World Bank Criteria Research Articles

Temporal trends in the visual impairment burden attributable to high fasting plasma glucose levels: a population-based study.

Elevated fasting plasma glucose (FPG) levels have been associated with visual impairment. Recognising global patterns of high FPG level exposure can facilitate the prevention and treatment of related visual impairment. We aimed to assessthe trendsof the visual impairmentburden attributable to high FPG levels globally, regionally, nationally, and by income level. We obtained data on the visual impairment burden attributable to high FPG levels from the Global Burden of Disease Study 2019. We evaluated the trends of related disability-adjusted life-years (DALYs) from 1990 to 2019 through joinpoint regression analysis and calculated the annual percentage change (APC) and average APC (AAPC). Countries/territories were categorised into high-, upper-middle-, lower-middle-, and low-income groups based on the 2019 World Bank criteria. The age-standardised rate of DALYs due to visual impairment attributable to high FPG levels significantly increased globally, from 6.75 (95% uncertainty interval [UI], 1.55-15.79) in 1990 to 8.44 per 100,000 population (95% UI, 2.00-19.63) in 2019 (AAPC, 0.79; 95% confidence interval [CI], 0.69-0.89; p < 0.001). The largest increases were observed in high-income (AAPC, 0.73; 95% CI, 0.60-0.85) and lower-middle-income countries/territories (AAPC, 0.68; 95% CI, 0.62-0.73). In 2019, lower-middle-income countries/territories had the highest age-standardised DALY rate (18.94 per 100,000 population; 95% UI, 4.39-43.98), whereas high-income countries/territories had the lowest (2.97 per 100,000 population; 95% UI, 0.75-6.74). The visual impairment burden associated with elevated FPG levels has increased significantly, necessitating enhanced public health prevention measures, clinical management, and treatment to mitigate adverse outcomes.

Kinerja Ekonomi Usaha Tani Tanaman Pangan dan Kontribusinya pada Kesejahteraan Petani di Desa Sekitar Kawasan Ekonomi Khusus Mandalika, Kabupaten Lombok Tengah

The Mandalika Special Economic Zone (SEZ) development in West Nusa Tenggara Province aims to accelerate economic growth, especially for people in Pujut District-Central Lombok Regency. This research aims to describe the economic performance of food crop farming in villages around the Mandalika SEZ and its contribution to the economic welfare of farmer households. This research uses descriptive methods, and the data was collected using survey techniques in 3 villages with potential for food crop farming, namely Sengkol, Rembitan, and Sukadana villages. The respondents were 75 farmers. The results showed that food crops in villages around the Mandalika SEZ consist of rice, soybeans, and corn, with low productivity and an R/C ratio of 1.48–2.02. The total income from food crop farming is IDR 7,903,504.28/year or 34.06% of the total household income of farmers. The contribution of food crop farming income to farmer welfare based on the Sajogyo criteria was 41.69%, and based on the World Bank Criteria, it was 18.95%. Keywords: food crop, farmers welfare, farmer household, special economic zone mandalika, Central Lombok

Diversity among editorial boards of genitourinary oncology journals.

481 Background: Several studies have evaluated the ethnic and gender diversity among editorial boards of academic journals in science and medicine, and revealed disparities among representation of historically underrepresented groups. However, the diversity among editorial boards in the field of genitourinary oncology remains unclear. Methods: Using the master journal list from Clarivate, we identified academic journals with a dedicated or primary focus in genitourinary cancers. We then identified the list of editorial board members on each journal’s website. We evaluated economic diversity based off each editor’s country of origin, and classified countries as high income based off World Bank listing for the 2024 fiscal year. We confirmed gender from each editor’s self-reported gender on his or her academic profile. Results: We identified 7 journals with a focus in genitourinary cancers. Among these journals, a total of 485 editor positions were identified, with 397 men (81.86%) and 80 women (16.49%). The gender of 8 individuals (1.65%) could not be confirmed. 28 editors (5.77%) were from countries not identified as high-income countries per World Bank criteria. Conclusions: There are disparities in country of origin among editors of genitourinary oncology journals, with a small proportion of editors originating from countries classified as middle- or low-income. [Table: see text]

