Systems In Low-income Countries Research Articles

Blockchain Technology in Lands Registration: A Systematic Literature Review

Blockchain technology (BT) is increasingly important in digital government as a means of efficient information management, decision making and an instrument for reform. This study presents a systematic review of BT's potential and application in land registration within low-income countries. The study uncovers diverse approaches to BT implementation that are influenced by local conditions and government structures. The study reveals that while there is a burgeoning interest in this field, actual implementations remain limited. The key barriers include resistance from government officials and a lack of local BT skills. Public blockchains have shown a high tendency for adoption, indicating a shift towards more transparent relationships between governments and citizens. The Hyperledger Fabric platform emerges as a popular choice due to its ability to provide secure, scalable, and robust solutions. However, there is a lack of clarity regarding the consensus mechanisms used, indicating a potential gap in current research practices. The study recommends an incremental approach to BT implementation, starting with non-threatening, transparent processes that could be expanded as part of broader government reform programs. Despite the potential of BT to revolutionize land registration systems and democratize tracking, it also poses a threat to existing power structures. Therefore, more robust empirical research is needed to evaluate the impacts and navigate the associated sociotechnical, legal, and institutional challenges. The study also proposes the establishment of a BT collaborative network among low-income countries to leverage shared experiences and develop a common framework for implementation. In the single instance where it was implemented in Georgia, public trust in government was restored. The study contributes to understanding how BT can be effectively harnessed to improve land registration systems in low-income countries.

Discovery and structural optimization of a new series of N-acyl-2-aminobenzothiazole as inhibitors of Zika virus

Zika virus infection is associated to severe diseases such as congenital microcephaly and Zika fever causing serious harm to humans and special concern to health systems in low-income countries. Currently, there are no approved drugs against the virus, and the development of anti-Zika virus drugs is thus urgent. The present investigation describes the discovery and hit expansion of a N-acyl-2-aminobenzothiazole series of compounds against Zika virus replication. A structure–activity relationship study was obtained with the synthesis and evaluation of anti-Zika virus activity and cytotoxicity on Vero cells of nineteen derivatives. The three optimized compounds were 2.2-fold more potent than the initial hit and 20.9, 7.7 and 6.4-fold more selective. Subsequent phenotypic and biochemical assays were performed to evidence whether non-structural proteins, such as the complex NS2B-NS3pro, are related to the mechanism of action of the most active compounds.

Energy accessibility via natural resources: Do natural resources ensure energy accessibility in low income countries?

Despite the abundance of natural resources in many low-income countries, energy accessibility remains a significant challenge for millions of people around the globe. Therefore, there is a need for research to understand the impact of natural resources on energy accessibility in low-income countries, and to identify the factors that contribute to successful energy access strategies. This research contributes to already established literature on energy accessibility and the management of natural resources, and it offers insights that can be used to inform the development of evidence-based policies and strategies that aim to promote more inclusive and sustainable energy systems in low-income countries. Using ARDL estimator, we find that GDP, mineral rent, natural gas rent, oil rent, renewable energy consumption, and technological innovation are crucial determinants of electricity accessibility in low-income countries. The positive impact of GDP, mineral rent, and natural gas rent on electricity accessibility suggests that national income and the extraction of natural resources are important for promoting energy accessibility in low-income countries.

Excess mortality associated with the COVID-19 pandemic during the 2020 and 2021 waves in Antananarivo, Madagascar

IntroductionCOVID-19-associated mortality remains difficult to estimate in sub-Saharan Africa because of the lack of comprehensive systems of death registration. Based on death registers referring to the capital city of Madagascar,...

The impact of COVID-19 on international development aid and health systems strengthening in low-income countries.

Health systems play a critical role in providing services that aim to improve, promote, restore, or maintain the health of communities. Unfortunately, health systems in low-income countries are fragile, having an adverse effect on the health of the population. Whereas international development aid remains crucial in strengthening health systems in low-income countries (LICs), COVID-19 has induced changes in the dynamics in the availability, provision and access to international development aid. These changes have aggravated the already weak health systems of LICs. Understanding the effects of the COVID-19 pandemic on the distribution of international development aid and how these effects impacted on the quality of the health systems in response to the outbreak is critical to improving the health of populations in LICs. This article discusses the impact of the challenges faced by LICs in the context of international development aid needed for the development of health systems.

