Middle-income Countries Research Articles

Expert Opinion on the Role of Sacubitril/Valsartan in the Management of Hypertension in India.

Hypertension, a key modifiable risk factor for cardiovascular diseases (CVD), significantly contributes to premature death and morbidity worldwide. Despite stabilization in age-adjusted global prevalence, the absolute number of hypertensive individuals doubled from 2000 to 2010, largely due to increases in low- and middle-income countries. In 2021, only 21% of hypertensive individuals globally had effective blood pressure (BP) control. In India, hypertension is the leading risk factor for death and disability, with prevalence rates of 24% in men and 21% in women, as reported by the 2019-2020 National Family Health Survey (NFHS-5). Alarmingly, just 25% of rural and 38% of urban hypertensive Indians are undergoing treatment, with only 10% and 20% achieving BP control, respectively. This highlights the hypertension paradox, where clinical inertia and hesitancy in intensifying BP-lowering therapy persist despite the availability of antihypertensive drugs. This expert opinion paper aims to provide a comprehensive evaluation of sacubitril/valsartan in hypertension management, leveraging insights from its approved use in heart failure and examining its benefits and challenges across diverse hypertensive populations. The formulation of this expert opinion involved employing evidence-based methodologies and utilizing all available data. The document underwent scrutiny by expert cardiologists, whose clinical experiences and examination of the evidence and guidelines informed the formation of the expert opinion. This expert opinion paper provides a thorough and informed evaluation of sacubitril/valsartan, highlighting its potential to address unmet needs in BP control, particularly in challenging cases such as resistant hypertension and chronic kidney disease.

GAPS Phase III: incorporation of capacity based weighting in the global assessment for pediatric surgery.

The Global Assessment for Pediatric Surgery (GAPS) tool was developed to enhance pediatric surgical care in Low- and Middle-Income Countries. This study presents the addition of a capacity-based weighting system to the GAPS tool. GAPS, developed through a multi-phase process including systematic review, international testing, item analysis, and refinement, assesses 64 items across 5 domains: human resources, material resources, education, accessibility, and outcomes. This new weighting system differentially weighs each domain. The GAPS Score was evaluated using pilot study data, focusing on hospital and country income levels, human development index, under-five mortality rate, neonatal mortality rate, deaths due to injury and deaths due to congenital anomalies. Analysis involved the Kruskal-Wallis test and linear regression. Benchmark values for the GAPS overall score and subsection scores were identified. The GAPS score's capacity-based weighting system effectively discriminated between levels of hospital (p = 0.0001) and country income level (p = 0.002). The GAPS scores showed significant associations with human development index (p < 0.001) and key health indicators such as under-five mortality rates (p < 0.001), neonatal mortality rate (p < 0.001), and deaths due to injury (p < 0.001). Benchmark scores for the GAPS overall score and the subsection scores included most institutions within their respective hospital level. The GAPS tool and score, enhanced with the capacity-based weighting system, marks progress in assessing pediatric surgical capacity in resource-limited settings. By mirroring the complex reality of hospital functionality in low-resource centers, it provides a refined mechanism for fostering effective partnerships and data-driven strategic interventions.

Neonatal Colonization With Antibiotic-Resistant Pathogens in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

