Set Of Countries Research Articles

Investigating students’ awareness of online privacy and cybersecurity: an empirical study with effective cybersecurity training framework

Purpose The main purpose of this study is to assess the level of cybersecurity and social media privacy awareness among college students in Bangladesh and propose a scalable cybersecurity training framework to promote safe online practices. Design/methodology/approach This study used a structured, printed questionnaire survey to collect data from the students of five renowned colleges from the southern part of Bangladesh. Stratified sampling technique was followed and a total of 353 data were collected. Collected data were analyzed using SPSS and Python programming languages. Findings The findings uncovered that most of the students possessed limited knowledge regarding fundamental cybersecurity concepts, though they were using different social media platforms and posting personal information frequently. The study found a significant positive relationship between students’ sharing of personal information on social media and becoming a victim of cybersecurity attacks. Contrarily, becoming a victim of a cybersecurity attack was negatively correlated with their ability to respond in case of cyberattacks. However, most of the students were interested in acquiring knowledge of cybersecurity. Based on these findings, the study proposed a game-based cybersecurity training framework for students named “CyberSAFE”. Originality/value Though several studies have proposed different cybersecurity frameworks in different contexts, this study, to the best of the authors’ knowledge, is the first attempt to explore college students’ cybersecurity knowledge and propose a game-based framework in a developing country setting.

ULACNet-301, OPTIMO protocol: optimizing HPV vaccination regimen for cancer prevention in children and adolescents living with HIV

BackgroundPersistent infection with human papillomavirus (HPV) is associated with most cervical and anal cancer cases and a large fraction of other anogenital and oropharyngeal cancers. The prophylactic HPV vaccines are known to prevent HPV infections and HPV-associated disease, although there is evidence of reduced response to the HPV vaccination among individuals living with HIV. Prior studies among individuals without HIV suggest that a single HPV vaccine dose induces humoral immune responses that, while lower than those induced by two or three doses, still confer protection against HPV infection. Current recommendations for HPV vaccine include a single-dose schedule for children 9–14-years-olds without HIV. Although two to three doses are recommended for children living with HIV (CLWH), there is very limited data comparing responses to one vs. 2–3 doses in CLWH.MethodsThe OPTIMO study will compare immune responses to HPV vaccination in CLWH by measuring antibody and memory B cell (Bmem) responses after 1, 2, or 3 doses of the 9-valent HPV (9vHPV) vaccine, Gardasil-9. A comparison group of children without HIV will receive one dose of the vaccine. The durability of the response will be assessed at 24 months after the last dose of a given regimen. The OPTIMO trial will take place among CLWH from low and middle-income country (LMIC) settings in Peru, Brazil, and Haiti.DiscussionPrevious studies of single-dose regimens in individuals without HIV raise questions about whether one dose would suffice for CLWH and, if not, whether two or three doses are needed to provide protection against HPV-related cancers. These questions have operational consequences in LMICs given the barriers to delivering multiple doses, uneven availability, and intermittent shortages of HPV vaccines. In addition, information on HIV status for children and adolescents is rarely available during vaccination campaigns based in schools or public health clinics, so CLWH may receive a single dose despite policy recommendations that they receive two or three. This study will provide evidence on the optimal number of doses needed for CLWH that can inform HPV vaccination campaigns in LMICs, especially those with a higher burden of HIV infection and higher incidence of HPV-related cancers.Trial registrationClinicalTrials.gov NCT04265950.

Correction to “The Impact of Sustainability Governance Attributes on Comprehensive CSR Reporting: A Developing Country Setting”

Correction to “The Impact of Sustainability Governance Attributes on Comprehensive <scp>CSR</scp> Reporting: A Developing Country Setting”

Whole-genome evaluation and prophages characterization associated with genome of carbapenem-resistant Acinetobacter baumannii UOL-KIMZ-24-2.

