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Malaysia has been experiencing rapid socioeconomic transition over many years and achieved remarkable socioeconomic development and economic growth in the last few decades. Basically, such growth and development brought significant improvements in the level of income of low- and middle-income households. However, the cost of living in Malaysia has increasingly become a serious economic issue due to the increase in inflation. This paper addresses the question of how the cost of living can affect household income and expenditure. The finding of this research is threefold. Firstly, the income gap between households is increasing every year. This implies that the program to increase the income of the lower-income group should be given priority so that national development can be felt by all levels of society to achieve the goal of inclusive national development. Secondly, the monthly income average of households shows a steady increase. However, B40 earnings growth needs to be improving greater as an effort to reduce the income gap between the highest with low- and medium-income groups. Thirdly, income growth for each household group is still greater than inflation. This shows that on average households can still cope with the burden of rising costs and thus deal with the cost of living depending on how they model their spending patterns. This study highlights that to address the cost of living problem, the policy or program planned by the government should touch three important elements of income, price, and spending patterns. Also, this study highlights that to address the cost of living problem, a holistic approach is essential. This study also proposes that each of the economic agents, the government, the private sector, and the households have their roles in economics to develop better economic welfare among society. [ABSTRACT FROM AUTHOR]

To describe patients, perioperative care, and outcomes undergoing supratentorial and infratentorial craniotomy for brain tumor resection in a tertiary-care hospital in Ethiopia. A retrospective cohort study of patients consecutively admitted between January 1, 2021, and December 31, 2021, was performed. We characterized patients, perioperative care, and outcomes. The final sample comprised 153 patients; 144 (94%) were 18 years and over, females (n = 48, 55%) with primarily American Society of Anesthesiologists physical class II (n = 97, 63.4%) who underwent supratentorial (n = 114, 75%), or infratentorial (n = 39, 25%) tumor resection. Patients were routinely admitted (95%) to floor/wards before craniotomy; Inhaled anesthetic (isoflurane 88%/halothane 12%) was used for maintenance of general anesthesia. Propofol (n = 93, 61%), mannitol (n = 73, 48%), and cerebrospinal fluid drain (n = 28, 18%), were used to facilitate intraoperative brain relaxation, while the use of hyperventilation was rare (n = 1). The average estimated blood loss was 1040 ± 727 ml; 37 (24%) patients received tranexamic acid, and 57 (37%) received a blood transfusion. Factors associated with extubation were a) infratentorial tumor location: relative risk (RR) 0.45 (95% confidence interval [CI] 0.29–0.69), preoperative hydrocephalus: RR 0.51, (95% CI 0.34–0.79), shorter total anesthesia duration: 277.8 + 8.8 versus 426.77 + 13.1 minutes, P < 0.0001, lower estimated blood loss: 897 + 68 ml versus 1361.7 + 100 ml, P = 0.0002, and cerebrospinal fluid drainage to facilitate brain relaxation: RR 0.52, 95% CI 0.32–0.84). Approximately one in ten patients experienced postoperative obstructive hydrocephalus, surgical site infections, or pneumonia. These findings suggest that certain factors may impact patient outcomes following craniotomy for tumor resection. By identifying these factors, health care providers may be better equipped to develop individualized treatment plans and improve patient outcomes. Additionally, the study highlights the importance of postoperative monitoring and management to prevent complications. [ABSTRACT FROM AUTHOR]

This article surveys the marquee events in the year ahead of Indonesia's 2024 election, finding that the field of democratic political contestation has further narrowed due to the criminalisation of political opponents, the end of the campaign against corruption, the decline of judicial activism, political recentralisation and the collapse of national protest movements. Examined in totality, this article argues not only that Indonesia's reformasi movement is dead as a salient political force, but also that today's political elites seek to roll back many of its core achievements. While elites continue to support national elections, those in 2024 will occur in the context of a weakened opposition and heavy presidential interference in the coalition formation of key candidates. Why has democratic contestation, including by oppositional and protest movements, contracted so noticeably under the two-term Joko Widodo (Jokowi) presidency? The article proposes a structural contribution to the continuing debate about Indonesia's democratic decline, arguing that Indonesia's middle-income status under Jokowi has been accompanied by dramatic changes to the country's socio-economic makeup. Importantly, Indonesia's electorate is now dominated by a massive number of 'precariously non-poor' whose dream of social mobility lies in the provision of quality government services and changes to the structure of labour. This article suggests that the intractable political challenge of managing this group's aspirations for economic security in a context of lagging reform has set in train the demobilisation of the opposition, the consolidation of President Jokowi's ruling coalition and the curtailing of political contestation. The project of managing the political economy of the middle-income trap will continue to dominate Indonesia's political future regardless of which coalition will triumph in 2024. [ABSTRACT FROM AUTHOR]