In low- and middle-income countries (LMICs), neonatal bacterial infections are mainly caused by Enterobacterales species and Staphylococcus aureus, which are also the leading causes of mortality directly attributable to antimicrobial resistance. As bacterial colonization often precedes infection, better knowledge of colonization is crucial to prevent antibiotic-resistant neonatal sepsis. To synthesize current evidence on the prevalence of and factors associated with colonization with third-generation cephalosporin-resistant Enterobacterales (3GCRE), carbapenem-resistant Enterobacterales (CRE), and methicillin-resistant S aureus (MRSA) during the first 3 months of life in LMICs. PubMed, Scopus, Web of Science, and the World Health Organization Global Index Medicus were searched for articles published from January 1, 2000, through July 29, 2024. Included studies were conducted in LMICs and reported prevalence rates or factors associated with colonization with 3GCRE, CRE, or MRSA in neonates and infants up to 3 months of age. Outbreak reports were excluded. Data extraction and risk-of-bias assessment using a Joanna Briggs Institute tool were performed by 2 independent reviewers. Pooled prevalence for each pathogen was computed using a random-effects model. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Prevalence of and factors associated with 3GCRE, CRE, and MRSA colonization. Of the 3147 articles identified in the search, 67 studies (51 for 3GCRE and CRE and 16 for MRSA) including 17 152 individuals were eligible. The pooled prevalence of 3GCRE colonization was 30.2% (95% CI, 21.4%-40.7%; τ2 = 1.48; I2 = 95.1%), varying from 18.2% (95% CI, 10.8%-29.1%) in nonhospitalized individuals to 48.2% (95% CI, 36.4%-60.2%) in hospitalized individuals. The prevalence of CRE colonization was 2.6% (95% CI, 0.7%-8.8%; τ2 = 7.79; I2 = 95.6%), while it was 2.7% (95% CI, 1.0%-6.7%; τ2 = 2.58; I2 = 93.5%) for MRSA. Increased risk of colonization with 3GCRE was associated with hospital birth (odds ratio [OR], 1.87; 95% CI, 1.33-2.64), neonatal antibiotic use (OR, 2.96; 95% CI, 1.43-6.11), and prolonged rupture of membranes (OR, 3.86; 95% CI, 2.19-6.84). In this systematic review and meta-analysis of antibiotic-resistant pathogen carriage in individuals aged 0 to 3 months, the pooled prevalence was substantial despite a limited exposure period. Although high heterogeneity between studies limited extrapolation of results, the findings highlight the need for further investigation to identify transmission routes and to design targeted and effective preventive measures.

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.

Vaccine equity implementation: exploring factors influencing COVID-19 vaccine delivery in the Philippines from an equity lens.

During the early phase of the COVID-19 vaccine rollout, low and middle-income countries (LMICs) were facing challenges in achieving equitable vaccine delivery. Few studies have contextualized global vaccine distributive injustice into national-specific contexts to understand its impact on vaccine delivery from an equity perspective. We aimed to investigate factors influencing equitable COVID-19 vaccine delivery in the Philippines and to provide recommendations to enhance equitable vaccine delivery in LMICs to prepare for future health emergencies. The Health Equity Implementation Framework was employed to guide this qualitative study. We recruited participants using purposeful and snowballing sampling strategies. Semi-structured interviews were conducted with participants in person, online, or over the phone. A reflective thematic analysis approach was employed to analyze data. We recruited 38 participants including seven high-level stakeholders from the public and private sectors, 14 health workers, and 17 community members in the province of Negros Occidental, Philippines. Equitable delivery of COVID-19 vaccines was influenced by an interplay of multiple factors operating in different domains. Contextually, the rapidly evolving nature of the COVID-19 virus, ongoing scientific advancements, and international negotiations directed national-level vaccine policies. Political commitment and support were recognized as crucial drivers for successful vaccine delivery, with a strong emphasis on health information framing and communication and adherence to human rights principles. The vulnerability of the health system significantly impacted the timely and effective distribution of vaccines. Furthermore, the geographical characteristics of the Philippines presented unique logistical challenges to vaccine delivery. At the recipient domain, individual perceptions of vaccines, shaped by their socioeconomic status, exposure to (mis)information, social influence, and entrenched religious beliefs, played a major role in their vaccine decisions and thus vaccine coverage regionally. Additionally, vaccine characteristics and operational challenges related to its distribution also impacted fair allocation. The findings highlight the urgent need for LMICs to strengthen their health system resilience and sustainability and use multilevel strategies to build public trust to improve vaccine uptake and coverage. Moreover, each LMIC must be attentive to its unique contextual factors to develop tailored implementation strategies to promote equitable vaccine distribution.

