of depression and AUD (n = 430). We measured total patient costs (direct patient costs (out-of-pocket payments (OOPP) plus indirect patient costs), and catastrophic costs. We applied a conceptual framework to guide multiple linear and logistic regression analyses examining factors associated with economic burden. Mean monthly total costs per patient and the percentage of these total costs attributable to OOPP were (US$9.78 [56.13%]; US$5.98 [24.58%]; US$7.16 [34.07%]) for the depression, AUD, and AUD and depression groups respectively. The depression group reported significantly more visits to private healthcare providers, higher OOPP and higher prevalence of catastrophe than other groups. OOPP were positively associated with urban location and higher educational attainment. Total patient costs were positively associated with urban location, HIV and diabetes comorbidity, and being employed. Higher utilisation was associated with greater odds of income loss. Results indicate a concerning economic burden in people with a chronic disease and co-occurring depression or AUD and suggest that cost and time may present barriers to accessing care. Given that psychological treatments for mental health conditions are largely unavailable in government health services, improving access to care for the most vulnerable may require coordination of financial risk protection mechanisms alongside scale-up of effective first-line psychological treatments.

Feasibility and Effectiveness of an Intervention to Reduce Intimate Partner Violence and Psychological Distress Among Women in Nepal: Protocol for the Domestic Violence Intervention (DeVI) Cluster-Randomized Trial.

Intimate partner violence (IPV) disproportionately affects people in low-and middle-income countries (LMICs), such as Nepal. Women experiencing IPV are at higher risk of developing depression, anxiety, and posttraumatic stress disorder. The shortage of trained frontline health care providers, coupled with stigma related to IPV and mental health disorders, fuels low service uptake among women experiencing IPV. The Domestic Violence Intervention (DeVI) combines the Problem Management Plus counseling program developed by the World Health Organization with a violence prevention component. This study aims to implement and evaluate the feasibility, acceptability, and effectiveness of DeVI in addressing psychological distress and enabling the secondary prevention of violence for women experiencing IPV. A parallel cluster-randomized trial will be conducted across 8 districts in Madhesh Province in Nepal, involving 24 health care facilities. The study will include women aged 18-49 years who are either nonpregnant or in their first trimester, have experienced IPV within the past 12 months, have a 12-item General Health Questionnaire (GHQ-12) score of 3 or more (indicating current mental health issues), and have lived with their husbands or in-laws for at least 6 months. A total sample size of 912 was estimated at 80% power and α<.05 statistical significance level to detect a 15% absolute risk reduction in the IPV frequency and a 50% reduction in the GHQ-12 score in the intervention arm. The health care facilities will be randomly assigned to either the intervention or the control arm in a 1:1 ratio. Women visiting the health care facilities in the intervention and control arms will be recruited into the respective arms. In total, 38 participants from each health care facility will be included in the trial to meet the desired sample size. Eligible participants allocated to either arm will be assessed at baseline and follow-up visits after 6, 17, and 52 weeks after baseline. This study received funding in 2019. As of December 29, 2022, over 50% of eligible women had been recruited from both intervention and control sites. In total, 269 eligible women have been enrolled in the intervention arm and 309 eligible women in the control arm. The trial is currently in the recruitment phase. Data collection is expected to be completed by December 2023, after which data analysis will begin. If the intervention proves effective, it will provide evidence of how nonspecialist mental health care providers can address the harmful effects of IPV in resource-constrained settings with a high burden of IPV, such as Nepal. The study findings could also contribute evidence for integrating similar services into routine health programs in LMICs to prevent IPV and manage mental health problems among women experiencing IPV. ClinicalTrials.gov NCT05426863; https://clinicaltrials.gov/ct2/show/NCT05426863. DERR1-10.2196/45917.

Barriers to mental health treatment in primary care practice in low- and middle-income countries in a post-covid era: A systematic review.

General primary care workers and family physicians are a crucial work force in managing the mental health of people in any given region. However, the barriers they face in low- and middle-income countries (LMICs) may be worsened by the pandemic. This review aims to bring together evidence about mental health treatment challenges experienced by people in LMICs in primary care settings. The review focuses on the shortage of essential mental healthcare services, stigma and lack of competent primary care professionals in establishing these services and their importance in the COVID-19 pandemic context. The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the search strategy included keyword search terms (MeSH) to perform a search across three electronic databases - Critical Appraisal Skills Program assessed PubMed, SpringerLink, and Cochrane and quality of the articles. The articles selected were analyzed through thematic analysis to identify the main themes and conclude our findings. Findings indicate that out of 1792 publications found, 14 studies matched the desired criteria for the studies. Endnotes, database search filters, and Covidence data extraction tools were used to generate the relevant articles in this study. This study shows that primary care institutions have financial and management issues in providing mental health services and a shortage of competent mental health experts in primary care, especially mental health-trained family physicians. The study also identifies community stigma as the most prevalent barrier to seeking mental health therapy, reflecting the lack of community health education in LMICs.

