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In this paper, we analyze the extent to which low-income countries integrate into the global knowledge production network. We develop an (undirected) research collaboration model based on which we identify the drivers of global research collaboration using publication data of the field Business and Economics from the Web of Science and macroeconomic data from the United Nations Educational, Scientific and Cultural Organization Institute for Statistics. Network and dynamic panel regression techniques are employed. Our results show that (i) reciprocal preferential attachment and the homophily between countries reinforce scientific collaboration, (ii) there is no evidence that low-income countries are becoming better integrated into the global knowledge production over the years, despite their active participation in international reserach collaboration, while (iii) high-income countries show a basic willingness to cooperate with them, which, in turn, promotes the integration of low-income countries, although this willingness seems to decline; and (iv) as to low-income countries, they have little choice but to invest more in education and R&D in order to advance in the global knowledge production network. [ABSTRACT FROM AUTHOR]

Background: Access to contraception can be a transformational intervention towards advancement of education, health, and freedom of choice. Countries have committed to improving access to contraception enshrined in the sustainable development goals (SDGs), indicator 3.7.1. Our study seeks to investigate the level of inequality in current use of modern contraception and unmet need for contraception among sexually active women of reproductive age in Zambia during 2007, 2013/14 and 2018 to inform family planning policy. Methods: We use three rounds of Zambia demographic and health survey datasets for the years 2007, 2013/14 and 2018, which are nationally representative surveys. We included a total of 19,973 sexually active women of reproductive age from 15 to 49 years living in Zambia. The level of inequality was assessed using concentration curves, and indices. The concentration indices were decomposed to identify the causes of the inequality. Results: Our analysis shows that there was inequality in the current use of modern contraception across the years 2007, 2013/14 and 2018. The concentration curves showed that current use of modern contraception was higher among the wealthy than the poor. This pro-rich trend was consistent throughout the study period. Erreygers concentration Index (EI) values were 0.2046 in 2007, 0.1816 in 2013/14, and 0.1124 in 2018. The inequality in current use of modern contraception was significantly influenced by having access to contraceptive counselling, education level and being in a union (living with a partner). In addition, there was inequality in unmet need for contraception with concentration curves showing that unmet need for modern contraception was experienced more among the poor compared to the wealthy. Unmet need was thus pro poor. The EI values were – 0.0484 in 2007, – 0.0940 in 2013/14 and – 0.0427 in 2018. This inequality was significantly influenced by education, employment status, being in a union, and having health insurance. Conclusion: Inequality in modern contraceptive use and unmet need for contraception exists and has persisted over the years in Zambia. Such inequality can be addressed through a multipronged approach that includes encouraging women to visit health facilities, access to contraceptive counselling, and promoting formal education. Plain Language Summary: Background to the study: The use of effective methods of contraception (also known as modern contraception) has several advantages including prevention of dropping out of school due to unintended pregnancies, increased freedom to choose when to have a child, among others. Such advantages translate into development of the community and society at large. Increasing access to contraception is one of the targets under the sustainable development goals. The level of inequality in contraceptive use affects the chances of achieving the target. Our study therefore aims to find out whether there are any existing inequalities in modern contraceptive use among women in Zambia that still have the capacity to give birth (from 15- to 49-yearolds). Methods used in this study: The study looks at two measures, using modern contraception and unmet need for contraception. Unmet need for contraception in this study is where a woman that is sexually active and does not want to get pregnant, but she is not using any form of contraception. We use information that has been collected in a way that it represents the population of Zambia. The information was collected at three time points, that is 2007, 2013/14, and 2018. A total 19,973 women provided the information. We investigate the presence of inequalities through graphs called concentration curves and estimate the quantity of inequality. We further use the latest and reliable method by find what causes the inequality. Results of the study: We find that there are inequalities in modern contraceptive use and unmet need for contraception based on population-based data collected during 2007, 2013/14, and 2018 in Zambia. The inequalities favour the rich people in society where you find rich people using modern contraception more than the poor people. For the inequality in unmet need for contraception, ACCEPTED MANUSCRIPT Accepted manuscript 4 which is a negative indicator, we found that it is the poor people that experience unmet need for contraception compared to the rich people. The causes of these inequalities included having no formal education, employment status, being in a union, and having health insurance. Conclusion of the study: There is inequality in the use of modern contraceptives and unmet need for contraception in Zambia. This inequality can be addressed through multiple ways including encouraging women to visit health facilities, access to contraceptive counselling, promoting formal education among others. [ABSTRACT FROM AUTHOR]

Background: The convergence of global demographic changes and rising humanitarian crises in low- and middle-income countries (LMICs) has raised the number of affected older people (OP). These individuals face the challenges of aging and the adverse conditions of disasters, particularly pronounced in LMICs. This review aims to explore literature on the health and well-being of older populations during humanitarian crises in LMICs. Methods: This scoping review included primary studies on the health and well-being of older populations in humanitarian crises in LMIC. A search was conducted in five bibliographic databases last updated in 2023. A numerical summary and thematic analysis of study characteristics and themes were executed and findings were narratively synthesized. Results: A total of 84 eligible studies were included. The majority of studies were quantitative (n = 56), followed by qualitative (n = 22) and mixed-methods (n = 6). Most literature focuses on the high burden of mental health conditions and their determinants, such as depression, anxiety, and Post-Traumatic Stress Disorder (PTSD). The second most common theme is physical health, discussing high levels of mortality, disability, some non-communicable diseases, and limited evidence on the poor nutritional status. OP lack access to routine healthcare due to cost barriers. The key gaps in the literature are in mental and psychosocial health, especially pertaining to vulnerabilities and risk factors, and to contextualized interventions. Physical health research is relatively narrow lacking a wider range of chronic diseases while no research was performed on communicable diseases other than COVID-19. Conclusions: Findings show the complex vulnerabilities of OP in humanitarian crises which exacerbate their physical, mental, and psychosocial health outcomes. There is a need to strengthen evidence on the effectiveness of interventions, and to investigate determinants of health, especially mental and psychosocial health, across different contexts. Research should also explore cross-cutting issues like gender, access to livelihoods, and equitable access to humanitarian assistance. [ABSTRACT FROM AUTHOR]

The unmet need for mental health care is a global concern. There is a lack of cross-cultural studies examining adolescent help-seeking behavior from both formal and informal sources, including both high-and lower-income countries. This study investigates mental health help-seeking behavior in eight Asian and European countries. Data from 13,184 adolescents aged 13–15 (51% girls) was analysed using mixed-effects logistic regression with school-wise random intercepts to compare countries and genders. Although a significant proportion of adolescents considered getting or sought informal help, formal help-seeking remained exceptionally low, especially in middle-income countries (< 1%), while it ranged from 2 to 7% in high-income countries. Among adolescents with high emotional and behavioral problems (scoring above the 90th percentile on the Strengths and Difficulties Questionnaire), 1–2% of those in middle-income countries and 6–25% of those in high-income countries sought formal help. Girls generally seek more help than boys. The study shows the most adolescents do not receive formal help for mental health problems. The unmet need gap is enormous, especially in lower-income countries. Informal sources of support, including relatives, peers, and teachers, play a crucial role, especially in lower-income countries. [ABSTRACT FROM AUTHOR]

Background and objectives: The rational for the Somaliland national harmonised curriculum (NHC) was driven by shared concern about the quality of medical education. Process: The Ministry of Education and Science and the Ministry of Health Development produced a Medical Education Policy 2018. Policy objectives included the development of the NHC and accreditation for medical schools that met the standards of the World Federation for Medical Education (WFME). Two bodies were asked to oversee these aims: the National Health Professions' Commission (NHPC) and the National Commission of Higher Education (NCHE). Between 2018 and 2020, a collaborative approach between the Somaliland government, medical school stakeholders, King's Global Health Partnership's (KGHP) volunteers and the Tropical Health Education Trust (THET) team was used to design the 6-years NHC. The NHC structure, content and delivery were grounded by WFME standards, health needs of the local population, student focused and active learning methods, and feasibility of implementation in medical schools. Outcomes: The NHC comprises details about the educational outcomes, curriculum model and framework, educational principles, instructional and learning methods, core as well as optional content, and assessment strategy. Conclusions: The approach used to develop the NHC ensured it is bespoken for Somaliland. Ongoing evaluation of patient and population needs, each medical school's review of programme implementation and outcomes will inform continuous revision and renewal. [ABSTRACT FROM AUTHOR]