Navigating the Global Dietary Transition and Its Impact on Planetary and Human Health: The Role of Middle-Income Countries

Abstract This case study examines global dietary transitions and their impact on environmental sustainability, nutritional well-being, and socio-economic inequalities, focusing on middle-income countries (MICs) like China, India, Brazil, Turkey, and Mexico. As economic expansion, urbanization, and cultural shifts drive changes in eating habits, MICs encounter both advantages and disadvantages. The study explores how socio-economic transformation influences dietary preferences, resulting in increased consumption of processed foods and animal-based products, linked to rising non-communicable diseases and environmental impacts such as greenhouse gas emissions and resource depletion. It delves into the influence of cultural heritage and social norms on dietary practices, alongside the impact of Western dietary patterns and media. Additionally, the case study underscores the role of governmental strategies in fostering sustainable and nutritious diets through policies that support local agriculture and public health. It also investigates contributions from the private sector and emphasizes the significance of community-driven and grassroots movements in promoting sustainable dietary habits and reinforcing food security. This study aims to provide insights into the interconnection between dietary transitions, their environmental and nutritional impacts, and the socio-economic drivers and disparities within and across MICs, offering guidance for sustainable development and public health improvement. Information © The Author 2024

Adopting a model of antimicrobial stewardship program to anti-tubercular treatment stewardship: A single-centre experience from a private tertiary care hospital in South India.

Tuberculosis (TB) remains a significant public health challenge in Low- and Middle-Income Countries (LMIC). Inappropriate use of Anti-Tubercular Treatment (ATT) undermines treatment efficacy and could contribute to drug resistance. While antimicrobial stewardship programs (AMSP) are well established, anti-tubercular treatment stewardship programs (ATTSP) in private hospitals do not have an established model. An AMSP model in a private tertiary care hospital in South India was repurposed to monitor the prescription appropriateness of ATT. A multidisciplinary team evaluated the ATT prescription appropriateness among inpatients over a one-year period with the 4R's criteria: Right Indication, Right Drug, Right Dose, and Right Frequency. The ATTSP team filed recommendations for inappropriate prescriptions to the primary clinical care team, and compliance to the recommendations was documented within 48 hours. During the study period, 172 ATT prescriptions were evaluated. Inappropriate dose and drug prescriptions were found in 16% and 7%, respectively. The primary clinical care teams complied with 83% of the recommendations within 48 hours. The potential impact of implementing the ATTSP model nationwide was assessed using published data, suggesting that the opportunities to correct inappropriate prescriptions could reach a quarter million. The study provides a proof of concept that an ATTSP can be successfully implemented in a TB endemic, resource-constrained setting. Extrapolation for implementing ATTSP across the country has the potential for huge public health benefits.

Bibliometric analysis of citizen science in global healthcare: Current trends, challenges, and future directions

With the development of information technologies such as big data, cloud computing, and artificial intelligence, the application scenarios of citizen science worldwide are no longer limited to natural science research. A large number of application cases have emerged in the field of medical health, which suggests that the development of citizen science may bring new impetus to medical health. This study employs CiteSpace for a bibliometric analysis to evaluate the current status, objectives, and methodologies of citizen science in global healthcare. An analysis of 248 articles from the Web of Science Core Collection reveals that citizen science is predominantly implemented in high-income countries, including the United States, the United Kingdom, Germany, and the Netherlands, with significant applications in public health, chronic disease management, infectious disease surveillance, and digital health. The COVID-19 pandemic has further catalyzed the integration of citizen science into health surveillance and public health responses. Conversely, in low- and middle-income countries (LMICs), the development and implementation of citizen science remain nascent, primarily concentrated in traditional domains such as environmental science, ecology, and biodiversity conservation, with limited penetration into the healthcare sector. Several structural barriers, including inadequate technological infrastructure, insufficient policy support, limited public engagement, and constrained resource allocation, have impeded the broader adoption of citizen science in these regions. To mitigate these challenges, this study proposes targeted strategies, these interventions are anticipated to facilitate the expansion of citizen sciences role in global health governance, ultimately contributing to improved public health outcomes and social welfare.