A Review of COVID-19 Response Challenges in Ethiopia.

Background: The COVID-19 pandemic has positioned fragile healthcare systems in low-income countries under pressure, leading to critical gaps in service delivery. The pandemic response demands the healthcare system to be resilient and continue provision of healthcare services. This review is aimed at describing the healthcare response challenges during the pandemic in Ethiopia. Methodology: Eligible studies dealing with challenges of the healthcare system in response to the COVID-19 pandemic in Ethiopia were included. The six World Health Organization (WHO) healthcare system building blocks were used to categorize healthcare challenges. PubMed ProQuest, databases were searched, and results were summarized using systematic review synthesis. Results: Financial constraints led to a shortage of mechanical ventilators. Furthermore, the pandemic hindered the capacity to avail full packages of personal protective equipment in health facilities and intensive care capacity. The pandemic also affected the delivery of maternal, child and new-born services, prevention, and treatment of childhood illness, including immunization services. Conclusions: The COVID-19 pandemic posed various challenges to the performance of the healthcare system in Ethiopia. It is recommended that policy makers and stakeholders enhance pandemic preparedness and strengthen response capacity by considering the six WHO healthcare system building blocks.

Challenges Faced by Hospital Pharmacists in Low-Income Countries Before COVID-19 Vaccine Roll-Out: Handling Approaches and Implications for Future Pandemic Roles

Coronavirus disease-2019 (COVID-19) is one of the greatest pandemics of modern times. More than one hundred eleven million global deaths have already been associated with COVID-19. The incidence of COVID-19 as well as morbidity and mortality due to COVID-19 have increased in low-income countries (LICs). COVID-19 has further weakened health systems in LICs, that are already distressed by inadequate funding, lack of human resources, and poor infrastructure and service delivery. Despite the resource crunch, hospital LICs have been instrumental in treating COVID-19 patients. Pharmacists working in hospitals play an indispensable role in providing pharmaceutical services for infection prevention and control. This study discusses the contribution of hospital pharmacists and the challenges faced by them for treating COVID-19 patients in LICs before the COVID-19 vaccine roll-out.

Prevalence of the need for adaptive seating systems among children with cerebral palsy in Egypt.

An adaptive seating system is a basic rehabilitation need for children and youth with cerebral palsy (CP) as it supports the structure and function of the musculoskeletal system and can positively affect their activities and participation. Despite the importance of adaptive seating systems, there is limited access to such systems in low-income countries. To determine the percentage of children and youth between 4 and 18 years of age with CP in Egypt whose activity level and sitting ability suggest the need for an adaptive seating system. Observational cross-sectional study. One hundred ninety-three participants were included after fulfilling the criteria of the Surveillance of Cerebral Palsy of Europe. Their level of activity was assessed by a physical therapist using the Gross Motor Function Classification System (GMFCS), and their sitting ability was evaluated using the Level of Sitting Scale (LSS). Participants were considered to require an adaptive seating system if they scored GMFCS level IV or V and LSS level 1-5 concurrently. Approximately 44% of the study participants were classified as GMFCS level IV or V and LSS level 1-5, suggesting that they were in need of an adaptive seating system. There is a large percentage of children and youth with CP in Egypt who need an adaptive seating system to be integrated into their rehabilitation.

COVID-19 Pandemic and Reimagination of Multilateralism through Global Health Diplomacy

The ongoing pandemic COVID-19 has made it very clear that no one is safe until everyone is safe. But how can everyone be safe when the pandemic has broken every nerve of the economy and put an extra burden on the already crippled healthcare systems in low-income countries? Thus, the pandemic has changed the orientation of domestic as well as global politics, with many geopolitical shifts. The exponential growing infected cases and more than four million deaths has demanded a global response in terms of multilateralism. However, declining multilateralism and the need for its reforms was a much-delayed response. Given this context, this paper aimed to link the decline of multilateralism in the face of the pandemic by highlighting various instances of its failure and success; and highlighting the need for its revival. The article critically examines and evaluates the responses of multilateralism and global health diplomacy (GHD) during the pandemic. The ongoing black swan kind of event (an unexpected event) has obligated global leadership to think in terms of the revival of multilateralism through GHD. Historically, multilateralism through GHD has been shown to play an important role in managing and combating pandemics. The article further discusses various theoretical aspects such as sovereignty and hegemonic stability theory as reasons for the failing of multilateralism. The paper concludes by emphasizing the importance of foresight in reviving multilateralism in the pursuit of a more sustainable future.