Carbapenem-resistant Acinetobacter baumannii (CRAB) is an emerging threat to healthcare settings in many countries, principally in South Asia. The current study was aimed to identify, evaluate whole-genome and characterize the prophages in genome of CRAB strain, recovered from patients of Lahore General Hospital, Lahore. More than 200 samples were collected and identified by morphological and biochemical tests. These strains were also subjected to a comprehensive antimicrobial susceptibility evaluation using Kirby-Bauer method and further confirmed as CRAB strains by exploring blaOXA-51. In addition, the whole-genome evaluation of a Acinetobacter baumannii UOL-KIMZ-24-2 was carried out using various Bioinformatics tools. A total of 150 strains of A. baumannii were recovered and identified in the current study. Among them, 49% strains were found resistant to carbapenem. The blaOXA-51 was found prevalent in the genome of A. baumannii recovered from medical ICU (38%). In addition, the UOL-KIMZ-24-2 genome analysis based on multilocus sequence typing (MLST) highlighted that UOL-KIMZ-24-2 belonged to ST2 (Pasteur scheme) sequence type. A total of 29 antimicrobial resistance (AMR) genes were present, importantly, blaOXA-66, blaOXA-23 and blaOXA-25. The mobile genetic elements (MGEs) were identified as transposases and belonged to four classes e.g. IS15d1, ISAba24, ISEc29, and ISEc35. A total of 14 virulence factors encoded by 58 different genes were detected in UOL-KIMZ-24-2. In addition, the phage sequences were identified in genome of UOL-KIMZ-24-2, divided into 3 regions. In conclusion, UOL-KIMZ-24-2 contained a mixture of AMR genes, MGEs. prophages sequences and virulence genes.

Outcomes of Specialist Palliative Care Consultation for Patients with Advanced Cancer in an Oncological Emergency Department: A Retrospective Analysis

Objectives: Research on palliative care (PC) consultation and its outcomes in the emergency department (ED) within a low-and middle-income country (LMIC) setting is limited. This study aimed to evaluate PC consultation outcomes, symptom burden and management, and referral patterns in patients with advanced cancer referred for specialist PC (SPC) in the ED of an urban tertiary care cancer centre in India. Materials and Methods: Data of adult advanced cancer patients referred for SPC services in the ED between August 2017 and June 2019 were retrospectively screened. Patients’ sociodemographic features, clinical characteristics, ED visit-related data, and treatment-related data were documented. Multinomial logistic regression, incorporating significant univariate factors, was performed to analyse the independent predictive factors of consultation outcomes in the ED. Results: Of the 644 consultations, 366 (56.8%) were discharged home, 166 (25.8%) were admitted to various settings (hospital/respite care/hospice), 74 (11.5%) died in the ED, and 38 (5.9%) were unresponsive upon arrival. Sex, performance status (PS), gastrointestinal and cardiovascular events, pain, cancer progression, and receipt of pharmacological treatment were predictive of consultation outcomes. Male patients and those with poor PS were more likely to be admitted to the ED, whereas patients with poor PS and cancer progression were more likely to die. Discharge rates were higher among females, those with gastrointestinal symptoms and pain, and those receiving pharmacological treatment. Conclusion: More than 50% of the patients referred for SPC consultations were discharged. In addition, we also identified predictors for each consultation outcome in the LMIC-ED setting. Future research should investigate advanced care planning and survival analyses in comparable ED settings.

Nuances in the Treatment of Ewing Sarcoma of the Head and Neck in a Low-Middle-Income Country Setting: A Multi-Disciplinary Approach.

