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BackgroundEggs are a rich source of choline, an essential nutrient important for child growth and development. In a randomized trial of 1 egg/d in young children in Ecuador, an egg intervention led to significant improvements in growth, which were partially mediated by increased plasma choline concentration. A similar trial in Malawi (clinicaltrials.gov: NCT03385252) found little improvement in child growth or development.ObjectivesWe aimed to evaluate the effect of 1 egg/d for 6 mo on plasma choline concentrations in Malawian children enrolled in a randomized trial.MethodsInfants aged 6-9 mo in rural Malawi were randomly assigned to receive 1 egg/d (n = 331) or serve as a nonintervention control (n = 329) for 6 mo. Anthropometric, developmental, and dietary data were collected at baseline and 6-mo follow-up, along with a blood draw. Plasma choline, betaine, dimethylglycine, trimethylamine N-oxide (TMAO), and DHA were measured at both time points using ultrahigh performance liquid chromatography-tandem MS (n = 200 per group). Linear regression analysis was used to determine the difference in plasma choline and related metabolites between groups after 6 mo of intervention.ResultsPlasma choline, betaine, dimethylglycine, and DHA concentrations did not differ between groups at 6-mo follow-up. Plasma TMAO was significantly (26%; 95% CI: 7%, 48%) higher in the egg intervention group in a fully adjusted model.ConclusionsProvision of 1 egg/d for 6 mo did not result in increases in plasma choline or related metabolites, except TMAO. This could partially explain the lack of effect on growth and development. Additional interventions are needed to improve choline status, growth, and development in this population.

Cancer incidence and mortality rates continue to rise globally, a trend mostly driven by preventable cancers occurring in low-and middle-income countries (LMICs). There is growing concern that many LMICs are ill-equipped to cope with markedly increased burden of cancer due to lack of comprehensive cancer control programs that incorporate primary, secondary, and tertiary prevention strategies. Notably, few countries have allocated budgets to implement such programs. In this review, we utilize a socio-ecological framework to summarize primary (risk reduction), secondary (early detection), and tertiary (treatment and survivorship) strategies to reduce the cancer burden in these countries across the individual, organizational, community, and policy levels. We highlight strategies that center on promoting health behaviors and reducing cancer risk, including diet, tobacco, alcohol, and vaccine uptake, approaches to promote routine cancer screenings, and policies to support comprehensive cancer treatment. Consistent with goals promulgated by the United Nations General Assembly on Noncommunicable Disease Prevention and Control, our review supports the development and implementation of sustainable national comprehensive cancer control plans in partnership with local communities to enhance cultural relevance and adoption, incorporating strategies across the socio-ecological framework. Such a concerted commitment will be necessary to curtail the rising cancer and chronic disease burden in LMICs.

BackgroundHIV/AIDS is now a manageable chronic illness owing to effective antiretroviral therapy (ART), which involves routine follow-up care, including regular physical visits to the clinic. In the recent past, and in wake of the COVID-19 pandemic, there has been increased need for virtual care and intervention delivery, a modality known as mobile health (mHealth), which includes cell phone-delivered services for medical and public health practice.ObjectiveHere we describe cell phone use and its relationship with alcohol use in a cohort of persons living with HIV and latent tuberculosis (TB).MethodsWe performed a cross-sectional analysis of baseline data from a cohort of persons living with HIV and latent TB in HIV care in southwestern Uganda. We estimated proportions of cell phone and text message use and evaluated their associations with alcohol use-a common modifiable behavior among persons living with HIV. Cell phone use (primary outcome) was defined as owning a cell phone that is turned on at least half of the day. Any alcohol use was defined as any self-reported alcohol use in the prior 3 months or a phosphatidylethanol (an alcohol biomarker) level of ≥8 ng/mL.ResultsA total of 300 participants (median age 40 years; n=146, 48.7% male) were included in the analysis. Most (n=267, 89.0%) participants had access to a phone and of them, 26 (9.7%) shared the phone with someone else. In total, 262/300 (87.3%) of participants owned a cell phone that is turned on at least half of the time; the majority (n=269, 89.7%) rarely or never sent text messages, and over two-thirds (n=200, 66.9%) rarely or never received text messages. Most (n=214, 71.3%) had any alcohol use in the prior 3 months. In adjusted analyses, any alcohol use was not significantly associated with cell phone use (adjusted odds ratio [aOR] 0.48, 95% CI 0.18-1.25; P=.13) or sending (aOR 0.82, 95% CI 0.28-2.37; P=.71) or receiving (aOR 1.31, 95% CI 0.70-2.47; P=.40) text messages.ConclusionsThere is hope that mHealth interventions in this population can be carried out using cell phones owing to their popularity; however, the interventions may need to employ methods that do not rely on the sending and receiving of text messages only.

Abstract Introduction There is a substantial body of knowledge on the effects of the COVID-19 pandemic on injuries showing frequent but inconsistent reductions in both volume and pattern. Yet, studies specifically addressing children are less common, not least from low- and middle-income countries. This study investigated whether changes in the pattern and outcome of paediatric injury admissions to Mozambique’s four regional referral hospitals during 2020. Methods Clinical charts of paediatric patients presenting to the targeted hospitals with acute injuries were reviewed using a set of child, injury, and outcome characteristics during each of two consecutive restriction periods in 2020 using as a comparator the same periods in 2019, the year before the pandemic. Differences between 2020 and 2019 proportions for any characteristic were examined using the t-test (significance level 0.05). Results During both restriction periods, compared with the previous year, reductions in the number of injuries were noticed in nearly all aspects investigated, albeit more remarkably during the first restriction period, in particular, greater proportions of injuries in the home setting and from burns (7.2% and 11.5% respectively) and a reduced one of discharged patients (by 2.5%). Conclusion During the restrictions implemented to contend the pandemic in Mozambique in 2020, although each restriction period saw a drop in the volume of injury admissions at central hospitals, the pattern of child, injury and outcome characteristics did not change much, except for an excess of home and burn injuries in the first, more restrictive period. Whether this reflects the nature of the restrictions only or, rather, other mechanisms that came into play, individual or health systems related, remains to be determined.

Abstract Introduction In 2019, smoking prevalence in North Macedonia was one of the world’s highest at around 46% in adults. However, access to smoking cessation treatment is limited and no co-ordinated smoking cessation programmes are provided in primary care. Methods We conducted a three parallel-armed randomised controlled trial (n = 1368) to investigate effectiveness and cost-effectiveness of lung age (LA) or exhaled carbon monoxide (CO) feedback combined with very brief advice (VBA) to prompt smoking cessation compared with VBA alone, delivered by GPs in primary care in North Macedonia. All participants who decided to attempt to quit smoking were advised about accessing smoking cessation medications and were also offered behavioural support as part of the “ACT” component of VBA. Participants were aged ≥ 35 years, smoked ≥ 10 cigarettes per day, were recruited from 31 GP practices regardless of motivation to quit and were randomised (1:1:1) using a sequence generated before the start of recruitment. The primary outcome was biochemically validated 7-day point prevalence abstinence at 4 weeks (wks). Participants and GPs were not blinded to allocation after randomisation, however outcome assessors were blind to treatment allocation. Results There was no evidence of a difference in biochemically confirmed quitting between intervention and control at 4wks (VBA + LA RR 0.90 (97.5%CI: 0.35, 2.27); VBA + CO RR 1.04 (97.5%CI: 0.44, 2.44)), however the absolute number of quitters was small (VBA + LA 1.6%, VBA + CO 1.8%, VBA 1.8%). A similar lack of effect was observed at 12 and 26wks, apart from in the VBA + LA arm where the point estimate was significant but the confidence intervals were very wide. In both treatment arms, a larger proportion reported a reduction in cigarettes smoked per day at 4wks (VBA + LA 1.30 (1.10, 1.54); VBA + CO 1.23 (1.03, 1.49)) compared with VBA. The point estimates indicated a similar direction of effect at 12wks and 26wks, but differences were not statistically significant. Quantitative process measures indicated high fidelity to the intervention delivery protocols, but low uptake of behavioural and pharmacological support. VBA was the dominant intervention in the health economic analyses. Conclusion Overall, there was no evidence that adding LA or CO to VBA increased quit rates. However, a small effect cannot be ruled out as the proportion quitting was low and therefore estimates were imprecise. There was some evidence that participants in the intervention arms were more likely to reduce the amount smoked, at least in the short term. More research is needed to find effective ways to support quitting in settings like North Macedonia where a strong smoking culture persists. Trial registration The trial was registered at http://www.isrctn.com (ISRCTN54228638) on the 07/09/2018.