Income Equality is one of the most significant ongoing problems on the national and global scales. It is accepted that Income Equality has many causes and is a social problem encountered by countries on both national and international levels. In terms of its consequences, it is seen to create negative situations including low growth rates, increased inequality of social opportunities in various areas such as health, education, nutrition and housing, and poverty. While fields such as development economics, fiscal policy and social policy are employed in terms of proposing solutions to Income Equality, it is argued that increased Financial Development would also contribute to the solution to this issue. The aim of this study is to test the validity of the Financial Kuznets Curve hypothesis. The study covers the period 2002-2018. 21 middle-income countries were used and analyzes were made using panel data. According to the analysis made by Fixed Effects, Pooled OLS and Two-Stage System GMM methods, an inverse U relationship was found between Financial Development indicators and Income Equality. In other words, it was concluded that the Financial Kuznets Curve hypothesis is valid in the 21 middle-income countries examined in this study. Accordingly, Financial Development can be considered as an important tool for reducing Income Equality.

The CPC's Report on the 20th National Congress reiterated that per capita GDP will reach the level of a moderately developed country(referred to as middle income) by 2035, and the rapid expansion of economic scale is bound to drive energy demand and increase energy consumption, posing challenges to energy supply. The “dual carbon” target promotes the “dual control” of energy consumption to the “dual control” of carbon emissions (referred to as the new “dual control”), which will make the carbon control measures more accurate and increase the pressure of low-carbon transition. Under the background of “middle income” and new “dual control”, it will be a challenging and unavoidable major subject of times to coordinate energy supply and low-carbon transformation, grasp the new opportunities of coal industry development, and enable the transformation and upgrading of the coal industry and high-quality development based on the basic national conditions dominated by coal. By reviewing the historical contribution of the coal industry to the development of the Chinese national economy, combined with the characteristics of China’s resource endowment and the reality of economic and social development at the present stage, it is believed that coal will still play an energy security role in the future and support the realization of the “middle income” goal. The problems of safety, ecology, and low intelligence in the process of coal development were deeply analyzed, and it was revealed that the new challenges facing the coal industry under the background of “middle income” and new “dual control” are mainly increased requirements for energy supply and increasing pressure of low-carbon transition. The change law of coal power consumption in different two-carbon periods was calculated: coal power consumption will be 2 billion tons in 2030, and will drop to 500 million tons in 2060, a decrease of 75%, which greatly impacts coal sales and brings huge potential risks to the development of the coal industry. New opportunities for the development of the coal industry in different periods of dual carbon were put forward. From now to the peak period of carbon emissions, the focus will be on promoting the coordinated development of energy conservation and low-carbon. Opportunities should be seized, such as the integration of coal and coal electricity, the integration of coal mine and circular economy industrial park, coordinated development of mining area restoration and ecology, coal feeding education strategy, coupling of mechanized coal mining and intelligent mining, resource utilization and energy utilization of coalbed methane, etc., to provide energy support for achieving the goal of “middle income”, and achieve high-quality development in the guarantee of supply, and provide a basis for green and low-carbon transition development. In the period from carbon peak to carbon neutral, the coupled development of coal and modern coal chemical industry, coal energy and new energy, will be vigorously developed to realize the leapfrog development of green and low-carbon transition based on high-quality development and help the early realization of the goal of carbon neutral.