Global health consensus in recent years has highlighted 'decolonisation' as an important factor in the pursuit of equity. Initiatives such as the United Nations' sustainable development goals for 2030 have come amid talk of 'bottom up' programming, driven by the needs of people living and working in the world's most deprived regions. However, most high-level meetings still take place in wealthy countries where United Nations bodies, major donors and the biggest non-governmental organisations are headquartered. In midwifery, maternity experts from low- and middle-income countries may struggle to take part in discussions because of barriers such as visa restrictions, travel costs and the challenge of breaking into old-school networks. Meanwhile multimillion dollar programmes designed to save mothers' and babies' lives lose out on insights from the very people that they are intended to help. With this in mind, a wave of non-governmental organisations focused on women's health and gender equality are moving their conferences closer to the action. This article explores a dynamic field, where forces for change are responding directly to evidence on 'conference inequity'. Non-governmental organisations including WomenLift Health and the International Confederation of Midwives explain how and why they are shaking things up. [ABSTRACT FROM AUTHOR]

In low- and middle-income countries (LMICs), barriers such as low system readiness, contextual mismatches, and resource limitations impede effective implementation of evidence-based interventions. This commentary offers insights into overcoming these challenges with a case study of the PRISM project, designed to reduce behavioral and psychological symptoms of dementia in older adults living in Thailand. The case highlights how combining two evidence-based models - the Reducing Disability in Alzheimer's Disease clinical intervention and the Getting To Outcomes implementation science process enhances program success. Using interviews with stakeholders across various health system levels, we identify factors critical to successful program implementation: (1) integrating interventions into policy frameworks, (2) empowering local implementers, (3) fostering collaborative learning, and (4) adapting interventions to local contexts. The case demonstrates that building system readiness through local engagement and ownership is central to scaling up health programs in LMICs. This commentary's contribution lies in its emphasis on the role of implementation science as a vehicle for translating research into practice. It presents a practical, adaptive model for embedding interventions into routine health systems, thereby offering a pathway for successfully scaling up evidence-based programs in LMICs. Such findings provide lessons for overcoming barriers to implementation in resource-limited environments. [ABSTRACT FROM AUTHOR]

The global burden of surgical conditions is becoming increasingly prevalent in the developing world. Hand surgery, in particular congenital hand surgery, presents with its own challenges, particularly the unique skill sets needed, multidisciplinary nature and heterogeneity of cases. The aim of this review article is to present our experience of practising congenital hand surgery in Cambodia, and to explore the feasibility of teaching this specialty in developing countries within a meaningful and sustainable framework. Since 2013, a group of hand surgeons and therapists have visited the Children Surgical Centre in Cambodia. A community-oriented curriculum was developed following the initial visits, with analysis of data and local surgeon's skill sets. These were further refined using the Pareto analysis and selected competency procedures to develop entrustable professional activities (EPAs). Common paediatric hand cases were identified and taught to the local surgeons. Essential elements of this model include the need for measurable outcomes, clear curriculum goals, long-term partnerships and information technology support. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) is the second most common pathogen causing infant mortality. Additionally, RSV is a major cause of morbidity and mortality in older adults (age ≥60 years) similar to influenza. A protein-based maternal vaccine and monoclonal antibody (mAb) are now market-approved to protect infants, while an mRNA and two protein-based vaccines are approved for older adults. First-year experience protecting infants with nirsevimab in high-income countries shows a major public health benefit. It is expected that the RSV vaccine landscape will continue to develop in the coming years to protect all people globally. The vaccine and mAb landscape remain active with 30 candidates in clinical development using four approaches: protein-based, live-attenuated and chimeric vector, mRNA, and mAbs. Candidates in late-phase trials aim to protect young infants using mAbs, older infants and toddlers with live-attenuated vaccines, and children and adults using protein-based and mRNA vaccines. This Review provides an overview of RSV vaccines highlighting different target populations, antigens, and trial results. As RSV vaccines have not yet reached low-income and middle-income countries, we outline urgent next steps to minimise the vaccine delay. [ABSTRACT FROM AUTHOR]

The term "urban–rural divide" encompasses several dimensions and has remained an important concern for any country. The economic disparity; lack of infrastructure; dearth of medical specialists; limited opportunities to education, training, and health care; lower level of sanitation; and isolating effect of geographical location deepens this gap, especially in low-income and middle-income countries (LMICs). This article gives an overview of the rural–urban differences in terms of facilities related to neurocritical care (NCC) in LMICs. Issues related to common clinical conditions such as stroke, traumatic brain injury, myasthenia gravis, epilepsy, tubercular meningitis, and tracheostomy are also discussed. To facilitate delivery of NCC in resource-limited settings, proposed strategies include strengthening preventive measures, focusing on basics, having a multidisciplinary approach, promoting training and education, and conducting cost-effective research and collaborative efforts. The rural areas of LMICs bear the maximum impact because of their limited access to preventive health services, high incidence of acquired brain injury, inability to have timely management of neurological emergencies, and scarcity of specialist services in a resource-deprived health center. An increase in the health budget allocation for rural areas, NCC education and training of the workforce, and provision of telemedicine services for rapid diagnosis, management, and neurorehabilitation are some of the steps that can be quite helpful. [ABSTRACT FROM AUTHOR]

• This paper investigates the impact of urban-rural electricity gap on human development index. • Urban-rural electricity gap significantly reduces human development index. • The nexus between urban-rural electricity gap and human development index is closer in low-income countries. • Urban-rural electricity gap directly affects three dimensions of human development index. • Urban-rural electricity inequality gap affects human development index by enlarging income inequality and deteriorating energy poverty. Based on the Instrumental Variables - Generalized Method of Moments (IV-GMM) model, this paper explores the relationship, heterogeneity, and mechanisms between the urban-rural electricity gap and the human development index for 176 countries during 2000–2020. The key findings are as follows: (1) Urban-rural electricity gap is harmful to the improvement of the human development index; an enlarged gap in electricity accessibility between urban and rural is detrimental to sustainable human development. (2) Urban-rural electricity gap is more harmful to the increase of human development index in low-income countries and low governance efficiency countries. Also, the heterogeneity exists in different quantiles, and their nexus is closer in countries with lower levels of human development index. (3) Income inequality and energy poverty act as mechanisms, which means that the urban-rural electricity gap inhibits the human development index by exacerbating income inequality and energy poverty. [ABSTRACT FROM AUTHOR]

To assess the application value of low-risk human papillomavirus (lrHPV) detection in the prevention and treatment of cervical cancer in low- and middle-resource areas (LMRAs). A retrospective cross-sectional study. Cervical HPV typing results were collected from 2019 to 2023, utilizing fluorescence PCR technology. An adjusted logistic regression model was used to assess the relative risk (OR) and 95 % confidence interval (CI) for co-infection with lrHPV and high-risk HPV (hrHPV). Out of 113,883 women included in the study, the overall lrHPV positivity rate was 1.9 %. In total, 47.7 % (1033/2167) of lrHPV positive women also had hrHPV co-infections. Multivariate analysis identified 12 hrHPV subtypes (T-hrHPV) significantly associated with co-infection risk, including HPV16, 31, 33, 39, 51, 52, 53, 56, 59, 66, 68, and 73. The risk of T-hrHPV infection was 3.77 times higher (95 % CI: 3.44-4.12) for women with a single lrHPV infection and 9.71 times higher (95 % CI: 4.72-19.99) for those with two lrHPV infections. Women screened in the gynecological outpatient clinic faced a T-hrHPV infection risk 2.64 times higher (95 % CI: 2.54-2.74) than those in the general health check department. lrHPV positivity significantly increases the risk of T-hrHPV co-infection, particularly under multiple infections, highlighting the importance of comprehensive HPV screening in LMRAs. The notable differences in T-hrHPV infection risks across various screening settings highlight their critical role in cervical cancer prevention and offer new insights into optimizing vaccination strategies to enhance effective prevention and treatment in LMRAs. [ABSTRACT FROM AUTHOR]

Vaccination against measles still stands as a highly impactful public health strategy for mitigating childhood morbidity and mortality. Relatively poor immunization coverage among children has been observed in low and middle-income countries (LMICs). Our study intended to determine socio-demographic factors associated with the 1st dose of measles vaccination among South Asian (SA) and SubSaharan African (SSA) countries children. This was a cross-sectional study. This study utilized demographic and health survey data from 42 low-and middle-income countries (LMICs) in SA and SSA. The children's dataset yielded 255,775 children between the ages of 12 and 59 months. The independent predictors were determined by using crude and adjusted odds ratios with 95% confidence intervals (CI). The prevalence of first-dose measles-immunized children was 55.5% for the selected LMICs. The multivariable analysis for combined regions (SA and SSA) showed that parents with a higher level of education, rich wealth quintile, mothers with media access, mothers with more than four antenatal care (ANC) visits and baby postnatal check-up (PNC) within two months were significantly associated with the first dose of measles vaccination among children. The first dose measles immunization coverage in the selected LMICs was considerably low. To boost the uptake of childhood measles vaccination, public health interventions particularly need to focus on children born to uneducated parents, poor families, and those who have not used health services (ANC and PNC). Financial funding is crucial for establishing mobile vaccination clinics to improve immunization rates among the impoverished. [ABSTRACT FROM AUTHOR]