Abstract The prevalence of non-communicable diseases, such as diabetes and cardiovascular disease, is rising in low- and middle-income countries (LMICs). Health behavior change (HBC) interventions such as the widely used Diabetes Prevention Program (DPP) are effective at reducing chronic disease risk, but have not been adapted for LMICs. Leveraging mobile health (mHealth) technology such as text messaging (SMS) to enhance reach and participant engagement with these interventions has great promise, yet we lack evidence-informed approaches to guide the integration of SMS specifically to support HBC interventions in LMIC contexts. To address this gap, we integrated guidance from the mHealth literature with expertise and first-hand experience to establish specific development steps for building and implementing SMS systems to support HBC programming in LMICs. Specifically, we provide real-world examples of each development step by describing our experience in designing and delivering an SMS system to support a culturally-adapted DPP designed for delivery in South Africa. We outline eight key SMS development steps, including: 1) determining if SMS is appropriate; 2) developing system architecture and programming; 3) developing theory-based messages; 4) developing SMS technology; 5) addressing international SMS delivery; 6) testing; 7) system training and technical support; and 8) cost considerations. We discuss lessons learned and extractable principles that may be of use to other mHealth and HBC researchers working in similar LMIC contexts. Trial registration Clinicaltrials.gov, NCT03342274 . Registered 10 November 2017.

Abstract Background Hypertension is the leading cause of death and disability. Clinical care for patients with hypertension in Kenya leverages referral networks to provide basic and specialized healthcare services. However, referrals are characterized by non-adherence and delays in completion. An integrated health information technology (HIT) and peer-based support strategy to improve adherence to referrals and blood pressure control was proposed. A formative assessment gathered perspectives on barriers to referral completion and garnered thoughts on the proposed intervention. Methods We conducted a qualitative study in Kitale, Webuye, Kocholya, Turbo, Mosoriot and Burnt Forest areas of Western Kenya. We utilized the PRECEDE-PROCEED framework to understand the behavioral, environmental and ecological factors that would influence uptake and success of our intervention. We conducted four mabaraza (customary heterogenous community assemblies), eighteen key informant interviews, and twelve focus group discussions among clinicians, patients and community members. The data obtained was audio recorded alongside field note taking. Audio recordings were transcribed and translated for onward coding and thematic analysis using NVivo 12. Results Specific supply-side and demand-side barriers influenced completion of referral for hypertension. Key demand-side barriers included lack of money for care and inadequate referral knowledge. On the supply-side, long distance to health facilities, low availability of services, unaffordable services, and poor referral management were reported. All participants felt that the proposed strategies could improve delivery of care and expressed much enthusiasm for them. Participants appreciated benefits of the peer component, saying it would motivate positive patient behavior, and provide health education, psychosocial support, and assistance in navigating care. The HIT component was seen as reducing paper work, easing communication between providers, and facilitating tracking of patient information. Participants also shared concerns that could influence implementation of the two strategies including consent, confidentiality, and reduction in patient-provider interaction. Conclusions Appreciation of local realities and patients’ experiences is critical to development and implementation of sustainable strategies to improve effectiveness of hypertension referral networks. Incorporating concerns from patients, health care workers, and local leaders facilitates adaptation of interventions to respond to real needs. This approach is ethical and also allows research teams to harness benefits of participatory community-involved research. Trial registration Clinicaltrials.gov, NCT03543787, Registered June 1, 2018. https://clinicaltrials.gov/ct2/show/NCT03543787

Abstract Background Continuous positive airway pressure (CPAP) has been a key treatment modality for Coronavirus Disease 2019 (COVID-19) worldwide. Globally, the demand for CPAP outstripped the supply during the pandemic. The LeVe CPAP System was developed to provide respiratory support for treatment of COVID-19 and tailored for use in low- and middle-income country (LMIC) settings. Prior to formal trial approval, received in November 2021, these devices were used in extremis to support critically unwell adult patients requiring non-invasive ventilatory support. Methods This is a retrospective descriptive review of adult patients with COVID-19 pneumonitis, who were treated with advanced respiratory support (CPAP and/or high-flow nasal oxygen, HFNO) at Mengo Hospital, Uganda. Patients were treated with the LeVe CPAP System, Elisa CPAP and/or AIRVO™ HFNO. Treatment was escalated per standard local protocols for respiratory failure, and CPAP was the maximum respiratory support available. Data were collected on patient characteristics, length of time of treatment, clinical outcome, and any adverse events. Results Overall 333 patients were identified as COVID-19 positive, 44 received CPAP ± HFNO of which 43 were included in the study. The median age was 58 years (range 28–91 years) and 58% were female. The median duration of advanced respiratory support was 7 days (range 1–18 days). Overall (all device) mortality was 49% and this was similar between those started on the LeVe CPAP System and those started non-LeVe CPAP System devices (50% vs 47%). Conclusions The LeVe CPAP system was the most used CPAP device during the pandemic, bringing the hospital’s number of available HFNO/CPAP devices from two to 14. They were a critical resource for providing respiratory support to the sickest group of patients when no alternative devices were available. The devices appear to be safe and well-tolerated with no serious adverse events recorded. This study is unable to assess the efficacy of the LeVe CPAP System; therefore, formal comparative studies are required to inform further use.

IntroductionTo effectively regulate and reduce antibiotic use, in the livestock sector, a thorough understanding of the flow of veterinary antibiotics will help to identify key nodes in the chain for targeted interventions. The aim of this study was to understand the flow of antibiotics from import to end-user, and identify relevant governance mechanisms.MethodsA mixed methods approach was used to collect data in three Kenyan counties (Nairobi, Kiambu, and Kajiado). Focus group discussions (n = 23), individual interviews (n = 148), and key informant interviews (n = 10) were conducted.ResultsThe key actors identified include primary wholesalers, secondary wholesalers, retailers, animal health service providers (AHSPs), and farmers. Kenya imports 100% of its veterinary antibiotics: primary wholesalers legally import antibiotics as finished pharmaceutical products (90%) or active pharmaceutical ingredients (10%) after approval by the Veterinary Medicines Directorate. Secondary wholesalers play a major role in the distribution of antibiotics (60% of antibiotics) from importers to farmers, AHSPs, and retailers. Some of the illegal sources of antibiotics include unlicenced/unauthorized middlemen and online platforms that sell directly to retailers, AHSPs, and farmers.DiscussionDespite the presence of various laws and regulations governing the antibiotic value chain, implementation has been a challenge due to financial and human resource constraints. This contributes to over-the-counter sale of antibiotics without prescription, unlicensed businesses selling antibiotics, illegal importation, and presence of poor-quality drugs. There is a need to review the applicability of existing policies and address policy gaps (e.g., product containing antibiotic combinations, and use of human critically important antibiotics) to ensure the prudent sale and use of antibiotics, pharmacovigilance, antimicrobial use surveillance, and developing a business model that aligns with antibiotic stewardship. Additional interventions include awareness raising and capacity building of the different stakeholders along the antibiotic distribution chain to reduce antibiotic mis- and overuse.

IntroductionThe COVID-19 pandemic has had a significant impact on mental health globally, with limited access to mental health care affecting low- and middle-income countries (LMICs) the most. In response, alternative strategies to support mental health have been necessary, with access to green spaces being a potential solution. While studies have highlighted the role of green spaces in promoting mental health during pandemic lockdowns, few studies have focused on the role of green spaces in mental health recovery after lockdowns. This study investigated changes in green space access and associations with mental health recovery in Bangladesh and Egypt across the pandemic.MethodsAn online survey was conducted between January and April 2021 after the first lockdown was lifted in Bangladesh (n = 556) and Egypt (n = 660). We evaluated indoor and outdoor greenery, including the number of household plants, window views, and duration of outdoor visits. The quantity of greenness was estimated using the normalized difference vegetation index (NDVI). This index was estimated using satellite images with a resolution of 10x10m during the survey period (January-April 2021) with Sentinel-2 satellite in the Google Earth Engine platform. We calculated averages within 250m, 300m, 500m and 1000m buffers of the survey check-in locations using ArcGIS 10.3. Multiple linear regression models were used to evaluate relationships between changes in natural exposure and changes in mental health.ResultsThe results showed that mental health improved in both countries after the lockdown period. People in both countries increased their time spent outdoors in green spaces after the lockdown period, and these increases in time outdoors were associated with improved mental health. Unexpectedly, changes in the number of indoor plants after the lockdown period were associated with contrasting mental health outcomes; more plants translated to increased anxiety and decreased depression. Refocusing lives after the pandemic on areas other than maintaining indoor plants may assist with worrying and feeling panicked. Still, indoor plants may assist with depressive symptoms for people remaining isolated.ConclusionThese findings have important implications for policymakers and urban planners in LMICs, highlighting the need to increase access to natural environments in urban areas to improve mental health and well-being in public health emergencies.

