Research In Low- And Middle-income Countries Research Articles

An evaluation of the Hawthorne effect in a clinical trial of trauma care in Ghana

AbstractIntroductionHawthorne effect refers to changes in clinician behavior in response to being observed. It has been minimally evaluated in trauma and surgical research, especially in low‐ and middle‐income countries (LMICs).MethodsWe used data from the first (control) phase of a randomized clinical trial in Ghana (2020‐21). Trained observers were stationed in emergency units in eight non‐tertiary hospitals to observe the achievement of key performance indicators (KPI) (KPIs) of trauma care. We hypothesized that the observers' presence would create a Hawthorne effect, resulting in clinicians (doctors, nurses) performing above their usual level, with performance highest immediately after the observers were introduced, and with performance then declining over time toward the usual baseline.ResultsWe enrolled 2067 injured patients. Achievement of 13 out of 16 KPIs declined significantly over the 14 months after the introduction of observers. For example, airway assessment declined from 77% initially to 60% at the end of the phase (p < 0.001). Chest examination declined from 66% to 31% (p < 0.001). Distal pulses checked declined from 45% to 7% (p < 0.001). The slope of decline in KPI achievement ranged from 0.8%/month (mobility assessed) to 15.9%/month (distal pulses checked).ConclusionsThe decline in KPI achievement over time is consistent with the hypothesis that clinicians performed above their usual level just after the observers were introduced, with performance then declining toward the usual baseline. This study is among the first to provide quantitative data on the Hawthorne effect for trauma research in LMICs. These data are useful for the design of future observational studies and clinical trials.

Challenges in institutional ethical review process and approval for international multicenter clinical studies in lower and middle-income countries: the case of PARITY study

BackgroundOne of the greatest challenges to conducting multicenter research studies in low and middle-income countries (LMICs) is the heterogeneity in regulatory processes across sites. Previous studies have reported variations in requirements with a lack of standardization in the Institutional Review Board (IRB) processes between centers, imposing barriers for approval, participation, and development of multicenter research.ObjectivesTo describe the regulatory process, variability and challenges faced by pediatric researchers in LMICs during the IRB process of an international multicenter observational point prevalence study (Global PARITY).DesignA 16-question multiple-choice online survey was sent to site principal investigators (PIs) at PARITY study participating centers to explore characteristics of the IRB process, costs, and barriers to research approval. A shorter survey was employed for sites that expressed interest in participating in Global PARITY and started the approval process, but ultimately did not participate in data collection (non-participating sites) to assess IRB characteristics.ResultsOf the 91 sites that sought IRB approval, 46 were successful in obtaining approval and finishing the data collection process. The survey was completed by 46 (100%) participating centers and 21 (47%) non-participating centers. There was a significant difference between participating and non-participating sites in IRB approval of a waiver consent and in the requirement for a legal review of the protocol. The greatest challenge to research identified by non-participating sites was a lack of research time and the lack of institutional support.ConclusionsGlobal collaborative research is crucial to increase our understanding of pediatric critical care conditions in hospitals of all resource-levels and IRBs are required to ensure that this research complies with ethical standards. Critical barriers restrict research activities in some resource limiting countries. Increasing the efficiency and accessibility of local IRB review could greatly impact participation of resource limited sites and enrollment of vulnerable populations.

Barriers to Implementing a Quality Improvement Program in Low- and Middle-Income Countries: Adequacy of Resources.

Low- and middle-income countries (LMICs) report disproportionally worse cancer mortality. Current global cancer control efforts focus predominantly on expanding access to multimodality treatment for patients, whereas less attention has been spent on implementing strategies to ensure sustained quality assessment and improvement across the cancer care continuum. The goal of this focused review was to examine specific resource barriers to the development and implementation of quality improvement programs in LMICs. In this article, we use a nonsystematic review process to discuss the existing literature on four resource barriers within the context of cancer care delivery in LMICs, focusing on staff, time allocated for quality improvement work, research infrastructure, and funding. We provide possible solutions to address these barriers and share examples of specific quality improvement initiatives implemented across different world regions. Possible solutions to address these resource barriers include investment in human resources by increasing recruitment and training of the workforce, engagement of medical trainees and patients in quality improvement work, establishment of cancer registries and electronic medical records, and prioritization by large international funding agencies to invest in quality improvement research in LMICs. This review highlights four prevalent resources barriers to quality improvement in LMICs. Using examples from Botswana, Colombia, India, and Rwanda, we demonstrate solutions that may help overcome these barriers.