This study aimed to identify the individual- and community-level determinants of mothers' healthcare-seeking behaviour for children under the age of 5 years with acute respiratory infection (ARI) symptoms in low-and middle-income countries (LMICs). Nationally representative Demographic and Health Survey datasets from 29 LMICs were used. The study included 16,893 children aged under 5 years with ARI symptoms in the 2 weeks prior to the survey. A multilevel logistic regression model was used to examine associations between individual- and community-level factors with health-seeking behaviour for ARIs. The adjusted odds ratio (AOR) along with 95% confidence intervals (CIs) were reported as a measure of association. The overall prevalence of healthcare-seeking behaviour for ARIs among children under 5 years in LMICs was 58.83% (95% CI: 58.08, 59.57). Findings showed that mothers with primary or higher education (AOR = 1.20; 95% CI: 1.08, 1.33), and those residing in rich households (AOR = 1.32; 95% CI: 1.18, 1.48), attending antenatal care (ANC) visits (AOR = 1.53; 95% CI: 1.31, 1.79) and delivering at a healthcare facility (AOR = 1.28; 95% CI: 1.16, 1.41) were more likely to seek healthcare for ARIs. A higher level of community maternal education (AOR = 1.44; 95% CI: 1.24, 1.68) was positively associated with seeking healthcare for ARIs, while a higher level of community poverty (AOR = 0.83; 95% CI: 0.72, 0.96) was negatively associated with healthcare seeking for ARIs. This study revealed that mothers' healthcare-seeking behaviour for ARIs was closely linked to modifiable risk factors, including maternal education, household wealth, use of maternal health services (e.g., ANC), as well as community poverty and literacy levels. Future interventions should consider these modifiable risk factors when developing strategies to improve child health outcomes in LMICs. [ABSTRACT FROM AUTHOR]

Primary central nervous system tumors are the second most common cancer among children in high-income countries (HICs). These tumors are also the leading cause of cancer-related deaths in children in this setting. Studies from HICs report gliomas as the most common pediatric cancer. However, there is paucity of data from low- and middle-income countries as not many publications have been made in this field. The objective was to describe the disparities in detection, treatment, and survival of children with central nervous system tumors in low-income countries (LICs) when compared with HICs, using a case series. A retrospective chart review of three children treated for medulloblastoma in Uganda was done. In addition, a review of the literature about management of pediatric central nervous system tumors in both LICs and HICs was conducted. There are no quantifiable results for this case series. There are notable differences in the quality of care for children with pediatric central nervous system tumors in LICs when compared with HICs. In Uganda, the challenges in management of these children include few multidisciplinary specialists, long distance from the neurosurgery centers, and difficulties in making a correct pathologic diagnosis, among others. [ABSTRACT FROM AUTHOR]

Introduction: In Ethiopia approximately 3,200,000 babies are born annually and 41.09 per 10,000 live births are affected by spina bifida. Hydrocephalus (HCP) is another common pediatric neurosurgical condition with studies in Ethiopia showing the most common etiology is post spina bifida closure. The out-of-pocket expense (OOPE) and indirect expense of patients treated surgically for spina bifida and hydrocephalus during the first year of life were assessed. Methods: A prospective hospital-based study was done on patients treated surgically for spina bifida and HCP in two university-affiliated hospitals, between April 1st, 2022, and April 1st, 2023. Data on direct and indirect expenses were collected during inpatient care and follow-up. Catastrophic health expenditure (CHE) was assessed, defined as total expenditure exceeding 10% of the total annual household expenditure. Result: A total of 245 patients were eligible for analysis. The median annual total expenditure of households for treatment was ETB 11,510.00 with ETB 5700.00 being indirect expenditure. Forty-nine percent of the households suffered CHE. In multivariate analysis, the factors which were found to have a statistically significant association with CHE were the hospital where the patient received the treatment, the household's wealth quintile, the place of residency, and pre-admission duration of stay. Conclusion: Our study revealed a high CHE in households with spina bifida and HCP. We recommend working on primary prevention of spina bifida, expanding surgical services regionally to minimize costs associated with travel for surgical care, and reducing pre-admission duration of stay by improving evaluation and investigations at outpatient clinics. [ABSTRACT FROM AUTHOR]

Purpose: Unresectable pediatric low-grade gliomas (LGG) usually need adjuvant therapy, and carboplatin hypersensitivity reaction (HR) commonly leads to premature treatment cessation of a standard chemotherapy regimen. In the molecular era, advances in understanding tumor genetic characteristics allowed the development of targeted therapies for this group of tumors; however, cost-effectiveness assessment of treatments, especially in low-income countries, is crucial. The aim is to describe the results of carboplatin desensitization protocol in a single center in a middle-income country. Method: Prospective analysis of children with LGG submitted to carboplatin desensitization from December 2017 to June 2020 with follow-up until April 2024. Results: Nine patients were included. The mean age was 11 years. Five patients were male. Seven had optic pathway and two cervicomedullary location. Six had histologic diagnosis and four molecular analyses. The incidence of carboplatin reactions during the study period was 39.1%. Six patients underwent skin prick test, three with positive results. The first HR occurred, on average, around the 9th cycle of treatment. All patients had cutaneous symptoms, and five out of nine had anaphylaxis as the first reaction. 77.7% of the patients completed the protocol, and the clinical benefit rate (stable disease and partial response) was 88.8%. Six patients further required other lines of therapy. Monthly, the total cost for carboplatin was $409.09, and for target therapies (dabrafenib plus trametinib), $4929.28 to $5548.57. Conclusion: Our study presented an interesting and cost-effective option where desensitization allowed children with HR to be treated with first-line therapy, avoiding the discontinuation of an effective treatment. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic presents an unprecedented challenge to community wellbeing and mental health. However, quantifiable information on the extent of mental health problems and associated factors due to the pandemic is still lacking in low-income countries. Thus, this study aimed to investigate the levels of depression, anxiety, and stress and their association with risk and resilience factors among residents of Jimma town in Southwestern Ethiopia. A community-based cross-sectional study was conducted between October 2021 and November 2021. Data were collected from 1196 adult Jimma town residents selected through multi-stage sampling. The following scales were used for the cross-sectional assessment of depressions, anxiety and stress and their associations: depression, anxiety, and stress-21(DASS-21), World Health Organization (WHO) wellbeing, University of California, Los Angeles Loneliness Scale (UCLA), Childhood trauma questionnaire, and brief resilience scales. A pre-tested, interviewer-completed questionnaire was used for data collection. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with depression, anxiety, and stress. Odds ratios consistent with 95% CI were used to report the presence of an association between risk and resilience factors and the outcome variable at a P-value < 0.05. Overall, 963 (80.53%) respondents had divergent DASS-21 score findings. Specifically, 27.68%, 31.52% and 21.32% experienced depression, anxiety, and stress respectively. Higher DASS-21 scores were associated with the presence of one or more COVID-19 risk factors for anyone close to the participants (AOR = 1.53, 95% CI 1.03–2.27), feelings of stress/burden (β = 1.09, 95% CI 1.07–1.12), positive coping (β = 1.044, 95% CI 1.01–1.07), loneliness (β = 1.063, 95% CI 1.04–1.08), and childhood trauma (β = 1.03, 95% CI 1.01–1.04). In contrast, lower DASS-21 scores were associated with beliefs about the necessity of solidarity-based behavior (β = 0.94, 95% CI 0.90–0.98), resilience (β = 0.92, 95% CI 0.87–0.97) and wellbeing (β = 0.90, 95% CI 0.87–0.94). In the course of the COVID-19 pandemic in 2021, symptoms of depression, anxiety, and stress in the study community were prevalent, and associated with numerous risk and resilience factors. Although causality cannot be inferred, these findings underscore the importance of strengthening mental health services and may guide COVID-19 prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