Ewing sarcoma of the head and neck (ES-HN) is a rare subsite of ES, where therapeutic outcomes need to be explored further. This retrospective study includes ES-HN patients registered at our center between 2003 and 2019. Demographic details and treatment outcomes were recorded from the hospital database. Prognostic factors for survival were identified by Cox regression. Eighty-five patients were included. Metastatic disease was seen in nine patients (10.59%). Local therapy included radiotherapy alone (n = 38; 44.7%), surgery plus radiotherapy (n = 15; 17.6%), or surgery alone (n = 8; 9.4%). The median overall survival (OS) was 37.4 months. On multivariable analysis, osseous primary (HR 0.40; p = 0.009) and male sex (HR 0.43; p = 0.023) were associated with superior OS. Leucocytosis (HR 3.46; p = 0.001) was associated with inferior OS. ES-HN has favorable biology with metastases being rare at baseline. However, leucocytosis, extra-osseous disease, and female sex are poor prognostic factors. In resource-challenged settings, difficulties in administering local therapy may contribute to inferior outcomes.

Factors affecting decisions to use antibiotic-sparing treatment approaches in women with uncomplicated urinary tract infections: a scoping review protocol.

This scoping review will explore the evidence on factors influencing the decisions to use antibiotic-sparing treatments in women with uncomplicated urinary tract infection. Overuse and misuse of antibiotics are the main drivers of antimicrobial resistance. Antibiotic-sparing treatments, such as symptomatic treatment with analgesics and delayed prescriptions, have considerable potential to reduce antibiotic consumption, but the majority of patients still receive antibiotics without delay. The reasons for the poor implementation of these alternative approaches are unknown. A better understanding of the factors influencing treatment decisions is needed. This review will consider the experiences and attitudes of health care professionals and women, in outpatient settings in high-income countries, regarding the use of antibiotic-sparing treatments for the diagnosis or suspected diagnosis of uncomplicated urinary tract infections (ie, healthy women aged 18-64years who are not pregnant, immunosuppressed, and have no functional or structural urinary tract abnormalities). This review will follow the JBI methodology for scoping reviews. MEDLINE (Ovid), Embase, and the Cochrane Library will be searched to identify peer-reviewed articles: original research (quantitative or qualitative studies, experimental or observational), reviews, case reports, and case series. Gray literature will also be searched for. Sources in any language from 2000 to 2024 will be included. Three reviewers will screen the sources and extract data using a tool developed by the reviewers. The analysis will use counts and descriptive qualitative content analysis. The results will be presented in visual, tabular, and narrative formats. https://osf.io/t8y5e/.

Exploring Dietary Assessment Methods Used to Measure Individual Dietary Intakes in Low- and Middle-Income Countries and Under-Served Populations in High-Income Countries.

For low- and middle- income country (LMIC) settings, a global nutrition transition is rapidly emerging as diets shift, resulting in a dual burden of malnutrition. High quality dietary intake data for these populations is essential to understand dietary patterns contributing to these nutrition issues. New technology is emerging to address dietary assessment challenges; however, it is unknown how researchers conducting studies with LMIC populations or under-served groups in high-income countries adopt technology-assisted methods. This study aimed to describe the features of the dietary assessment methods used in these settings. A cross-sectional survey of members of an online international nutrition network was conducted. Participants completed an online questionnaire collecting data on dietary assessment method use, populations studied, and factors influencing method selection. Of 45 participants (ranging from 27 to 60 years) who completed the questionnaire, 67% conducted dietary assessments in children aged 1-5 years, 60% in pregnant women and 60% in female adults. Dietary assessment was conducted predominantly in countries classified as LMIC (n = 50), compared to the assessment of vulnerable groups in high-income countries (n = 3). All participants reported using 24-h recalls, 80% used food frequency questionnaires, while 22% used image-based and 22% used image-assisted methods. Predominant modes were interviewer-administered, paper questionnaires and manual analysis; however, digital survey platforms were used by nearly half of participants. Although traditional dietary assessment methods continue to dominate in LMICs, evidence of technological-assisted method use is emerging. Technology-assisted methods, tailored to address challenges in collecting quality dietary intake data in LMICs, are becoming more accessible.