Revitalizing blockchain technology potentials for smooth academic records management and verification in low-income countries

Higher education systems in low-income countries are usually fragile and sensitive to the surrounding political and economic environment. This environment poses various problems for students, graduates, and universities with regard to issuance and verification of academic records management. The process of verification and accreditation of certificates is long and costly for both students and universities.This study endeavors to address these problems by introducing an innovative solution based on blockchain technology. We propose establishing a national hybrid blockchain-based platform that brings together all possible stakeholders in the field of higher education, including students, universities, government agencies, policymakers, and companies from the business sector. This study evaluates the costs and benefits from establishing this platform and investigates the possible commercialization of its contracts. Furthermore, we test the feasibility of this platform in two of the most instable low-income countries: Syria and Sudan. We find that this platform is feasible and can serve as a marketplace for all stakeholders in the higher education system and would increase the internationalization of higher education. The establishment of this platform will ensure inclusive and equitable education and promotes lifelong learning opportunities for students from low-income countries and thus meets the fourth goal of Sustainable Development.

Losing the Energy to Cook: An Exploration of Modern Food Systems and Energy Consumption in Domestic Kitchens

The Modern Energy Cooking Services (MECS) programme has generated data on the amount of energy required to cook meals using different fuels and cooking devices. Fuel stacking is commonplace, especially among households with access to modern fuels. Experience shows that people tend to use modern fuels for quick tasks, such as preparing a cup of tea, but prefer to use biomass fuels for foods that take longer to cook. Therefore, changes in the choice of foods in the household menu have the potential to affect the transition to modern fuels. This paper discusses the potential of innovative and emerging aspects of food systems in low-income countries to impact on households. It starts by looking at the processing of indigenous crops to create convenient and nutritious food products. This leads to an overview of the rapid growth of the food processing industry and future opportunities. Consuming food that has been prepared outside of the home is also a common and rapidly growing practice, which is likely to be driven (and disrupted) by technological innovation. Cooking energy considerations depend largely on fuel stacking behaviours, and the paper argues that modern food systems have the potential to reduce energy consumption in the kitchen, and to play a role in displacing traditional biomass fuels with modern fuels.

Birth companionship in a government health system: a pilot study in Kigoma, Tanzania

BackgroundHaving a companion of choice throughout childbirth is an important component of good quality and respectful maternity care for women and has become standard in many countries. However, there are only a few examples of birth companionship being implemented in government health systems in low-income countries. To learn if birth companionship was feasible, acceptable and led to improved quality of care in these settings, we implemented a pilot project using 9 intervention and 6 comparison sites (all government health facilities) in a rural region of Tanzania.MethodsThe pilot was developed and implemented in Kigoma, Tanzania between July 2016 and December 2018. Women delivering at intervention sites were given the choice of having a birth companion with them during childbirth. We evaluated the pilot with: (a) project data; (b) focus group discussions; (c) structured and semi-structured interviews; and (d) service statistics.ResultsMore than 80% of women delivering at intervention sites had a birth companion who provided support during childbirth, including comforting women and staying by their side. Most women interviewed at intervention sites were very satisfied with having a companion during childbirth (96–99%). Most women at the intervention sites also reported that the presence of a companion improved their labor, delivery and postpartum experience (82–97%). Health providers also found companions very helpful because they assisted with their workload, alerted the provider about changes in the woman’s status, and provided emotional support to the woman. When comparing intervention and comparison sites, providers at intervention sites were significantly more likely to: respond to women who called for help (p = 0.003), interact in a friendly way (p < 0.001), greet women respectfully (p < 0.001), and try to make them more comfortable (p = 0.003). Higher proportions of women who gave birth at intervention sites reported being “very satisfied” with the care they received (p < 0.001), and that the staff were “very kind” (p < 0.001) and “very encouraging” (p < 0.001).ConclusionBirth companionship was feasible and well accepted by health providers, government officials and most importantly, women who delivered at intervention facilities. The introduction of birth companionship improved women’s experience of birth and the maternity ward environment overall.