POVERTY AND INEQUALITY ANALYSIS OF POPULATION EXPENDITURE IN WEST NUSA TENGGARA

This study aims to analyze and describe the development of poverty and inequality of population expenditure in West Nusa Tenggara. The research method used is descriptive research using secondary data from 2014-2021. The analysis technique used in this study was analyzing data using tables related to the aspects studied: population expenditure data analysis to determine inequality occurrence using the Gini efficiency and the World Bank criteria.The results show that the development of the number of poor people has always decreased, with the number of poor people in rural areas being smaller than in urban areas. The distribution of the poverty line in both urban and rural areas averaged more than 70% for food needs, the remaining less than 30% for non-food needs. On average, the percentage of poor people during 2014-2021 for urban and rural areas is 15,15%. The average poverty depth index (P1) was 2.700 for urban and rural areas, and the average poverty severity index (P2) during the year was 0,670%.The average inequality of population expenditure based on the Gini coefficient is 0.379 for urban and rural areas, which is “moderate”. Based on World Bank criteria, inequality of population expenditure in rural areas is classified as “mild or low inequality,” while in urban areas, it is classified as “moderate inequality.” Expenditure inquality for rural and urban areas is classified as “mild or low inequality.”

Assessment of Income Inequality of Shallot and Paddy Farming in The Coastal Area of Bantul Regency

This study attempts: (1) to estimate the income of shallot and paddy farming, (2) to calculate the contribution of shallot and paddy farming to the household income of the farmer, (3) to know the structure pattern of farm household income, and (4) to analyze the inequality of farm household income in the coastal area of ​​Bantul Regency. This research was located in Sanden and Kretek Sub-District of Bantul Regency. The samples were 45 farmer households that did shallot and paddy farming. Farming income contribution was gained by calculating the percentage of farming income to the total household income. The data were analyzed by a one-sample t-test. The contribution pattern was obtained by descriptive analysis. The income gap was identified by the Gini index analysis, Gini index decomposition, World Bank criteria, and Lorenz curve. The results showed that (1) the average income of shallot farming was greater than paddy farming, (2) the contribution of shallot farming income was higher than paddy farming income to farm household’s income, (3) the structure of farm household’s income has a different pattern – households with above-average income have a structural pattern that is dominated by non-shallot and paddy farming, and (4) based on Gini Index and World Bank category, farm household’s income inequality is in the medium category.

Global Overview on Current Paediatric Dentistry Teaching: A Survey of National Member Societies of the IAPD.

There is limited published information on the teaching and recognition of paediatric dentistry (PD) worldwide. To investigate the status of current teaching of undergraduate and postgraduate training in PD and identify differences by country-level economic development. Representatives from 80 national member societies of the IAPD were invited to complete a questionnaire on undergraduate and postgraduate PD curricula, types of postgraduate education offered and recognition of the specialty. Country economic development level was classified according to World Bank criteria. Chi-square test and Spearman correlation coefficient were used for data analysis (α=0.005) RESULTS: Response rate was 63%. Teaching of PD at the undergraduate level was present in all countries, but PD specialization, Masters, and PhD coursework was offered in 75%, 64%, and 53% of surveyed countries, respectively. Postgraduate specialization courses were offered in a significantly larger proportion of high-income countries than in upper-middle or lower-middle income countries (p<0.01). In 20% of participating countries, PD was not an officially recognized specialty with no difference in recognition of the specialty by country's economic development level (p=0.62). PD is taught at the undergraduate level universally but at the postgraduate level there are significantly fewer available courses especially in lower-income countries.