The association of pain with suicidal ideation and suicide attempts with depressive symptoms among adults aged ≥50years from low- and middle-income countries.

We aimed to examine the relationship of pain with suicidal ideation and suicide attempts with depressive symptoms among adults aged ≥50years from six low- and middle-income countries (LMICs) (China, Ghana, India, Mexico, Russia, and South Africa). Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health were analyzed. Self-reported information on past 12-month suicidal ideation and suicide attempts among people with depressive symptoms was collected. Pain was assessed with the question "Overall in the last 30days, how much of bodily aches or pain did you have?" With answer options: "none", "mild", "moderate", "severe/extreme". Multivariable logistic regression was done to assess associations. Data on 34,129 adults aged ≥50years (mean [SD] age 62.4 [16.0] years; males 47.9%) were analyzed. Compared to no pain, mild, moderate, and severe/extreme pain were associated with 2.83 (95% CI=1.51-5.28), 4.01 (95% CI=2.38-6.76), and 12.26 (95% CI=6.44-23.36) times higher odds for suicidal ideation. For suicide attempt, only severe/extreme pain was associated with significantly increased odds (OR=4.68; 95% CI=1.67-13.08). In this large sample of older adults from multiple LMICs, pain was strongly associated with suicidal thoughts and suicide attempts with depressive symptoms. Future studies should assess whether addressing pain among older people in LMICs may lead to reduction in suicidal thoughts and behaviors.

Gender differences in HIV knowledge among adolescents and young people in low-and middle-income countries: a systematic review.

This review seeks to critically analyze studies assessing gender differences in HIV-related knowledge among adolescents and young people in low- and middle-income countries. Using PRISMA guidelines and searching Pubmed and Scopus online databases, the search strategy combined search keywords with Boolean operators: (HIV OR AIDS) AND (knowledge) AND (gender) AND (adolescents). AC and EG conducted the search and independently reviewed all articles in Covidence software; conflicts were resolved by GC. Articles were included if they evaluated differences in HIV knowledge in at least two groups ages 10-24 and were implemented in a low or middle-income country. The search resulted in 4,901 articles, of which fifteen studies, implemented in 15 countries, met selection criteria. Twelve evaluated differences in HIV knowledge in school settings; three evaluated participants in clinic settings. Adolescent males consistently scored higher in composite knowledge scores, as well as knowledge of HIV transmission, prevention, attitudes and sexual decision-making. We found gender-based discrepancies between knowledge, perception of risk and HIV prevalence among youth globally, with boys consistently scoring higher in HIV knowledge. However, there is significant evidence that social and cultural contexts render girls at high risk of HIV infection, and the gaps in girls' knowledge and boys' roles in HIV risk must be addressed urgently. Future research should consider interventions that facilitate discussion and HIV knowledge building across genders.

Effects of mobile technology-based interventions in promoting mental health and psychosocial wellbeing among young people in low-and middle-income countries: a systematic review protocol.

This review will aim to examine the effectiveness of mobile-based technologies among young people (10 to 24 years) in low- and middle-income countries in order to promote their mental health and psychosocial well-being. Such promotional interventions may be in the form of mobile technology-based education, information, or psychosocial counseling. Young people in low- and middle-income countries have limited access to mental health services. Mobile-based technologies, such as remote consultations, telehealth, and smartphone applications, can offer improved access to mental health services; however, to the best of our knowledge, there are no systematic reviews of effectiveness on this topic. Evidence sources from low- and middle-income countries involving mobile-based technologies for mental health and psychosocial support interventions for young people will be included. All experimental and observational studies published in English from 2010 to 2022 will be included. The review will follow JBI methodology for systematic reviews of effectiveness. Embase (Ovid), CINAHL (EBSCO), PsycINFO (ProQuest), AMED (Ovid), HMIC (Ovid) MEDLINE (PubMed), and Web of Science will be searched. Gray literature will be identified through Directory of Open Access Journals, ProQuest Dissertations and Theses, EThOs, Asia eHealth Information Network, Google Scholar, and Grey Literature Report. Retrieved articles will be screened against the inclusion criteria, followed by an assessment by 2 independent reviewers for methodological quality using standardized JBI appraisal tools. Data extraction will be done using standardized JBI data extraction tools. Narrative synthesis will be preferred if meta-analysis is not feasible and certainty of evidence will be assessed using the GRADE approach. PROSPERO CRD42022338749.

