Practice In Low-income Countries Research Articles

Improved menstrual health and the workplace: An RCT with female Bangladeshi garment workers

Menstrual hygiene practices in low-income countries are often limited by lack of finances and information, with potentially adverse consequences for women’s well-being and workplace outcomes. In a randomized controlled trial with around 1,900 female workers from four Bangladeshi garment factories, we relax both constraints individually and jointly by providing free sanitary pads and information on hygienic menstrual practices. Both access to sanitary pads and information improve menstrual practices, either by the adoption of new products, or by knowledge gains and improved use of traditional materials, and both interventions improve health outcomes. However, these positive effects do not translate to better labor outcomes, such as earnings and work attendance.

Assessing the effectiveness of a sexual and reproductive health and rights training programme in changing healthcare practitioners’ attitudes and practices in low-income countries

ABSTRACT Introduction In low-income countries the utilisation of sexual and reproductive health and rights (SRHR) services is influenced by healthcare practitioners’ knowledge, attitudes and practices. Despite awareness of the potential problems due to ingrained biases and prejudices, few approaches have been effective in changing practitioners’ knowledge, attitudes and practices concerning SRHR in low-income countries. Objectives 1) To assess whether participating in an SRHR international training programme (ITP) changed healthcare practitioners’ SRHR knowledge, SRHR attitudes and SRHR practices and 2) examine associations between trainees’ characteristics, their SRHR work environment and transfer of training. Methods A pre- and post-intervention study, involving 107 trainees from ten low-income countries, was conducted between 2017 and 2018. Paired samples t-test and independent samples t-test were used to assess differences between trainees’ pre- and post-training scores in self-rated SRHR knowledge, attitudes, knowledge seeking behaviour and practices. Linear regression models were used to examine association between trainees’ baseline characteristics and post-training attitudes and practices. Results Trainees’ self-rated scores for SRHR knowledge, attitudes and practices showed statistically significant improvement. Baseline high SRHR knowledge was positively associated with improvements in attitudes but not practices. High increases in scores on knowledge seeking behaviour were associated with higher practice scores. No statistically significant associations were found between scores that measured changes in SRHR knowledge, attitudes and practices. Conclusion The findings indicate that the ITP was effective in improving trainees’ self-rated scores for SRHR knowledge, attitudes and behaviours (practices). The strongest association was found between improvement in SRHR knowledge seeking behaviour and the improvement in SRHR practices. This suggests that behaviour intention may have a central role in promoting fair open-minded SRHR practices among healthcare practitioners in low-income countries.

Can tourism support resource circularity in small islands? On-field analysis and intervention proposals in Madagascar.

Open dumping and burning of solid waste are common practices in low-income countries. On small and touristic islands, the problem is exacerbated due to the additional volume of waste amount generated by tourists. This article presents how, using Nosy Be island in Madagascar as a case study, waste recovery and recycling can be fostered by tourism to tackle the waste challenge. About 95% of the waste of Nosy Be is openly dumped, discarded to sea or openly burned. Field analysis, interviews with local stakeholders and waste flow analysis served as methodological tools to assess the current solid waste management (SWM) system of Nosy Be. Stakeholder mapping and involvement as well as first exchange among local and international actors provided the basis to identify key practice and opportunities. Research findings highlight the importance of active participation and involvement of local partners supported by international experts, to suggest how touristic centres can serve as core of circular approaches. The article presents potential circular models to be implemented in Nosy Be, taking tourism as the entry point including the aspects of financial support, separated waste flows and the interest in 'green tourism marketing'. This case study underlines how international cooperation, touristic activities and common efforts can potentially help low-income communities improve their SWM practices.

Review of the slippage factors from open defecation-free (ODF) status towards open defecation (OD) after the Community-Led Total Sanitation (CLTS) approach implementation.