Auditory statistical learning, or the ability to detect statistical regularities in continuously presented stimuli, is thought to be one element that underlies language acquisition. Prior studies have uncovered behavioral and neural correlates of statistical learning, yet additional work is needed from low- and middle-income countries to explore whether statistical learning varies across cultures or underlies associations often found between socioeconomic status (SES) and language outcomes. In the present study, we explored the feasibility of using functional near-infrared spectroscopy (fNIRS) to explore auditory statistical learning in Bangladesh, a lower-middle-income country. Participants were 102 2-year-old (M = 25.72 months, SD = 2.07 months) and 125 5-year-old children (M = 62.35 months, SD = 2.46 months) living in a low-income urban neighborhood of Dhaka (average family income of 28,145.13 Bangladeshi Takas or 260.06 U.S. dollars per month). We also collected measures of SES and language outcomes. Brain responses during the statistical learning paradigm could be detected with fNIRS in both two- and 5-year-olds, with 2-year-olds exhibiting a higher response to predictable sequences and 5-year-olds exhibiting higher responses to unpredictable sequences. fNIRS correlates of statistical learning were not related to language outcomes but were associated with SES in the 5-year-old cohort. This study demonstrates the utility of employing fNIRS to study the neural correlates of statistical learning in low- and middle-income countries and the feasibility of expanding the representativeness of the existing literature. These findings also highlight potential areas for inquiry into how SES may relate to individual differences in statistical learning responses. Public Significance Statement: Two- and 5-year-old-children living in profound poverty in Dhaka, Bangladesh, showed different brain responses to familiar and novel auditory patterns. These brain responses were not associated with language outcomes in either age group but, for 5-year-olds only, were related to socioeconomic status. These results show the utility of brain imaging techniques in uncovering how children's early environments may relate to auditory processing during different periods of development. [ABSTRACT FROM AUTHOR]

Background and aim: Globally, harmful substance use is among the leading causes of premature deaths in the general population, and most of these behaviours are initiated during pre‐adolescence to young adulthood. Preventing the onset or reducing the prevalence of substance use among young people is thus a global health priority. Diverse school‐based interventions have been implemented in low‐and‐middle‐income countries (LMICs); however, evidence regarding their theoretical underpinnings and core components is lacking. The aim of this scoping review was to identify the underlying (social/behavioural) theories, models or frameworks (TMF) and core (practical) components of school‐based interventions in LMICs aimed at preventing the onset or reducing the prevalence of substance use among young people. Methods: Using the Joanna Briggs Institute (JBI) guidance for conducting scoping reviews, we searched scientific literature databases for articles published from 1995 to 2022. A further search was conducted using the reference lists of included articles. We selected randomized and non‐randomized trials of school‐based interventions in LMICs that aimed at preventing the onset or reducing the prevalence of substance use among young people. We used Covidence software to screen titles and abstracts, as well as full texts. We then extracted the data and analysed it using a descriptive content analysis approach. Two reviewers conducted the screening, extraction and data analysis and discussed discrepancies, and clarified doubts and uncertainties through consultation with the other team members. Findings: A total of 58 articles were included in the review. Most articles (63.8%) used either a single or combination of two or more TMFs to inform their interventions. The most widely used TMF was social learning theory followed by theory of planned behaviour. We identified six core components of substance use prevention interventions: education, school environment, school policy, parental involvement, peer engagement and counselling. Conclusion: This scoping review outlines the core components of school‐based substance use prevention interventions used in low‐and‐middle‐income countries and the common theories, models or frameworks that underpin the design of those interventions. [ABSTRACT FROM AUTHOR]

Aims: Very low‐calorie diet (VLCD) can induce weight loss and diabetes remission (DR) amongst people with obesity and recent‐onset type 2 diabetes (T2D). We aimed to determine the effectiveness and acceptability of VLCD in achieving DR amongst Sri Lankan adults with T2D. Methods: A retrospective analysis was conducted in a diabetes practice where VLCD‐based Diabetes Remission Programme (VDRP) was offered for adults (>18 years) with T2D for <3 years and body mass index over 25 kg/m2. VLCD (~800 kcal/day, provided with/without diet replacement formula) was offered for 8–12 weeks, followed by gradual food reintroduction and exercise. DR was defined as HbA1c <6.5% at least 3 months after stopping glucose‐lowering medications. Results: A total of 170 participants who enrolled in the VDRP (mean age 38.4 years [±11.1], men 68%, mean baseline HbA1c 86.9 [±18.1] mmol/mol (10.1 [±2.1]%), median duration of T2D 2 years [IQR 1–2]) and 87 (51%) of them followed the programme (attended at least one follow‐up visit). Amongst the individuals who followed the VDRP, 40.2% achieved DR (35/87), compared with 2.4% (2/83) amongst those who did not follow the VDRP (aHR 9.3, 95% CI 2.2–16.4, p = 0.002). The proportion achieving normoglycaemia (HbA1c < 6.5%) but continued to take glucose‐lowering medication was 20/87 among VDRP followers and 20/85 amongst VDRP non‐followers. The commonest reasons for not following the VDRP were too restrictive dietary quantity (92%) and difficulties in finding recommended food items (67%). Majority (79%) would recommend VDRP to others. Conclusions: VDRP is effective in achieving T2D remission amongst Sri Lankan adults with recently diagnosed T2D and obesity. Over half of the participants followed the programme and over 75% would recommend it to others, indicating good acceptability. [ABSTRACT FROM AUTHOR]

Digital health technology interventions have shown promise in enhancing self-management practices among adolescents living with Human Immunodeficiency Virus (ALHIV). The objective of this scoping review was to identify the preferences of ALHIV in low- and middle-income countries (LMICs) concerning the use of digital health technology for the self-management of their chronic illness. Electronic databases, including PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) (Plus with Full Text), Central (Cochrane Library), Epistemonikos, and Medline (EbscoHost), were searched. The review focused on English articles published before June 2023, that described a technology intervention for ALHIV specifically from LMIC. The screening and data extraction tool Covidence facilitated the scoping review process. Of the 413 studies identified, 10 were included in the review. Digital health technology interventions can offer enhanced support, education, and empowerment for ALHIV in LMICs. However, barriers like limited access, stigma, and privacy concerns must be addressed. Tailoring interventions to local contexts and integrating technology into healthcare systems can optimize their effectiveness. Review registration: OSF REGISTRIES () [ABSTRACT FROM AUTHOR]

Aim: Many countries risk failing the Sustainable Development Goal to reduce neonatal mortality to 12 in 1000 live births before 2030, necessitating intervention. This scoping review assesses available evidence from studies implementing smartphone application‐based education and clinical decision support in neonatal emergency care in low‐ and middle‐income countries and describes applied assessment tools to highlight gaps in the current literature. Methods: A systematic search on 28 March 2024 of PubMed, Web of Science, and EMBASE identified original research papers published in peer‐reviewed journals after 2014 in English. The evaluation was based on Kirkpatrick's framework. Results: In total, 20 studies assessing eight different smartphone applications were included. Participants found applications acceptable and feasible in 11 of 14 studies. Knowledge and/or skills were improved in 11 of 12 studies. Behaviour was assessed in 10 studies by tracking app usage. Patient outcome was assessed in four studies, focusing on perinatal mortality, Basic Newborn Care outcomes and correct assessment of newborns. Conclusion: Data from included studies further strengthens hope that smartphone applications can improve neonatal mortality rates in low‐ and middle‐income countries. However, further research into the effectiveness of these applications is warranted. This review highlights gaps in the current literature and provides guidance for future trials. [ABSTRACT FROM AUTHOR]

Aim s : Research capacity strengthening (RCS) is crucial in enhancing healthcare outcomes, particularly in low‐ and middle‐income countries (LMICs), which face challenges due to limited resources, unequal access to care and the need for evidence‐based decision‐making. We seek to move beyond a surface‐level understanding of RCS, unearthing the core attributes, the factors that precede its implementation and the transformative outcomes it generates within the LMIC healthcare landscape. Design: This study employs the Walker and Avant approach to concept analysis to comprehensively explore the dimensions and attributes of RCS as it pertains to allied and public health professionals in LMICs, propose empirical referents and suggest an operational definition. Data Sources: Ovid MEDLINE, Embase, CINAHL and Cochrane CENTRAL were searched from inception to 27 July 2023, to identify studies on RCS in LMICs. The Walker and Avant approach to concept analysis was selected because it provides a framework for systematically examining and clarifying the meaning and implications of RCS. This method involves a structured process of defining RCS, identifying its attributes, antecedents, consequences and cases, and ultimately providing a clear understanding of its meaning and implications. Identifying empirical referents offers measurable indicators that researchers and policymakers can use to assess the effectiveness of RCS initiatives in LMICs. Conclusion: RCS for health professionals in LMICs involves a sustainable process that equips them with essential research skills, fostering the ability to conduct high‐quality research and improve healthcare delivery in resource‐constrained settings. Implications: RCS aims to empower health professionals to apply evidence‐based practices, reduce disparities and enhance the well‐being of populations in LMICs. Impact: Ultimately, a concept analysis of RCS empowers us to harness the full potential of research to enhance healthcare delivery, improve patient outcomes and advance the well‐being of populations worldwide. [ABSTRACT FROM AUTHOR]