Bangladesh is an emerging nation that is urbanizing the fastest. Generally, middle-income families (as the main economic contributors) reside in high-density urban housing due to their socioeconomic disparities in Dhaka, Bangladesh, where physical design aspects focus on current housing sectors. The congested living situation worsens indoor environmental quality and has a negative impact on occupants' mental well-being in their dwellings, resulting in a direct or indirect adverse effect on their productivity. Occupants' living conditions can be improved by adjusting individual perceptions and experiences in their domestic environments. This study has developed an "Environmental Experience Design (EXD)" methodological approach that reflects a user-centered design theoretical framework. A field study on dwelling units (±1000 sq ft) conducted throughout the selected housings in Dhaka, Bangladesh, was carried out to examine occupants' domestic experiences using semi-structured and structured interviews. After binary and thematic coding with significance, "Association Rules and Cluster Analysis" were used to ascertain relationships between three aspects (spatial, environmental, and user context) to explore and customize outcomes. This EXD methodological approach can be utilized to create an environmental (architectural) design solution that will enhance mental well-being by considering occupants' needs and demands in household settings locally and worldwide. [ABSTRACT FROM AUTHOR]

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This essay focuses on three broad sets of issues that may not slow China's GDP growth to under 3 percent a year, but they will almost certainly create major social and physical problems that will be difficult to deal with. The first is the demographic and education challenges featured by a rapidly aging population combined with a large share of the population being under‐educated. The second is the environmental challenges China faces in achieving the state goal of carbon neutrality by 2060. The third challenge is low consumption and unprecedentedly high investment, a strategy that has driven China's high growth rates in the past decades but is no longer sustainable. These three challenges are intertwined, making China's adjustment path even more uncertain. What would a sustainable development strategy involve? The clearest need is to shift investment away from energy‐intensive housing and infrastructure and toward investment in people. [ABSTRACT FROM AUTHOR]

Background: Timely delivery of high-quality cancer care to all patients is barely achieved in South Africa and many other low- and middle-income countries, mainly due to poor care coordination and access to care services. After health care visits, many patients leave facilities confused about their diagnosis, prognosis, options for treatment, and the next steps in their care continuum. They often find the health care system disempowering and inaccessible, thereby making access to health care services inequitable, with the resultant outcome of increased cancer mortality rates. Objective: The aim of this study is to propose a model for cancer care coordination interventions that can be used to guide and achieve coordinated access to lung cancer care in the selected public health care facilities in KwaZulu-Natal. Methods: This study will be conducted through a grounded theory design and an activity-based costing approach that will include health care providers, patients, and their caregivers. The study participants will be purposively selected, and a nonprobability sample will be selected based on characteristics, experiences of the health care providers, and the objectives of the study. With the study's objectives in mind, communities in Durban and Pietermaritzburg were selected as study sites, for the study along with the 3 public health facilities that provide cancer diagnosis, treatment, and care in the province. The study involves a range of data collection techniques, namely, in-depth interviews, evidence synthesis reviews, and focus group discussions. A thematic and cost-benefit analysis will be used. Results: This study receives support from the Multinational Lung Cancer Control Program. The study obtained ethics approval and gatekeeper permission from the University's Ethics Committee and the KwaZulu-Natal Provincial Department of Health, as it is being conducted in health facilities in KwaZulu-Natal province. As of January 2023, we had enrolled 50 participants, both health care providers and patients. Dissemination activities will involve community and stakeholder dissemination meetings, publications in peer-reviewed journals, and presentations at regional and international conferences. Conclusions: This study will provide comprehensive data to inform and empower patients, professionals, policy architects, and related decision makers to manage and improve cancer care coordination. This unique intervention or model will address the multifactorial problem of cancer health disparities. If successful, this study will affect the design and implementation of coordination programs to promote optimal cancer care for underserved patients. [ABSTRACT FROM AUTHOR]

Abstract Background Use of electronic data collection, management and analysis tools to support outbreak response is limited, especially in low income countries. This can hamper timely decision-making during outbreak response. Identifying available tools and assessing their functions in the context of outbreak response would support appropriate selection and use, and likely more timely data-driven decision-making during outbreaks. Methods We conducted a systematic review and a stakeholder survey of the Global Outbreak Alert and Response Network and other partners to identify and describe the use of, and technical characteristics of, electronic data tools used for outbreak response in low- and middle-income countries. Databases included were MEDLINE, EMBASE, Global Health, Web of Science and CINAHL with publications related to tools for outbreak response included from January 2010–May 2020. Software tool websites of identified tools were also reviewed. Inclusion and exclusion criteria were applied and counts, and proportions of data obtained from the review or stakeholder survey were calculated. Results We identified 75 electronic tools including for data collection (33/75), management (13/75) and analysis (49/75) based on data from the review and survey. Twenty-eight tools integrated all three functionalities upon collection of additional information from the tool developer websites. The majority were open source, capable of offline data collection and data visualisation. EpiInfo, KoBoCollect and Open Data Kit had the broadest use, including for health promotion, infection prevention and control, and surveillance data capture. Survey participants highlighted harmonisation of data tools as a key challenge in outbreaks and the need for preparedness through training front-line responders on data tools. In partnership with the Global Health Network, we created an online interactive decision-making tool using data derived from the survey and review. Conclusions Many electronic tools are available for data -collection, −management and -analysis in outbreak response, but appropriate tool selection depends on knowledge of tools’ functionalities and capabilities. The online decision-making tool created to assist selection of the most appropriate tool(s) for outbreak response helps by matching requirements with functionality. Applying the tool together with harmonisation of data formats, and training of front-line responders outside of epidemic periods can support more timely data-driven decision making in outbreaks.