Is There a Role for Daratumumab Retreatment in Patients with Relapsed/Refractory Multiple Myeloma?

Multiple myeloma (MM) is a hematologic disease characterized by the clonal expansion of malignant plasma cells that accumulate in the bone marrow, leading to osteolytic bone disease, hypercalcemia, anemia, and renal dysfunction. Daratumumab was the first monoclonal anti-CD38 antibody approved for the treatment of MM, initially in relapse/refractory settings and, more recently, for newly diagnosed patients. Increased first-line usage of daratumumab will also substantially change treatment approaches for patients with relapsed/refractory disease. Due to the cost and availability of bispecific T cell redirecting antibodies (BsAbs) and chimeric antigen receptor T cell therapy (CAR-T) in real-life settings in many countries, retreatment with daratumumab in subsequent lines of therapy might be a reasonable choice. Data regarding efficacy and optimal combinations of daratumumab retreatment are lacking, and here we provide a short literature review of available data. We identified only a small number of articles based on retrospective analysis of medical records in real-life settings. A strong consistency in results regarding response rates and treatment duration was noticed among mainly heavily pre-treated MM patients, with approximately half of patients achieving at least partial remission (PR) after retreatment with daratumumab-based protocol. The duration of treatment and time to the next treatment for retreatment episodes were considerable and consistent with clinical expectations for later lines of therapy. The analysis of data in this literature review indicates that daratumumab retreatment may provide meaningful clinical benefit to some patients with relapsed/refractory MM despite having prior exposure. However, further research is needed to identify clinical and biological parameters that may predict favorable responses to daratumumab retreatment.

Cross-country Variations in Infrastructure Development, Inflow of FDI and Quality of Institutions

This study tries to investigate the cross-country variations in infrastructure development among different sets of countries with varying institutional rankings, over time, by building five infrastructure indices. Along with building the total/composite infrastructure index, four other (energy, ICT, finance and transport) sub-indices are also built in this study. The strength of our study lies in the fact that we not only find variations in the total infrastructure development but also within the sub-indices. We have introduced the role of country-specific Institutional quality and inflow of FDI empirically in this regard to determine the cross-country variance in infrastructure development. The core hypothesis of our study is that countries that receive a good amount of FDI inflows will have impressive infrastructure development provided the country-specific institutional quality is high. On the contrary, countries with low institutional indexes may not have a positive association between FDI inflows and infrastructure development. However, there are exceptions. For example, institutionally strong countries like Ireland and Belgium should invest more funds to boost their financial infrastructure sector. On the other hand, another institutionally strong country like Norway should develop its transport infrastructure. In this study, we are mainly interested in the joint impact of FDI inflows with the institutional variable on infrastructure development that has been largely neglected in the empirical literature. Using two-dimensional panel data for FDI inflows for 39 countries over the period 2000–20, we find that the conditional effects are positive and significant. From the policy point of view, we identify the possible areas of the infrastructure of a country that needs capital to be invested and at the same time identify some of the countries that need to improve their institutional quality that will eventually lead to improvement in the infrastructure development. The results of our study are robust to different institutional measures and infrastructure indices.

Geographic disparities impacting oral vaccine performance: Observations and future directions.

Oral vaccines have several advantages compared with parenteral administration: they can be relatively cheap to produce in high quantities, easier to administer, and induce intestinal mucosal immunity that can protect against infection. These characteristics have led to successful use of oral vaccines against rotavirus, polio, and cholera. Unfortunately, oral vaccines for all three diseases have demonstrated lower performance in the highest-burden settings where they are most needed. Rotavirus vaccines are estimated to have >85% effectiveness against hospitalization in children <12 months in countries with low child mortality, but only ~65% effectiveness in countries with high child mortality. Similarly, oral polio vaccines have lower immunogenicity in developing country settings compared with high-resource settings. Data are more limited for oral cholera vaccines, but suggest lower titers among children compared with adults, and, for some vaccines, lower efficacy in endemic settings compared with non-endemic settings. These disparities are likely multifactorial, and available evidence suggests a role for maternal factors (e.g., transplacental antibodies, breastmilk), host factors (e.g., genetic polymorphisms-with the best evidence for rotavirus-or previous infection), and environmental factors (e.g., gut microbiome, coinfections). Overall, these data highlight the rather ambiguous and often contradictory nature of evidence on factors affecting oral vaccine response, cautioning against broad extrapolation of outcomes based on one population or one vaccine type. Meaningful impact on performance of oral vaccines will likely only be possible with a suite of interventions, given the complex and multifactorial nature of the problem and the degree to which contributing factors are intertwined.