Effectiveness of Telemedicine and Remote Monitoring in Reducing Postpartum Hemorrhage Rates: A Meta-Analysis

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide, particularly in low- and middle-income countries (LMICs) with limited access to healthcare. Telemedicine and remote monitoring technologies offer potential solutions for early detection and management of PPH. This meta-analysis aimed to evaluate the effectiveness of these technologies in reducing PPH rates. A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted for studies published between 2013 and 2024 investigating the impact of telemedicine and remote monitoring interventions on PPH rates. Randomized controlled trials (RCTs) and observational studies with a control group were included. The primary outcome was the incidence of PPH (blood loss ≥500 ml after vaginal delivery or ≥1000 ml after cesarean delivery). Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Publication bias was assessed using funnel plot asymmetry and Egger's test. Six studies involving 4200 women met the inclusion criteria. The pooled analysis demonstrated a statistically significant reduction in PPH rates in the intervention groups compared to the control groups (RR 0.56; 95% CI 0.47-0.67; p&lt;0.00001). The funnel plot was symmetrical, and Egger's test was not statistically significant (p=0.45), suggesting no evidence of publication bias. Telemedicine and remote monitoring interventions are associated with a significant reduction in PPH rates. These findings support the integration of these technologies into postpartum care to improve maternal outcomes, particularly in resource-constrained settings.

Service-Delivery Models to Increase the Uptake of Non-Communicable Disease Screening in South-Central Ethiopia: A Difference-In-Differences Analysis

Background: Screening for non-communicable diseases (NCDs) is a critical step for early detection and the prevention of consequent morbidity and mortality. To facilitate NCD screening, the Ethiopian Ministry of Health has developed screening guidelines. However, like other low- and middle-income countries, interventions to increase the uptake of NCD-screening services in Ethiopia remain ineffective. Thus, this study aimed to determine the effectiveness of service delivery models to increase NCD-screening service uptake in south-central Ethiopia. Method: A health-facility-based quasi-experimental study design was employed to determine the effectiveness of providing a multiple-NCD-screening service in addition to social- and behavioral-change communication (SBCC) intervention to increase the uptake of NCD-screening services. The interviewer-administered structured questionnaire was adapted from previously published research and used to collect data during the baseline and end-line survey periods. A difference-in-differences analysis was used to determine the effectiveness of the intervention. Results: Compared with routine care, the availability of a multiple-NCD-screening service, together with SBCC intervention, was found to significantly increase the uptake of cervical cancer screening, clinical breast examination, blood pressure measurement, and blood glucose-measurement services, by 18, 9, 44 and 23 percent points, respectively. However, the availability of a multiple-NCD-screening service without SBCC intervention increased clinical breast-examination service uptake by 9% point and blood glucose-measurement service uptake by 18% point without increasing the uptake of cervical cancer-screening or blood pressure-measurement services. Conclusion: The integration of multiple-NCD-screening services accompanied by SBCC intervention that promotes them is an important approach for improving the uptake of NCD-screening services.

E-dengue System Insights: Exploring the Factors Influencing Dengue-related Deaths in an Urbanized State in a Low-Middle Income Country (LMIC).