Aims: To evaluate factors associated with fall protection motivation to engage in fall preventive behaviour among rural community‐dwelling older adults aged 55 and above using the protection motivation theory scale. Design: A cross‐sectional study. Methods: The study was conducted in a healthcare clinic in Malaysia, using multistage random sampling from November 2021 to January 2022. Three hundred seventy‐five older adults aged 55 and older were included in the final analysis. There were 31 items in the final PMT scale. The analysis was performed within the whole population and grouped into 'faller' and 'non‐faller', employing IBM SPSS version 26.0 for descriptive, independent t‐test, chi‐square, bivariate correlation and linear regressions. Results: A total of 375 older participants were included in the study. Fallers (n = 82) and non‐fallers (n = 293) show statistically significant differences in the characteristics of ethnicity, assistive device users, self‐rating of intention and participation in previous fall prevention programmes. The multiple linear regression model revealed fear, coping appraisal and an interaction effect of fear with coping appraisal predicting fall protection motivation among older adults in rural communities. Conclusion: Findings from this study demonstrated that coping appraisal and fear predict the protection motivation of older adults in rural communities. Older adults without a history of falls and attaining higher education had better responses in coping appraisal, contributing to a reduction in perceived rewards and improving protection motivation. Conversely, older adults from lower education backgrounds tend to have higher non‐preventive behaviours, leading to a decline in fall protection motivation. Implications for the profession and/or patient care: These results contribute important information to nurses working with older adults with inadequate health literacy in rural communities, especially when planning and designing fall prevention interventions. The findings would benefit all nurses, healthcare providers, researchers and academicians who provide care for older adults. Patient or Public Contribution: Participants were briefed about the study, and their consent was obtained. They were only required to answer the questionnaire through interviews. Older individuals aged fifty‐five and above in rural communities at the healthcare clinic who could read, write or understand Malay or English were included. Those who were suffering from mental health problems and refused to participate in the study were excluded from the study. Their personal information remained classified and not recorded in the database during the data entry or analysis. [ABSTRACT FROM AUTHOR]

All UN member States committed to realizing universal health coverage (UHC) when they included UHC as Target 3.8 in the Sustainable Development Goals in 2015. However, the global commitment to UHC has not been matched with action on the ground. According to the World Health Organization, about half of the world population lacks full coverage for essential health services. To accelerate progress toward UHC, a close understanding of factors that drive adoption of UHC policies at the national and local levels is essential. The purpose of this study was to investigate the impetus for establishing a sub-national health insurance program in Kenya—the Makueni county government health insurance program (MakueniCare)—which led to increasing the percentage of the county population with health insurance, the majority of whom live in poverty, from 8.8% in 2013 to 91% in 2018. This qualitative case study drew on Kenyan law and policy documents as well as semi-structured interviews with 30 key informants in government and NGOs to understand the drivers that led to the establishment of MakueniCare. Findings revealed that several drivers—namely, global norms, decentralization, democratic competition, and the strategic action of social change-minded leaders—coalesced to influence the adoption of MakueniCare. The study offers timely insights into the factors driving UHC in Makueni, Kenya and lessons for other low- and middle-income countries working toward UHC. [ABSTRACT FROM AUTHOR]

Background: Childhood trauma adversely impacts adolescents, and consequently, they develop behavioural problems. Understanding the distribution of childhood traumas and their association with behavioural problems among adolescents is paramount for the preventive efforts. Aim/Objective: The present research aimed to investigate this association among adolescents. Methods: This association was investigated among adolescents (N = 200) between 12 and 18 years. Childhood Trauma Questionnaire and Strength and Difficulty Questionnaire was used to assess the distribution of trauma and internalizing and externalizing behavioural problems among adolescents through purposive and convenience sampling technique. Results: The findings across trauma distribution indicated higher distribution of childhood abuse and neglect across males as compared to females. Males further significantly scored higher on sexual abuse and emotional neglect. Apparently, a large number of adolescents experienced all five sub types of childhood traumas (sexual abuse, emotional abuse, physical abuse, emotional and physical neglect). Additionally, across the severity continuum of childhood traumas, male scored higher on the severe to extreme continuum for all subtypes except physical abuse, where females scored higher. Lastly, logistic regression analysis indicated higher peer problems among those adolescents who have experienced all types of childhood traumas. Conclusion: These findings could be beneficial for intervention-based programs and policies to help trauma-exposed adolescents cope with their lives. [ABSTRACT FROM AUTHOR]

Objective This study aimed to assess the viability of implementing a tele-educational training program in neurocritical care for newborns diagnosed with hypoxic–ischemic encephalopathy (HIE) and treated with therapeutic hypothermia (TH), with the goal of reducing practice variation. Study Design Prospective study including newborns with HIE treated with TH from 12 neonatal intensive care units in Brazil conducted from February 2021 to February 2022. An educational intervention consisting of 12 biweekly, 1-hour, live videoconferences was implemented during a 6-month period in all centers. Half of the centers had the assistance of a remote neuromonitoring team. The primary outcome was the rate of deviations from TH protocol, and it was evaluated during a 3-month period before and after the intervention. Logistic regression via generalized estimating equations was performed to compare the primary and secondary outcomes. Protocol deviations were defined as practices not in compliance with the TH protocol provided. A subanalysis evaluated the differences in protocol deviations and clinical variables between centers with and without neuromonitoring. Results Sixty-six (39.5%) newborns with HIE were treated with TH during the preintervention period, 69 (41.3%) during the intervention period and 32 (19.1%) after intervention. There was not a significant reduction in protocol deviations between the pre- and postintervention periods (37.8 vs. 25%, p = 0.23); however, a decrease in the rates of missing Sarnat examinations within 6 hours after birth was seen between the preintervention (n = 5, 7.6%) and postintervention (n = 2, 6.3%) periods (adjusted odds ratio [aOR]: 0.36 [0.25–0.52], p < 0.001). Centers with remote neuromonitoring support had significantly lower rates of seizures (27.6 vs. 57.5%; aOR: 0.26 [0.12–0.55], p < 0.001) and significant less seizure medication (27.6 vs. 68.7%; aOR: 0.17 [0.07–0.4], p < 0.001). Conclusion This study shows that implementing a tele-educational program in neonatal neurocritical care is feasible and may decrease variability in the delivery of care to patients with HIE treated with TH. Key Points Neurocritical care strategies vary widely in low- and middle-income countries. Heterogeneity of care may lead to suboptimal efficacy of neuroprotective strategies. Tele-education and international collaboration can decrease the variability of neurocritical care provided to infants with HIE. [ABSTRACT FROM AUTHOR]

Background: The prevalence of type 2 diabetes is rising quickly in low- and middle-income nations like India. In order to develop preventive strategies and comprehend the effects of diabetes as a contributing factor to other non-communicable diseases (NCDs), it is essential to have robust population-level epidemiological data. It is challenging to generalize findings from regional studies given the diversity of India's population, cultural practices, and dietary patterns. Objective: The primary goal of the national Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study was to produce high-quality data on the prevalence of diabetes and other NCDs, such as dyslipidemia, hypertension, and obesity at the country and state levels. Methods: This is a door-door cross-sectional, multi-stage stratified sampled survey from 2008 to 2020; 31 Indian states and union territories were surveyed for the ICMR-INDIAB study. Findings: National projections for NCDs from this study include 101.3 million with diabetes, 136.0 million with prediabetes, 315.5 million with hypertension, 254.2 million with generalized obesity, 213.3 million with hypercholesterolemia, and 185.7 million with high HDL cholesterol. Knowledge and awareness of diabetes are still largely inadequate. Less than 8% of individuals met the treatment goals for glycemia, blood pressure, and lipid goals. Physical inactivity levels are high in India. Reducing carbohydrate intake and increasing protein intake could help in the prevention of progression of dysglycemia as well as reversal of diabetes. Conclusion: In India, the prevalence of diabetes, prediabetes, and other metabolic risk factors such as obesity, dysglycemia, blood pressure, and physical inactivity is rising. [ABSTRACT FROM AUTHOR]

The article examines the management of focal segmental glomerulosclerosis (FSGS) in resource-limited regions, highlighting the challenges of achieving remission and optimal treatment outcomes. Topics discussed include the variability in steroid responsiveness among different populations, the barriers to accessing genetic testing and appropriate therapies in low- and middle-income countries, and the potential for future therapeutic advancements to improve kidney survival rates.