Summary: Background: While acute SARS-CoV-2 infection and associated inflammation resulted in substantial morbidity and mortality during the COVID-19 pandemic, particularly in unvaccinated patients, long-term effects of SARS-CoV-2 exposure for reactivation of latent oncogenic herpesviruses, such as KSHV, is unknown. Methods: We performed a longitudinal observational cross-sectional study on 407 non-hospitalised adult HIV-infected (CD4 count

Traumatic tension pneumocephalus is a rare and life-threatening complication of traumatic brain injury necessitating prompt diagnosis and neurosurgical treatment. Nevertheless, various possibilities for impedance in timely management, including patient-related barriers are commonly experienced in low-and middle-income countries setting. Here we presented a delay of management in traumatic tension pneumocephalus case due to initial refusal for emergency surgery. A 59-year-old male presented to the emergency department following a motorcycle accident fully alert with no neurological deficit. He acknowledged clear nasal discharge within 1 h after the initial trauma, but no rhinorrhea or otorrhea was present during physical examination. Head CT revealed extensive pneumocephalus with “Mount Fuji sign,” anterior skull base fracture, and frontal sinus fracture. The patient initially refused immediate surgical intervention due to excellent clinical condition and financial scare. Acute decrease of consciousness occurred 40 h post-trauma: GCS of 6 with slight dilatation of both pupils (4 mm) and sluggish pupillary reflex. Emergency bifrontal craniotomy, subdural air drainage, and dura mater tear repair were performed afterwards. Postoperative care was uneventful, with rapid improvement of consciousness and follow-up head CT showing minimal subdural fluid collection and absence of remaining pneumocephalus. The patient was discharged from the hospital after 7 days with GCS of 15 and GOS of 5, proving the importance of overcoming barriers for delay in delivering neurotrauma care in low-and middle-income countries.

IntroductionThe survival time of human immunodeficiency virus (HIV)–infected individuals or patients with acquired immunodeficiency syndrome (AIDS) is influenced by multiple factors. Studying survival and influential factors after antiretroviral therapy (ART) contributes to improving treatment protocols, management strategies, and prognosis for people living with HIV/AIDS (PLWHA).MethodsThis retrospective cohort study collected case data and follow-up records of PLWHA who received ART in Dazu District, Chongqing City, between 2007 and 2022. Cumulative survival rates were calculated using life tables. Survival curves were plotted using the Kaplan–Meier method. Uni-variable and multivariable Cox proportional hazards models analyzed factors influencing survival.ResultsThe study included 5,237 PLWHA receiving ART. Within the first year of ART initiation, 146 AIDS-related deaths occurred, accounting for 29.49% (146/495) of total deaths. Cumulative survival rates at 1, 5, 10, and 15 years were 0.97, 0.90, 0.85, and 0.79, respectively. During the observation period, male patients who received ART had a 1.89 times higher risk of death compared to females (aHR, 1.89; 95%; CI, 1.50–2.37). Patients aged ≥60 years had a 3.44-fold higher risk of death than those aged

The World Health Organization recommends human papillomavirus (HPV) testing for cervical screening. Extended genotyping can identify the highest‐risk HPV‐positive women. An inexpensive, rapid, mobile isothermal amplification assay (ScreenFire HPV RS test) was recently redesigned to yield four channels ordered by cancer risk (ie, hierarchical approach): HPV16, HPV18/45, HPV31/33/35/52/58 and HPV39/51/56/59/68. Stored specimens from 2076 women (mean age 30.9) enrolled in a colposcopy clinic, with high HPV prevalence, were tested with ScreenFire. We calculated hierarchical channel positivity and non‐hierarchical channel and type positivity, according to histologic diagnosis (256 cancer, 350 cervical intraepithelial neoplasia [CIN]3, 409 CIN2, 1020 < CIN2) and known virologic reference results (Linear Array and TypeSeq). Additionally, we analyzed ScreenFire time‐to‐positive up to 60 min by channel and histology. Overall clinical sensitivity for CIN3+ was 94.7% (95% confidence interval 92.6‐96.4), similar to Linear Array (92.3, 89.7‐94.3) and TypeSeq (96.0, 93.9‐97.6). Sensitivity was high for all types and channels. The hierarchical approach was well in line with HPV typing and histologic diagnosis, prioritizing higher risk women having HPV16 and precancer. For HPV16, time‐to‐positive was shorter in women with precancer. ScreenFire showed excellent agreement with research reference typing tests and detection of CIN2+. Risk‐based type results could help guide clinical management of HPV‐positive women. Time‐to‐positive combined with genotyping might be useful. ScreenFire is rapid, mobile, relatively inexpensive and designed for implementation of HPV‐based screening and management, including in lower‐resource settings. Further validation in screening by self‐sampling and practical effectiveness merit evaluation. [ABSTRACT FROM AUTHOR]

Psychological interventions have demonstrated effectiveness in treating perinatal depression (PND), but understanding for whom, how and under what conditions they improve symptoms in low- and middle-income countries (LMICs) is largely unknown. This review aims to synthesise current knowledge about predictors, moderators and mediators of psychological therapies to treat PND in LMICs. Five databases were searched for studies quantitatively examining the effects of at least one mediator, moderator or predictor of therapies for PND in LMICs. The review sampled seven publications evaluating findings from randomised trials conducted in Asia and sub-Saharan Africa. The small number of included studies limited generalisability of findings. Analyses of trials with acceptable quality suggest that patient activation in Pakistan and social support in both India and Pakistan may mediate psychotherapy effectiveness, higher baseline depression severity may moderate treatment response in South Africa, and shorter depression duration at baseline may moderate intervention response in India. This review highlights current gaps in evidence quality and the need for future trials exploring PND psychotherapy effectiveness in LMICs to follow reporting guidelines to facilitate appropriate predictor, moderator and mediator analyses. [ABSTRACT FROM AUTHOR]

Background: High rates of intimate partner violence (IPV) and mental disorders are present in Mozambique where there is a significant treatment gap. We aimed to report Mozambican community stakeholder perspectives of implementing couple-based interpersonal psychotherapy (IPT-C) in preparation for a pilot trial in Nampula City. Methods: We conducted 11 focus group discussions (6-8 people per group) and seven in-depth interviews with key informants in mental health or gender-based violence (n = 85) using purposive sampling. We used grounded theory methods to conduct an inductive coding and then deductively applied the consolidated framework for implementation research (CFIR). Results: For the outer setting, local attitudes that stigmatize mental health conditions and norm IPV as well as an inefficient legal system were barriers. Stakeholders expressed high acceptability of IPT-C, although a lack of resources was a structural challenge for the inner setting. Adaptation of the approach to screen for and address potentialmediators of IPV was important for adopting a multisectoral response to implementation and planning. Delivering IPT-C in the community and in collaboration with community stakeholders was preferable. Conclusion: Stakeholders recommended multilevel involvement and inclusion of communitybased programming. Task shifting and use of technology can help address these resource demands. [ABSTRACT FROM AUTHOR]

Research capacity building is a process by which individuals and organizations develop skills and infrastructure resulting in greater ability to conduct useful research. Frequently, research quality and productivity measures focus on outcomes, such as peer-reviewed publications or grants awarded. Such distal measures are not informative when measuring initial stages of research, a common situation in low- and middle-income countries. This study used Cooke's six-principle framework to assess the progress of an autism research collaborative in northern Mexico. We established 64 criteria across the six principles and rated them as Not Started, In Progress, or Achieved, based on narratives and process documentation collected for this purpose. Ratings were established for the years 2018, 2020, and 2022, which correspond to Years 5, 7, and 9 since the beginning of the collaborative, respectively. As of 2022, Principles 2 and 3 ("Close to practice" and "Linkages, collaborations, and partnerships," respectively) had all begun; no criteria were rated as Not started. The principles with the highest Achieved rates were "Linkages, collaborations, and partnerships" (90%), and "Infrastructure" (Principle 6, 70%). Cooke's research capacity building framework is a useful way to monitor progress of research capacity building and contribute to harmonious development of relevant principles at different levels. To inform improvement of care and public policy, quality research is required. Conducting research projects requires skills and infrastructure. Research capacity building is the process by which individuals and organizations develop greater ability to conduct useful research. However, in the scientific community, research quality and productivity measures are often focused on long-term products, such as publications or grants awarded. Those measures are not helpful when measuring initial stages of research, a common situation in low- and middle-income countries. We used a six-principle framework designed by J. Cooke to assess the progress of an autism research collaborative in northern Mexico. We established 64 criteria across the six principles, and rated them as Not Started, In Progress, or Achieved, based on narratives and process documentation collected for this purpose. Ratings were established for the Years 2018, 2020, and 2022. The principles with the highest Achieved rates were "Linkages, collaborations, and partnerships" (90%), and "Infrastructure" (Principle 6, 70%). Cooke's research capacity building framework is a useful way to monitor progress of research capacity building and contribute to harmonious development of relevant principles at different levels. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Introduction: The Baylor International Pediatric AIDS Initiative (BIPAI) Network supports a network of independent nongovernmental organizations providing health care for children and families in low- and middle-income countries (LMIC). Using a community of practice (CoP) framework, a continuing professional development (CPD) program was created for health professionals to enhance knowledge and exchange best practices. Methods: An online learning platform (Moodle), videoconferencing (Zoom), instant messaging systems (Whatsapp), and email listserv facilitated learning and interaction between program participants. Target participants initially included pharmacy staff and expanded to include other health professionals. Learning modules included asynchronous assignments and review of materials, live discussion sessions, and module pretests and posttests. Evaluation included participants' activities, changes in knowledge, and assignment completion. Participants provided feedback on program quality via surveys and interviews. Results: Five of 11 participants in Year 1 earned a certificate of completion, and 17 of 45 participants earned a certificate in Year 2. Most modules showed an increase in module pretest and posttest scores. Ninety-seven percent of participants indicated that the relevance and usefulness of modules were good or outstanding. Ongoing evaluation indicated changes in Year 2 for program improvement, and notable outcomes indicated how CoP added value in developing a true community. Discussion: Using a CoP framework allowed participants to improve their personal knowledge and become part of a learning community and network of interdisciplinary health care professionals. Lessons learned included expanding program evaluation to capture potential value creation of the community of practice in addition to individual-level development; providing briefer, more focused programs to better serve busy working professionals; and optimizing use of technological platforms to improve participant engagement. [ABSTRACT FROM AUTHOR]