The International Continence Society (ICS) survey on intermittent catheterization and global practices with regard to the reuse of catheters

Objective:To survey members of the International Continence Society (ICS) for exploring global differences in practices with regard to intermittent catheterization (IC) and reuse of catheters in the neuro-urological patient. A project of the Neuro-Urology Promotion Committee (NUPC) of the ICS. Methods:Cross-sectional survey of ICS members using the SurveyMonkey platform. Initial survey preparation, revisions, pilot, and finalization were performed within the NUPC. Opt-in survey emailed to all members by the ICS office. Foundation questions ascertained type of clinical practice, health care system, and country of residence which was stratified by World Bank criteria as ‘high-income group, HIG’ or ‘not high-income group, non-HIG’ for analysis. Several questions addressed the reuse of catheters and related practices. Survey results were analyzed using R (version 3.1.3) statistical analysis (p-value <0.05 significant, two-way testing). Results:244 out of 1107 members (22.0%) responded. Respondents were from 57 countries including 89 (36.5%) from non-HIG countries. 61.1% respondents were urologists and 62.7% were working at public teaching hospitals. Single-use catheters were prescribed by 113 (46.7%), reuse by 51 (21.1%), and both techniques by 78 (32.2%). Reuse was reported by 38.3% and 76.4% of respondents from HIG and non-HIG countries, respectively. There was marked variation with regard to the frequency of IC, method of cleaning of hands and genitalia, and the method of cleaning and storing catheters. Instruction in IC was most commonly provided by nurses in HIG countries (93.6%) but by urologists in non-HIG countries (66.3%). Reuse was recommended between 2–5 times, 6–10 times, 11–30 times, 31–50​ times, 51–90 times, >90 times, and till visible deterioration in 25.0%, 25.8%, 15.8%, 7.5%, 5.0%, 5.0%, and 15.8%, respectively. Conclusion:Reuse of catheters by patients on IC was not restricted to less affluent countries. There were wide variations in every aspect of the IC protocol. These issues are critical to patients, communities, and the environment and urgently require research.

ANALISIS SUMBER DAN KETIMPANGAN PENDAPATAN NELAYAN PESISIR DI KOTA TARAKAN

This study aims analyze the source of income of fishing families meet household needs in Tarakan City and to analyze the level of income inequality of fishing communities in Tarakan City. This research was conducted in 2021 in Tarakan City. The results showed that the fishermen's family income comes from the husband and additional income from the wife and children, contributes of each family income; husband is 45%, wife is 54% and 5% Children, and per capita income of Rp. 772,753. The Gini Index of 0.41 is classified as moderate inequality. The Lorenz curve shows that 50% of the population enjoys less than 40% of the total income. The distribution of income for fishermen in the coastal TarakanCity, of the World Bank criteria shows that 40% of low-income fishermen enjoy 23.69% of the total income, while 40% of middle-income earners enjoy 38.76% and 20% of high-income earners enjoy 38.55% of total income , the income distribution of fishermen in the coastal city of Tarakan is not too unequal (low inequality), greater than 17%, base on the World Bank criteria. Keywords : Gini Index, Income Inequality, Coastal Fishermen, Urban

INCOME DISTRIBUTION OF CORPORATE FARMING MODEL IN CENTRAL JAVA

Corporate farming is an agricultural model carried out with the principle of expanding the planting area by eliminating land boundaries. The aim is to improve group production and productivity. This agricultural model is also a solution to the conversion of functions and increasingly massive land fragmentation. As a result, the income obtained by farmers is limited to subsistence land. This study aimed to determine the income distribution of corporate farming model farmers in Sukoharjo Regency, Central Java. Sukoharjo Regency was chosen as the research location with consideration as a national food barn that implements corporate farming. Sampling using a census of 51 farmers. The study results show that farmers' incomes have reached a prosperous degree according to the World Bank's criteria. The distribution of farmers' income is even with a low level of income inequality.

Meta-analysis of donor–recipient gender profile in paediatric living donor liver transplantation

ObjectivePaediatric living donor liver transplantation (LDLT) has gained popularity due to limited deceased donor organ supply. Some studies report inequalities in donor and recipient gender profiles, but data are sparse....