Dengue has emerged as a rapidly escalating health issue in low- and middle-income countries, with its burden and geographic spread increasing over the years. Malaysia, in particular, has witnessed a significant rise in dengue cases, accompanied by a spike in mortality rates. Several studies have identified various factors, primarily focusing on the 27 clinical aspects of severe dengue infection and the development of dengue-related fatalities. Expanding on this focus, this study aims to identify the demographic, clinical, and environmental factors contributing to dengue mortality, providing a more comprehensive understanding of the variables influencing dengue-related fatalities. This study utilized a 1:2 case-control design, analyzing data from the E-dengue system database and medical records from January 2015 to December 2022, involving 219 participants (73 dengue fatalities as cases and 146 recovered patients as controls). Dengue deaths were confirmed by the Penang State Mortality Review Committee, and controls were randomly selected from laboratory-confirmed dengue cases. Statistical analyses were performed using SPSS software, including descriptive statistics, chi-square tests, and multivariable logistic regression to identify predictors of dengue mortality, with variables included in the multivariable model if p < 0.05. Several significant predictors of dengue-related mortality, including clinical and environmental factors were identified. Key predictors were a platelet count below 50,000/µL (OR 15.70; 95% CI: 5.65-43.53), presence of one comorbid condition (OR 2.90; 95% CI: 1.22-6.90), more than two comorbid conditions (OR 10.15; 95% CI: 3.53-29.23), bronchial asthma (OR 12.00; 95% CI: 1.08-132.13), and outbreak locality status (OR 2.3; 95% CI: 1.11-4.79). An interaction was also found between locality status and platelet levels. The study emphasizes the need for developing risk profiles for dengue patients by integrating factors such as platelet levels, comorbidities, and locality status to improve clinical care. Nuanced protocols are needed to address the specific challenges of single-case and outbreak areas. In single-case localities, patients with low platelet counts (below 100,000/µL) should be prioritized for rapid intervention to mitigate severe outcomes. In outbreak areas, healthcare systems should bolster resources and apply comprehensive triage approaches considering platelet levels and other risk factors. Implementing predictive models that account for geographical factors can enhance resource allocation and preparedness for dengue outbreaks. These recommendations aim to empower public health personnel, healthcare providers, and communities to collectively reduce dengue-related mortality rates.

Lateral Flow Assay for Preeclampsia Screening Using DNA Hairpins and Surface-Enhanced Raman-Active Nanoprobes Targeting hsa-miR-17-5p

Preeclampsia (PE) is a serious complication that poses risks to both mothers and their children. This condition is typically asymptomatic until the second or even third trimester, which can lead to poor outcomes and can be costly. Detection is particularly challenging in low- and middle-income countries, where a lack of centralized testing facilities coincides with high rates of PE-related maternal mortality. Variations in the levels of hsa-miR-17-5p have been identified as constituting a potential early indicator for distinguishing between individuals with PE and those without PE during the first trimester. Thus, developing a screening test to measure hsa-miR-17-5p levels would not only facilitate rapid detection in the early stages of pregnancy but also help democratize testing globally. Here, we present a proof-of-principle lateral-flow assay (LFA) designed to measure hsa-miR-17-5p levels using DNA-hairpin recognition elements for enhanced specificity and nanoprobes for sensitive surface-enhanced resonance Raman scattering (SERS) signal transduction. The theoretical limit of detection for hsa-miR-17-5p was 3.84 × 10−4 pg/µL using SERS.

Global Disparities of Cancer and Its Projected Burden in 2050.