Capacity building for road safety in LMICs: the need for a sustainable local knowledge and research infrastructure

Road crashes continue to be a major cause of death and serious injury for low- and middle-income countries (LMICs). At the global level, 90% of traffic fatalities occur in these countries with a dramatic daily amount of 3 260 road deaths, many of whom are children. The first UN Decade of Action for Road Safety 2011–2020 was designed to develop a massive movement towards a decrease of these numbers. This resulted in many initiatives to introduce the safe system approach in LMICs, i.e. to implement road safety management, make roads, road users, and vehicles safer, and improve post-crash health care. International organisations together with NGOs and universities prepared road safety guides and manuals, gave courses and webinars, introduced auditing and inspection systems, with the overall intention to build capacity in LMICs. Together these actions contributed to a variety of road safety developments in LMICs but the overall results were still modest. At the third Global Ministerial Conference on Road Safety in Stockholm, 2020, and in the Global Status report by the World Health Organization, 2023, the results of all efforts were presented and evaluated. Many countries made progress through road safety management and better legislation addressing risk factors such as speeding, drinking and driving, failing to use seatbelts, and poor infrastructure design. However, the reduction in road deaths strongly lagged behind the original goals. Continued implementation of programs and development of new approaches are needed to make a breakthrough, and to reach the goals of the 2nd Decade of Action, i.e. a 50% reduction in fatalities by 2030, and the same percentage reduction in injuries. The present position paper argues that despite the enormous amount of road safety information, which has been and is ‘sent’ to LMICs, and despite the quality and robustness of international organisations behind these programs, there is a shortfall in the scale of the knowledge and research infrastructure currently existing in LMICs, which is needed to ‘receive and transfer’ this knowledge. In order to develop evidence-based policy, LMICs need research programs that are able to transfer safe system principles to the local context and culture. Several literature overviews illustrate the lack of such research in LMICs, i.e. the limited number of programs at local universities and research institutes. Although recently initiatives have been taken in some countries, the implementation of such programs is urgently needed. Based on this observation we call on international organisations to establish a special program for the development of a sustainable road safety knowledge and research infrastructure in LMICs. Such structural local capacity is a prerequisite to translate international road safety knowledge into local guidelines and to develop an evidence-based road safety policy. Most importantly, this local infrastructure will give countries a national knowledge bank, thus providing them with an urgently needed sustainable road safety memory.

Development of a target product profile for new glucose self-monitoring technologies for use in low- and middle-income countries.

Most glucose self-monitoring devices have been developed with high-income countries in mind. We developed a target product profile (TPP) for new glucose self-monitoring technologies for users in low- and middle-income countries (LMICs). A draft TPP including 39 characteristics was developed by an expert group including diabetes specialists, device specialists, and people with diabetes, incorporating findings from qualitative research in LMICs. Each characteristic had minimal and optimal requirements for two use cases, frequent and sporadic use. Characteristics requiring refinement were identified via online survey. Characteristics with agreement level <90% for any requirement were reviewed by the expert group and amended as appropriate. One characteristic (shelf life) had agreement <75% (both requirements for both use cases). Characteristics with agreement ≥75% and <90% for the frequent use case included infrastructure level, measurement cycle, duration of use before replacement, interchangeability, and calibration (both requirements), and activity log and price per month to end payer (minimal requirement). Intended use (both requirements), accuracy, and price per month to end payer (optimal requirement) had agreement ≥75% and <90% for the sporadic use case. This TPP will inform developers on requirements for glucose self-monitoring technologies for LMICs, and support decision-makers in evaluating existing devices.

Community engagement in research addressing infectious diseases of poverty in sub-Saharan Africa: A qualitative systematic review.