Implementing a Social Accountability Approach for Maternal, Neonatal, and Child Health Service Performances in Ethiopia: A Pre-Post Study Design.

Social accountability approaches, such as the community scorecard (CSC), can improve the performance of health systems in low-income countries by providing a mechanism for obtaining and incorporating community input. This longitudinal study assessed the effects of CSCs implemented by primary health care units (PHCUs) on health system performance in Ethiopia. This study used a pre-post design and was conducted from October 2018 to September 2019 in 159 PHCUs in 31 districts in Amhara and Southern, Nations, Nationalities and Peoples' regional states. The data were extracted from a routine health information management system database at baseline, midterm, and endline stages over 12 months for statistical analysis. The effects of implementing CSCs on health system performance were evaluated against selected key performance indicators (KPIs). The CSC measurement results were based on input from 38,556 community representatives. The mean CSC score with standard deviation (±SD) was 60.8%±12.5%, 66.3%±10.8%, and 70.6%±10.0% at baseline, midterm, and endline, respectively. The mean KPI score was 54.9%±17.4%, 61.9%±15.1%, and 67.6%±14.6% at baseline, midterm, and endline, respectively. The average CSC and KPI values were positively correlated (r>0.37). Using a nonparametric Friedman's test, we found a statistically significant difference in CSC and KPI scores at baseline, midterm, and endline (P=.001). Post hoc analysis with Wilcoxon signed-rank tests was conducted with a Bonferroni correction and the results showed higher CSC and KPI values from baseline to midterm and from midterm to endline (P<.017). The use of CSCs in Ethiopia contributed to the health system's performance in terms of maternal and child health services. The responsiveness of health workers and utilization of basic health services by community members were found to increase significantly with CSC use. We recommend continued implementation of the CSC intervention at PHCUs.

Pharmacovigilance quality system for vaccine monitoring (COVID-19) using quality indicators: a scoping review

This scoping review responds to the appeal of the scientific community for collaboration between different entities for pharmacovigilance and active surveillance of coronavirus disease 2019 (COVID-19) vaccines. The objective is to identify, systematically evaluate, and synthesize the best scientific evidence available on the indicators used in pharmacovigilance systems. Our results demonstrate that approximately 50% of the 25 studies used in this review have been carried out in the past 5 years. Of these, only four used the pharmacovigilance indicators proposed by the World Health Organization (WHO). Eighty-seven pharmacovigilance indicators were identified, of which seven (8.0%) related to signal detection. While the WHO advocates signal detection as routine pharmacovigilance, in special situations – such as accelerated clinical studies where adverse events are not yet well known – other indicators related to signal detection appear to be good options for maintaining quality pharmacovigilance and active surveillance in the development of the COVID-19 vaccine. However, the less robust pharmacovigilance systems in low-income countries will necessitate greater involvement of health professionals from public and private sectors, pharmaceutical companies, academic institutions, and the general public, to ensure information security and detection of signals for the COVID-19 vaccine.

A Review on Drone-Based Data Solutions for Cereal Crops

Food security is a longstanding global issue over the last few centuries. Eradicating hunger and all forms of malnutrition by 2030 is still a key challenge. The COVID-19 pandemic has placed additional stress on food production, demand, and supply chain systems; majorly impacting cereal crop producer and importer countries. Short food supply chain based on the production from local farms is less susceptible to travel and export bans and works as a smooth system in the face of these stresses. Local drone-based data solutions can provide an opportunity to address these challenges. This review aims to present a deeper understanding of how the drone-based data solutions can help to combat food insecurity caused due to the pandemic, zoonotic diseases, and other food shocks by enhancing cereal crop productivity of small-scale farming systems in low-income countries. More specifically, the review covers sensing capabilities, promising algorithms, and methods, and added-value of novel machine learning algorithms for local-scale monitoring, biomass and yield estimation, and mapping of them. Finally, we present the opportunities for linking information from citizen science, internet of things (IoT) based on low-cost sensors and drone-based information to satellite data for upscaling crop yield estimation to a larger geographical extent within the Earth Observation umbrella.