Barriers to Premarital Thalassemia Screening in Asia

Thalassemia is a genetic disorder of hemoglobin synthesis. Every year 70,000 infants are born with beta thalassemia globally. Its incidence can be reduced by premarital thalassemia screening This review aims to focus on barriers to premarital thalassemia screening and to observe the current thalassemia practices in Asian countries. This study was conducted on six countries of Asia based on economic status according to World Bank criteria. High income states included Kingdom of Saudi Arabia, and Oman, Iran constituted an upper middle-income country and in lower middle-income category Sri Lanka, Pakistan and Bangladesh were considered. Search engines like PubMed, Research Gate and Google scholar were used to look for relevant articles from 2005 to 2019. A total of (89) articles were reviewed and (61) articles were finally selected to be included in this review. In Saudi Arabia, major obstacles for premarital thalassemia screening included planned weddings (43%), fear of social disgrace (21%), pressure from family (17%), and religious factors (14%). While in Oman, 4% of the people feared positive results and also considered it as an insult. Amongst the Iranian population, financial burden on couples, disease phobia, fear of positive results, difficulty in accessibility, tribal variances and sociodemographic factors were frequent hindrances to a screening program. Religious factors, financial constraint and lack of awareness cause reluctance in Pakistan and Bangladesh. Moreover, in Sri Lanka, factors like cancellation of marriage and sociocultural norms were identified as negative outcomes of the screening. In conclusion, a negative attitude and reluctant response to premarital thalassemia screening was observed in people belonging to all the countries included. Major contributing factors were religious misconceptions, social stigma, varying ethnicities, low financial status and poor accessibility to screening programs. Key words: Beta thalassemia, thalassemia screening, premarital screening, consanguineous marriage, social impact

Barriers to the Development and Sustainability of Bone Banking Programs in Low- and Middle-Income Countries: A Systematic Review.

Purpose: The number of bone allograft transplantations required in low- and middle-income countries (LMICs) is growing very quickly. No previous study has investigated the challenges clinical banks face to sustain operations or meet this demand. The purpose of this study was to conduct a systematic review of the barriers to implementation and sustainability of clinical bone tissue banks in LMICs. Barriers identified in clinical bone banking can shed light on strategies for overcoming obstacles in other biobanking programs. Methods: A systematic review protocol was registered with PROSPERO under identification number CRD42019136045. LMIC was defined using World Bank criteria. A search strategy targeting PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and the World Health Organization (WHO) Global Health Library was used. Studies from the inception of bone banking until June 4, 2019, that discussed an identifiable barrier to bone banking were included. Study quality was assessed using The Critical Appraisals Skills Programme (CASP) Qualitative Checklist. Results: Of studies identified, 33 studies were included in the final analysis. Based on the full-text review, the primary barriers identified were lack of regulation, low donor rates, and insufficient training and staffing. CASP analysis performed on the 24 qualitative articles showed an average of 3.6 qualitative measurements met. Conclusions: As international organizations such as the International Atomic Energy Agency (IAEA) restructure their participation in global bone banking regulation, these barriers such as lack of regulation, low donor rates, and insufficient training and staffing could pose a challenge to meeting the rising demand for bone transplantation in LMICs. Articles with higher quality evidence are needed to better define barriers and propose evidence-based solutions.

Case fatality rates of COVID-19 across the globe: are the current draconian measures justified?