Cancer prevention and care efforts have been challenged by the COVID-19 pandemic and armed conflicts, resulting in a decline in the global Human Development Index (HDI), particularly in low- and middle-income countries. These challenges and subsequent shifts in health care priorities underscore the need to continuously monitor cancer outcome disparities and statistics globally to ensure delivery of equitable and optimal cancer prevention and care in uncertain times. To measure the global burden of 36 cancers in 2022 by sex, age, and geographic location and to project future trends by 2050. This cross-sectional study used population-based data from 2022 in 185 countries and territories were obtained from the Global Cancer Observatory database. Data extraction and analysis were carried out in April 2024. Counts, rates, prevalence, mortality to incidence ratios (MIRs), and demography-based projections were used to characterize current and future cancer burden. This population-based study included 36 cancer types from 185 countries and territories. By 2050, 35.3 million cancer cases worldwide are expected, a 76.6% increase from the 2022 estimate of 20 million. Similarly, 18.5 million cancer deaths are projected by 2050, an 89.7% increase from the 2022 estimate of 9.7 million. Cancer cases and deaths are projected to nearly triple in low-HDI countries by 2050, compared to a moderate increase in very high-HDI countries (142.1% vs 41.7% for cancer cases and 146.1% vs 56.8% for cancer deaths). Males had a higher incidence and greater number of deaths in 2022 than females, with this disparity projected to widen by up to 16.0% in 2050. In 2022, the MIR for all cancers was 46.6%, with higher MIRs observed for pancreatic cancer (89.4%), among males (51.7%), among those aged 75 years or older (64.3%), in low-HDI countries (69.9%), and in the African region (67.2%). In this cross-sectional study based on data from 2022, cancer disparities were evident across HDI, geographic regions, age, and sex, with further widening projected by 2050. These findings suggest that strengthening access to and quality of health care, including universal health insurance coverage, is key to providing evidence-based cancer prevention, diagnostics, and care.

The CHALO! 2.0 mHealth-Based Multilevel Intervention to Promote HIV Testing and Linkage-to-Care Among Men Who Have Sex with Men in Mumbai, India: Protocol for a Randomized Controlled Trial.

Current programs to engage marginalized populations such as gay and bisexual individuals and other men who have sex with men (MSM) in HIV prevention interventions do not often reach all MSM who may benefit from them. To reduce the global burden of HIV, far-reaching strategies are needed to engage MSM in HIV prevention and treatment. Globally, including low- and middle-income countries, MSM are now widely using internet-based social and mobile technologies (SMTs; eg, dating apps, social media, and WhatsApp [Meta]), which provides an unprecedented opportunity to engage unreached and underserved groups, such as MSM for HIV prevention and care. This study aimed to assess the effectiveness of a multilevel mobile health (mHealth)-based intervention to improve HIV testing uptake and status neutral linkage-to-care among sexually active MSM reached through internet-based platforms in Mumbai, India. In this randomized controlled trial, we will determine whether CHALO! 2.0 (a theory-based multilevel intervention delivered in part through WhatsApp) results in increased HIV testing and linkage-to-care (prevention or treatment). This study is being conducted among 1000 sexually active MSM who are unaware of their HIV status (never tested or tested >6 months ago) and are recruited through SMTs in Mumbai, India. We will conduct a 12-week, 3-arm randomized trial comparing CHALO! 2.0 to 2 control conditions-an attention-matched SMT-based control (also including a digital coupon for free HIV testing) and a digital coupon-only control. The primary outcomes will be HIV testing and status neutral linkage-to-care by 6 months post enrollment. Participants will be followed up for a total of 18 months to evaluate the long-term impact. The study was funded in 2020, with recruitment having started in April 2022 due to delays from the COVID-19 pandemic. Baseline survey data collection began in April 2022, with follow-up surveys starting in July 2022. As of April 2022, we enrolled 1004 participants in the study. The completion of follow-up data collection is expected in January 2025, with results to be published thereafter. While global health agencies have called for internet-based interventions to engage populations vulnerable to HIV who are not being reached, few proven effective and scalable models exist and none is in India, which has one of the world's largest HIV epidemics. This study will address this gap by testing a multicomponent mHealth intervention to reach and engage MSM at high priority for HIV interventions and link them to HIV testing and prevention or treatment. ClinicalTrials.gov NCT04814654; https://clinicaltrials.gov/study/NCT04814654. Clinical Trial Registry of India CTRI/2021/03/032280. DERR1-10.2196/59873.