Equity in Global Health Research.

Equity in Global Health Research.

Exploring barriers to, and enablers of, evidence-informed hip fracture care in five low- middle-income countries: China, India, Thailand, the Philippines and Vietnam.

Globally, populations are ageing and the estimated number of hip fractures will increase from 1.7 million in 1990 to more than 6 million in 2050. The greatest increase in hip fractures is predicted in Low- and Middle-Income Countries (LMICs), largely in the Asia-Pacific region where direct costs are expected to exceed $US15 billion by 2050. The aims of this qualitative study are to identify barriers to, and enablers of, evidence-informed hip fracture care in LMICs, and to determine if the Blue Book standards, developed by the British Orthopaedic Association and British Geriatrics Society to facilitate evidence-informed care of patients with fragility fractures, are applicable to these settings. This study utilized semi-structured interviews with clinical and administrative hospital staff to explore current hip fracture care in LMICs. Transcribed interviews were imported into NVivo 12 and analysed thematically. Interviews were conducted with 35 participants from 11 hospitals in 5 countries. We identified five themes-costs of care and the capacity of patients to pay, timely hospital presentation, competing demands on limited resources, delegation and defined responsibility and utilization of available data-and within each theme, barriers and enablers were distinguished. We found a mismatch between patient needs and provision of recommended hip fracture care, which in LMICs must commence at the time of injury. This study describes clinician and administrator perspectives of the barriers to, and enablers of, high-quality hip fracture care in LMICs; results indicate that initiatives to overcome barriers (in particular, delays to definitive treatment) are required. While the Blue Book offers a starting point for clinicians and administrators looking to provide high-quality hip fracture care to older people in LMICs, locally developed interventions are likely to provide the most successful solutions to improving hip fracture care.

Systematic Review of Physical Activity, Sedentary Behaviour and Sleep Among Adults Living with Chronic Respiratory Disease in Low- and Middle-Income Countries.

Physical activity (PA), sedentary behaviour (SB) and sleep are important lifestyle behaviours associated with chronic respiratory disease (CRD) morbidity and mortality. These behaviours need to be understood in low- and middle-income countries (LMIC) to develop appropriate interventions.PurposeWhere and how have free-living PA, SB and sleep data been collected for adults living with CRD in LMIC? What are the free-living PA, SB and sleep levels of adults living with CRD?Patients and MethodsThe literature on free-living PA, SB and sleep of people living with CRD in LMIC was systematically reviewed in five relevant scientific databases. The review included empirical studies conducted in LMIC, reported in any language. Reviewers screened the articles and extracted data on prevalence, levels and measurement approach of PA, SB and sleep using a standardised form. Quality of reporting was assessed using bespoke criteria.ResultsOf 89 articles, most were conducted in Brazil (n=43). PA was the commonest behaviour measured (n=66). Questionnaires (n=52) were more commonly used to measure physical behaviours than device-based (n=37) methods. International Physical Activity Questionnaire was the commonest for measuring PA/SB (n=11). For sleep, most studies used Pittsburgh Sleep Quality Index (n=18). The most common ways of reporting were steps per day (n=21), energy expenditure (n=21), sedentary time (n=16), standing time (n=13), sitting time (n=11), lying time (n=10) and overall sleep quality (n=32). Studies revealed low PA levels [steps per day (range 2669–7490steps/day)], sedentary lifestyles [sitting time (range 283–418min/day); standing time (range 139–270min/day); lying time (range 76–119min/day)] and poor sleep quality (range 33–100%) among adults with CRD in LMIC.ConclusionData support low PA levels, sedentary lifestyles and poor sleep among people in LMIC living with CRDs. More studies are needed in more diverse populations and would benefit from a harmonised approach to data collection for international comparisons.