Open-defecation (OD) is one of the most widespread sanitation practices in low-income countries. This practice often causes diarrheal diseases and 760,000 deaths per year. To eradicate OD, several approaches have been developed, including Community-Led-Total Sanitation (CLTS) which is a participatory and community approach. The specificity of CLTS is that it is managed by the community itself, as its name implies, and that no subsidies or financial contributions from outside the community are used in the construction of the facilities. Although, the CLTS is effective in the short-term for eradicating OD, the long-term results are not encouraging: Open-Defecation-Free (ODF) communities revert to OD or partially use latrines. The present research is based on literature review and authors investigation in Burkina Faso. It was conducted to provide a comprehensive understanding of the factors that affect the sustainability of ODF-status leading to slippage in communities. It was found that these factors can be grouped into five categories: behavioral and social, technological, organizational, and vulnerability factors. The last one, socio-political factors, is a contribution from the authors as it was not reported in the literature yet. The authors have proposed graphical synthesis of all the slippage factors and their associated categories in the ODF-communities. Finally, authors have suggested that to sustain ODF-status of communities: include all stages of the sanitation value chain (SVC) in the CLTS, the follow-up activities after achieving ODF-status must be planned well in advance, sanitation marketing should be developed and the sanctions against the practice of OD have to be reinforced. Governments and donors should pay particular attention to the following options: raising awareness and regular monitoring after ODF certification, encouraging research on sustainable and pro-poor sanitation technologies, and building the capacity of implementing actors including facilitators. While obtaining ODF status is materialized by a sign with the status on it, this paper drew the attention of CLTS implementers to the lack of materialization of slippage when it occurs, and the absence of studies on the evolution of the community sanitation scale after ODF-status.

Level of shared decision making and associated factors among patients with mental illness in Northwest Ethiopia: Explanatory sequential mixed method study.

Shared decision-making is a patient-centered and a recovery-oriented mental health system in which consumers are encouraged to actively engage in illness management. Although shared decision-making research in mental health has evolved rapidly in the past two decades, there is a lack of studies examining the level and factors associated with shared decision-making practice in low-income countries like Ethiopia. An institutional-based explanatory sequential mixed method study design was conducted from July 18 to September 18, 2022, at Bahir Dar city specialized hospitals. A systematic random sampling technique was used. The level of shared-decision making was measured by 9-item shared decision-making questionnaire among 423 patients with mental illness. Epicollect5 was used to collect data, which was then exported to the Statistical Package for social science version 25 for analysis. Variables with a P-value < 0.25 were considered candidates for the multivariate logistic regression analysis. The odds ratio with a 95% confidence interval was used to show the strength of the association. An in-depth interview was conducted among ten purposively selected participants. Low shared decision-making practice was found to be 49.2% (95% CI 45.9%-55.7%). The Multivariate analysis showed that low perceived compassionate care (AOR = 4.45; 95%CI 2.52-7.89), low social support (AOR = 1.72; 95% CI 1.06-2.80), and no community-based health insurance (AOR = 1.96; 95%CI l.04-3.69) were positively associated with low shared decision making. The qualitative result showed that the most common barriers to shared decision-making were a lack of empathy and a shortage of mental health workers. Almost half of the patients had low shared decision-making practices. This implies that shared decision-making requires high attention as it is essential for patient-centered care.

Infant and Young Child Feeding Practices and Mycotoxin Contamination of Complementary Food Ingredients in Kongwa District, Tanzania