Assessment of wetland loss through industrialization and community expansion: a case study of the greater amanzule wetland in the Ellembelle district of Ghana

Wetland ecosystems provide numerous services to humanity and the biosphere at large. However, these services are constantly dwindling due to the massive wetland loss caused by urbanization. Urbanization-induced wetland loss is a global problem, with most developing countries experiencing it currently. Several studies on wetland loss have been conducted. However, there is a dearth of studies integrating GIS and other ecological models to estimate the periodic deterioration of wetlands in rural settings in underdeveloped nations. As a result, this study aims to determine wetland loss in a developing country’s countryside, using the Greater Amanzule Wetland in the Ellembelle District of Ghana as a case study. The study used the GIS and Remote Sensing dataset, the Normalization Difference Vegetation Index, and the InVEST-Habitat Quality model to analyze the spatial pattern of wetland loss and habitat quality variations caused by industrialization and community expansions between 2000 and 2020. Our results indicate that, from 2000 to 2015, community built-up and industrial land areas grew from 25.19 ha to 84.21 ha and 0–4.71 ha respectively, causing a wetland loss of −39.64 ha (−31.10%). Between 2015 and 2020, community built-up land grew to 78.65 ha while industrial land slightly reduced to 2.54 ha, leading to the wetland degradation of approximately −69.06 ha (−42.53%). Wetland habitat quality steadily declined, from 0.97 in 2000 to 0.93 in 2015 and 0.93 in 2020. The study findings led to policy recommendations to reduce wetland encroachment and enhance sustainability. These recommendations included conducting effective land-use plan inspections before issuing permits, coordinating effective management, and promoting the recovery of natural and artificial vegetation to sustain the wetland.

Nucleoside Analogues for Chagas Disease and Leishmaniasis Therapy: Current Status and Future Perspectives

Chagas disease and leishmaniasis are two neglected tropical diseases that affect millions of people in low- and middle-income tropical countries. These diseases caused by protozoan parasites pose significant global health challenges, which have been exacerbated by the recent COVID-19 pandemic. There is an urgent need for novel therapeutics as current treatments are limited by toxicity and drug resistance. Nucleoside analogues, which have been extensively studied and successfully applied in antiviral and antitumor therapies, hold potential that has yet to be fully explored for treating these neglected diseases. In this review, we discuss the use of nucleoside analogues as promising therapeutic agents for Chagas disease and leishmaniasis. After briefly examining the pathology, progression, and current treatment options for these diseases, we provide a comprehensive analysis of the status of nucleoside analogues and explore their prospects. By outlining the current landscape and future directions, this review aims to guide research and development efforts towards more effective nucleoside-based treatments for Chagas disease and leishmaniasis.

Do public-private partnerships (PPPs) promote the sustainable development of infrastructure (SDI)? Evidence from China

PurposeTo address challenges such as inadequate funding and inefficiency in public infrastructure construction, PPPs have gained significant global traction. This study aims to comprehensively assess the impacts and mechanisms of PPPs on the SDI and to provide rational policy recommendations based on the findings.Design/methodology/approachWe collated a dataset from 30 Chinese provinces covering the years 2005–2020 as our research sample. The study’s hypotheses are tested using a double fixed-effects model, a chained mediated-effects model and a multidimensional heterogeneity analysis.FindingsOur findings indicate that PPPs have a facilitating effect on SDI in general. This boost usually lags behind policy implementation and is cyclical in the time dimension. In the spatial dimension, PPPs contribute significantly to SDI in the eastern and western regions, but not in the central region. From the perspective of the dynamics of economic, social and industrial development, PPPs in economically backward areas are difficult to promote SDI, promote it the most in economically medium regions and are slightly less in economically developed regions than in medium regions. This promotion effect has an inverted U-shaped relationship with social development and diminishes with industrial structure upgrading. Finally, due to the negative relationship between PPPs and social development and between social development and SDI, PPPs are shown to contribute to SDI and are identified as critical paths. However, PPPs suppress SDI by inhibiting economic and industrial development.Originality/valueThis study makes three novel contributions to the existing body of knowledge: (1) we innovatively introduce the United Nations Sustainable Development Goals (SDGs) into the field of infrastructure research, offering fresh perspectives on SDI enhancement; (2) revealing the mechanisms by which PPPs affect SDI through the three dimensions of economic, social and industrial development enabling policymakers to better understand and optimize resource allocation and improve planning, design and management of PPP projects for sustainable infrastructure and (3) we assess the spatiotemporal variances of PPPs’ effects on SDI and the diversity across regions at different social, economic and industrial structures developmental stages, offering critical insights to global decision-makers to devise tailored policy measures.