Background: Two billion people in low- and middle-income countries (LMICs) are deficient in key nutrients. Nutritional deficiencies worsen during pregnancy, causing adverse outcomes for the mother and the fetus, with consequences after pregnancy. These effects may be mitigated by providing micronutrient supplementation to women during pregnancy and lactation. However, the effects of micronutrient supplementation on the nutritional status of pregnant and lactating women and that of their infants remain largely unclear in LMICs. Objective: The purpose of this systematic review and meta-analysis is to determine the effects of single, double, or multiple micronutrient supplements during pregnancy or lactation on maternal and infant nutritional status in LMICs. Methods: Randomized controlled trials of single, double, or combinations of micronutrients assessing effects on the maternal (serum, plasma, and breastmilk) and infant (serum and plasma) nutritional status will be included. MEDLINE (through PubMed), EMBASE, CENTRAL (through Cochrane Library), and the World Health Organization (WHO) library database will be used to identify relevant published studies, starting from the inception of each database until February 28, 2022. The Cochrane Risk of Bias Tool will be used to assess the risk of bias in the included studies. The selection of studies, data extraction, and risk of bias assessment will be carried out independently by 2 reviewers. A narrative summary will be provided of all the included studies. Meta-analyses will be performed whenever possible, and the heterogeneity of effects will be evaluated using I², subgroup analyses, and metaregression. The certainty of the evidence for each outcome will be assessed using the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach. Results: We will conduct meta-analyses using Stata software (version 16, StataCorp) and present both a narrative and systematic summary of all studies included in this review in text and table form. For continuous outcomes, effect estimates will be expressed as mean differences and standardized mean differences, while for binary outcomes, they will be expressed as risk ratios, rate ratios, hazards ratios, or odds ratios, all with 95% CIs and comparing the intervention group with the control group. When studies for an outcome are adequately consistent with respect to intervention, comparator, and definition of the outcome, a random-effects, inverse variance-weighted meta-analysis will be conducted. We will provide a narrative synthesis for outcomes with insufficient data or extreme heterogeneity. Conclusions: This review will provide evidence upon which to base policy and programming for women in LMICs to supplement micronutrients in pregnancy and lactation. Detailed results disaggregated by variables such as maternal age, sex of infant, duration, and dose of intervention may also help policy makers, researchers, practitioners, and government agencies to adopt more effective maternal and child health policies and programs in LMICs. The review will also identify any gaps in the existing evidence. Trial Registration: PROSPERO CRD42022308715; https://tinyurl.com/y33cxekr. International Registered Report Identifier (IRRID): PRR1-10.2196/40134 [ABSTRACT FROM AUTHOR]

Background: Low- and middle-income countries face difficulties in providing adequate health care. One of the reasons is a shortage of qualified health workers. Diagnostic decision support systems are designed to aid clinicians in their work and have the potential to mitigate pressure on health care systems. Objective: The Artificial Intelligence-Based Assessment of Health Symptoms in Tanzania (AFYA) study will evaluate the potential of an English-language artificial intelligence-based prototype diagnostic decision support system for mid-level health care practitioners in a low- or middle-income setting. Methods: This is an observational, prospective clinical study conducted in a busy Tanzanian district hospital. In addition to usual care visits, study participants will consult a mid-level health care practitioner, who will use a prototype diagnostic decision support system, and a study physician. The accuracy and comprehensiveness of the differential diagnosis provided by the diagnostic decision support system will be evaluated against a gold-standard differential diagnosis provided by an expert panel. Results: Patient recruitment started in October 2021. Participants were recruited directly in the waiting room of the outpatient clinic at the hospital. Data collection will conclude in May 2022. Data analysis is planned to be finished by the end of June 2022. The results will be published in a peer-reviewed journal. Conclusions: Most diagnostic decision support systems have been developed and evaluated in high-income countries, but there is great potential for these systems to improve the delivery of health care in low- and middle-income countries. The findings of this real-patient study will provide insights based on the performance and usability of a prototype diagnostic decision support system in low- or middle-income countries. [ABSTRACT FROM AUTHOR]