BackgroundInadequate infant and young child feeding (IYCF) practices in low income countries contribute to poor child growth and development. ObjectivesTo assess IYCF practices and mycotoxin contamination in complementary food ingredients across 2 seasons in Kongwa District, Tanzania. MethodsEarly feeding practices in 115 rural households from 25 villages in Kongwa District, Dodoma region, Tanzania, were assessed. The primary caregiver for the index child (6–18 mo of age) was interviewed using a structured dietary questionnaire at recruitment (October/November 2017), and revisited 6 mo later. The questionnaire included questions on typical food consumption in the past 24 h. This study reports 7 of the revised and new IYCF indicators, including minimum dietary diversity (MDD). Aflatoxins (AF) and fumonisins (FUM) were analyzed in complementary food ingredients for pooled household samples to broadly establish patterns of contamination at the village level. ResultsThe MDD was not met for 80% of infants at recruitment (survey 1) as compared with 56% in survey 2 (P < 0.05). Changes in MDD between the 2 surveys were dependent on season but not age. Maize was consumed by >90% of households in both surveys, whereas groundnut was consumed by 44% and 64% of households in surveys 1 and 2, respectively. AF concentrations in maize and groundnuts were found to be higher in survey 1 than in survey 2. Overall, AF exceeded the legal limit in 18% of maize and 61% of groundnut pooled samples in both surveys. Maize was also contaminated with significant FUM concentrations. ConclusionsPoor diets were common among children in Kongwa District. Reliance on maize and groundnuts exposes this vulnerable age group to AF (also to FUM in maize). Inadequate diet and exposure to AF and FUM have separately been linked to linear growth retardation. Low diet diversity and mycotoxins contamination are plausible causes for poor growth and development among infants in Central Tanzania. Curr Dev Nutr 20XX;x:xx.

Hysterosalpingographic, ultrasonographic and clinical profile of infertile women in Butembo, Eastern Democratic Republic of Congo.

infertility is a reproductive health issue in modern society. In developing countries, ultrasonography and hysterosalpingography (HSG) are first-line exams investigating infertility in women. It is a highly reported issue in Africa and is linked to abnormalities diagnosed by medical imagery investigations. Our research aimed to evaluate ultrasonography and HSG usage in female infertility investigation in eastern DR Congo, and to point out the most frequent lesions in infertile women in this area. it was a cross-sectional research. It included 1024 patients in four equipped hospitals with HSG and ultrasonography, who consulted from January 1st, 2019 up to December 31st, 2021. Data were collected from consultation dossiers and imagery protocols. of 1024 patients, the mean age was 30.85±5.05 years, 41.79 % (n=428) had primary infertility and 57.71% (n=591) had secondary infertility with parity ranges 1.28±1.25, abortion 1.17±1.33. HSG usage rate was 26.85% (n=275) whereas ultrasonography was 66.01%(n=749). The prevalent diagnosed lesions were uterine myomas 10.51 % (n=71), polycystic ovary syndrome (PCOS) 8.28%(n=56), endometrial dysplasia 7.99% (n=54), ovarian cysts 5.03% (n=34) at ultrasonography and tubal obstructions 53.45 %(n=147), hydrosalpinx 4.73% (n=13), cervical impotence 3.27% (n=9), uterine synechias 2.55%(n=7), müllerian abnomalies 2.55%(n=7), uterine retroversion 2.18% (n=6) at HSG. History of upper genital infection was a risk factor aOR= 3.71, 95%CI 1,55-8,88; p <0.001 for tubal obstruction to HSG. regarding the high prevalence of tubal and uterine abnormalities in infertile women of eastern DR Congo, ultrasonography, and HSG should be more performed exams in clinical practice in low-income countries.

The usefulness of nutrition and health videos displayed on mobile phones in rural Uganda: Experiences of community health workers and mothers.