Though engaging communities in research processes has several advantages and implications, research efforts are poorly embedded in and linked with communities, especially in low- and middle-income countries (LMICs). There is also a need for more empirical evidence on effectively engaging communities in research in LMICs, specifically in Sub-Saharan Africa (SSA). Thus, there is an urgent need to synthesize existing evidence on community engagement experiences in research in SSA. Therefore, this review aimed to synthesize the existing community engagement experiences and related barriers to engaging communities in health research focusing on infectious diseases of poverty in SSA. The systematic review was conducted following the JBI methodology for qualitative systematic reviews. The review included both published and unpublished studies. A thematic analysis approach was used for data synthesis. A total of 40 studies were included in the review. Community engagement in the conceptualization of the research project, analysis, dissemination, and interpretation of the result was rare. On top of this, almost all the research projects engaged the community at a lower level of engagement (i.e., informing or consulting the community at some point in the research process), suggesting the importance of integrating communities in the entire research cycle. The lack of shared control over the research by the community was one of the significant challenges mentioned. This review uncovered that community engagement in the research process is minimal. Nevertheless, the review generated valuable evidence that can inform researchers and research stakeholders to promote effective community engagement in the research process addressing infectious diseases of poverty. Despite these, it requires rigorous primary studies to examine the applicability and usefulness of community engagement, including developing valid metrics of engagement, standardizations of reporting community engagements, and views and understandings of communities and stakeholders on the values, expectations, and concepts of community engagement in research.

Examining the involvement of guardians of children with acute lymphoblastic leukemia in Tanzania as public contributors to inform the design and conduct of the GuardiansCan project: A mixed-methods study protocol.

Public contribution in research can lead to the design and conduct of more feasible and relevant research. However, our understanding of the acceptability and feasibility of public contribution and the evidence base regarding its impact in low- and middle-income countries (LMICs) is limited. In this study protocol, we describe a mixed-method examination of public contribution activities in the GuardiansCan project. The GuardiansCan project aims to respond to Tanzanian guardians' poor adherence to children's follow-up care after treatment for acute lymphoblastic leukemia (ALL) with the help of Mobile Health technology. We aim to: (1) involve guardians of children treated for ALL as Guardians Advisory Board (GAB) members in the managing and undertaking, analysis and interpretation, and dissemination phases of the GuardiansCan project; and (2) examine the acceptability, feasibility, and perceived impact of GAB members' contribution to the GuardiansCan project from the perspective of the GAB members and public contribution coordinators. We will recruit six to eight guardians of children treated for ALL to the GAB. We will hold workshops where GAB members contribute to all project phases. Using impact logs, we will record GAB workshop activities and the perceived impact of these activities. We will interview GAB members and public contribution coordinators 6 months after establishing the GAB, and at the end of each study within the project, to examine the acceptability, feasibility, and perceived impact of public contribution activities. We expect GAB contribution to increase project quality and relevance, and inform how to best embed public contribution in research in LMICs.

Novel approaches to enable equitable access to monoclonal antibodies in low- and middle-income countries.

Monoclonal antibodies (mAbs) are revolutionizing management of non-communicable diseases in high-income countries and are increasingly being advanced for a range of infectious diseases (IDs). However, access to existing mAbs is limited in low- and middle-income countries (LMICs), and investment in developing fit-for-purpose mAbs for IDs that disproportionately affect LMICs has been limited. Underlying these access barriers are systemic challenges, including a lack of commercial incentives to target LMIC markets and complexity in manufacturing and regulatory processes. Novel strategies are needed to overcome systemic access barriers for mAbs. We outline key areas where new approaches could address these barriers, based on a multistakeholder consultation in March 2023. Three disease-market archetypes are identified to guide thinking about business models tailored to different contexts. New business models are needed to incentivize development and manufacturing of ID mAbs and to ensure mAbs are optimized with a target product profile and cost of goods that enable use in diverse LMIC settings. Lessons can be applied from voluntary licensing strategies and product development partnerships that have shown success in catalysing development and affordable supply for a range of infectious diseases. Technology transfer will be key to expand LMIC research and manufacturing capacity and to enable sustainable and diversified supply. Improved market intelligence, demand aggregation mechanisms, and portfolio-based manufacturing models could be used to de-risk commercial investment and establish a sustainable manufacturing ecosystem for affordable mAbs. Novel regulatory approaches and robust technology transfer may reduce data requirements and timelines for biosimilar approvals. Trailblazer products, with coordinated "end-to-end" support from funders, can demonstrate proof of concept for pathways to accessible mAbs across a broader range of LMICs. Research funders; local, regional, global health agencies; and, private sector partners should commit to implementing innovative partnerships and end-to-end strategies that enable equitable access to mAbs for infectious diseases in LMICs.