There is a huge demand for housing in Johannesburg, South Africa, due to significant in-migration as well as the legacy of apartheid. Rental housing supply in Johannesburg is particularly constrained. Despite this, little is known about the formal rental market in terms of middle income access. Thus, this explorative qualitative study seeks to partially address this research gap. Results show that specific legislative constraints, namely the National Credit Act and the Prevention of Illegal Eviction and Unlawful Occupation of Land Act, have created an imbalance between the rights and responsibilities of landlords and tenants, driving onerous credit checks and documentary demands, all of which are inadvertently excluding individuals from the formal rental market. Thus, while race previously excluded many from the suburbs under study, class now seems to be a significant factor in terms of who can access rental property. As such, rental housing supply is to some degree artificially constrained.

Existing research has enumerated why people move; this article responds to recent calls for increased focus on residential immobility – or staying in place – by focusing on why and how middle-income renters remain immobile as housing costs change around them. This article examines how middle-income renters make sense of housing cost change and their ability to remain in place. Using thirty-two semi-structured interviews with middle-income renters in New York City, this research analyses housing narratives to understand the financial and social complexities of remaining in place. Middle-income renters who are intentionally immobile explain how they stay in their neighbourhood area by making financial trade-offs and negotiating landlord relationships to avoid rent increases. Within a broader narrative of inevitable price displacement, this demonstrates how structural processes of urban housing and urban change manifest in the housing narratives of middle-income renters as they act to defer their own displacement and actively hold their place in changing neighbourhoods. [ABSTRACT FROM AUTHOR]

Financial fragility is an important issue in the well-being of individuals. Previous studies have shown that many young people are vulnerable to financial fragility. To add value to previous findings, the issue of financial fragility was focused on single youths in the middle-income group (M40) in urban areas. The objective of the study was to determine the factors influencing the financial fragility of single youth (M40) in urban areas. A quantitative approach using a survey method was applied. The study's sample consisted of 25–34-year-old single urban youths. Questionnaires were used as research instruments and were distributed online. A total of 374 samples were analyzed using multilevel regression. The results of the analysis show that spending knowledge, financial behavior, saving behavior, and financial shock are the determining factors of financial fragility among M40 single youth in urban areas. [ABSTRACT FROM AUTHOR]

There is a huge demand for housing in Johannesburg, South Africa, due to significant in-migration as well as the legacy of apartheid. Rental housing supply in Johannesburg is particularly constrained. Despite this, little is known about the formal rental market in terms of middle income access. Thus, this explorative qualitative study seeks to partially address this research gap. Results show that specific legislative constraints, namely the National Credit Act and the Prevention of Illegal Eviction and Unlawful Occupation of Land Act, have created an imbalance between the rights and responsibilities of landlords and tenants, driving onerous credit checks and documentary demands, all of which are inadvertently excluding individuals from the formal rental market. Thus, while race previously excluded many from the suburbs under study, class now seems to be a significant factor in terms of who can access rental property. As such, rental housing supply is to some degree artificially constrained. [ABSTRACT FROM AUTHOR]

Cross‐cultural adaptation is an important part of using validated questionnaires across countries and settings. Here we describe the cross‐cultural process adopted in the STRiDE (STrengthening Responses to dementia in DEveloping countries) program. We adopted a cross‐cultural adaptation process including forward translation, back translations, and cognitive interviews of the STRiDE toolkit. In total, 50 older adults and 41 carers across sites in Indonesia and South Africa participated in cognitive interviews; field notes and verbatim quotes are reported. We describe the cross‐cultural adaptation process of the STRiDE toolkit. During the process, issues were identified with the translated toolkit, including aspects related to cultural appropriateness, terminology equivalence, and timings. The data demonstrate that a rigorous, yet pragmatic, cross‐cultural adaptation process can be achieved even with limited resources. Our process should help the design and conduct of future dementia research in various contexts. [ABSTRACT FROM AUTHOR]