Accessibility of basic paediatric emergency care in Malawi: analysis of a national facility census

BackgroundEmergency care is among the weakest parts of health systems in low-income countries with both quality and accessibility constraints. Previous studies estimated accessibility to surgical or emergency care based on population travel times to nearest hospital with no assessment of hospital readiness to provide such care. We analysed a Malawi national facility census with comprehensive inventory audits and geocoded facility locations to identify hospitals equipped to provide basic paediatric emergency care with estimated travel times to these hospitals from non-equipped facilities and in relation to Malawi’s population distribution.MethodsWe analysed a Malawi national facility census in 2013–2014 to identify hospitals equipped to manage critically ill children according to an extended version of WHO Emergency Triage, Assessment and Treatment (ETAT) guidelines. These guidelines include 25 components including staff, transport, equipment, diagnostics, medications, fluids, feeds and consumables that defined an emergency-equipped hospital in our study. We estimated travel times to emergency-equipped hospitals from non-equipped facilities and relative to population distributions using geocoded facility locations and an established accessibility mapping approach using global road network datasets from OpenStreetMap and Google.ResultsFour (3.5, 95% CI: 1.3–8.9) of 116 Malawi hospitals were emergency-equipped. Least available items were nasogastric tubes in 34.5% of hospitals (95% CI: 26.4–43.6), blood typing services (40.4, 95% CI: 31.9–49.6), micro nebulizers (50.9, 95% CI: 41.9–60.0), and radiology (54.2, 95% CI: 45.1–63.0). Nationally, the median travel time from non-equipped facilities to the nearest emergency-equipped hospital was 73 min (95% CI: 67–77) ranging 1–507 min. Approximately one-quarter (27%) of Malawians lived over 120 min from an emergency-equipped hospital with significantly better accessibility in Central than North and South regions (16% vs. 38 and 35%, p < 0.001).ConclusionsThere are unacceptable deficiencies in accessibility of basic paediatric emergency care in Malawi. Reliable supply chains for essential drugs and commodities are needed, particularly nasogastric tubes, asthma drugs and blood, along with improved capacity for time-sensitive referral. Further child mortality reductions will require substantial investments to expand basic paediatric emergency care into all Malawi hospitals for better managing critically ill children at highest mortality risk.

Hospital side hustles: Funding conundrums and perverse incentives in Tanzania's publicly-funded health sector

Following three decades of international financial institutions implementing austerity measures in sub-Saharan Africa, many health systems remain chronically underfinanced. During this period, countries like Tanzania have moved from a post-independence vision of a strong social sector providing free care for citizens, to a model of increased privatization of public health facilities, shifting the burden of self-financing to individual health facilities and the constituents they serve. Drawing on longitudinal ethnographic research and document analysis undertaken between 2008 and 2017 within three publicly-funded hospitals in north-central Tanzania, this article examines the actions and perspectives of administrators to explore how novel shifts towards semi-privatization of public facilities are perceived as taken-for-granted solutions to funding shortfalls. Specifically, hospital administrators used “side hustle” strategies of projectification and market-based income generating activities to narrow the gap between inadequate state financing and necessary recurrent expenditures. Examples from publicly-funded hospitals in Tanzania demonstrate that employing side hustles to address funding conundrums derives from perverse incentives: while these strategies are supposed to generate revenues to sustain or bolster services to poor clients, in practice these market-based approaches erode the ability of publicly-funded hospitals to meet their obligations to the poorest. These cases show that neoliberal ideas promoting health financing through public-private initiatives offer little opportunity in practice for strengthening health systems in low income countries, undermining those health systems' ability to achieve the goal of universal health care.