Improvements in community health workers' (CHWs) knowledge and practices in low‐income countries increasingly involve mobile phones and videos. However, little data exists on CHWs’ and mothers’ experiences of using such phones and videos. In this study, educational videos on nutrition, health and hygiene were downloaded onto mobile phones, which were given to 12 CHWs in rural Uganda. In 2018, these CHWs used the videos for a period of 3 months to support their work during their visits with families. We subsequently conducted individual interviews with eight CHWs and held four focus group discussions with 16 mothers. From the inductively analysed data, we identified four key themes: impact, competence, meaningfulness and choice, which are also dimensions of the Intrinsic Task Motivation Model. The model describes the motivation of workers and has previously been used in connection with CHWs. In our study, CHWs and mothers considered that the videos had more strongly impacted their learning than traditional teaching methods, and they felt the videos improved the child feeding and caring competence of both CHWs and mothers. Furthermore, the CHWs found that the videos enhanced the meaningfulness of their work, as they felt more greatly appreciated and necessary. In addition, they experienced more freedom of choice in their ability to influence their working routines. This study shows that educational videos are well received among CHWs and mothers. Educational videos are a promising method to maintain and improve the motivation of voluntary CHWs and influence correct child feeding and hygiene practices in Uganda.

A 10-hours workshop improves physical activity prescription for mental illness knowledge and confidence in health care professionals: a nation-wide multicentre study from Uganda

Purpose Lack of knowledge about and confidence in physical activity (PA) prescription for people with mental illness are important barriers for clinical practice in low-income countries. The aim of this study was to evaluate whether a 10-hour workshop improved the knowledge and confidence in PA prescription among health care professionals in 13 regional referral hospitals across Uganda. Material and methods 260 health care professionals (age = 40.4 ± 10.8 years; 48% women; 63.8% nurses, 10% social workers, 8.1% psychologists, 7.3% medical doctors, 5.8% psychiatrists, 5% physical or occupational therapists) completed the Exercise in Mental Illness Questionnaire – Health Professionals Version (EMIQ-HP) pre- and post-workshop. Results The EMIQ-HP PA knowledge score (3.1 ± 0.7 versus 1.3 ± 1.3, p < 0.001, Cohen’s d = 1.28, 95% confidence interval, CI = 1.04–1.52, i.e., large effect) and EMIQ-HP confidence in PA prescription score (3.0 ± 0.8 versus 1.2 ± 1.2, p < 0.001, Cohen’s d = 1.14, 95% CI = 0.91–1.36, i.e., large effect) improved significantly following training. Significantly more benefits and fewer barriers to prescribing PA in busy low-resourced settings were reported. Conclusions Training in PA counselling improved the knowledge and confidence in PA prescription in Ugandan health care professionals. Future research should investigate whether PA uptake in people with mental illness can be improved via additional training of health care professionals. IMPLICATIONS FOR REHABILITATION The majority of mental health professionals never recommend physical activity to their patients in low-resourced settings and increased awareness is needed to improve rehabilitation programs. Training in prescribing physical activity using the 5A framework improves knowledge about physical activity prescription in mental health professionals at all levels of care. Training in prescribing physical activity using motivational interviewing improves confidence in physical activity prescription in rehabilitation programs. Training in prescribing physical activity reduces perceived barriers for prescribing in rehabilitation programs in low-resourced settings.

Analysis of Human Gut Microbiota Composition Associated to the Presence of Commensal and Pathogen Microorganisms in Côte d’Ivoire

Background: The human gut microbiota is a microbial ecosystem contributing to the maintenance of host health with functions related to immune and metabolic aspects. Relations between microbiota and enteric pathogens in sub-Saharan Africa are scarcely investigated. The present study explored gut microbiota composition associated to the presence of common enteric pathogens and commensal microorganisms, e.g., Blastocystis and Entamoeba species, in children and adults from semi-urban and non-urban localities in Côte d’Ivoire. Methods: Seventy-six stool samples were analyzed for microbiota composition by 16S rRDNA sequencing. The presence of adeno-, entero-, parechoviruses, bacterial and protozoal pathogens, Blastocystis, and commensal Entamoeba species, was analyzed by different molecular assays. Results: Twelve individuals resulted negative for any tested microorganisms, 64 subjects were positive for one or more microorganisms. Adenovirus, enterovirus, enterotoxigenic Escherichia coli (ETEC), and Blastocystis were frequently detected. Conclusions: The bacterial composition driven by Prevotellaceae and Ruminococcaceae confirmed the biotype related to the traditional dietary and cooking practices in low-income countries. Clear separation in UniFrac distance in subjects co-harboring Entamoeba hartmanni and Blastocystis was evidenced. Alpha diversity variation in negative control group versus only Blastocystis positive suggested its possible regulatory contribution on intestinal microbiota. Pathogenic bacteria and virus did not affect the positive outcome of co-harbored Blastocystis.