Introduction: Action 3 of the UN Decade of Healthy Ageing plan is to deliver integrated care to improve older adults' lives. Integrated care is vital in meeting the complex needs of people with dementia but little is known about how this is or could be delivered in low and middle income countries (LMIC). This paper provides insights into previously unknown care system structures and on the potential and reality of delivering integrated care in Central America for people with dementia. Methods: A social network analysis (SNA) methodology was adopted to engage with providers of services for older adults and families with dementia in Guatemala, El Salvador, Honduras, Costa Rica and Panama. Sixty-eight (68) semi-structured interviews were completed, 57 with organisations and 11 with families. Results: Across the five countries there was evidence of fragmentation and low integration within the dementia care systems. A variety of services and types of providers are present in all five countries, and high levels of diversified connections exist among organisations of differing disciplines. However, unawareness among network members about other members that they could potentially form active links with is a barrier on the path to integration. Conclusion: This innovative and robust study demonstrates SNA can be applied to evaluate LMIC care systems. Findings provide baselines of system structures and insights into where resources are needed to fortify integration strategies. Results suggest that Central American countries have the building blocks in place to develop integrated care systems to meet the needs of people with dementia, but the links across service providers are opportunistic rather than context based coordinated integration policies. [ABSTRACT FROM AUTHOR]

Background: Governmental and non-governmental organizations across medical, legal, and psychosocial sectors providing care to survivors of gender-based violence (GBV) and their families rapidly digitalized services during the COVID-19 pandemic. GBV prevention/ response services working with women and children who are forcibly displaced and/or living in low-and-middle income countries (LMIC) were no exception to the rapid digitalization trend. Literature is lacking a critical synthesis of best practices and lessons learned since digitalization replaced major operations involved in GBV prevention/response. Objective: This research qualitatively investigated how GBV service providers, located in a range of socio-political settings, navigated the process of digitalizing GBV prevention/ response during the COVID-19 crisis. Method: Semi-structured key informant interviews (KII) with GBV service providers in varied sectors were implemented virtually (2020–2021) in Brazil, Guatemala, Iraq, and Italy (regarding forcibly displaced women/girls for the latter). Participants were recruited using purposive and snowball sampling. Interview guides covered a range of topics: perceived changes in violence and service provision, experiences with virtual services, system coordination, and challenges. The KIIs were conducted in Portuguese, Spanish, Arabic, and Italian. Interviews were audio-recorded, transcribed, and translated into English. The research team conducted thematic analysis within and between countries using a structured codebook of data driven and theory driven codes. Results: Major themes concerned the: (1) spectrum of services that were digitalized during the COVID-19 crisis; (2) gender digital divide as a barrier to equitable, safe, and effective service digitalization; (3) digital violence as an unintended consequence of increased digitalization across social/public services. Conclusion: Digitalization is a balancing act with respect to (1) the variety of remotelydelivered services that are possible and (2) the access/safety considerations related to the gender digital divide and digital violence. [ABSTRACT FROM AUTHOR]

Using simulated patients to mimic 9 established noncommunicable and infectious diseases, we assessed ChatGPT's performance in treatment recommendations for common diseases in low- and middle-income countries. ChatGPT had a high level of accuracy in both correct diagnoses (20/27, 74%) and medication prescriptions (22/27, 82%) but a concerning level of unnecessary or harmful medications (23/27, 85%) even with correct diagnoses. ChatGPT performed better in managing noncommunicable diseases than infectious ones. These results highlight the need for cautious AI integration in health care systems to ensure quality and safety. [ABSTRACT FROM AUTHOR]

Background: Evidence-based decision-making is essential to improve public health benefits and resources, especially in low- and middle-income countries (LMICs), but the mechanisms of its implementation remain less straightforward. The availability of high-quality, reliable, and sufficient data in LMICs can be challenging due to issues such as a lack of human resource capacity and weak digital infrastructure, among others. Health information systems (HISs) have been critical for aggregating and integrating health-related data from different sources to support evidence-based decision-making. Nutrition information systems (NISs), which are nutrition-focused HISs, collect and report on nutrition-related indicators to improve issues related to malnutrition and food security—and can assist in improving populations' nutritional statuses and the integration of nutrition programming into routine health services. Data visualization tools (DVTs) such as dashboards have been recommended to support evidence-based decision-making, leveraging data from HISs or NISs. The use of such DVTs to support decision-making has largely been unexplored within LMIC contexts. In Bangladesh, the Mukto dashboard was developed to display and visualize nutrition-related performance indicators at the national and subnational levels. However, despite this effort, the current use of nutrition data to guide priorities and decisions remains relatively nascent and underused. Objective: The goal of this study is to better understand how Bangladesh's NIS, including the Mukto dashboard, has been used and areas for improvement to facilitate its use for evidence-based decision-making toward ameliorating nutrition-related service delivery and the health status of communities in Bangladesh. Methods: Primary data collection was conducted through qualitative semistructured interviews with key policy-level stakeholders (n=24). Key informants were identified through purposive sampling and were asked questions about the experiences and challenges with the NIS and related nutrition dashboards. Results: Main themes such as trust, data usability, personal power, and data use for decision-making emerged from the data. Trust in both data collection and quality was lacking among many stakeholders. Poor data usability stemmed from unstandardized indicators, irregular data collection, and differences between rural and urban data. Insufficient personal power and staff training coupled with infrastructural challenges can negatively affect data at the input stage. While stakeholders understood and expressed the importance of evidence-based decision-making, ultimately, they noted that the data were not being used to their maximum potential. Conclusions: Leveraging DVTs can improve the use of data for evidence-based decision-making, but decision makers must trust that the data are believable, credible, timely, and responsive. The results support the significance of a tailored data ecosystem, which has not reached its full potential in Bangladesh. Recommendations to reach this potential include ensuring a clear intended user base and accountable stakeholders are present. Systems should also have the capacity to ensure data credibility and support ongoing personal power requirements. [ABSTRACT FROM AUTHOR]

Background: Health care organizations globally have seen a significant increase in the frequency of cyberattacks in recent years. Cyberattacks cause massive disruptions to health service delivery and directly impact patient safety through disruption and treatment delays. Given the increasing number of cyberattacks in low- and middle-income countries (LMICs), there is a need to explore the interventions put in place to plan for cyberattacks and develop cyber resilience. Objective: This study aimed to describe cybersecurity interventions, defined as any intervention to improve cybersecurity in a health care organization, including but not limited to organizational strategy(ies); policy(ies); protocol(s), incident plan(s), or assessment process(es); framework(s) or guidelines; and emergency planning, implemented in LMICs to date and to evaluate their impact on the likelihood and impact of attacks. The secondary objective was to describe the main barriers and facilitators for the implementation of such interventions, where reported. Methods: A systematic search of the literature published between January 2017 and July 2024 was performed on Ovid Medline, Embase, Global Health, and Scopus using a combination of controlled terms and free text. A search of the gray literature within the same time parameters was undertaken on the websites of relevant stakeholder organizations to identify possible additional studies that met the inclusion criteria. Findings from included papers were mapped against the dimensions of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework and presented as a narrative synthesis. Results: We included 20 studies in this review. The sample size of the majority of studies (13/20, 65%) was 1 facility to 5 facilities, and the studies were conducted in 14 countries. Studies were categorized into the thematic dimensions of the ECHO framework, including context; governance; organizational strategy; risk management; awareness, education, and training; and technical capabilities. Few studies (6/20, 30%) discussed cybersecurity intervention(s) as the primary focus of the paper; therefore, information on intervention(s) implemented had to be deduced. There was no attempt to report on the impact and outcomes in all papers except one. Facilitators and barriers identified were grouped and presented across national or regional, organizational, and individual staff levels. Conclusions: This scoping review's findings highlight the limited body of research published on cybersecurity interventions implemented in health care organizations in LMICs and large heterogeneity across existing studies in interventions, research objectives, methods, and outcome measures used. Although complex and challenging, future research should specifically focus on the evaluation of cybersecurity interventions and their impact in order to build a robust evidence base to inform evidence-based policy and practice. [ABSTRACT FROM AUTHOR]