AimThe current study assessed the case fatality rate (CFR) across different income level countries of the world, and the virulence pattern of COVID-19, against the backdrop of panic and uncertainty faced by many governments, who are trying to impose draconian containment measures to control the outbreak. Subjects and Methods: Data on confirmed cases and number of deaths due to coronavirus infection were retrieved from the WHO as on 30 March 2020, and examined for the various income level countries, per the World Bank criteria. The CFR was calculated country-wise and estimated for the various groups such as low, lower-middle, upper-middle, and high-income, and the data was analyzed.ResultsThe overall CFR for the high income countries was 5.0%, compared with a CFR of 2.8% for low-income countries. The upper-middle-income countries showed a CFR of 4.3%, while the lower-middle-income countries stood at 3.7%. The results from our study predict that the maximum CFR in high-income countries will be contained at approximately 5% (95% CI). The CFR for the low, lower-middle, and upper-middle-income countries will range between 2.8 and 4.3% (95% CI).ConclusionCOVID-19, irrespective of its transmissibility, produces a lower CFR compared with that of SARS-Cov and MERS-Cov, although COVID-19 has infected eight times more countries than MERS-Cov and SARS-Cov, and caused a higher number of deaths. The nation-wide lockdown measures to prevent the spread of the virus may be reconsidered, given the hardships for the population and their impact on the economic system.

Abstract PS7-21: Timelines to initiate an adjuvant phase III trial across the globe: A sub-analysis of the APHINITY trial

Abstract Background:Previous analysis of an adjuvant breast cancer trial (NCT00490139) suggested that geographical location and income affected the time required to set up a clinical trial, being significantly longer in South American and upper-middle income economies, potentially affecting access of innovative therapies in these locations. Understanding that this can be a dynamic process, we performed a similar analysis for the recent global phase III APHINITY trial (NCT01358877), which investigated the addition of pertuzumab to chemotherapy and trastuzumab as adjuvant therapy for patients with HER2-positive primary breast cancer. Methods:Time to regulatory authority (RA) submission to approval, time to ethics committee/institutional review board (EC/IRB) approval, time from study approval by EC/IRB to first randomized patient, and time from first to last randomized patient were collected prospectively. Analyses were conducted by grouping countries either by geographical region or economic income classification as per 2019 World Bank criteria. Descriptive statistics of medians and ranges were calculated for the different timelines evaluated. Differences between geographical regions and economic income classification groups were calculated using one-way analysis of variance (ANOVA) following data normalization on square roots of the time to local RA. Geographical regions represented by only one participating country were not included in the ANOVA calculations. Results:APHINITY randomized 4805 patients between November 2011 and August 2013. Of the 42 participating countries, 41 had data available regarding all relevant timelines. Of those, 21 (51.2%) were located in Europe, 9 (21.9%) in the East Asia-Pacific region, 8 (19.5%) in Latin America and Caribbean, 2 (4.8%) in North America, and 1 (2.4%) in Sub-Saharan Africa. Twenty-seven (65.8%) of the participating countries had high, 11 (26.8%) upper-middle, and 3 (7.3%) had lower-middle income economies. Except for time from first patient to last patient randomized, there was wide variation in timelines within geographical region and across economic income classification. For example, the median time from EC/IRB approval to first recruited patient across all geographical regions was 118 days, but the range was wide (13– 463 days). There was, however, no statistical difference between the time to RA according to geographical region (p=0.47) although there was a trend to longer time to RA in upper-middle income economies compared to the others (p=0.07). Conclusion Our results did not demonstrate a significantly longer time for trial activation in Latin American &amp; Caribbean countries and upper-middle income economies compared to other groups in the APHINITY trial. When compared to a previous report, this may reflect collective work from collaborative research groups, pharmaceutical industry sponsors and regulatory authorities across the globe and is to be welcomed. Variability in timelines within geographical regions and income classifications may exist and should be further investigated. Table 1: Timelines in the activation process of APHINITY across geographical region and economic income classification.Time to RA (days)*Time to EC/IRB (days)Time from EC/IRB approval to first patient (days)Time from first patient to last patient randomized (months)Europe and Central Asia56 (4-135)67 (22-164)109 (13-257)17.6 (13.2-21.7)North America31 (30-32)73 (19-126)126 (86-165)17.6 (13.8-21.5)East Asia and Pacific53 (15-372)67 (31-421)108 (56-147)18 (8.7-19.9)Latin America and Caribbean51 (15-276)43 (19-273)232 (98-463)14.6 (6.5-17.5)Middle East and North Africa-141 (141-141)92 (92-92)13.9 (13.9-13.9)Sub-Saharan Africa103 (103-103)14 (14-14)185 (185-185)18.2 (18.2-18.2)Overall53 (4-372)56 (14-421)118 (13-463)17 (6.5-21.7)High income45 (4-276)60 (19-273)98 (13-257)18.2 (11.9-21.7)Upper middle income92 (15-372)54 (14-421)185 (73-463)14.2 (6.5-18.2)Lower middle income55 (32-111)33 (32-78)201 (147-209)15.1 (13.5-17.4)Overall53 (4-372)56 (14-421)118 (13-463)17 (6.5-21.7)Data are medians (range)*The protocol was not submitted to a country regulatory authority for Israel. The corresponding timelines for Israel cannot be calculated.EC/IRB = ethics committee/institutional review board; RA = regulatory approval Citation Format: Maria Alice Franzoi, Marion Procter, Orianne Emond, Damien Parlier, Noam Pondé, Daniel Eiger, Sebastien Guillaume, Linda Reaby, Christopher Twelves, Emma Clark, Evandro de Azambuja, Jose Bines. Timelines to initiate an adjuvant phase III trial across the globe: A sub-analysis of the APHINITY trial [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-21.