A critical review of literature and a conceptual framework for organising and researching urban health and community health services in low- and middle-income countries.

Low- and middle-income countries (LMIC) are rapidly urbanizing, and in response to this, there is an expansion in the body of scholarship and significant policy interest in urban healthcare provision. The idea and the reality of 'urban advantage' has meant that health research in low- and middle-income countries (LMICs) has disproportionately focused on health and healthcare provision in rural contexts and is yet to sufficiently engage with urban health as actively. We contend that this research and practice can benefit from a more explicit engagement with the rich conceptual understandings that have emerged in other disciplines around the urban condition. Our critical review included publications from four databases (MEDLINE, EMBASE, CINAHL and Social Sciences Citation Index) and two CHW resource hubs. We draw upon scholarship anchored in sociology to unpack the nature and features of the urban condition; we use these theoretical insights to critically review the literature on urban community health worker programs, as a case to reflect on community health practice and urban health research in LMIC contexts. Through this analysis, we delineate key features of the urban - such as heterogeneity, secondary spaces and ties, size and density, visibility and anonymity, precarious work and living conditions, crime, and insecurity, and specifically the social location of the urban CHWs and present their implications for community health practice. We propose a conceptual framework for a distinct imagination of the urban to guide health research and practice in urban health and community health programs in the LMIC context. The framework will enable researchers and practitioners to better engage with what entails a 'community' and a 'community health program' in urban contexts.

The Subject-to-Tax Rule in East Africa: Is it Worth it?

The two-pillar approach focusses on BEPS issues in developing countries to a greater extent than preceding OECD agreements. In particular, the Subject-to-Tax Rule (STTR) is intended to address BEPS risks in low-income countries’ tax treaties. BEPS is undoubtedly a critical issue in East Africa since corporate income tax is an unusually important source of tax revenue in Africa. This article analyses the STTR alongside treaties and domestic law to understand the likely impact of the rule in the region. It also considers the diverse domestic policy landscapes to explore whether the STTR is an attractive measure for countries in East Africa. The author believes that implementation of the rule will be complex, challenging already stretched tax administrations. Furthermore, some low-income countries may prefer not to engage with reforms that increase source taxation. The analysis concludes that any hopes that the STTR will mark a major step in addressing BEPS in this part of the world are likely to be disappointed, but it could form part of a portfolio of measures for some specific countries.

The Subject-to-Tax Rule in East Africa: Is It Worth It?

The two-pillar approach focusses on BEPS issues in developing countries to a greater extent than preceding OECD agreements. In particular, the Subject-to-Tax Rule (STTR) is intended to address BEPS risks in low-income countries’ tax treaties. BEPS is undoubtedly a critical issue in East Africa since corporate income tax is an unusually important source of tax revenue in Africa. This article analyses the STTR alongside treaties and domestic law to understand the likely impact of the rule in the region. It also considers the diverse domestic policy landscapes to explore whether the STTR is an attractive measure for countries in East Africa. The author believes that implementation of the rule will be complex, challenging already stretched tax administrations. Furthermore, some low-income countries may prefer not to engage with reforms that increase source taxation. The analysis concludes that any hopes that the STTR will mark a major step in addressing BEPS in this part of the world are likely to be disappointed, but it could form part of a portfolio of measures for some specific countries.