Policy analysis of self-care program: a qualitative study protocol

BackgroundOver the recent years, the self-care program has been a significant policy in the field of health. The WHO recommended self-care for every country and economic setting for reaching universal health coverage, promoting health, keeping the world safe and serving the vulnerable. Conducting a policy analysis study can be useful in closely examining the self-care program’s content, process, context and actors.MethodsA qualitative policy analysis will be conducted in four phases to analyse the self-care program, focussing in Iran. The first phase will involve a scoping review to identify policies related to self-care worldwide. In the second phase, a qualitative study will be conducted to determine the status of the self-care program in Iran. The third phase will involve analysing the self-care program in Iran using the policy triangle framework of Walt and Gilson (1994). In the final phase, initial policy recommendations related to the self-care program will be formulated, and validation and finalization of the initial recommendations will be carried out in a panel of experts.DiscussionTo thoroughly examine the self-care program’s content, process, context and actors, a policy analysis study can be helpful. Therefore, this study will aim to analyse the self-care program using policy analysis approach. By identifying the challenges of the program’s content, process, context and actors, corrective solutions to improve the program’s current status, as well as policy recommendations appropriate to the country’s context, will be provided. In addition, policy-makers in various authorities at the national, regional and provincial levels would benefit from the results of this study.

Amikacin therapeutic drug monitoring: Evaluation of therapy performance and analytical techniques in a developing country setting.

Healthcare systems face several challenges, with microbial infections being one of the main concerns. Therapeutic drug monitoring (TDM) is a strategy that has been encouraged to optimize antimicrobial regimens, particularly those with significant toxicity and narrow therapeutic indices, such as amikacin (AMK). We aimed to evaluate AMK concentrations of patients in a non-routine TDM setting and compare the performance of immunoassay and chromatography methods for routine clinical use. In this prospective study, peak (Cmax) and trough (Cmin) plasma samples were collected from 39 adult patients and quantified by ultra-performance liquid chromatography coupled with mass spectrometry (UPLC-MS/MS). Relevant clinical information was collected from medical records. AMK concentrations and clinical data were analyzed to evaluate therapy performance and influencing factors. In addition, fluorescence polarized immunoassay (FPIA) and UPLC-MS/MS were compared with Passing-Bablok regression and Bland-Altman plot analysis. AMK concentrations varied widely, with a median Cmax of 41.40µg/mL (interquartile range [IQR] 27.60 - 56.75µg/mL) and a median Cmin of 1.87µg/mL (IQR 0.7 - 6.19µg/mL). A high proportion of patients (83.1%) failed to achieve the Cmax therapeutic target, while 31.7% failed to achieve the Cmin therapeutic target. Overall, elderly patients and those with reduced renal function had higher Cmax target attainment, while the same groups had lower Cmin target attainment. The method comparison showed a mean difference of 1.54% (limits of agreement -42.46% to 45.54%) in measured concentrations, with good correlation and no constant or proportional differences. Many patients failed to reach the Cmax target and were at risk of treatment failure, although adequate Cmin was achieved more often. TDM with dose adjustments could improve AMK therapy, but further research is needed.

Harm reduction associated with heated tobacco products: A systematic review and meta-analysis.