Background: Limited data exists regarding the clinical course and outcomes of children with primary focal segmental glomerulosclerosis (FSGS) from low- and middle- income countries. Methods: Children aged 1–18 years with biopsy-proven primary FSGS followed from January 2010–June 2023 in a tertiary-care center were enrolled and their clinical profile, histological characteristics, kidney outcomes, and predictors of adverse outcomes were determined. Results: Over 13 years, 73 (54.8% boys) children with median (IQR) age at FSGS diagnosis 6.7 (3,10) years were recruited and followed up for median 4 (2.5,8) years. FSGS-not otherwise specified (NOS) was the most common histological subtype, in 64 (87.6%) children, followed by collapsing variant in 5 (6.8%) children. At last follow-up, 43 (58.9%), 2 (2.7%) and 28 (38.3%) children were in complete remission (CR), partial remission (PR), and no remission (NR) respectively. Calcineurin inhibitors led to CR or PR in 39 (62%) children. Overall, 21 (28.7%) children progressed to chronic kidney disease (CKD) stage 2–5 (19 from NR vs. 2 from PR group; p = 0.03); with 41% of those NR at 12 months progressing to CKD 4–5 by last follow-up. On multivariable analysis, collapsing variant [adjusted HR 2.5 (95%CI 1.5, 4.17), p = 0.001] and segmental sclerosis > 25% [aHR 9.9 (95%CI 2.2, 45.2), p = 0.003] predicted kidney disease progression. Conclusions: In children with FSGS, response to immunosuppression predicts kidney survival as evidenced by nil to lower progression to CKD 2–5 by median follow-up of 4 (2.5,8) years in children with CR and PR, compared to those with no remission at 12 months from diagnosis. Segmental sclerosis > 25% and collapsing variant predicted progression to advanced CKD. [ABSTRACT FROM AUTHOR]

Background: Medication reconciliation is one of the best measures to prevent medication-related errors at the time of admission and discharge of patients. We conducted a quasi-experimental study to evaluate the impact of a Medication reconciliation improvement package (intervention) on adherence to medication reconciliation at the time of admission in Department of Internal Medicine. The study included all adult patients admitted to internal medicine from August 2019 to December 2020. Pre-intervention data on adherence to medication reconciliation was less than 50%. The study involved creation of a quality improvement team to conduct a root-cause analysis which identified the need to target physician related issues and hence drafted a medication reconciliation improvement package which included meetings with physicians on the internal medicine floor, dedicated WhatsApp groups for repeated reminders, and appreciation messages for timely adherence. We used the Chi Square test to check the association between adherence to medication reconciliation and physicians and acuity level. Findings: We included 7914 records of patients, in which 4471 participants (56.4%) were from pre-intervention phase and 3443 (43.5%) were from intervention groups. The overall adherence to medication reconciliation was 54.3% (4297/7914). Adherence of medication reconciliation increased from 44.4% (1983/4471) in the pre-intervention phase to 67.2% (2314/3443) in the intervention phase (P <.001). Improvement was observed in adherence of medication reconciliation done by residents and in low acuity areas (P <.005). Conclusion: The Medical reconciliation improvement package is a simple low-cost intervention that resulted in improvement in adherence to medication reconciliation but needs further studies to assess its sustainability. However, it awaits to be seen if the same improvement can also be replicated to qualitative medication errors and clinical outcomes respectively. [ABSTRACT FROM AUTHOR]

This scoping review aimed to examine how self-healing practices had been addressed in the empirical literature on suicide bereavement. Adhering to PRISMA-ScR guidelines, we searched five databases for peer-reviewed studies that reported using self-healing practices, either as a primary or secondary finding and 32 studies were included. The results highlight a substantial research gap in understanding self-healing practices' definition, implementation, and effectiveness in suicide bereavement. Further studies are necessary to clarify the definition, identify facilitators and barriers to implementation, and explore the applicability of these strategies in diverse contexts, particularly in non-Western and Low-and Middle-income countries. [ABSTRACT FROM AUTHOR]

Pneumonia is one of the causes of acute respiratory distress syndrome (ARDS) in pediatrics, which can progress to severe conditions such as pulmonary hypertension, leading to right ventricular failure or cor pulmonale. Pediatric patients requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support are challenging in our country, from the time of initiation to another critical dilemma between managing massive bleeding and preventing clotting in the ECMO circuit. An 18-month-old boy presented in a ward with a 5-day history of fever, cough, and increased work of breathing over the prior 24 hours. He was diagnosed with bronchopneumonia and treated with antibiotic therapy. The patient had a rapid deterioration, requiring endotracheal intubation. Blood gas analysis showed oxygenation and ventilation failure with . pulmonary hypertension resulting in cor pulmonale. The patient then underwent cannulation to central VA-ECMO via sternotomy. During the 11-day intensive care unit (ICU) stay, massive bleeding occurred from the cannulation site, with the team attempting to balance between hemorrhage and preventing clot formation in the circuit. The patient died from the failure of the oxygenator, as lung rest could not be achieved due to systemic complications from massive bleeding. For pediatric patients with acute cor pulmonale, it is necessary to be more aggressive in the timing of ECMO initiation, as indicated in the guidelines, and to evaluate the indications for VA-ECMO carefully. This evaluation should consider the benefits and drawbacks from all aspects, including the complications of bleeding that can lead to multiple organ failures in the patient. [ABSTRACT FROM AUTHOR]

Epilepsy is a significant public health problem. More than 50 million people worldwide live with epilepsy, and over three‐quarters of them are in low‐ and middle‐income countries. The situation in Chad regarding people with epilepsy is challenging to assess, starting from the shortage of scientific data, the inadequacy of technical facilities, the lack of human resources, and the inadequacy of government action. The Ministry of Health and Chadian Society of Neurology are looking forward to prioritizing epilepsy as well as improving the living conditions of persons with this disease. The epilepsy treatment issue is also problematic. Most of the patients are either off treatment or under‐medicated. Few antiseizure medications (ASMs) are available, notably carbamazepine, phenobarbital, and valproic acid. Epilepsy remains little‐known and does not seem to be a priority for decision‐makers. We describe the current situation in Chad, to improve the conditions under which epilepsy is treated. Plain Language Summary: Epilepsies is a chronic brain problem that is common in poorer settings. The daily lives of people with epilepsy are chaotic in Chad. The challenges are numerous, particularly those related to health infrastructures, due to the lack of adequate diagnostic means and the lack of neurologists. The cultural and language challenges, especially since epilepsy is still considered the devil's disease and the name differs according to the dialects. Stigmatization is also frequent and is often responsible for school dropout, refusal, or dismissal from work. Care and prevention are daily challenges that require government action. Social coverage is insufficient and almost absent in rural areas. It is urgent to prioritize epilepsy in future action plans and also to increase awareness of the conditions to overcome these challenges. [ABSTRACT FROM AUTHOR]

Aim: The present systematic review with meta‐analysis aimed to investigate the global association between smokeless tobacco (SLT) use and periodontitis, considering significant effect size variation based on the income levels of countries. Methods: We searched seven databases to identify studies that assessed the prevalence of periodontitis in adult SLT users compared to non‐users. The quality of studies was evaluated using the 10‐item risk‐of‐bias tool, and publication bias was addressed through the trim‐and‐fill method. Sensitivity analysis utilized the leave‐one‐out approach. Meta‐analysis and meta‐regression, stratified by country income, SLT type, and smoking status, employed robust variance estimation. Results: From an initial pool of 484 studies, 29 studies met the selection criteria and were subjected to qualitative synthesis. Subsequently, data from 19 studies were included in the meta‐analysis. SLT users exhibited a nearly threefold greater likelihood of periodontitis compared to non‐users (OR = 2.99; 95% CI: 2.10, 4.27; p <.01). The pooled estimate did not vary significantly based on the type of SLT used or concurrent smoking. However, the odds of periodontitis varied according to the economic level of the country; the pooled estimate was higher in high‐income countries (OR = 1.69; 95% CI: 1.20, 2.37; p <.01) and even higher in lower‐middle‐income and lower‐income countries (OR = 3.91; 95% CI: 2.66, 5.77; p <.01). Conclusions: Smokeless tobacco users have a higher likelihood of developing periodontitis. This study underscores global disparities in the SLT–periodontitis relationship, highlighting the need for targeted interventions, particularly in economically challenged areas where SLT use is largely unregulated. [ABSTRACT FROM AUTHOR]