How “global” is research in early intervention for psychosis? A bibliometric analysis

IntroductionUnlike high-income countries (HICs), there are few early intervention services for psychosis in low-and middle-income countries (LAMICs). In HICs, research spurred the growth of such services. Little is known about the state of EIP research in LAMICs, which we address by examining their research output and collaborations vis-à-vis that of HICs. MethodsWe conducted a search in Scopus database for early psychosis publications in scientific journals since 1980. Data from each record, including title, author affiliation, and date, were downloaded. For HIC-LAMIC collaborations, data on first, corresponding and last authors’ affiliations, and funding were manually extracted. Descriptive statistics and social network analysis were conducted. ResultsGlobally, early psychosis publications increased from 24 in 1980 to 1297 in 2022. Of 16,942 included publications, 16.1 % had LAMIC authors. 71.3 % involved authors from a single country (regardless of income level). 21.9 % were collaborations between HICs, 6.6 % between HICs and LAMICs, and 0.2 % among LAMICs. For research conducted in LAMICs and involving HIC-LAMIC collaborations, the first, last, and corresponding authors were LAMIC-based in 71.8 %, 60.7 %, and 63.0 %, respectively. These positions were dominated (80 %) by authors from four LAMICs. 29.4 % of the HIC-LAMIC subset was funded solely by LAMIC funders, predominantly two LAMICs. ConclusionsLAMICs are starkly underrepresented in the otherwise flourishing body of early psychosis research. They have far fewer collaborations and less funding than HICs. Closing these gaps in LAMICs where most of the world’s youth live is imperative to generate the local knowledge needed to strengthen early psychosis services that are known to improve outcomes.

Urgent appeal for expanded initiatives in gastric motility disorders across low and middle-income countries: illustrating the example of gastroparesis.

This paper provides a comprehensive exploration of the current state of gastroparesis management in low and middle-income countries (LMICs), emphasising recent innovations, persistent challenges, and future prospects. Gastroparesis, a condition characterised by delayed stomach emptying, presents debilitating symptoms and is notably linked to neuropathic disorders, including diabetes mellitus. Despite an apparent higher prevalence in LMICs compared to the global average, epidemiological data remains scarce. The paper highlights pioneering research in Pakistan, Brazil, and China, showcasing a transformative shift toward comprehensive studies that delve into nuanced aspects of gastroparesis epidemiology, gender-specific patterns, and innovative therapeutic approaches such as acupuncture. However, challenges impeding clinical management and research in LMICs are identified, encompassing the absence of extensive epidemiological studies, lack of treatment guidelines, and the scarcity of specialised training programs for healthcare professionals. These challenges are intertwined with broader issues such as limited healthcare infrastructure, resource disparities, and healthcare workforce shortages. The paper proposes a multifaceted approach for addressing these challenges, involving international collaboration, capacity building, and the integration of gastroparesis management into primary healthcare services. Strategies to combat brain drain, such as collaborative agreements akin to the UK-South Africa Memorandum of Understanding, are advocated.

Best Practices for Developing International Academic Partnerships in Orthopaedics.

Traumatic and nontraumatic orthopaedic conditions are major contributors to global morbidity and account for the majority of life-years lived with disability worldwide. Additionally, the burden of musculoskeletal injuries has increased substantially over the past 3 decades. Unfortunately, in low and middle-income countries (LMICs), access to orthopaedic care is limited, leading to a disproportionate burden of disease. The Lancet Commission on Global Surgery has emphasized the urgent need for unified international commitment and research collaboration to achieve universal access to safe and affordable surgical care. However, conducting high-quality orthopaedic research in LMICs remains challenging as a result of disparities in training, access to resources, infrastructure, and equipment availability. Partnerships between high-income countries (HICs) and LMICs have emerged in recent decades as an effective approach to combatting some of these challenges. These partnerships aim to bridge the gaps by facilitating collaborative research and knowledge exchange. The establishment of successful partnerships requires a collaborative and reciprocal approach that starts with a clear understanding of mutual research aims and the availability of resources. Despite the potential benefits, various factors can make establishing such partnerships difficult. However, these partnerships can have a substantial impact in delivering quality orthopaedic education and research training, thus improving access to care in resource-limited environments. This paper represents the collaborative effort of multiple international academic orthopaedic surgeons with extensive experience in HIC-LMIC partnerships. Our aims were to outline the best practices for conducting orthopaedic research within these relationships and to provide guidance for future successful collaborations.