Associations of childhood exposure to malaria with cognition and behavior outcomes: a systematic review protocol

BackgroundMalaria is one of the major contributing risk factors for poor development of children living in low- and middle-income countries (LMICs). However, little is known about the specific domains of cognition and behavior that are impacted by malaria, the extent of these deficits, and the different types of the malaria spectrum that are associated with these deficits. The objective of this systematic review is to determine the association of the different types of malaria infection on cognition and behavioral outcomes among children living in LMICs.Methods and analysisWe will systematically search online bibliographic databases including MEDLINE (via PubMed), CINAHL (via EBSCO), PsycINFO (via EBSCO), Embase, and The Cochrane Central Register of Controlled Trials (CENTRAL) as well as Google Scholar and bibliographies of pertinent articles. We will include studies with a comparison group (e.g., clinical trials, cohort, observational, cross-sectional case–control, and controlled before and after or interrupted–time–series studies) involving children under 18 years of age living in LMICs, as determined by the World Bank criteria, with either an active malaria infection or history of malaria. Included articles must also measure cognitive and/or behavior outcomes determined by standardized psychological assessments (questionnaire-based scales and or neurocognitive assessments). Studies will be excluded if they are not in English, lack a control group, take place in a high-income country, or if a standardized instrument was not used. Two reviewers will independently review all articles to determine if they meet eligibility criteria. Any conflicts will be resolved after discussion with a third reviewer. When a list of included articles is finalized, two reviewers will extract data to populate and then cross check within an electronic table. Risk of bias and the strength of evidence and recommendations will be assessed independently using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, and a final score will be given upon consensus. For sufficiently homogeneous data on measured outcomes in multiple studies, we will investigate the possibility of pooling data to perform a meta-analysis.DiscussionThis systematic review will evaluate the evidence of the association of malaria on the cognitive and behavioral outcomes. Findings from this planned review will generate insight on the domains affected by the different forms of malaria infection and may inform subsequent malaria interventions and future research in pediatric care.Systematic review registrationPROSPERO CRD42020154777

Training of oncologists: results of a global survey.