This paper provides a fuzzy logic approach with multi-stakeholder decision support to evaluate and rank different strategies as well as policies that may have a direct impact on the implementation of low emission zones in low income and developing countries. The multi decision-making analysis, which was performed using the Delphi method and fuzzy logic and applied on the city of Amman, suggested that promoting and investing in last-mile delivery solutions, such as electric vehicles and cargo bikes has the highest impact on implementing low emission zones in Amman and this strategy could increase the sustainability. According to local decision makers, encouraging and investing in last-mile delivery alternatives, such as EVs and cargo bikes, has the most impact on adopting LEZ in Amman's inner city. [ABSTRACT FROM AUTHOR]

This study explores the impact of intellectual capital on innovation using a cross-sectional sample of 132 countries: 50 high-income and 82 low-income countries, during the period 2015–2020. Our research provides empirical evidence of the significant impact of intellectual capital on innovation. Analysis of the entire sample revealed that higher levels of knowledge enable the creation of new products and services to meet clients' diversified requirements. However, different results were obtained when we analyzed the two subgroups of high- and low-income countries. We found that the impact in which the level of intellectual capital spurs the increase of innovation is 2.8 times higher in low-income countries than in high-income ones. However, the development process in low-income countries is based on technology transfer rather than on technological development. Additionally, our results for the high-income countries suggest a shallow impact of intellectual capital on innovation. The robustness checks performed consolidate our results. This study could have significant implications for policy-makers, who must acknowledge the vital role of intellectual capital in innovation. [ABSTRACT FROM AUTHOR]

The trillion-dollar construction sector has exacerbated the significant challenge of global water scarcity. However, a notable gap exists in the availability of a comprehensive water footprint (i.e., water use through supply chain) map specific to the global construction sector and its impact on local water scarcity. Our study developed a water scarcity assessment model and linked it with the global environmental-extended multi-regional input-output model covering 120 sectors and 154 countries. With this, our study assessed the water footprints by final demands of the construction sector and their impact on local water shortages. Our findings indicate that the global construction sector's water footprint is approximately 61 billion tons, constituting 5.3% of global water withdrawal in 2020. Both building construction and civil engineering construction sectors exhibit similar water footprints. Notably, water-scarce countries experience a disproportionate impact, with higher-income nations more significantly affected by their construction water footprint compared to low-income countries. The novelty of the study lies in the detailed economy-by-economy WF estimation of global build and civil construction sector and linked it with local water scarcity. Our results underscore the urgency of implementing measures by water scarcity countries and key sectors to mitigate and reduce the water footprint of the construction sector, thereby contributing to global water sustainability. [ABSTRACT FROM AUTHOR]

The energy sector in many developing nations faces the difficulty of insufficient financing throughout the low-carbon transition, highlighting the importance of international green financing in alleviating financial constraints. The advancement of digital technology could facilitate green financing for energy transition in the digital economy, but this statement lacks empirical evidence. The primary objective of this research is to investigate the impact of international green financing on low-carbon energy transformation in developing nations. Additionally, we investigate the moderating role of digital economy between the two. Our findings validate the favorable impact of international green financing on low-carbon energy transformation, and this impact is particularly evident for hydro and wind energy consumption. We show that this beneficial effect is greater for low-income countries or regions with high levels of energy transition. We also provide evidence of the positive moderation effects of digital economy and find that its effects are still present in the transition to hydro and wind energy. This research helps to broaden green financing channels for the energy sector in developing countries, especially from the perspective of digital economy. [ABSTRACT FROM AUTHOR]

Objectives: To determine a pooled prevalence of depression and its influencing factors among nursing home residents. Method: PsycINFO, PubMed, Embase, and Web of Science were searched for studies investigating the prevalence and risk factors of late-life depression among nursing home residents between January 2012 and November 2022. Two reviewers independently completed the literature screening, data extraction and quality assessment. A random-effects model was utilized to pool the prevalence of depression and summarize the influencing factors. Results: This meta-analysis included 48 studies involving 28,501 participants. The pooled prevalence of depressive mood and major depressive disorder was 53% and 27%, respectively. The rate of depressive mood is higher in lower-middle-income countries (60.0%), compared with high- (53.0%) and upper-middle-income countries (44.0%). The rate of depressive mood (35.0%) is higher among females than male (19.0%). Depression was influenced by factors, including male (OR = 0.28), insufficient income (OR = 3.53), comorbidities (OR = 2.66), pain (OR = 2.67; r = 0.31), functional disability (r = 0.33), loneliness (r = 0.43), number of chronic health problems (r = 0.18), social support (r = −0.28), activities of daily living (r = −0.43), subjective health (r = −0.28), autonomy (r = −0.41), environment (r = −0.50) and physical (r = −0.57) and psychological health (r = −0.65). Conclusion: The prevalence of depressive mood is high among nursing home residents, especially in lower-middle-income countries. It is influenced by factors including gender, income, social support, daily activities, environment, physical and psychological health and autonomy. Understanding those factors can provide evidence-based recommendations for improved awareness, prevention and better management of late-life depression. [ABSTRACT FROM AUTHOR]

More efficient use of renewable energy to reduce carbon emission requires a more comprehensive understanding of the impact of renewable energy on carbon emissions. To this end, this work investigates the linear and nonlinear relationship between renewable energy consumption and carbon emissions in 130 countries from the new perspective of resource capital factors (total natural resources rents) and human capital (human capital index). The results are given that from a global perspective, the increase in the proportion of renewable energy consumption can accelerate the reduction of per capita carbon emissions before reaching a particular threshold value of total natural resources rents. When a specific natural threshold value is reached, the increase in the proportion of renewable energy consumption will reduce the rate of per capita carbon emissions. Another interesting finding is that the greater the human factor, the lower the reduction rate of per capita carbon dioxide emissions. To explain the above phenomenon, all countries are divided into four different income levels for further heterogeneity research. When the threshold variables are different, the impact on carbon emissions in various income countries is heterogeneous, which is further analyzed in the article. Furthermore, a meaningful discovery shows that whether the threshold variable is natural or human factor, low-income countries benefit the most from the carbon reduction effect brought by the increase in the proportion of renewable energy consumption, followed by lower-middle income and upper-middle income countries, and the lowest is higher-income countries. [ABSTRACT FROM AUTHOR]

Psychological preparedness for entrepreneurial actions helps to connect macro-institutional support for entrepreneurs to actions of entrepreneurs. Action knowledge and personal initiative are part of entrepreneurial preparedness, and there are two training concepts that have been developed to increase the number of entrepreneurs among BA and high school students in low- and middle-income countries and to improve the skills and mindset of entrepreneurs. I discuss large-scale randomized controlled interventions in both of these areas with the STEP and personal initiative training. Showing that psychological preparedness for entrepreneurial actions can be enhanced, the question is whether methods shown to work in low-income countries can inform entrepreneurship research in general. Issues that seem to speak against generalizing are often seen in necessity, survivalist, and informal entrepreneurship. These issues are discussed and are deemed of lower importance for generalization of findings. There are also methodological advantages when doing research in low- and middle income countries. Practical and policy implications are also provided. Plain English Summary: Entrepreneurship is about taking action and seizing opportunities. People often think of African entrepreneurs as just trying to survive, but there is more to it. In fact, Africa has likely many more entrepreneurs than the West, and these young business people are keen to learn and grow. We have created training programs for university and high school students to boost the number of entrepreneurs and improve their skills. We have tested these programs with over 6000 students across 11 developing countries, and they have been successful: Training participants started 30% more businesses than the control group. We have also developed a training called personal initiative to help entrepreneurs increase their profits by up to 30%. This has been tested with thousands of participants in ten countries. What makes these training programs special is that they are scientifically tested and proven to be highly effective (the tests were similar to examining the effectiveness of a new medicine). They focus on immediate skill and mindset learning. Psychological training helps entrepreneurs be ready to make the most of government and macro-economic support for businesses. So, there is a lot we can learn from entrepreneurship in Africa. [ABSTRACT FROM AUTHOR]