Using National Survey Data From Nigeria to Assess Maternal-Child Dietary Concordance and Inform Nutrition Program Strategy

Abstract Objectives Improving child diet diversity is a policy priority in many settings. Multiple factors influence complementary feeding practices in low-income countries including household food access, caregiver-level factors and cultural practices. Child's dietary data is often available in national surveys (i.e., Demographic and Health Surveys, DHS), but they typically lack diet data from adults. The 2018 Nigeria DHS was among the first to measure food group intake in both young children and women. We describe the relationship between child and maternal diet diversity in Nigeria and highlight implications for design of infant and young child feeding (IYCF) programs. Methods Using the Nigeria DHS 2018 dataset, we estimated consumption of individual food groups in the previous 24 hours as well as minimum dietary diversity for children 6–23 months (MDD-C) and their mothers, women 15–49 years (MDD-W) using WHO-UNICEF definitions. We compare rates of concordance and discordance between n = 8975 mother-child pairs for individual food groups and MDD using McNemar's tests. Probit regression was used to identify drivers of MDD-C. Results Nationally, 22% of children achieve MDD-C; 51% of mothers achieve MDD-W. For both populations, the most commonly consumed group is grains, roots and tubers (&amp;gt;80%) Dairy and eggs are the least consumed. Maternal-child (age 12–23 months) discordance is highest for consumption of legumes and nuts (36%), vitamin A rich fruits and vegetables (39%) and other fruits and vegetables (57%); mothers consume these more frequently. Children are more likely than mothers to consume dairy (19% vs 8%) and eggs (8% vs 4%). Maternal-child food group discordance is consistently higher for children 6–11months than children 12–23 months. Results vary at state level and by maternal age group. Children's MDD probability is increased by MDD-W (27%, P &amp;lt; 0.001), higher maternal education (8%, P &amp;lt; 0.01) and household wealth (7%, P &amp;lt; 0.01). Conclusions Maternal and child diet diversity is suboptimal in Nigeria. Maternal diet is a primary driver of child diet in Nigeria. Legumes and nuts and fruits and vegetables are available but not consistently fed to children; an important finding for IYCF program design. The forthcoming DHS-8 core questionnaire will provide child and maternal diet data for more than 90 countries. Funding Sources Bill &amp; Melinda Gates Foundation.

Bias in the perceived prevalence of open defecation: Evidence from Bihar, India.

People often form perceptions about how prevalent a behavior is in a social group. However, these perceptions can be inaccurate and biased. While persistent undesirable practices in low-income countries have drawn global attention, evidence regarding people's perception of how prevalent these practices are is scarce. Among those harmful practices, open defecation in India remains a significant public health concern, where it perpetuates the vicious cycle of disease and poverty. In this study, we focus on measuring the perceived prevalence of open defecation among respondents in Bihar, India. We examined the bias in perceived prevalence, which is defined as a pattern of deviation from the actual prevalence of open defecation. Results showed that respondents who defecate in the open overestimate the prevalence of open defecation, whereas those who consistently use toilets underestimate it. This finding suggests a false consensus bias in the perceived prevalence of open defecation. Scholars, policymakers, and program implementers who seek to correct misperceptions about open defecation by broadcasting real prevalence should be aware of biases in the perceived prevalence and address them in behavior change interventions.