Background and Hypothesis Oxidative stress pathways may play a role in schizophrenia through direct neuropathic actions, microglial activation, inflammation, and by interfering with NMDA neurotransmission. N -acetylcysteine (NAC) has been shown to improve negative symptoms of schizophrenia, however, results from trials of other compounds targeting NMDA neurotransmission have been mixed. This may reflect poor target engagement but also that risk mechanisms act in parallel. Sodium Benzoate (NaB) could have an additive with NAC to act on several pathophysiological mechanisms implicated in schizophrenia. Study Design A multicenter, 12 weeks, 2 × 2 factorial design, randomized double-blind placebo-controlled feasibility trial of NaB and NAC added to standard treatment in 68 adults with early schizophrenia. Primary feasibility outcomes included recruitment, retention, and completion of assessments as well as acceptability of the study interventions. Psychosis symptoms, functioning, and cognitive assessments were also assessed. Study Results We recruited our desired sample (n  = 68) and retained 78% (n  = 53) at 12 weeks, supporting the feasibility of recruitment and retention. There were no difficulties in completing clinical outcome schedules. Medications were well tolerated with no dropouts due to side effects. This study was not powered to detect clinical effect and as expected no main effects were found on the majority of clinical outcomes. Conclusions We demonstrated feasibility of conducting a clinical trial of NaB and NAC. Given the preliminary nature of this study, we cannot draw firm conclusions about the clinical efficacy of either agent, and a large-scale trial is needed to examine if significant differences between treatment groups emerge. Trial Registration ClinicalTrials.gov: NCT03510741. [ABSTRACT FROM AUTHOR]

To explore the personal and system factors that motivate and enhance outcomes for patients accessing a prosthetic service and using a lower-limb prosthesis within a low resource setting. This study employed a qualitative approach to explore the motivations and satisfaction of individuals with lower limb loss engaging with a prosthetic service in Mombasa, Kenya. In-depth interviews were conducted over Microsoft Teams with 10 lower limb prosthesis users and thematic analysis was applied. Five key themes emerged: acceptance, self-determination, hope, clinician relationship and perception. These findings demonstrate the importance of hopeful thinking and a supportive community in overcoming physical and stigmatising challenges. The findings further highlight the value of the service provider relationship beyond just prescribing an assistive device. These results have relevance in developing patient-centred services, assistive devices and personnel training that are responsive, motivating, and cognisant of the service user. This is of particular interest as assistive technology services are newly developed in low resource settings. This research provides an understanding of lower-limb prosthesis users' satisfaction of a device and motivation for engaging with a prosthetic service within a low resource setting. The relationship the rehabilitation professional has with the service user plays a significant role in facilitating motivation during rehabilitation. Rehabilitation professionals should consider how they can foster a network of support amongst service users when planning services in remote, rural locations. Rehabilitation professionals should be aware of how hopeful thinking can be facilitated during rehabilitation to support motivation. When reviewing the success of services, or designing new service models, the service users should be consulted on what they would deem as a successful outcome. [ABSTRACT FROM AUTHOR]

Introduction: Pharmaceutical companies invested billions in direct marketing to medical practitioners as it increased sales of prescription drugs. Medical professionals believed that their decision-makings was not influenced by such interactions, but studies have shown that engaging with the industry and accepting gifts might lead to impulses to reciprocate, such as prescribing marketed drugs. This study explored the views and experiences of PCP on interactions with the pharmaceutical industry's representatives. Methods: We used qualitative methods using semi-structured interviews among primary care practitioners from three sectors; academic, public and private. Participants were purposively sampled from various sectors. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Results: A total of 32 participants were interviewed. The ages of the participants ranged from 33 to 53 years. Most of the participants were female, of Malay ethnicity and from the public sector. Four themes emerged from the analysis: (1) Perceived impact of interactions on prescribing habits, (2) Perceived benefit and harm of interactions, (3) Previous positive or negative encounters, (4) the role of geographical, organisational and policy. Conclusion: The study highlighted the views and factors influencing PCP interactions with the representatives of the pharmaceutical industry in Malaysia. Understanding PCPs' viewpoints on such interactions could help PCP better navigate their future interactions without compromising their clinical decision-making through multi-agency collaborations and actions. [ABSTRACT FROM AUTHOR]

In sub-Saharan Africa, the estimated prevalence of scoliosis ranges from 3.3% to 5.5%. The management of these deformities is restricted due to lack of infrastructure and access to deformity spine surgeons. Utilizing surgical camps has been demonstrated to be efficient in transferring skills to low-resource environments; however, this has not been documented concerning deformity surgery. We conducted a cross-sectional study. The scoliosis camp was held at a major referral spine center in East Africa. We documented information about the organization of the course. We also collected clinical and demographic patient data. Finally, we assessed the knowledge and confidence among surgeon participants on the management scoliosis. The camp lasted 5 days and consisted of lectures and case discussions, followed by casting and surgical sessions. Five patients were operated during the camp. All the patients in the study were diagnosed with AIS, except one with a congenital deformity. The primary curve in the spine was in the thoracic region for all patients. Six months postoperative Scoliosis Research Society-22R Scoring System (SRS-22R) score ranged from 3.3–4.5/5. 87.5% of the participants found the course content satisfactory. To the best of our knowledge, this is the first time an African scoliosis camp has been established. The study highlights the difficulty of conducting such a course and illustrates the feasibility of executing these complex surgeries in a resource-limited environment. [ABSTRACT FROM AUTHOR]

Low- and middle-income countries (LMICs) bear a heavier burden of neurosurgical diseases than high-income countries. Brazil, a growing middle-income country, holds promise as a health care market. However, there exists a lack of information to characterize the state of neurosurgical practice and access to care in Brazil. This study aimed to characterize neurosurgical practice in Brazil and identify barriers to care. A collaborative survey was developed with Brazilian neurosurgeons and distributed by the Brazilian Society of Neurosurgery. The survey gathered demographic information, practice characteristics, case volume, referral patterns, income sources, and assessed barriers using a Likert scale. Descriptive statistics were employed for data analysis. One-hundred and forty-nine neurosurgeons participated (response rate: 17.5%), representing various states in Brazil. Neurosurgeons practiced in more than 4 different hospital systems on average, with most consultations and procedures occurring in public hospitals. Common procedures included tumor surgeries, general neurosurgery, spine surgeries, trauma surgeries, and hydrocephalus management. Equipment shortage and systemic issues were identified as major barriers to care. Neurosurgical practice in Brazil exhibits diverse age distribution, widespread distribution across states, and involvement in both public and private hospitals. Survey insights shed light on neurosurgical workload and neurosurgical practice characterization. Lack of equipment and inadequate postoperative resources pose significant barriers to care. The findings highlight the need for investments in equipment, critical care facilities, and improved health care system coordination to enhance access to neurosurgical care in Brazil. [ABSTRACT FROM AUTHOR]