We conducted a systematic review and meta-analysis of randomised studies in humans comparing the outcomes of switching to heated tobacco products (HTPs) versus continuing conventional tobacco smoking by burning. We searched the electronic databases which included PubMed, Web of Science, Cochrane Controlled Trials Register, and Google Scholar from inception to May 2023. Randomised Controlled Trials (RCTs) in humans comparing HTPs with conventional burnt tobacco products were selected. Our search yielded 4817 search results, of which six RCTs (number of participants 1362, all from high-income countries) were selected. Five of the six included RCTs had low risk in four of five domains of bias; only one study had a high risk of bias in one domain. PRISMA guidelines were followed. There were 40 biomarkers of harm reduction reported categorised into six categories. One cancer biomarker (nitrosamine) and two cardiovascular biomarkers (eosinophils and total bilirubin) showed statistically significant harm reduction (total NNAL SMD=0·82, 95% CI 0·67-0·98, eosinophils SMD=0·38, 95% CI 0·12-0·65, total bilirubin SMD=0·71, 95% CI 0·28-1·31). The remaining biomarkers of harm in cardiovascular, inflammatory, metabolic, pulmonary, and renal categories showed imprecise findings. In RCTs of moderate quality, some biomarkers show harm reduction associated with switching from burnt tobacco smoking to HTPs. The majority of the findings are imprecise due to the small sample sizes of the included studies. Sufficiently powered, robust RCTs targeting key harm reduction biomarkers within both upper and low-middle income country settings are required in the future.

Optimizing data collection for obstetrical ultrasound research at the primary health care level in rural Uganda

ABSTRACT Background Neonatal and maternal mortality remains high in low- and middle-income countries (LMIC), especially in sub-Saharan Africa. Quality data collection is crucial to understand the magnitude of these problems and to measure the impact of interventions aimed at improving neonatal and maternal mortality. However, data collection in the low-income country setting, especially in rural areas, has been a challenge for researchers, policy makers, and public health officials. Here, we describe the methodology, experience and lessons learned while collecting data at lower-level primary health care facilities in rural Uganda. Methods Data collection was performed at Health Center III sites in rural Uganda, in partnership with Imaging the World and its affiliate Imaging the World Africa. The primary purpose of the data collection was to study the efficacy and clinical effect of introducing prenatal ultrasound services at these sites. Local data clerks were hired to perform the data collection through a combination of intensive training and on-the-ground support. Frequent oversight was used to support data collection. Results Of 2,397 enrolled pregnant women, 1,977 (82.5%) had complete outcome data. Upon independent expert audit, the data were >80% accurate for 10/11 variables and >90% accurate for 6/11 variables. Overall, the data collected at the rural HCs were 90% accurate. Discussion Accurate and complete data collection is possible in an LMIC setting if appropriate training and oversight are employed.

Organisational culture and its influence on employees' attitude towards organisational change in a developing country setting

This study aimed to investigate the influence of organisational culture on employee attitudes towards organisational change in a South African state-owned enterprise. A cross-sectional survey was conducted with a random sample (n = 373) of employees at a state-owned enterprise. The Organisational Culture Questionnaire (OCQ) and the Employee Attitudes to Organisational Change Scale were evaluated. Correlation and multiple regression analyses were used to determine the influence of organisational culture on employee attitudes towards organisational change. The findings indicate that organisational culture is related positively and significantly to employees' attitudes towards organisational change. Furthermore, the results indicate that organisational culture influences employees' attitudes towards change. The findings provide new evidence that an organisation that promotes positive organisational culture practices influences employee behaviour and attitudes positively towards organisational change in a South African government organisation.

The Use of "Cancer Ratio" in Differentiating Malignant and Tuberculous Pleural Effusions: Protocol for a Prospective Observational Study.