Artificial Intelligence and Journalistic Practice: The Crossroads of Obstacles and Opportunities for the Pakistani Journalists

ABSTRACT In the past two decades, technological advancement has reshaped the news media landscape in many developed and developing countries of the world. Journalistic practice, especially in large-scale economies, is experiencing transformations due to the introduction of automatic artificial intelligence processes into different aspects of news production and dissemination. Now devices and machines are taking on the role of communicator, replacing journalists as communicators. It is important to analyse whether journalism in low income countries has begun to feeling the ripple of artificial intelligence for technologically advanced journalistic practices and newsrooms. Using the Human-Machine Communication framework, this study advances knowledge about what AI can do to transform journalism practice in low-income countries, which is vital to compare the implications of AI in other similar socioeconomic contexts and news media ecologies. Thus, this study specifically reflects upon the case of Pakistan. It investigates how the Pakistani journalists perceive AI technology in the role of communicator and how they view the human-machine communication process. This study identifies constraints and explores opportunities for the use of artificial intelligence in Pakistan’s mainstream news media. To address these aims, this study uses the qualitative method of in-depth interviews, and presents the findings using thematic analysis.

Critical insights on the demographic concept of “birth spacing”: locating Nef in family well-being, bodies, and relationships in Senegal

Birth spacing has emerged since the early 1980s as a key concept to improve maternal and child health, triggering interest in birth spacing practices in low-income countries, and drawing attention to prevailing norms in favour of long birth intervals in West Africa. In Senegal, the Wolof concept of Nef, which means having children too closely spaced in time, is morally condemned and connotes a resulting series of negative implications for family well-being. While Nef and “birth spacing” intersect in key ways, including acknowledging the health benefits of longer birth intervals, they are not translations of each other, for each is embedded in distinct broader cultural and political assumptions about social relations. Most notably, proponents of the demographic concept of birth spacing assume that the practice of using contraception after childbearing to postpone births could contribute to “empowering” women socially. In Senegal, by contrast, preventing Nef (or short birth intervals) is also viewed as strengthening family well-being by allowing women to care more fully for their family. This paper draws on policy documents and interviews to explore women's and men's understanding of Nef, and in turn critically reflect on the demographic concept of birth spacing. Our findings reinforce the relevance of the concept of birth spacing to engage with women and men around family planning services in Senegal. Accounts of the Nef taboo in Senegal also show that social norms stigmatising short birth intervals can legitimise constraints faced by women on control of their body.

Socioeconomic restraints and brain tumor surgery in low-income countries.

Healthcare spending has become a grave concern to national budgets worldwide, and to a greater extent in low-income countries. Brain tumors are a serious disease that affects a significant percentage of the population, and thus proper allocation of healthcare provisions for these patients to achieve acceptable outcomes is a must. The authors reviewed patients undergoing craniotomy for tumor resection at their institution for the preceding 3 months. All the methods used for preoperative planning, intraoperative management, and postoperative care of these patients were documented. Compromises to limit spending were made at each stage to limit expenditure, including low-resolution MRI, sparse use of intraoperative monitoring and image guidance, and lack of dedicated postoperative neurocritical ICU. This study included a cohort of 193 patients. The average cost from diagnosis to discharge was $1795 per patient (costs are expressed in USD). On average, there was a mortality rate of 10.5% and a neurological morbidity rate of 14%, of whom only 82.2% improved on discharge or at follow-up. The average length of stay at the hospital for these patients was 9.09 days, with a surgical site infection rate of only 3.5%. The authors believe that despite the great number of financial limitations facing neurosurgical practice in low-income countries, surgery can still be performed with reasonable outcomes.

Non-adult child supervision practices in Lao People's Democratic Republic.