Introduction: Rapid urbanisation affects lifestyle and eating habits, predominantly causing a dietary shift that adds challenges to meet dietary recommendations within a complex food system. This research investigated dietary diversity and food choice drivers among low‐income consumers in three urban settlements (Nairobi, Kenya; Bulawayo, Zimbabwe and Lilongwe, Malawi, representing rapid, moderate and slow urban growth patterns, respectively) as a first step towards improving diets across cultures and geographies. Methods: Mixed methods data collection was employed for this study. Qualitative methods such as rapid foodscape appraisal workshops and food stories in selected low‐income settlements in Nairobi, Bulawayo and Lilongwe were utilised to collect information on the food environments (food balances, infrastructure, safety, policies and institutions). Quantitative data such as socio‐demographic characteristics and dietary diversity were collected via structured questionnaires using Cognitive Edge's SenseMaker® (n = 890, 450 and 440 for Nairobi, Bulawayo and Lilongwe, respectively). The dietary intake of respondents was assessed using a 24‐h recall, which was then converted to the food group diversity score (FGDS). Results: Different levels of compounded stress affected dietary diversity and quality, including high food prices, concerns about sanitation and hygiene and the role of food standards regulation bodies. The mean FGDS across all locations was lower than the recommended cut‐off of 5 (4.5, 2.8 and 2.6 across Nairobi, Zimbabwe and Lilongwe, respectively). Additionally, in Nairobi, there were gender differences in diet diversity, with men having a higher dietary diversity score than women (4.6% vs. 4.3%; p = 0.004). The majority of respondents in Lilongwe (65%) reported price as the most important driver of food choice, compared to 38% in Nairobi and 42% in Bulawayo. Discussion/Conclusions: Our observation of poor‐quality diets provides further evidence of the need for food policies that are cognisant of the nutrition and health of the growing population of the urban poor. Such policies would focus on lowering the costs of nutritious foods as well as ensuring food safety within the complex food system observed in the urban low‐income environment. Key points: An investigation conducted in contrasting food environments in three urban low‐income settlements in Lilongwe, Bulawayo and Nairobi suggests low consumption of nutrient‐dense foods, such as fruits and animal‐source foods.Several drivers of dietary diversity and food choice, as well as perceptions, were identified. Price and convenience were identified as key drivers of food choice, with gender differences reported in dietary diversity.Policies and programmes need to consider steering diets towards higher consumption of nutrient‐dense foods while taking into account price, convenience and environmental sustainability. [ABSTRACT FROM AUTHOR]

Background: Families are the primary caregivers for persons with intellectual disability (ID), offering informal support to ensure community living. Ensuring families are adequately supported is key to reduce the financial, physical, mental and social toll which long-standing inadequately supported care giving may evoke. Respite care is such a support service offered to caregivers and care-recipients with ID. Objective: Part of a larger study aimed at developing a respite care service framework for persons with ID for South Africa, the review aimed to elucidate what principles and practices inform current respite care services for this population globally. Method: The Joanna Briggs Institute (JBI) scoping review framework guided the review. Databases were searched using key and surrogate terms for relevant literature published from 2006 to 2021. Results: Thirty-one sources met the inclusion criteria from 417 screened sources of evidence. These were published between 2006 and 2020, and included grey and peer-reviewed articles, the latter mostly mixed design. Information on respite care service characteristics, principles, practices, guidelines, evaluations and impacts were found for high- but not low-and-middle-income countries (LMICs). Conclusion: There is an existing knowledge base that can be drawn on to inform the development of quality respite care. The lack of published information on respite care in LMICs necessitates further research to ensure contextually appropriate respite care developments in these settings. Contribution: This study contributes to the knowledge base on respite care for persons with ID and points out the research gap in LMICs. [ABSTRACT FROM AUTHOR]

Introduction: Although there are multiple drugs approved for the treatment of metastatic castration-resistant prostate cancer (CRPC), the cost can be a limiting factor in using them in a resource-limited setting. Therefore, less expensive alternatives are the need of the hour. We have been using Fosfestrol which is a cheap and orally administered oestrogen analogue in metastatic CRPC. We carried out a retrospective study to analyse its efficacy and toxicity. Results: A total of 65 patients received Fosfestrol during 2015-2020. The median age was 65 years (range 50-83 years). Thirty-four patients (53%) had other medical comorbidities. Skeletal-only metastasis was the commonest pattern of metastasis (n = 41, 64%) followed by skeletal with nodal metastasis (n = 15, 23%). The majority of the patients had undergone upfront surgical castration (n = 60, 93%). All the patients had adenocarcinoma and 38 patients (58%) had a high Gleason's score. Forty-one patients (63%) had a prostatespecific antigen (PSA) response (decrease of =50% in the PSA concentration from the pre-treatment baseline PSA value) and 54 patients (83%) had a symptomatic response. At the end of a median follow-up of 16 months, the median progression-free survival (PFS) was 8.3 months (CI 4.7-11.8) and the median overall survival (OS) was 27.5 months (CI 25.4-29.5). PSA response and prior treatment with abiraterone acetate were found to have a significant association with survival outcomes. Patients with PSA response had better median PFS and OS; while patients who have received prior abiraterone acetate therapy had worse survival outcomes. Twenty-nine patients (45%) received some form of subsequent treatment after stopping Fosfestrol. The most common oxicity observed was thrombosis (n = 9, 13%) followed by gynecomastia (n = 4, 6%). Conclusion: We conclude that oral Fosfestrol is a cheap and effective agent in the armamentarium against metastatic CRPC and warrants further studies in a clinical trial setting. [ABSTRACT FROM AUTHOR]

For over 25 years, new programs to attempt to stem the HIV epidemic have been developed in Africa by country governments as well as external donors. These programs and activities have built and operated facilities, trained clinicians, financed drugs and commodities, supported and helped finance government health planning and operations, and contributed in other ways. Who has benefited from this massive mobilization? While some single country and narrowly focused studies have been done, the issue of equity of HIV programs for vulnerable populations has not been examined in a large set of countries. Using Population-based HIV Impact Assessment (PHIA) data, we examine equity of the HIV programs in 13 African countries to determine if vulnerable groups (such as those with low wealth, rural populations, young adults, and females) have achieved comparable levels of access to HIV program services. In contrast, we also compare the equity of the HIV response to rural and low-wealth populations with the equity of corresponding domestic health systems using Demographic and Health Survey data. This study found that in over half of the countries, the HIV response indicators were equitable for vulnerable population segments including the low-wealth population (in seven countries) and rural population segment (in nine countries). In no country was the domestic health system equitable for these two groups. However, HIV programming does show some clear patterns of inequity for low-wealth and rural populations in some countries. For gender and young adults, the HIV response indicators show that in all 13 countries men and young adults are consistently underserved relative to their counterparts. [ABSTRACT FROM AUTHOR]

The global cancer statistics are stark, accounting for nearly 10 million deaths in 2020, around one in six of all deaths globally. The World Health Organization estimates that 70% of these cancer deaths occur in low‐ and middle‐income countries and cancer will continue to rise as a proportion of deaths in these settings. We may usefully characterize cancer as a "social mess," a set of interrelated problems and other messes including poverty and social determinants of health. One part of cancer's "messiness" is the governance deficit around cancer burden and regional inequities This policy paper assesses the field of global oncology governance and the interplay of legal instruments, soft law, national developments, donor activities, as well as partnerships, networks, and coalitions. Cancer governance is central to tackling cancer inequalities. Continuing to probe the complexities of cancer governance requires attention to market mechanisms, international agreements, soft power, political willpower, partnerships, collaborations and networks, and patient participation. Governance is inseparable from "paradigmatic" framings and cancer must be seen as a human rights issue. Key points: Cancer is a "social mess," a set of interrelated problems and other messes including poverty and social determinants of health. Cancer governance is central to tackling cancer inequalities: legal instruments, soft law, donor activities, networks, and coalitions. Governance is inseparable from "paradigmatic" framings and cancer must be framed as a human rights issue. [ABSTRACT FROM AUTHOR]

Burundi, like many African nations, faces challenges in providing accessible emergency care. The aim of this study was to assess the type of staff training, accessibility to imaging, and availability of essential equipment in the district hospitals of Burundi in order to inform strategic planning for healthcare delivery. In June 2022 an online survey was sent to each district hospital of the country. Complete responses were analysed and, where appropriate, significance determined by chi-square analysis, with p <0.05 considered significant. Forty of 45 district hospitals completed the survey, of which 35 were rural (matching national demographics). The majority of district hospitals (21/40) had ready access to ≥4/5 critical drugs while few (5/40) were equipped with ≥4/5 key material. One quarter had 24/7 physician coverage and X-ray available. Only 3 had continuous access to ultrasound studies despite most district hospitals having ultrasound machines. Trained emergency room staff were almost totally absent from the field, with only 6 nurses, 4 generalists, and 1 specialist reported across 9 sites. Even a single EM-trained staff member was significantly correlated with being better equipped for emergencies (p <0.01). Burundi needs a strategic investment in emergency preparedness and care. Policy initiatives and technology purchases have demonstrated reasonable penetration down to the district hospital level, however, trained personnel are essential to develop sustainable emergency capacity. [ABSTRACT FROM AUTHOR]

UNESCO's Global Education Monitoring Report (2020) strongly recommends the adoption of Universal Design for Learning (UDL) at the government level so that it becomes an integral part of countries' inclusive education policies. However, UDL has largely been developed in high-income countries with technology as a central theme. The question is whether the purported benefits of the UDL approach can translate into low and middle-income country (LMIC) contexts. This study explores the relevance and fit of UDL to LMIC contexts by use of interviews (either individual or group) with 12 representatives of international agencies, non-governmental organizations (NGOs), and UDL experts who have experience in providing inclusive education services in LMICs. Three themes are reported: understanding of UDL, UDL supporting inclusive education, and UDL in teacher-training initiatives and capacity building. The concept of UDL is not new in LMICs, although the name may be. The potential for UDL to support inclusive education in LMICs is recognized. UDL needs to be mainstreamed in teacher training programs, and its implementation should be adapted to respond to the contextual realities of LMICs. The encounter between UDL proponents from high-income countries and education stakeholders in LMICs should be mutually enriching rather than imposing the approach from high-income countries on those in LMICs. [ABSTRACT FROM AUTHOR]