Agents of Change for Mental Health: A Survey of Young People’s Aspirations for Participation Across Five Low- and Middle-Income Countries

PurposeEffective intervention, policy, and research in mental health and well-being (MHWB) require young people to be understood not only as beneficiaries, but also as active agents in codesigning and implementing initiatives. To identify pathways for young people’s participation in promoting MHWB in low- and middle-income countries (LMICs), this study surveyed young people’s aspirations for engagement, their spheres of influence, capacity building needs, and key barriers to participation. MethodsUsing U-Report, United Nations Children’s Emergency Fund’s social messaging tool and data collection platform, we distributed a short quantitative survey to a nonrepresentative, but large sample of young people aged 15–29 across five LMICs: Nigeria, Brazil, Jamaica, South Africa, and Burundi. ResultsA total of 42,689 young people responded, with representation from most or all provinces within each country. Participants’ average age was 23.8 years (SD = 3.77). Young people’s core aspirations were to join a mental health awareness project and to support their peers. Participants considered schools and community settings to be the most important spheres for engagement. Lack of information about mental health was the main perceived barrier to participation, and mental health classes the main training need. DiscussionIn many countries, MHWB is not taught or discussed in schools and youth-led mental health interventions are rare. Findings from this study reveal clear aspirations for participatory engagement to promote MHWB among young people in LMICs. To support meaningful participation, policymakers and youth service providers must ensure that young people have access to mental health literacy training and opportunities to raise awareness in schools or community settings.

Anesthesiology Training in LMICs: Defining the Problem, Challenges, and Solutions

Features| October 2021 Anesthesiology Training in LMICs: Defining the Problem, Challenges, and Solutions Eugene Tuyishime, MBBS, MMed, MSc; Eugene Tuyishime, MBBS, MMed, MSc Search for other works by this author on: This Site PubMed Google Scholar William F. Powell, Jr., MD, MPH; William F. Powell, Jr., MD, MPH Search for other works by this author on: This Site PubMed Google Scholar Faye M. Evans, MD, FAAP Faye M. Evans, MD, FAAP Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor October 2021, Vol. 85, 35–36. https://doi.org/10.1097/01.ASM.0000795116.04062.61 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Eugene Tuyishime, William F. Powell, Faye M. Evans; Anesthesiology Training in LMICs: Defining the Problem, Challenges, and Solutions. ASA Monitor 2021; 85:35–36 doi: https://doi.org/10.1097/01.ASM.0000795116.04062.61 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu nav search search input Search input auto suggest search filter All ContentAll PublicationsASA Monitor Search Advanced Search Topics: advocacy, anesthesia care, anesthesia department, hospital, care of intensive care unit patient, developing countries, health status, income, internship and residency, mentorships, outreach The Lancet Commission on Global Surgery highlights the disparities that currently exist in access to surgical and anesthesia care in low-and middle-income countries (LMICs). It is estimated that nine in 10 people in LMICs are unable to obtain safe surgical care when needed (Lancet 2015;386:569-624). One of the major deficiencies is the lack of anesthesia providers. The World Federation of Societies of Anaesthesiologists (WFSA) workforce map demonstrates how skewed this gap is worldwide. For example, the density of physician anesthesia providers (PAPs) in high-income countries is 17.96 per 100,000, which is in stark contrast to the density of PAPs in low-income countries, which is only 0.19 per 100,000 (Anesth Analg 2017;125:98-90). This disparity exists for both PAPs and non-physician anesthesia providers (NPAPs). In order to provide safe surgical care worldwide, a scale-up of both PAPs and NPAPs is desperately needed. The solution seems simple: more anesthesia... You do not currently have access to this content.

No One Left Behind: Using Mixed-Methods Research to Identify and Learn from Socially Marginalised Adolescents in Low- and Middle-Income Countries

This article describes the mixed-methods approach used by the Gender and Adolescence: Global Evidence (GAGE) research programme. It discusses how qualitative and quantitative methods can be used both in isolation and combined to learn about the lives of adolescents in low- and middle-income countries (LMICs), focusing on the methodological and ethical approaches used to reach socially marginalised adolescents (including adolescents with disabilities, adolescents not in school, adolescent refugees, adolescents living in urban slums, adolescents who married as children, and adolescent mothers). We reflect on the implementation of the GAGE conceptual framework, discussing its strengths and weaknesses, and the challenges to promoting inclusive and genuinely mixed-methods research practices. While these methods have been adapted in the countries where research was undertaken, the conceptual framework provides a common methodological approach, utilising an intersectional lens. We show how mixed-methods approaches can contribute to the knowledge base on research with socially marginalised adolescent girls and boys globally, serving as an important resource for future research with young people in LMICs.

PROTOCOL: The effectiveness of social protection interventions in low- and middle-income countries: An evidence and gap map.