While several studies have highlighted the global shortages of oncologists and their workload, few have studied the characteristics of current oncology training. In this study, an online survey was distributed through a snowball method for cancer care providing physicians in 57 countries. Countries were classified into low- or lower-middle-income countries (LMICs), upper-middle-income countries (UMICs) and high-income countries (HICs) based on World Bank criteria. A total of 273 physicians who were trained in 57 different countries responded to the survey: 33% (90/273), 32% (87/273) and 35% (96/273) in LMICs, UMICs and HICs, respectively. About 60% of respondents were practising physicians and 40% were in training. The proportion of responding trainees was higher in LMICs (51%; 45/89) and UMICs (42%; 37/84), than HICs (19%; 28/96; p = 0.013). A higher proportion of respondents from LMICs (37%; 27/73) self-fund their core oncology training compared to UMICs (13%; 10/77) and HICs (11%; 10/89; p < 0.001). Respondents from HICs were more likely to complete an accepted abstract, poster and publication from their research activities compared to respondents from UMICs and LMICs. Respondents identified several barriers to effective training, including skewed service to education ratio and burnout. With regard to preparedness for practice, mean scores on a 5-point Likert scale were low for professional tasks like supervision and mentoring of trainees, leadership and effective management of an oncology practice and understanding of healthcare systems irrespective of country grouping. In conclusion, the investment in training by the public sector is vital to decreasing the prevalence of self-funding in LMICs. Gaps in research training and enhancement of competencies in research dissemination in LMICs require attention. The instruction on cancer care systems and leadership needs to be incorporated in training curricula in all countries.

Antibiotic prescription practices in primary care in low- and middle-income countries: A systematic review and meta-analysis.

The widespread use of antibiotics plays a major role in the development and spread of antimicrobial resistance. However, important knowledge gaps still exist regarding the extent of their use in low- and middle-income countries (LMICs), particularly at the primary care level. We performed a systematic review and meta-analysis of studies conducted in primary care in LMICs to estimate the prevalence of antibiotic prescriptions as well as the proportion of such prescriptions that are inappropriate. We searched PubMed, Embase, Global Health, and CENTRAL for articles published between 1 January 2010 and 4 April 2019 without language restrictions. We subsequently updated our search on PubMed only to capture publications up to 11 March 2020. Studies conducted in LMICs (defined as per the World Bank criteria) reporting data on medicine use in primary care were included. Three reviewers independently screened citations by title and abstract, whereas the full-text evaluation of all selected records was performed by 2 reviewers, who also conducted data extraction and quality assessment. A modified version of a tool developed by Hoy and colleagues was utilized to evaluate the risk of bias of each included study. Meta-analyses using random-effects models were performed to identify the proportion of patients receiving antibiotics. The WHO Access, Watch, and Reserve (AWaRe) framework was used to classify prescribed antibiotics. We identified 48 studies from 27 LMICs, mostly conducted in the public sector and in urban areas, and predominantly based on medical records abstraction and/or drug prescription audits. The pooled prevalence proportion of antibiotic prescribing was 52% (95% CI: 51%-53%), with a prediction interval of 44%-60%. Individual studies' estimates were consistent across settings. Only 9 studies assessed rationality, and the proportion of inappropriate prescription among patients with various conditions ranged from 8% to 100%. Among 16 studies in 15 countries that reported details on prescribed antibiotics, Access-group antibiotics accounted for more than 60% of the total in 12 countries. The interpretation of pooled estimates is limited by the considerable between-study heterogeneity. Also, most of the available studies suffer from methodological issues and report insufficient details to assess appropriateness of prescription. Antibiotics are highly prescribed in primary care across LMICs. Although a subset of studies reported a high proportion of inappropriate use, the true extent could not be assessed due to methodological limitations. Yet, our findings highlight the need for urgent action to improve prescription practices, starting from the integration of WHO treatment recommendations and the AWaRe classification into national guidelines. PROSPERO registration number: CRD42019123269.