Reliable data on slums or deprived living conditions remain scarce in many low- and middle-income countries (LMICs). Global high-resolution maps of deprived areas are fundamental for both research- and evidence-based policies. Existing mapping methods are generally one-off studies that use proprietary commercial data or other physical or socio-economic data that are limited geographically. Open geospatial data are increasingly available for large areas; however, their unstructured nature has hindered their use in extracting useful insights to inform decision making. In this study, we demonstrate an approach to map deprived areas within and across cities using open-source geospatial data. The study tests this methodology in three African cities—Accra (Ghana), Lagos (Nigeria), and Nairobi (Kenya) using a three arc second spatial resolution. Using three machine learning classifiers, (i) models were trained and tested on individual cities to assess the scalability for large area application, (ii) city-to-city comparisons were made to assess how the models performed in new locations, and (iii) a generalized model to assess our ability to map across cities with training samples from each city was designed. Our best models achieved over 80% accuracy in all cities. The study demonstrates an inexpensive, scalable, and transferable approach to map deprived areas that outperforms existing large area methods. [ABSTRACT FROM AUTHOR]

Background and Aims: Among all the social media, Facebook is the most popular social networking site among students. That raises a chance of excessive Facebook usage being a form of addiction to hamper students' mental health. The primary goal of this study was to find the association of Facebook addiction with the depression level of university students during the COVID‐19 pandemic. Method: Four hundred ten university students from Bangladesh were selected randomly as samples for this investigation. In this study, the Bergen Facebook Addiction Scale and nine‐item Patient Health Questionnaire were used to assess the level of Facebook Addiction and depression status of the students, respectively. Ordered probit models were employed to identify the connection between Facebook addiction and depression. Ordinary least square models were utilized further to check the robustness of the findings. Results: Ordered probit results confirm that Facebook addiction increases the likelihood of having heightened depression among university students. Besides, sex, household income, and history of being infected by COVID‐19 also appeared to be correlated with the depression level of the students. Conclusion: Creating opportunities for students to participate in more physically demanding outdoor activities should be prioritized as it could ultimately enhance their capacity to mitigate depression. Appropriate measures must be taken to increase the number of recreational facilities on the campus for students, considering their age, gender, and preferences. [ABSTRACT FROM AUTHOR]

Background: Factors influencing the health of populations are subjects of interdisciplinary study. However, datasets relevant to public health often lack interdisciplinary breath. It is difficult to combine data on health outcomes with datasets on potentially important contextual factors, like political violence or development, due to incompatible levels of geographic support; differing data formats and structures; differences in sampling procedures and wording; and the stability of temporal trends. We present a computational package to combine spatially misaligned datasets, and provide an illustrative analysis of multi-dimensional factors in health outcomes. Methods: We rely on a new software toolkit, Sub-National Geospatial Data Archive (SUNGEO), to combine data across disciplinary domains and demonstrate a use case on vaccine hesitancy in Low and Middle-Income Countries (LMICs). We use data from the World Bank's High Frequency Phone Surveys (HFPS) from Kenya, Indonesia, and Malawi. We curate and combine these surveys with data on political violence, elections, economic development, and other contextual factors, using SUNGEO. We then develop a stochastic model to analyze the integrated data and evaluate 1) the stability of vaccination preferences in all three countries over time, and 2) the association between local contextual factors and vaccination preferences. Results: In all three countries, vaccine-acceptance is more persistent than vaccine-hesitancy from round to round: the long-run probability of staying vaccine-acceptant (hesitant) was 0.96 (0.65) in Indonesia, 0.89 (0.21) in Kenya, and 0.76 (0.40) in Malawi. However, vaccine acceptance was significantly less durable in areas exposed to political violence, with percentage point differences (ppd) in vaccine acceptance of -10 (Indonesia), -5 (Kenya), and -64 (Malawi). In Indonesia and Kenya, although not Malawi, vaccine acceptance was also significantly less durable in locations without competitive elections (-19 and -6 ppd, respectively) and in locations with more limited transportation infrastructure (-11 and -8 ppd). Conclusion: With SUNGEO, researchers can combine spatially misaligned and incompatible datasets. As an illustrative example, we find that vaccination hesitancy is correlated with political violence, electoral uncompetitiveness and limited access to public goods, consistent with past results that vaccination hesitancy is associated with government distrust. [ABSTRACT FROM AUTHOR]

Genetic disorders are significant contributors to infant hospitalization and mortality globally. The early diagnosis of these conditions in infants remains a considerable challenge. Clinical exome sequencing (CES) has shown to be a successful tool for the early diagnosis of genetic conditions, however, its utility in African infant populations has not been investigated. The impact of the under representation of African genomic data, the cost of testing, and genomic workforce shortages, need to be investigated and evidence-based implementation strategies accounting for locally available genetics expertise and diagnostic infrastructure need to be developed. We evaluated the diagnostic utility of singleton CES in a cohort of 32 ill, South African infants from two State hospitals in Johannesburg, South Africa. We analysed the data using a series of filtering approaches, including a curated virtual gene panel consisting of genes implicated in neonatal-and early childhood-onset conditions and genes with known founder and common variants in African populations. We reported a diagnostic yield of 22% and identified seven pathogenic variants in the NPHS1, COL2A1, OCRL, SHOC2, TPRV4, MTM1 and STAC3 genes. This study demonstrates the utility value of CES in the South African State healthcare setting, providing a diagnosis to patients who would otherwise not receive one and allowing for directed management. We anticipate an increase in the diagnostic yield of our workflow with further refinement of the study inclusion criteria. This study highlights important considerations for the implementation of genomic medicine in under-resourced settings and in under-represented African populations where variant interpretation remains a challenge. [ABSTRACT FROM AUTHOR]

Background: Globally, the majority of strokes affect people residing in lower-and lower-middle-income countries (LMICs), but translating evidence-based knowledge into clinical practice in regions with limited healthcare resources remains challenging. As an LMIC in South Asia, stroke care has remained a healthcare problem previously unaddressed at a national scale in Nepal. The Nepal Stroke Project (NSP) aims to improve acute stroke care in the tertiary healthcare sector of Nepal. We hereby describe the methods applied and analyze the barriers and facilitators of the NSP after 18 months. Methods: The NSP follows a four-tier strategy: (1) quality improvement by training healthcare professionals in tertiary care centers; (2) implementation of in-hospital stroke surveillance and quality monitoring system; (3) raising public awareness of strokes; and (4) collaborating with political stakeholders to facilitate public funding for stroke care. We performed a qualitative, iterative analysis of observational data to analyze the output indicators and identify best practices. Results: Both offline and online initiatives were undertaken to address quality improvement and public awareness. More than 1,000 healthcare professionals across nine tertiary care hospitals attended 26 stroke-related workshops conducted by Nepalese and international stroke experts. Monthly webinars were organized, and chat groups were made for better networking and cross-institutional case sharing. Social media-based public awareness campaigns reached more than 3 million individuals. Moreover, live events and other mass media campaigns were instituted. For quality monitoring, the Registry of Stroke Care Quality (RES-Q) was introduced. Collaboration with stakeholders (both national and international) has been initiated. Discussion: We identified six actions thatmay support the development of tertiary care centers into essential stroke centers in a resource-limited setting. We believe that our experiences will contribute to the body of knowledge on translating evidence into practice in LMICs, although the impact of our resultsmust be verified with process indicators of stroke care. [ABSTRACT FROM AUTHOR]