Long-term health effects of outdoor air pollution on asthma and respiratory symptoms among adults in low-and middle-income countries (LMICs): a systematic review and meta-analysis

BackgroundFew studies have investigated the association between long-term exposure to outdoor air pollution and the risk of asthma and respiratory symptoms in low-and middle-income countries (LMICs).ObjectiveTo systematically evaluate the epidemiological evidence regarding the associations between long-term exposure to outdoor air pollution and respiratory symptoms in LMICs.MethodsWe searched for literature published between January 1946 and September 2022 in Embase (Ovid), Medline (Ovid), and Web of Science (Core Collection). The air and gaseous pollutants studied included particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2), and black carbon (BC), and exposure was 1-year duration or more. We conducted a systematic review and meta-analysis with a random-effects model to calculate the relative risk (RR) estimates. A rerun of the databases was conducted in November 2023 with no eligible studies found.ResultsOf the 1,346 studies identified, only six met our inclusion criteria, and these six reported PM2.5, PM10, and NO2 with asthma as the main outcome. Three of these included studies were further included in the meta-analysis because they had data on the same exposure and outcome (PM2.5 and asthma). The main result of our study showed a borderline significant association between a 10 µg/m3 increase in exposure to PM2.5 and an increased risk of asthma (RR 1.21, 95% CI 0.93, 1.50). There was evidence of considerable heterogeneity (I2 = 75.87%). The regression-based Egger test for small-study effects showed no significant publication bias among these three studies.ConclusionOur results indicate that long-term exposure to PM2.5 increases the risk of asthma in LMICs, but studies are scarce and there is a large need for more research in LMICs in this field.Systematic Review Registrationhttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0288667, PROSPERO (CRD42022311326).

Social innovation in health training to engage researchers in resource-limited settings: process description and evaluation.

Research on social innovations in health has increased in recent years. However, little training is geared toward enhancing social innovation research capacity. Most health training for low- and middle-income countries (LMICs) is developed by individuals in high-income countries, disregarding LMIC researchers' wisdom and insights and the communities' needs. Our team organized a multi-phase investigation involving a series of surveys and co-creation group discussions to assess individuals' training needs that directly informed a subsequent co-created training workshop series. We conducted a Hennessy-Hicks Training Needs Assessment among the Social Innovation in Health Initiative (SIHI) network and formed a co-creation group comprising SIHI fellows to design related training workshops. We ran a final evaluation survey and analyzed the workshop series' strengths, weaknesses and threats. Descriptive and thematic analysis were employed to analyze survey data and open-ended responses. The final evaluation survey captured data from 165 learners in 35 countries, including 26 LMICs. Most participants (67.3%, 111/165) rated the training workshop series as excellent, and 30.3% (50/165) rated it as good on a five-point scale. The need for writing research grants and manuscripts was rated the highest priority. Learners were interested in community-engaged research and diversity, equity and inclusion. This workshop illustrated how co-creation could be an effective tool for developing training materials tailored for LMIC researchers. We also offer a template for conducting a needs assessment and subsequent training workshops for LMICs. The ground-up, locally developed courses may be more effective than externally developed training programs intended for LMICs.

The HI V O pen Call on I nformed C onsent and E thics in Research (VOICE) for Adolescents and Young Adults: A Digital Crowdsourcing Open Call in Low- and Middle-Income Countries.

Many adolescents and young adults (AYAs; 10-24 years old) are excluded from HIV research because of social, ethical, and legal challenges with informed consent, resulting in limited AYA-focused data. We use a participatory approach to identify strategies for improving AYA consent processes in HIV research in low- and middle-income countries (LMICs). We conducted a digital crowdsourcing open call for ideas to improve AYA consent to HIV research in LMICs. Crowdsourcing involves engaging a group of people in problem-solving, then sharing emergent solutions. Submissions were evaluated by 3 independent judges using predefined criteria, with exceptional strategies receiving prizes. Demographic data were collected, and textual data were qualitatively analyzed for emergent themes in barriers and facilitators for improving AYA consent in HIV research, guided by a socioecological model. We received 110 strategies total; 65 were eligible for evaluation, 25 of which were identified as finalists. Fifty-eight participants from 10 LMICs submitted the 65 eligible submissions, of which 30 (52%) were 18 to 24 years old. Thematic analysis identified 10 barriers to AYA consent, including HIV stigma, limited education, and legal/regulatory barriers. Strategies for improving AYA consent processes revealed 7 potential facilitators: enhancing AYA engagement in research, involving parents/guardians, improving education/awareness, improving institutional practices/policy, making research participation more AYA-friendly, enhancing engagement of other key communities of interest, and empowering AYA. Diverse communities of interest in LMICs developed compelling strategies to enhance informed consent that may improve AYA inclusion in HIV research. These data will be used to develop practical guidance on improving AYA consent processes.