Background: Poor child health and hygiene practices are persistent issues in resource-constrained settings, particularly in low-income countries. This study assessed the impact of skill-based health education (SBHE) on school and child hygiene practices in rural Bangladesh. Methods: A cluster-randomised-controlled intervention with cross-cutting/factorial design was conducted in 180 randomly selected primary schools, stratified by school type, in Jhenaidah District, Bangladesh. Weekly SBHE sessions were delivered to half of the schools by locally recruited para-teachers for one year. A cross-cutting soap provision treatment was given monthly to half of the SBHE-treatment schools and half of the SBHE-control schools. Treatment assignment was masked to all baseline and endline surveyors. Data were collected at both the school and child levels, with child-level data aggregated at the school level. Outcome measures were grouped into five thematic families. The primary outcome families were school hygiene practice & maintenance, school-aggregated child handwashing and school-aggregated child dentalcare. Utilising the difference-in-differences estimator with seemingly unrelated regression, we estimated the average treatment effect for each family of multiple outcomes. The intervention spillover effect to neighbouring schools along with the time-period effect were also evaluated. The project's cost-effectiveness was additionally assessed. Results: Our findings revealed that SBHE had a positive impact on primary outcomes related to healthy practices and behavioural changes, resulting in a 0.32SD improvement in school hygiene practices and maintenance (p < 0.001), a 0.47SD increase in child handwashing (p < 0.001), and a 0.43SD enhancement in child dentalcare (p < 0.01). Despite its imperfect implementation, the provision of soap itself showed no significant effect. Furthermore, significant spillover effects of healthy practices were observed in neighbouring non-treatment schools. The cost-effectiveness analysis indicated that our SBHE program was cost-effective. Conclusions: Our study provides compelling evidence of the positive impact of SBHE on school hygiene and child health practices in rural Bangladesh, with notable spillover effects. The cost-effectiveness analysis underscores the value of SBHE, affirming its potential as an effective intervention method in improving school health and hygiene practices in primary schools and beyond. [ABSTRACT FROM AUTHOR]

Background: The use of Clean Delivery Kits (CDKs) promotes healthy birth outcome. Nevertheless, representative data are lacking for low- and middle-income countries. Thus, study aimed at determining the overall estimate of clean delivery kit use among low and middle income countries. Methods: A comprehensive review of the Science Direct, Scopus, Google Scholar, EMBASE, and PubMed databases was part of the current investigation. Microsoft Excel (version 14) was used to extract the data, and STATA statistical software was used for analysis. The presence of publication bias was assessed using DOI Plots in the study. By calculating I2 and doing an overall estimation analysis, heterogeneity was evaluated. Furthermore, a subgroup analysis was carried out according to the sample size, publication year, and study design. Results: Out of 654 articles, 12 met the inclusion criteria and were included in the analysis, covering 19,889 study participants. In low- and middle-income countries, the pooled proportion of clean delivery kits use was 54% (95%CI: 31. 60, 76.82, I2 = 70%). Notably, the cross-sectional study revealed the lowest incidence of delivery kit use, with a proportion of 54.29%, while the cohort study revealed the highest proportion, at 72.37%. In studies with sample sizes < 500, clean delivery kit use was higher (60.28%) compared to studies with sample sizes > 500 (45.75%). Lastly, the proportion of clean delivery kits was found to be 62.53% for studies published after 2010, compared to 48.25% for studies published before 2010. Conclusion: In summary, the proportion of clean delivery kits use was 54%. Healthcare systems should focus on different strategies to improve clean delivery kit use. [ABSTRACT FROM AUTHOR]

Introduction: Increasing knowledge of obstetric danger signs (ODS) and encouraging birth preparedness and complication readiness (BPCR) practices are strategies to increase skilled maternal health service utilization in low-income countries. One of the methods to increase mothers' knowledge about ODS and promote BPCR practice is through health education intervention (HEI). However, the effect of context-specific community-based health education led by women's groups on these outcomes has yet to be comprehensively studied, and the existing evidence is inconclusive. Thus, we aimed to evaluate the effect of a context-specific community-based HEI led by women's groups on mothers' knowledge regarding ODS and BPCR practices in southern Ethiopia. Methods: An open-label, two-arm parallel group cluster-randomized controlled trial was conducted from January to August 2023 on pregnant women from 24 clusters (kebeles) (12 interventions and 12 controls) in the northern zone of the Sidama region. The Open Data Kit smartphone application was utilized to collect data. The intention-to-treat analysis was used to compare outcomes between groups. We fitted multilevel mixed-effects modified Poisson regression with robust standard error to account for between and within cluster effects. Results: One thousand and seventy pregnant women (540 in the intervention and 530 in the control clusters) responded to this study, making the overall response rate 95.02%. Excessive vaginal bleeding (94.3% in the interventional group vs. 88.7% in the control group) was the commonest ODS mentioned during childbirth. Overall, 68.7% of women in the intervention group and 36.2% of mothers in the control group had good knowledge of ODS (P-value < 0.001). Saving money and materials (97.1% in the interventional group vs. 92.7% in the control group) was the most frequently practiced BPCR plan. Overall, 64.3% of women in the intervention group and 38.9% of mothers in the control group practiced BPCR (P-value < 0.001). HEI significantly increased overall knowledge of ODS (adjusted risk ratio [ARR]: 1.71; 99% CI: 1.14–2.57) and improved overall BPCR practice (ARR: 1.55; 99% CI: 1.02–2.39). Conclusions: A community-based HEI led by women's groups improved mothers' knowledge regarding ODS and BPCR practices in a rural setting in southern Ethiopia. Interventions designed to increase women's knowledge of ODS and improve BPCR practice must implement context-specific, community-based HEI that aligns with World Health Organization recommendations. Trial registration: NCT05865873. [ABSTRACT FROM AUTHOR]

Background: Oral diseases remain a significant public health problem worldwide despite being largely preventable. Oral disorders such as dental caries, periodontal diseases, and oral cancers are highly prevalent chronic conditions that negatively impact quality of life. The oral health practice in Somalia has been evolving over the years, we therefore explored the challenges of oral health practice in a security-constrained poorly regulated environment to guide policy development. Methods: We conducted a descriptive cross-sectional study among 15 oral health practitioners in Somalia. Using in-depth interviews, we gathered data on challenges working in private dental clinics and governmental institutions. Additionally, we gathered data on gender, age, marital status, profession, country of graduation, current location of practice, and years of clinical experience. Because the participants worked in different cities, we conducted interviews over the phone and recorded them. The data were analyzed via thematic analysis. Results: In this study, 9 of the participants were men and the median age was 29 years. Most of the participants (10) were dentists and remaining were dental specialists. The findings on challenges fall under four broad thematic areas: (1) Patient-related challenges; low patient literacy, preference for dental quacks, delay in seeking oral care, and dental phobia. (2) Institutional-related challenges: limited access to basic oral health services, oral health not an integral part of primary health care, and unregulated private dental clinics resulting in unqualified quacks practising as private caregivers. (3) Societal-related challenges, the absence of community-oriented preventive oral health services and low prioritization of oral health. (4) Personal-related challenges: female dentists in this study faced challenges related to the preference of male dentists and the shortage of oral health specialists in the country. Conclusion: This study reveals the need for the establishment and strengthening of regulation of oral services and its inclusion into the basic primary service package provided to the populace. It also calls for community enlightenment and more investment in dental health care in Somalia. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

As a low-income country, Pakistan is particularly vulnerable to various natural and human-induced disasters, which have significant consequences for both the environment and human life. A substantial share of the provincial budget is allocated to disaster response and recovery efforts. Prioritizing investment in disaster risk reduction (DRR) is essential to protect lives and assets. Although there is a complex relationship between investments made before and after disasters and their effectiveness in DRR, this dynamic remains insufficiently understood in Pakistan's Khyber Pakhtunkhwa (KP) province. The current study was designed to analyze the developmental budgeting for DRR in the financial years 2000–2022 in KP province. The Sen's Slope Estimator and modified Mann-Kendall tests were used to determine the significance trend, while the correlation coefficient test was used to find the correlation between investment in DRR and disaster-induced damages such as deaths, injuries and houses damaged. The study findings reveal that the occurrence of disasters influences post-disaster spending in the KP province, with a significant negative correlation between expenditure and disaster-related damages, implying that increased DRR investment has significantly reduced the consequences of disasters. To minimize vulnerability to future disasters, the province should integrate risk-sensitive planning across all sectoral departments at local, district, and provincial levels, guided by a risk-informed development approach. This proactive strategy would embed disaster resilience within developmental activities, ensuring that each sector aligns with principles of risk reduction and sustainable growth. [ABSTRACT FROM AUTHOR]