A Review of Breast Cancer

Breast cancer is the second most common cancer worldwide is the most common cancer among women. And it is the leading cause of Oncer mortality, and one of the leading causes of morbidity and mortality in women worldwide [1, 2].Fifty years ago cancer of the cervix and child bearing complications were the leading health care problems of wom en Breast cancer is a multifactorial disease and various factors contribute to its currence.15! Hreast cancer occurs all over the world, its incidence, mortality, and survival rates vary considerably among different parts of the world, which could be due to many factors such as population structure, Mestyle, as well as both genetic and environmental factors.co The main risk factors are ape, low parity, and a low rate of breastfeeding. This is why it is common in high resource nations, however it is increasing in almost all countries. [4] Changes in risk factors have led to an increase in the prevalence of breast cancer.[7] The world population continues to rise and the life expectancy for women has reached 80-plus year in most nations, especially western.The single most important demographic factor determinine future health care burdens will be age. One oncolog cal disease certain to increase in all nations is breast cancer.Breast cancer is an individual tragedy for those affected. It is a highly curable disease when detected early, and an inevitably fatal disease when discovered too late. Access to high-quality care leading to early diagnosis and proper surgical and medical treatment can mean the difference between lide and death. 17 Breast cancer is a major health care burden. Screening programs are costly and difficult to organise, involving major lopatie and quality control issues.Proper surgical treatment requires appropriate operating roor facilities and highly qualified healthcare providers Local radiation requires facilities beyond the scope of most health care systems in low income countries. Adequate systemic treatment with chemotherapy and hormonal therapy is costly both in itself, as well as in mangement of their potentially severe adverse effects. All sophisticated breast cancer treatment requires the resour es of advanced pathological laboratory investigation including immunohistochemistry and molecular pathology analysis.New targeted therapis remain an evolving field where only one thing is certain, individual treatment costs are already threatening the best founded healthcare system. Breast cancer is a challenge for all countries. Organizing and centraling breast cancer care around integrated breast Cancer Centers can potentially provide optimal care to individual patients within different health care sy tems the reverse wil strain healthcare systems.

Face and content validity of a prospective multidimensional performance instrument for service delivery in district health systems in low-income countries: a Delphi study

Valid performance indicators help to track and improve health services. The aim of this study was to test the face and content validity of a set of performance indicators for service delivery in district health systems of low-income countries. A Delphi method with three stages was used. A panel of experts voted (yes vs no) on the face value of performance indicators. Agreement on the inclusion of indicators was a score of >75% and ≥50% during stages one and two, respectively. During stage three, indicators with a mean score of ≥3.8 on a five-point scale were included. The panel also rated the content validity of the overall set of indicators. The panel agreed on the face value of 59 out of 238 performance indicators. Agreement on the content validity of the set of indicators reached 100%. Most of the retained indicators were related to the capacity of health facilities, the quality of maternal and child health services and HIV care and treatment. Policymakers in low-income countries could use a set of performance indicators with modest face and high content validity, and mainly aspects of capacity and quality to improve health service delivery in districts.

Breast cancer care in Uganda: A multicenter study on the frequency of breast cancer surgery in relation to the incidence of breast cancer

BackgroundBreast cancer is the most common cancer in women worldwide. Considerable funding and efforts are invested in breast cancer research and healthcare, but only a fraction of this reaches women and healthcare systems in low income countries. Surgical treatment is an essential part of breast cancer care, but access to surgery is in general very limited in low income countries such as Uganda. In this study, the previously unknown nationwide rate of breast cancer surgery was investigated.Methods and findingsThis was a multicenter, retrospective study, investigating breast cancer surgery in the public healthcare system in Uganda. Data were collected from operating theater registries at primary, secondary and tertiary level healthcare centres throught the country, including 14 general hospitals, the 14 regional referral hospitals and the national referral hospital. Patients who underwent major surgery for breast cancer at these hospitals during 2013 and 2014 were included. The number of breast cancer procedures performed, geographical variation, level of healthcare staff performing surgery and patient characteristics were investigated. After correction for missing data, a total of 137 breast cancer procedures were performed each year within the public healthcare system, corresponding to 5.7% of the breast cancer incidence in the country at that time. Most procedures (n = 161, 59.0%) were performed at the national referral hospital by qualified surgeons. Many of the patients were young; 30.1% being less than 40 years old. The proportion of male breast cancers in the study was large (6.2%).ConclusionsThe rate of breast cancer surgery in Uganda is minimal and in several parts of the country breast cancer surgery is not performed at all. More resources must be directed towards breast cancer in low income countries such as Uganda. The fact that the patients were young calls for further research, prevention and treatment specifically targeting young women in the study setting.