Bangladesh is an emerging nation that is urbanizing the fastest. Generally, middle-income families (as the main economic contributors) reside in high-density urban housing due to their socioeconomic disparities in Dhaka, Bangladesh, where physical design aspects focus on current housing sectors. The congested living situation worsens indoor environmental quality and has a negative impact on occupants’ mental well-being in their dwellings, resulting in a direct or indirect adverse effect on their productivity. Occupants’ living conditions can be improved by adjusting individual perceptions and experiences in their domestic environments. This study has developed an “Environmental Experience Design (EXD)” methodological approach that reflects a user-centered design theoretical framework. A field study on dwelling units (±1000 sq ft) conducted throughout the selected housings in Dhaka, Bangladesh, was carried out to examine occupants’ domestic experiences using semi-structured and structured interviews. After binary and thematic coding with significance, “Association Rules and Cluster Analysis” were used to ascertain relationships between three aspects (spatial, environmental, and user context) to explore and customize outcomes. This EXD methodological approach can be utilized to create an environmental (architectural) design solution that will enhance mental well-being by considering occupants’ needs and demands in household settings locally and worldwide.

Background: The rehabilitation of children with disabilities has received considerable attention from the United Nations. However, the state of rehabilitation services for children with disabilities worldwide remains far from optimistic, even in economically affluent middle- and high-income countries., Objective: This scoping review aimed to identify the rehabilitation needs of children with disabilities and their barriers to rehabilitation services in middle- and high-income countries., Methods: A systematic search was conducted using MEDLINE and Web of Science for papers published from January 2013 to December 2023. Studies were included if they were peer-reviewed, full-text articles related to children with disabilities, reporting on their access to rehabilitation services, and conducted in countries classified by the World Bank 2023 as middle- and high-income economies. Exclusion criteria included duplicates, unavailable full texts, and studies without distinct outcomes. A total of 27 studies were selected following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on children, their families, or service providers., Results: The suitability, availability, and affordability of rehabilitation services were identified as the major needs and barriers for children with disabilities in middle- and high-income countries. This included communication barriers, a need for more personnel and facilities, and the stagnation and inadequacy of economic subsidies., Conclusions: Middle- and high-income countries have relatively well-established rehabilitation infrastructure and support systems. They are nevertheless insufficient for meeting the needs of children with disabilities. More attention should be paid to these issues to improve the well-being of children with disabilities. The data provided by this review can help raise awareness of rehabilitation needs and barriers at the policy level., (©Yijun Xie, Jing Wu, Yao Li, Hui Liu, Yanyan Peng, Ping Zhou, Yizhou Sun, Luyan Kang, Chenghua Jiang, Hengjing Wu. Originally published in the Interactive Journal of Medical Research (https://www.i-jmr.org/), 07.08.2024.)

Background: Use of electronic data collection, management and analysis tools to support outbreak response is limited, especially in low income countries. This can hamper timely decision-making during outbreak response. Identifying available tools and assessing their functions in the context of outbreak response would support appropriate selection and use, and likely more timely data-driven decision-making during outbreaks.Methods: We conducted a systematic review and a stakeholder survey of the Global Outbreak Alert and Response Network and other partners to identify and describe the use of, and technical characteristics of, electronic data tools used for outbreak response in low- and middle-income countries. Databases included were MEDLINE, EMBASE, Global Health, Web of Science and CINAHL with publications related to tools for outbreak response included from January 2010-May 2020. Software tool websites of identified tools were also reviewed. Inclusion and exclusion criteria were applied and counts, and proportions of data obtained from the review or stakeholder survey were calculated.Results: We identified 75 electronic tools including for data collection (33/75), management (13/75) and analysis (49/75) based on data from the review and survey. Twenty-eight tools integrated all three functionalities upon collection of additional information from the tool developer websites. The majority were open source, capable of offline data collection and data visualisation. EpiInfo, KoBoCollect and Open Data Kit had the broadest use, including for health promotion, infection prevention and control, and surveillance data capture. Survey participants highlighted harmonisation of data tools as a key challenge in outbreaks and the need for preparedness through training front-line responders on data tools. In partnership with the Global Health Network, we created an online interactive decision-making tool using data derived from the survey and review.Conclusions: Many electronic tools are available for data -collection, -management and -analysis in outbreak response, but appropriate tool selection depends on knowledge of tools' functionalities and capabilities. The online decision-making tool created to assist selection of the most appropriate tool(s) for outbreak response helps by matching requirements with functionality. Applying the tool together with harmonisation of data formats, and training of front-line responders outside of epidemic periods can support more timely data-driven decision making in outbreaks. [ABSTRACT FROM AUTHOR]