This evidence and gap map will provide an overview of the existing systematic reviews and impact evaluations on the key outcome domains and interventions aimed at improving social protection among people living in low- and middle-income countries (LMICs). The specific objectives of this map are to: (1) Develop a clear framework of types of interventions and outcomes related to the effectiveness of interventions on social protection for people in LMICs. (2) Map available systematic reviews and primary studies on the effectiveness of interventions on social protection for people in LMICs. (3) Provide a structured and accessible collection of existing evidence and identifying gaps in the available evidence on social protection intervention, thereby helping to inform the research agendas of funders and other organisations.

Community-Based Interventions for the Treatment and Management of Conflict-Related Trauma in Low-Middle Income, Conflict-Affected Countries: a Realist Review

Where low- and middle-income countries have limited economic resources to provide individualized mental health services to people exposed to conflict, community-based interventions may be more appropriate. We aimed to evaluate community level interventions for improving mental health outcomes in Low- and Middle-income countries (LMIC). A realist review of community-based interventions (CBIs) to improve mental health for people in LMIC following conflict. Five databases (Cochrane, PubMed, PsychINFO, Medline, and CINAHL) and a manual search of individual papers. We found 1318 articles, of which 29 were selected. Out of the 29 primary articles, 19 showed successful results, 4 showed mixed results, 1 showed inconclusive results, and 1 showed unsuccessful results. After analyzing the results, we found 3 mechanisms that may influence the effectiveness of these CBIs: the use of lay community members as intervention deliverers, the application of transdiagnostic approaches, and customized outcome assessment tools. Community-based approaches to improve mental health in LMICs are rare and evidence for their effectiveness is limited. Interventions that have a wide scope, train lay mental health workers, and use contextually adapted outcome assessment tools show promise.

A cross-cultural investigation of the conceptualisation of frailty in northern Tanzania

AbstractFrailty prevalence is higher in low- and middle-income countries (LMICs) compared with high-income countries when measured by biomedical frailty models, the most widely used being the frailty phenotype. Frailty in older people is becoming of global public health interest as a means of promoting health in old age in LMICs. As yet, little work has been done to establish to what extent the concept of frailty, as conceived according to ‘western’ biomedicine, has cross-cultural resonance for a low-income rural African setting. This study aimed to investigate the meaning of frailty contextually, using the biomedical concept of the frailty phenotype as a framework. Qualitative interviews were conducted with a purposive sample of older adults, their care-givers and community representatives in rural northern Tanzania. Thirty interview transcripts were transcribed, translated from Kiswahili to English and thematically analysed. Results reveal that despite superficial similarities in the understanding of frailty, to a great extent the physical changes highlighted by the frailty phenotype were naturalised, except when these were felt to be due to a scarcity of resources. Frailty was conceptualised as less of a physical problem of the individual, but rather, as a social problem of the community, suggesting that the frailty construct may be usefully applied cross-culturally when taking a social equity focus to the health of older people in LMICs.

Objectively measured far vision impairment and sarcopenia among adults aged ≥ 65years from six low- and middle-income countries.

There are currently no studies on visual impairment and sarcopenia. We investigated the cross-sectional association between objectively measured far vision impairment and sarcopenia in a nationally representative sample of older adults aged 65years and over from six low- and middle-income countries (LMICs). Cross-sectional, community-based data from the study on global ageing and adult health (SAGE) were analyzed. Far vision acuity was measured using the tumbling E LogMAR chart and classified as: no vision impairment (6/12 or better); mild vision impairment (6/18 or better but worse than 6/12); moderate vision impairment (6/60 or better but worse than 6/18); severe vision impairment (worse than 6/60). Sarcopenia was defined as having low skeletal muscle mass and either a slow gait speed or a weak handgrip strength. Associations were assessed with multivariable logistic regression. Fourteen thousand five hundred andeighty five individuals aged ≥ 65years were included in the analysis [mean (SD) age 72.6 (11.5) years; 54.1% females]. After adjustment for multiple potential confounders, compared to those with no vision impairment, the OR (95% CI) for sarcopenia in those with mild, moderate, and severe vision impairment were 1.10 (0.87-1.40), 1.69 (1.25-2.27), and 3.38 (1.69-6.77), respectively. The estimates for females and males were similar. The odds for sarcopenia increased with increasing severity of far vision impairment among older people in LMICs. The mere co-occurrence of these conditions is concerning, and it may be prudent to implement interventions to address/prevent sarcopenia in those with far vision impairment through the promotion of physical activity and appropriate nutrition.