Enterotoxigenic Escherichia coli (ETEC) is one of the leading bacterial causes of diarrhoea, especially among children in low-resource settings, and travellers and military personnel from high-income countries. WHO's primary strategic goal for ETEC vaccine development is to develop a safe, effective, and affordable ETEC vaccine that reduces mortality and morbidity due to moderate-to-severe diarrhoeal disease in infants and children under 5 years of age in LMICs, as well as the long-term negative health impact on infant physical and cognitive development resulting from infection with this enteric pathogen. An effective ETEC vaccine will also likely reduce the need for antibiotic treatment and help limit the further emergence of antimicrobial resistance bacterial pathogens. The lead ETEC vaccine candidate, ETVAX, has shown field efficacy in travellers and has moved into field efficacy testing in LMIC infants and children. A Phase 3 efficacy study in LMIC infants is projected to start in 2024 and plans for a Phase 3 trial in travellers are under discussion with the U.S. FDA. Licensing for both travel and LMIC indications is projected to be feasible in the next 5–8 years. Given increasing recognition of its negative impact on child health and development in LMICs and predominance as the leading etiology of travellers' diarrhoea (TD), a standalone vaccine for ETEC is more cost-effective than vaccines targeting other TD pathogens, and a viable commercial market also exists. In contrast, combination of an ETEC vaccine with other vaccines for childhood pathogens in LMICs would maximize protection in a more cost-effective manner than a series of stand-alone vaccines. This 'Vaccine Value Profile' (VVP) for ETEC is intended to provide a high-level, holistic assessment of available data to inform the potential public health, economic and societal value of pipeline vaccines and vaccine-like products. This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships, and multi-lateral organizations. All contributors have extensive expertise on various elements of the ETEC VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using only existing and publicly available information. [ABSTRACT FROM AUTHOR]

The neurosurgical workforce in the Caribbean and surrounding countries is largely unknown due to the diversity in cultural, linguistic, political, financial disparities, and colonial history between the countries. About 45 neurosurgeons serve 16 million people in the Caribbean Community and Common Market, a trade alliance including most Caribbean nations. We aimed to understand the current scope of neurosurgical workforce in this region while highlighting any system challenges and potential solutions for upscaling the workforce. We surveyed neurosurgeons within Caribbean countries and surrounding countries online using qualitative and quantitative methods via Qualtrics. Of the 38 countries within the Caribbean and surrounding countries, 26 (68%) were surveyed and of which 18 (69%) replied. In total, 172 regional neurosurgeons were identified, of which 61 (35%) replied—with a majority of general neurosurgeons (56%). Remarkably, the majority of countries failed to meet the threshold workforce density for safe health care—either expressed by full-time equivalent neurosurgeons or neurosurgical centers (see table). Most neurosurgical practices confirmed receiving or sending medical referrals. If so, most referrals took longer than 8 hours without significant difference regarding the destination. Lastly, challenges confronting neurosurgical advancement were found in the following: technology and equipment (40%), trained personnel (31%), hospital or medical center infrastructure (14%), neurosurgical education, and training (44%). To our knowledge, this is the first qualitative and quantitative study exploring the current status of the neurosurgical workforce within the Caribbean and surrounding countries. Identifying resources and challenges can contribute to improving regionalized neurosurgical care. [ABSTRACT FROM AUTHOR]

Objective: Contrast enhanced mammography (CEM), a relatively new and promising modality, combines mammography (MMG) with an iodinated contrast material to illuminate neovascularity within the breast; analogous to magnetic resonance imaging (MRI). CEM improves the overall sensitivity of MMG; reduces the need for unnecessary biopsies and follow-up imaging and can be considered a reasonable substitute for MRI. In Pakistan, CEM was recently introduced and to assess its usability a study was conducted on five patients before making it available as a regular investigation. Case presentations: Four out of the five patients had a clinical suspicion of malignancy with two patients having heterogeneously dense breasts and two with dense breasts. All enhancing lesions were concordant on biopsy and had similar corresponding findings on additional imaging such as ultrasound (US) and/or MRI. CEM in all four cases of biopsy proven malignancy facilitated surgical planning. The fifth patient underwent CEM for screening and was found to have no enhancing lesion. Conclusion: In low-middle-income countries (LMICs) where breast MRI is not readily available and expensive for the populace, CEM can be a reliable alternative. The initial experience with CEM at our hospital shows better visualization of malignant lesions in dense and heterogeneously dense breasts with an easy-to-perform technique and a shorter imaging time while facilitating surgical decision-making in terms of breast conservation. [ABSTRACT FROM AUTHOR]

Summary: Anaesthesia has been shown to contribute disproportionately to maternal mortality in low‐resource settings. This figure exceeds 500 per 100,000 live births in Tanzania, where anaesthesia is mainly provided by non‐physician anaesthetists, many of whom are working as independent practitioners in rural areas without any support or opportunity for continuous medical education. The three‐day Safer Anaesthesia from Education (SAFE) course was developed to address this gap by providing in‐service training in obstetric anaesthesia to improve patient safety. Two obstetric SAFE courses with refresher training were delivered to 75 non‐physician anaesthetists in the Mbeya region of Tanzania between August 2019 and July 2020. To evaluate translation of knowledge into practice, we conducted direct observation of the SAFE obstetric participants at their workplace in five facilities using a binary checklist of expected behaviours, to assess the peri‐operative management of patients undergoing caesarean deliveries. The observations were conducted over a 2‐week period at pre, immediately post, 6‐month and 12‐month post‐SAFE obstetric training. A total of 320 cases completed by 35 participants were observed. Significant improvements in behaviours, sustained at 12 months after training included: pre‐operative assessment of patients (32% (pre‐training) to 88% (12 months after training), p < 0.001); checking for functioning suction (73% to 85%, p = 0.003); using aseptic spinal technique (67% to 100%, p < 0.001); timely administration of prophylactic antibiotics (66% to 95%, p < 0.001); and checking spinal block adequacy (32% to 71%, p < 0.001). Our study has demonstrated positive sustained changes in the clinical practice amongst non‐physician anaesthetists as a result of SAFE obstetric training. The findings can be used to guide development of a checklist specific for anaesthesia for caesarean section to improve the quality of care for patients in low‐resource settings. [ABSTRACT FROM AUTHOR]

There is growing interest in the epidemiology of asthma in developing countries, especially in the Asia‐Pacific Region (APR). A number of reviews have been published in this field, but a comprehensive synthesis of overall data has not been reported. Here, we summarized the burden, risk factors and challenges of asthma management in developing countries with a specific emphasis on the APR by consolidating evidence from both systematic and narrative reviews published up until February 2023. We found that although asthma prevalence in low and low‐middle‐income countries (LMICs) is known to be generally lower compared to high‐income countries, the burden is substantially greater. Studies conducted in APR LMIC have reported a range of risk factors, including pre‐ and post‐natal factors, environmental considerations, lifestyle measures, individual features and genetics. The low and inequitable distribution of quality preventive and curative health care, a lack of advanced diagnostic measures, non‐availability and non‐affordability of novel therapeutics, cultural beliefs and practices, and diverse disease phenotypes make it challenging to achieve optimal asthma control in the region. Hence, we call for the development of a region‐specific blueprint for action to mitigate this challenging situation, to help reduce the burden of asthma in APR LMIC. [ABSTRACT FROM AUTHOR]

As community engagement (CE) is implemented for sustainable maternal and newborn health (MNH) programming, it is important to determine how these approaches work. Low- and middle-income countries (LMICs) have become a particular focus for MNH CE activities due to their high burden of maternal and neonatal deaths. MNH messaging and communication to engage communities are likely to differ by context, but how these approaches are actually developed and implemented within CE is not well understood. Understanding how communications in CE actually work is vital in the translation of learnings across programmes and to inform future projects. The purpose of this realist review is to describe how, why, to what extent and for whom communications in CE contribute to MNH programming in LMICs. After searching academic databases, grey literature and literature suggested by the expert advisory committee, documents were included if they described the CE communication processes/activities used for MNH programming in an LMIC. Relevant documents were assessed for richness (depth of insight) and rigor (trustworthiness and coherence of data/theories). Data were extracted as context–mechanism–outcome configurations (CMOCs) and synthesized into demi-regularities to contribute to theory refinement. After screening 416 records, 45 CMOCs were extracted from 11 documents. This informed five programme theories explaining that communications in CE for an MNH programme work when: communities are actively involved throughout the programme, the messaging and programme are acceptable, communication sources are trusted, the community has a reciprocal relationship with the programme and the community sees value in the programme. While these findings reflect what is often anecdotally known in CE or acknowledged in communications theory, they have implications for policy, practice and research by highlighting the importance of centring the community's needs and priorities throughout the stages of developing and implementing communications for CE in MNH. [ABSTRACT FROM AUTHOR]

It has become increasingly apparent that publishing research on child development from certain countries is especially challenging. These countries have been referred to collectively as the Majority World, the Global South, non‐WEIRD (Western, Educated, Industrial, Rich, and Democratic), or low‐ and middle‐income countries. The aim of this paper is to draw attention to these persistent challenges, and provide constructive recommendations to contribute to better representation of children from these countries in child development research. In this paper, we outline the history of publication bias in developmental science, and issues of generalization of research from these countries and hence where it 'fits' in terms of publishing. The importance of explaining context is highlighted, including for research on measurement child development outcomes, and attention is drawn to the vicious publication‐funding cycle that further exacerbates the challenges of publishing this research. Specific recommendations are made to assist child development journals achieve their stated goals of creating a more inclusive, equitable, diverse, and global field of child development. [ABSTRACT FROM AUTHOR]