Abstract Background Short birth intervals increase risk for adverse maternal and infant outcomes including preterm birth, low birth weight (LBW), and infant mortality. Although postpartum family planning (PPFP) is an increasingly high priority for many countries, uptake and need for PPFP varies in low- and middle-income countries (LMIC). We performed a systematic review and meta-analysis to characterize postpartum contraceptive use, and predictors and barriers to use, among postpartum women in LMIC. Methods PubMed, EMBASE, CINAHL, PsycINFO, Scopus, Web of Science, and Global Health databases were searched for articles and abstracts published between January 1997 and May 2018. Studies with data on contraceptive uptake through 12 months postpartum in low- and middle-income countries were included. We used random-effects models to compute pooled estimates and confidence intervals of modern contraceptive prevalence rates (mCPR), fertility intentions (birth spacing and birth limiting), and unmet need for contraception in the postpartum period. Results Among 669 studies identified, 90 were selected for full-text review, and 35 met inclusion criteria. The majority of studies were from East Africa, West Africa, and South Asia/South East Asia. The overall pooled mCPR during the postpartum period across all regions was 41.2% (95% CI: 15.7–69.1%), with lower pooled mCPR in West Africa (36.3%; 95% CI: 27.0–45.5%). The pooled prevalence of unmet need was 48.5% (95% CI: 19.1–78.0%) across all regions, and highest in South Asia/South East Asia (59.4, 95% CI: 53.4–65.4%). Perceptions of low pregnancy risk due to breastfeeding and postpartum amenorrhea were commonly associated with lack of contraceptive use and use of male condoms, withdrawal, and abstinence. Women who were not using contraception were also less likely to utilize maternal and child health (MCH) services and reside in urban settings, and be more likely to have a fear of method side effects and receive inadequate FP counseling. In contrast, women who received FP counseling in antenatal and/or postnatal care were more likely to use PPFP. Conclusions PPFP use is low and unmet need for contraception following pregnancy in LMIC is high. Tailored counseling approaches may help overcome misconceptions and meet heterogeneous needs for PPFP.

Faculty members in low- and middle-income countries (LMICs) are seeking to develop simulation centers with fewer resources. The aim of this study was to describe an effective approach to build capacity and facilitate the incorporation of simulation into the curriculum of a nursing program in a middle-income country. A team of expert faculty members from the United States visited Jamaica to provide a train-the-trainer simulation workshop. Innovative and engaging strategies were used to foster faculty member development including codevelopment of simulations, implementation of simulation, codebriefing experiences, and curriculum development. Boards of nursing in LMICs are hesitant to accept simulation as the majority of evidence supporting simulation has been conducted in high-income countries. To influence policy, faculty members are urged to conduct more simulation research in LMICs to establish an evidence base. Collaborations of nurse faculty members involving high-, middle-, and low-income countries are recommended to further the science of simulation worldwide. • Faculty in middle- and low-income countries are increasingly seeking to develop their own simulation centers with fewer resources. • As simulation centers begin to proliferate across low- and middle-income countries, therein lies opportunities for international collaborations to improve nursing education. • As a solid body of evidence is lacking, it is critical that simulation research be conducted in low- and middle-income countries to influence policy, improve nursing education, and improve patient outcomes globally. • Collaborations of nurse faculty members from high-income and middle- to low-income countries are recommended to further the science of simulation and facilitate adoption of simulation worldwide. [ABSTRACT FROM AUTHOR]

Road traffic injuries (RTIs) constitute one of the five major disease burdens in South Africa with high mortality and morbidity. Thus far, the scientific enquiry into this burden has not been accompanied by successful government efforts to meet the challenge. Currently, more than 1.2 million people die and 20–50 million are with disabilities annually country-wide from RTIs. While there is a progressive reduction in mortality related to human immunodeficiency virus (HIV) conditions as a result of interventions, the mortality from RTI is seen to be progressively worsening as a result of increasing motorisation. There are disparities in the burden of RTI across different countries, with low- and middle-income countries bearing the highest burden. In Africa, 24.1 per 100 000 people die annually from RTI compared to 10.3 per 100 000 people in European countries. This opinion article investigates the magnitude, trends and prevention of RTI in South Africa.