Differentiating between tuberculosis and malignancy as the cause of an exudative lymphocyte predominant pleural effusion is difficult due to similarities in the cellular and biochemical characteristics of the pleural fluid in both conditions. Microbiological tests in tubercular pleural effusions have a poor diagnostic yield, and the long turnaround time for results prevents an early diagnosis. The diagnosis of malignant pleural effusion (MPE) is hampered by a variable yield of pleural fluid cytology and closed pleural biopsy and the fact that thoracoscopy may not be readily available or feasible in each patient. A key gap in the existing knowledge is the performance of the serum lactate dehydrogenase to pleural adenosine deaminase ratio (ie, "cancer ratio"; CR) in differentiating between tuberculous and MPE in a high tuberculosis prevalence country like India, although its use has been well established in Western literature. The CR may find a practical application in the community health care settings in low-income countries without ready access to biopsy. This study aimed to evaluate the CR as a test to differentiate tubercular and malignant etiology in patients with an exudative lymphocyte predominant pleural effusion. Secondary objectives to be assessed include a comparison of CR to pleural fluid carcinoembryonic antigen in MPE and the association of histologic type of lung carcinoma to the CR positivity. This hospital-based, prospective, observational study will include patients admitted with pleural effusion whose pleural fluid reports indicate a lymphocyte-predominant exudate. The ability of the CR to discriminate between tuberculous and MPE will be evaluated as a primary objective of this study. The performance of CR and pleural fluid carcinoembryonic antigen in the diagnosis of MPE will be compared using the receiver operating characteristics and area under the curve for both tests as a secondary objective. The association between a positive CR and histologic type of lung cancer will be analyzed as well. Data collection began in June 2022. As of March 24, 2024, we have recruited 22 patients. Outcomes of the study are expected at the end of 2024. The results of this study will provide an objective basis for the use of CR in differentiating between tuberculosis and malignancy as the cause of an exudative lymphocyte predominant pleural effusion. DERR1-10.2196/56592.

Vaccination strategies to identify and reach zero-dose and under-immunized children in crisis-affected states in Sudan: a qualitative study

Abstract Background Globally, 21 million children were un- or under-vaccinated with Diphtheria-Tetanus-Pertussis (DTP)-containing vaccines in 2023. Around 20% of zero-dose children, those who had not received any DTP doses, live in conflict-affected settings in low and middle-income countries. There is insufficient evidence on vaccination interventions to identify and reach zero-dose children in these settings. This study aimed to map and assess current vaccination strategies to identify and reach zero-dose and under-vaccinated children in the crisis-affected states of South Kordofan, South Darfur and Blue Nile in Sudan. Methods We conducted a cross-sectional qualitative study guided by the (Identify-Reach-Monitor-Measure-Advocate (IRMMA) framework, developed by Gavi, the Vaccine Alliance. We conducted 20 individual semi-structured interviews during November and December 2022. We interviewed governmental and non-governmental vaccination stakeholders at federal, state and locality levels. We used the IRMMA framework to analyze the interview transcripts. Results Zero-dose and under-immunized children in the study sites were concentrated in opposition-controlled areas, nomadic communities, and remote rural areas. Zero-dose and under-immunized children in accessible areas were identified through routine vaccination strategies and surveillance reports. Various strategies were used in inaccessible areas. This includes tasking local institutions and individuals trusted by communities to identify and reach children, and infrequent integration and co-delivery of routine vaccines with other health interventions such as COVID-19 vaccination and insecticidal net distribution. There are inaccurate population estimates and a lack of guidance from ministries of health for measuring and monitoring zero-dose and under-immunized children. Respondents conflated advocacy with mobilization, and advocacy was broadly characterized as an ad hoc activity mostly connected to immunization campaigns. Conclusions Our study underscored the complexity of vaccinating zero-dose and under-immunized children in crisis-affected states of Sudan. Further research is needed to evaluate these practices and the role of non-governmental organizations (NGOs) and community engagement in improving vaccination coverage. Furthermore, exploring alternative funding methods and using geographic information systems (GIS) could enhance vaccination data and address funding limitations.