Effectiveness of road safety interventions: An evidence and gap map.

Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge. The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels. The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019. The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes. The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2. The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality. The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.

The COVID-19 pandemic's effects on mental and psychosocial health in the Philippines: A scoping review.

Low- and middle-income countries (LMICs) remained at elevated risk for the effects of the COVID-19 pandemic because of persistent stressors to their health systems. Simultaneously facing high infection rates, strict containment measures and natural disasters, the Philippines provides important grounds for health research in LMICs. This review examined how the COVID-19 pandemic affected mental and psychosocial health in the Philippines. This scoping review included literature in English from 2020 to mid-2022 from PubMed, PsycInfo and SCOPUS, and used the PRISMA-ScR and PCC-question model. Two independent reviewers conducted blind article screening and data extraction using COVIDENCE software, followed by consensus building, data charting and analyses. This work identified 405 publications across PubMed (N=56), PsycInfo (N=106) and SCOPUS (N=243), of which 76 articles addressed the Philippines. Article types included 54 research articles, 10 opinion pieces, 4 literature reviews, 6 letters to journals, 1 study protocol and 1 other report. These findings focused primarily on health professionals (N=23) and educators/learners (N=22) and reported mostly on moderate-to-severe clinical outcomes such as fear, depression, anxiety or stress. Coping behaviors, like resiliency and other ways of adapting to the pandemic, including religious, spiritual and community-oriented approaches highlighted experiences with stringent infection prevention and control measures to contain COVID-19 in the Philippines. The COVID-19 pandemic brought severe challenges to mental and psychosocial health in the Philippines. The literature focused mostly on healthcare workers and educators/learners, and moderate-to-severe mental health outcomes in these groups. There is a need to expand studies to other sociodemographic groups and communities across the Philippines. Future work stands to benefit from more in-depth qualitative, mixed methods, longitudinal and representative quantitative research in LMICs following this pandemic. Literature reviews remain important to synthesize post-pandemic experiences by providing context for future studies and health practice in the Philippines and other LMICs.

Digital rights and mobile health in Southeast Asia: A scoping review.

Digital technology has the potential to support or infringe upon human rights. The ubiquity of mobile technology in low- and middle-income countries (LMICs) presents an opportunity to leverage mobile health (mHealth) interventions to reach remote populations and enable them to exercise human rights. Yet, simultaneously, the proliferation of mHealth results in expanding sensitive datasets and data processing, which risks endangering rights. The promotion of digital health often centers on its role in enhancing rights and health equity, particularly in LMICs. However, the interplay between mHealth in LMICs and digital rights is underexplored. The objective of this scoping review is to bridge this gap and identify digital rights topics in the 2022 literature on mHealth in Southeast Asian LMICs. Furthermore, it aims to highlight the importance of patient empowerment and data protection in mHealth and related policies in LMICs. This review follows Arksey and O'Malley's framework for scoping reviews. Search results are reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Frequency and content analyses were applied to summarize and interpret the data. Three key findings emerge from this review. First, the digital rights topics covered in the literature are sparse, sporadic, and unsystematic. Second, despite significant concerns surrounding data privacy in Southeast Asian LMICs, no article in this review explores challenges to data privacy. Third, all included articles state or allude to the role of mHealth in advancing the right to health. Engagement in digital rights topics in the literature on mHealth in Southeast Asian mHealth is limited and irregular. Researchers and practitioners lack guidance, collective understanding, and shared language to proactively examine and communicate digital rights topics in mHealth in LMIC research. A systematic method for engaging with digital rights in this context is required going forward.

Sexual and reproductive health research capacity strengthening programs in low- and middle-income countries: A scoping review.