Researchers have paid little attention to non-adult child supervision and the prevalence and factors influencing this practice in low-income countries. A better understanding of this phenomenon is needed to inform the development and implementation of policies and interventions to enhance child supervision in those settings. This study explores the prevalence and factors associated with young children being home alone or under the care of another young child in Lao People's Democratic Republic. Using the 2011-2012 Lao Social Indicator Survey (N = 10,740 for the subsample of 'child was home alone' and N = 10,539 for the subsample of 'child cared by another child < 10 years of age'), multi-level Poisson regressions were performed to determine the number of days children under five years of age were home alone or under the care of another child younger than 10 years of age. Large discrepancies across provinces and between urban and rural populations within each province were found. Children living in rural areas were more than five times more likely to be unsupervised than children living in urban settings (incidence rate ratio, IRR 5.2; 95% CI: 1.8-15.2), and children living in rural areas were nearly twice more likely to be under the care of another child than children living in urban settings (IRR 1.9; 95% CI: 1.3-2.8). Age was also a common factor in explaining variation in both dependent variables. Policies aimed at facilitating adequate child care and supervision should consider rurality to increase children's protection.

Dietary Diversity Practice and Associated Factors Among Infants and Young Children in Haramaya Town, Ethiopia

Optimum child feeding is crucial for growth, development, and better health in later life. Dietary diversity is a critical part of the feeding practices. However, there is limited evidence on dietary diversity practice in low-income countries, like Ethiopia. This study assessed dietary diversity practice and associated factors among mothers of infants and young children aged 6-23 months in Haramaya Town, Eastern Ethiopia&lt;strong&gt;. &lt;/strong&gt;Community based cross-sectional study design was used and study participants were selected by simple random sampling. Data were collected using a pre-tested questionnaire by face-to-face interview. The collected data were entered to EpiData version 3.1 and exported to SPSS version 22.0 for analysis. Characteristics of the study participants were described by using frequencies, percentages, summary measures, and tables. Bi-variable and multi-variable analyses were used to identify the associated factors. Statistical significance was declared at p-value &amp;lt; 0.05. The study included 635 participants yielding to a response rate of 98.1%. The prevalence of dietary diversity practice was 25.2%. Mothers learned up to secondary level or above [(AOR=2.97, 95% CI: (1.26, 6.99)], mothers who had job [(AOR=3.21, 95% CI: (1.41, 7.29)], older children [(AOR=2.51, 95% CI: (1.45, 4.34)], male children [(AOR= 2.08, 95% CI: (1.29, 3.33)], healthy children [(AOR=2.65, 95% CI: 1.36, 5.16)] and richest households [(AOR=4.45, 95% CI: 1.94, 10.22)] were associated with dietary diversity practice. Generally, the dietary diversity practice was low. Therefore, attention should be given to mothers with no formal education and efforts should be done to improve the socioeconomic status of the households.

Calcium Supplementation to Prevent Preeclampsia: Translating Guidelines into Practice in Low-Income Countries

The WHO issued a strong recommendation that pregnant women be provided calcium supplements to prevent preeclampsia. This is the first recommended nutritional intervention to prevent this condition, a leading cause of maternal mortality globally. As health systems seek to implement this new intervention, a number of issues require further clarification and guidance, including dosage regimen, supplement formulation, and alignment with other antenatal nutritional interventions. We summarize key evidence on the above points and offer our views on good practices. Most developing countries have low calcium intake, so where habitual calcium intake is unknown, calcium supplements are likely beneficial. In our view, policymakers and program planners should consider adopting doses between 1.0 and 1.5 g elemental calcium/d, depending on the local average and variation in dietary calcium intake, logistical feasibility, and acceptability in the target population. Prudent practice would entail daily administration as calcium carbonate administered in divided doses of not >500 mg elemental calcium per dose. For ease of prescribing and adherence, calcium [as with iron and folic acid (IFA)] should be administered routinely to pregnant women from the earliest contact in pregnancy until delivery. Calcium's acute inhibitory effect on iron absorption translates to minimal effects in clinical studies. Therefore, to simplify the regimen and facilitate adherence, providers should not counsel that calcium and IFA pills must be taken separately. Although further research will shed more light on clinical and programmatic issues, policies can be implemented with ongoing revision as we continue to learn what works to improve maternal and newborn health.