Cytomorphological changes of oral mucosal cells among smokeless tobacco users in low and middle-income country settings: new findings from Pakistan

BackgroundChronic tobacco use, in any form, induces significant cellular alterations in the oral mucosa. This study investigates four distinct cytomorphological changes in oral mucosal cells among smokeless tobacco users, examining their association across different genders and age groups.Materials and methodsThis cross-sectional study involved collecting mucosal samples from smokeless tobacco (naswar/snuff) users through consecutive sampling. The prepared smears were examined for dysplastic changes. Data analysis was performed using SPSS, with Chi-square tests and logistic regression employed to evaluate proportions and associations. ResultsAmong 100 Naswar/snuff users, the labial sulcus mucosa was the most common site affected (47%). The most frequent cytomorphological change was micronuclei (46%), followed by nuclear budding (25%), perinuclear halo (18%), and binucleated cells (14%). In the 51–60 age group, micronuclei (78.9%), nuclear budding (55.3%), binucleation (31.6%), and perinuclear halo (36.8%) were more prevalent (P < 0.005). Gender analysis revealed that micronuclei were more common in females (54.2%) compared to males (43.4%), while nuclear budding was more prevalent in males (27.6%) than females (P < 0.28). Logistic regression indicated that individuals aged 51–60 were more likely to exhibit micronuclei (OR = 1.15, 95% CI: 0.22 to 5.83, P = 0.863) and nuclear budding (OR = 15.34, 95% CI: 9.23 to 30.75, P < 0.05).ConclusionThe dysplastic changes observed included micronuclei, nuclear budding, binucleated cells, and perinuclear halo, with micronuclei being the most prevalent. These findings could facilitate the early diagnosis of oral lesions and their timely management in habitual smokeless tobacco users.

Establishing Core elements for a Prehospital Emergency Care Systems Evaluation Tool (PECSET) for systems in early stages of development: A Delphi consensus

ABSTRACT OBJECTIVES International Prehospital Emergency Care (PEC) standards have been primarily developed by and for high resource settings. Most PEC systems in Asia, which are still in the early stages of development, struggle to achieve these standards. There is a need for an evaluation tool which can define achievable basic building blocks for PEC systems in low resource settings to improve quality of PEC. We aimed to identify the core, basic elements (building blocks of a PEC system) for a Prehospital Emergency Care Systems Evaluation Tool (PECSET) for low resource settings in Asia. METHODS A 4-stage modified Delphi consensus method was used to engage 32 PEC experts from 12 Asian countries. Participants voted on 32 elements identified from a prior scoping review, focus group discussions, and survey. Each round of voting was conducted through an anonymous, web-based application and followed by face-to-face group discussions. The first two rounds aimed to answer, “Is the element important and feasible in a low resource setting?” The last two stages aimed to answer “Should this element be prioritized as core in the tool?” A thematic analysis of the recorded and transcribed discussions was used to identify participants’ rationale for prioritization. RESULTS After four rounds of voting, 12 elements were identified as core elements: 1) dispatch assisted instructions, 2) protocols for screening, triage and destination, (3) medical direction, 4) standardized training programs, 5) minimum ambulance standards, 6) operational metrics, 7) quality assurance, 8) operational safety protools, 9) essential patient care documentation, 10) medical records management, 11) layperson awareness and education and 12) universal access emergency number. However, the participants decided to include all 32 elements in the tool grouped into broader categories by percent agreement for a tiered approach for early, intermediate, and advanced PEC systems. Rationales for prioritization included a need for focus on basic infrastructure and building resilience in resource-stretched systems. CONCLUSIONS Through a Delphi consensus process, stakeholders identified core elements for PEC systems in low resource settings. These findings will inform the development of a tool for quality assurance and monitoring in low resource settings in South and Southeast Asian countries.