ANALISIS KETIMPANGAN DISTRIBUSI PENDAPATAN RUMAHTANGGA (Studi Kasus: Kecamatan Percut Sei Tuan)

This study aims to analyze the income inequality in the four villages, namely: (1) Percut, (2) Saentis, (3) Tembung and (4) Bandar Khalifah in District Percut Sei Tuan Deli Serdang. The data used in this study are primary and secondary data. While methods to collect data using the method of observation while digunanakan data collection techniques are simple random sampling technique. The method of analysis is the analysis of the Gini index, Lorenz curve and the World Bank criteria. The results showed that the analysis of income inequality according to the Gini index in the village Percut 0.39; Saentis 0.29; Tembung 0.24; Bandar Caliph overall 0.32 and 0.42. While the results according to criteria of the World Bank in the village Percut 17.98%; Saentis 24.94%; Tembung 28.98%; Bandar Caliph 23.84% and 21.21% overall. Income inequality in the four villages based on the Gini index Analysis Percut village and Bandar Khalifah included in katerogi being while Saentis village and Tembung included in the overall category is low and the four villages included in the medium category. In addition, based on the analysis of the overall World Bank criteria are included in the low category.

Dietary Sources of Salt in Low- and Middle-Income Countries: A Systematic Literature Review.

Rapid urbanization in low- and middle-income countries (LMICs) is transforming dietary patterns from reliance on traditional staples to increased consumption of energy-dense foods high in saturated fats, trans fats, sugars, and salt. A systematic literature review was conducted to determine major food sources of salt in LMICs that could be targeted in strategies to lower population salt intake. Articles were sourced using Medline, Web of Science, Scopus, and grey literature. Inclusion criteria were: reported dietary intake of Na/salt using dietary assessment methods and food composition tables and/or laboratory analysis of salt content of specific foods in populations in countries defined as low or middle income (LMIC) according to World Bank criteria. Of the 3207 records retrieved, 15 studies conducted in 12 LMICs from diverse geographical regions met the eligibility criteria. The major sources of dietary salt were breads, meat and meat products, bakery products, instant noodles, salted preserved foods, milk and dairy products, and condiments. Identification of foods that contribute to salt intake in LMICs allows for development of multi-faceted approaches to salt reduction that include consumer education, accompanied by product reformulation.

Training of oncologists: Results of a global survey.

10526 Background: While several studies have highlighted the global shortages of oncologists and their workload, few have studied the characteristics of current oncology training. Methods: An online survey was distributed through a snowball method via national oncology societies and a pre-existing network of contacts to cancer care providing physicians in 57 countries. Countries were classified into low- or lower-middle-income countries (LMICs), upper-middle-income countries (UMICs), and high-income countries (HICs) based on World Bank criteria. Results: 273 physicians who trained in 57 different countries responded to the survey; 33% (90/273), 32% (87/273), and 35% (96/273) in LMICs, UMICs and HICs respectively. 60% of respondents were practicing physicians and 40% were in training. The proportion of trainees was higher in LMICs (51%; 45/89) and UMICs (42%; 37/84), than HICs (19%; 28/96; P = 0.013). A higher proportion of respondents from LMICs (37%; 27/73) self-fund their core oncology training compared to UMICs (13%; 10/77) and HICs (11%; 10/89; P &lt; 0.001). Respondents from HICs were more likely to complete an accepted abstract, poster and publication from their research activities compared to respondents from UMICs and LMICs (abstract: 37/72 (51%) from HICs, 18/66 (27%) from UMICs, 24/65 (37%) from LMICs, P = 0.014; poster: (42/72 (58%) from HICs, 28/66 (42%) from UMICs, 13/65 (20%) from LMICs, P &lt; 0.001; publication: 43/72 (60%) from HICs, 32/66 (49%) from UMICs, 24/65 (37%) from LMICs, P = 0.029). Respondents identified several barriers to effective training including skewed service to education ratio and burnout. With regards to preparedness for practice, mean scores on a 5-point Likert scale were low for professional tasks like supervision and mentoring of trainees, leadership and effective management of an oncology practice, and understanding of healthcare systems irrespective of country grouping. Conclusions: Investment in training by the public sector would be vital to decreasing the prevalence of self-funding in LMIC. Gaps in research training and enhancement of competencies in research dissemination in LMIC require attention. Instruction on cancer care systems and leadership need to be incorporated in training curricula in both LMICs and HICs.