The Surgical Workforce and Surgical Provider Productivity in Sierra Leone: A Countrywide Inventory

BackgroundLimited data exist on surgical providers and their scope of practice in low-income countries (LICs). The aim of this study was to assess the distribution and productivity of all surgical providers in an LIC, and to evaluate correlations between the surgical workforce availability, productivity, rates, and volume of surgery at the district and hospital levels.MethodsData on surgeries and surgical providers from 56 (93.3 %) out of 60 healthcare facilities providing surgery in Sierra Leone in 2012 were retrieved between January and May 2013 from operation theater logbooks and through interviews with key informants.ResultsThe Sierra Leonean surgical workforce consisted of 164 full-time positions, equal to 2.7 surgical providers/100,000 inhabitants. Non-specialists performed 52.8 % of all surgeries. In rural areas, the densities of specialists and physicians were 26.8 and 6.3 times lower, respectively, compared with urban areas. The average individual productivity was 2.8 surgeries per week, and varied considerably between the cadres of surgical providers and locations. When excluding four centers that only performed ophthalmic surgery, there was a positive correlation between a facility’s volume of surgery and the productivity of its surgical providers (rs = 0.642, p < 0.001).ConclusionsLess than half of all of the surgery in Sierra Leone is performed by specialists. Surgical providers were significantly more productive in healthcare facilities with higher volumes of surgery. If all surgical providers were as productive as specialists in the private non-profit sector (5.1 procedures/week), the national volume of surgery would increase by 85 %.

Annals of Tropical Paediatricswill becomePaediatrics and International Child Healthfrom 2012

The title of Annals of Tropical Paediatrics: International Child Health will change to Paediatrics and International Child Health with effect from February 2012 with publication of the first issue of Volume 32. A new editorial board has been appointed and members were published in the February 2011 issue. The abbreviated title will be Paediatr Int Child Health. The rationale for the change is as follows. Annals of Tropical Paediatrics publishes papers on topics relevant to developing countries from a wide variety of countries throughout the world, mainly developing or low-income countries, but also from industrialised settings, on subjects relevant to developing countries. Thus, the word ‘tropical’ is no longer considered appropriate to publications from many of those countries which do not have a tropical climate and therefore do not have tropical diseases in the strictest sense. The new title embraces the key elements of the papers we publish: paediatrics, which encompasses clinical and laboratory aspects, and international child health which covers the wide spectrum of topics in community child health. Notwithstanding the majority of their populations being poor, some developing counties are now using advanced medical treatments and surgical and medical procedures at a level seen in industrialised countries. Submissions relating to these are considered for publication as long as they have a broad relevance to practice in low-income countries. However, authors of highly technical papers or reports of very expensive investigations or treatments are usually advised to consider submitting to more specialised journals of paediatrics. Since 2005, the journal has published invited reviews on a variety of subjects at a state-of-the-art level. We are very grateful to these authors for the quality of their work and the support they give the journal. Unsolicited and systematic reviews are also welcome, and those which receive favourable peer review are published. In the past, there have been occasional commentaries on papers in current issues. We now try to publish commentaries regularly, depending, of course, on receipt of papers appropriate for comment. Original articles of high quality are welcome, particularly those which report scientific research and prospective clinical and community studies. Case reports are also encouraged but these must be on unusual conditions or complications, not mere repetition of the known topics which are readily available in textbooks of paediatrics. To be of value to readers, the discussion must be of a high quality based on a substantial review of the literature. It is hoped that the new title will attract an even broader spectrum of paediatrics than the journal has published hitherto. Paediatrics and International Child Health will retain the ethos of the journal when it was first published in 1981 under the editorship of the founder, Ralph Hendrickse: to provide an opportunity for paediatricians working in developing countries, often under very difficult conditions, to publish in an international journal. Annals of Tropical Paediatrics (2011) 31, 189–190