Sexual and reproductive health (SRH) research capacity strengthening (RCS) programs in low- and middle-income countries (LMICs) are needed to foster the discovery of context-specific solutions to improve patient outcomes and population health. There remains a limited understanding of SRH research strengthening programs to raise skill sets, publications, and infrastructure and ultimately influence health policy and patient outcomes in LMICs. More information is needed to understand how SRH research is sustained after program completion. To inform efforts to implement programs that strengthen SRH research and foster sustainability, we conducted a scoping review to identify and synthesize strategies used in SRH research strengthening programs in LMICs. A literature search of nine scholarly databases was conducted. We synthesized data extracted from included articles and presented results highlighting the format, duration, and topics covered of program interventions to strengthen SRH research in LMICs. We organized information about primary outcomes into themes and summarized how SRH research capacity was sustained after program completion. Twenty-four articles were included in the scoping review. The articles generally focused on outcomes within the themes of advocacy/capacity, education, policy, project life cycle, and writing/publication. Few articles reported metrics or other evidence of long-term program sustainability of SRH RCS projects in LMICs. Results from this scoping review can be used to strengthen SRH research programs in LMICs. More energy must be directed toward correcting power imbalances in capacity strengthening initiatives. To address additional gaps, future directions for research should include an exploration of SRH research mentorship, the cost of SRH RCS interventions, and how to foster institutional support.

To adopt or adapt an existing neonatal core outcome set in Kenya: a study protocol

BackgroundDevelopment and use of core outcome set(s) (COS) in research can reduce research wastage by ensuring that a minimum set of outcomes are always reported on. Neonatal morbidity and mortality are a big burden in low- and middle-income countries (LMICs). Research is continuously being undertaken to reduce this burden. Currently, there is no COS for neonatal research in LMICs but there exists one for neonatal research in high-income countries (HICs).ObjectivesTo determine outcomes that are useful for neonatal care in Kenya to inform whether an existing COS should be adopted or adapted. To assess the feasibility of a routine data collection system to collect data of the agreed-on COS.MethodsA review of existing literature on neonatal research in LMICs followed by a qualitative study of key stakeholders in neonatal care. To explore whether to adapt or adopt, in two hospitals, two focus group discussions with 6–8 parents/caregivers will be undertaken (one each in two hospitals). Key informant interviews will also be conducted with 6 health care providers in each of the hospitals. At the policy-making level, we will conduct 10 key informant interviews. Qualitative data will be analyzed thematically. A consensus meeting will be undertaken with key stakeholders, who will be presented with an overview of the COS developed for HICs, key findings from the literature, and the qualitative study to determine context-appropriate COS. The agreed-on outcomes will be counterchecked against the case records in the two hospitals. The feasibility of collecting the outcomes on a routine electronic research database, the Clinical Information Network that collects standardized data at admission and discharge, will be explored. The congruence (or not) of the outcomes will be documented and be used to enrich the discussion and provide a snapshot of the feasibility of the health information system to collect routine data on the COS.ConclusionsA COS for use in neonatal care in Kenya will help enhance outcome measurements and reporting not just in research but also in routine practice. This will enhance the comparability of interventions in trials and routine settings leading to reduced research wastage and likely improved quality of care. Additionally, the methodology used for this work can be adopted in other settings as a means of adopting or adapting an existing COS.

Training and Accompaniment Model for Expanding ADRD Research in LMICs – The Atlantic Fellows for Equity in Brain Health Experience

AbstractBackgroundOften, global health programs are designed to train individuals from low‐ and middle‐income countries (LMICs) with training provided in more resourced regions. Subsequently, the trainees return to their home community with limited additional resources. When research is funded, capacity‐building is rarely prioritized and partnership for core administrative and study management needs is absent. A program of ‘accompaniment’ where programs partner with trainees after their training period is less frequent and could alter the landscape of research capacity building for dementia.MethodsThe Atlantic Fellows for Equity in Brain Health program provides both a one‐year in‐residence learning experience and seeks to accompany fellows as they return to their home community. Resources and activities in the post‐training period include funding for small pilot projects, networking and community building, training in grants management, support for logistic and administrative activities related to grants, partnering with grant and manuscript writing and assistance with data collection and management.ResultsOver seven years, Atlantic Fellows have received 137 Pilots Awards ($25k each) for activities in 41 countries. Many of these awards serve as launching pads for future funding. For example, the Multi‐Partner Consortium for Dementia Research in Latin America (ReDLat) grew out of a Pilot awarded to an Atlantic Fellow from Latin America uniting 14 research centers across six Latin American countries aiming to identify the unique genetic and social determinants of health that drive Alzheimer’s disease and related dementias. Work is underway and includes prominent capacity building activities with more than $12M in committed from global partners. More than 1454 individuals have been enrolled. Eleven Atlantic Fellows are directly involved in the project. Other examples include work in Brazil that has now been transformed into US National Institutes of Health funding. New work is currently launched in East Africa leading to competitive research applications under review.ConclusionsAn intentional model of accompaniment can achieve substantial impact on dementia research in LMICs.