Abstract Background High pharmaceutical expenditure is one of the main concerns for policymakers worldwide. In Colombia, a middle-income country, outpatient prescription represents over 10% of total health expenditure in the mandatory benefits package (POS), and close to 90% in the complementary government fund (No POS). In order to control expenditure, since 2011, the Ministry of Health introduced price caps on inpatient drugs reimbursements by active ingredient. By 2013, more than 400 different products, covering 80% of public pharmaceutical expenditure were controlled. This paper investigates the effects of the Colombian policy efforts to control expenditure by controlling prices. Methods Using SISMED data, the official database for prices and quantities sold in the domestic market, we estimate a Laspeyres price index for 90 relevant markets in the period 2011–2015, and, then, we estimate real pharmaceutical expenditure. Results Results show that, after direct price controls were enacted, price inflation decreased almost − 43%, but real pharmaceutical expenditure almost doubled due mainly to an increase in units sold. Such disproportionate increase in units sold maybe attributable to better access to drugs due to lower prices, and/or to an increase in marketing efforts by the pharmaceutical industry to maintain profits. Conclusions We conclude that pricing interventions should be implemented along with a strong market monitoring to prevent market distortions such as inappropriate and unnecessary drug use.

This paper investigates the causal relationship between financial deepening and economic growth for fourteen upper middle income countries for the period during 1987-2015. Broad money supply, private credits, financial system deposit liabilities and deposit money banks’ assets are determined as proxies of financial deepening. Kónya (2006) bootstrap panel granger causality approach is used for this relationship based on Seemingly Unrelated Regression (SUR) model. Empirical findings indicate that countries can be clustered according to supply-leading and demand following approach. Besides, there exists evidence for bidirectional causality for some countries.

Road traffic injuries (RTIs) constitute one of the five major disease burdens in South Africa with high mortality and morbidity. Thus far, the scientific enquiry into this burden has not been accompanied by successful government efforts to meet the challenge. Currently, more than 1.2 million people die and 20-50 million are with disabilities annually country-wide from RTIs. While there is a progressive reduction in mortality related to human immunodeficiency virus (HIV) conditions as a result of interventions, the mortality from RTI is seen to be progressively worsening as a result of increasing motorisation. There are disparities in the burden of RTI across different countries, with low- and middle-income countries bearing the highest burden. In Africa, 24.1 per 100 000 people die annually from RTI compared to 10.3 per 100 000 people in European countries. This opinion article investigates the magnitude, trends and prevention of RTI in South Africa. [ABSTRACT FROM AUTHOR]

Cervical cancer screening by HPV testing Cervical cancer screening has traditionally been based on detection of cytological abnormalities in cervical cell samples, so-called cytology-based screening. Keywords: Human papillomavirus; HPV; Cervical cancer; Cancer cervix uteri; Screening; Prevention; Middle income EN Human papillomavirus HPV Cervical cancer Cancer cervix uteri Screening Prevention Middle income 1 3 3 07/16/21 20210714 NES 210714 This comment refers to the article available at https://doi.org/10.1186/s12916-021-02026-0. [Extracted from the article]

Survival of newborns with gastroschisis is significantly higher in high-income versus low and middle-income countries. We reviewed treatment and outcomes of gastroschisis in a middle-income country setting with increasing protocolized management. All newborns with gastroschisis treated during the period 1989–2013 at a single Brazilian academic surgical service were studied retrospectively. Protocolized diagnosis, delivery, nutrition, medical interventions, and surgical interventions were introduced in 2002. Outcomes before and after protocol introduction were studied using univariate and multivariate analysis. One hundred fifty-six newborns were treated for gastroschisis: 35 (22.4%) and 121 (77.6%) before and after 2002, respectively. When compared to the earlier cohort, patients treated after 2002 had higher rates of prenatal diagnosis (90.9% vs. 60.0%, p < 0.001) , delivery at a tertiary center (90.9% vs. 62.9%, p < 0.001) , early closure (65.3% vs. 33.3%, p = 0.001), primary repair (55.4% vs. 31.4%, p = 0.013), monitoring of bladder pressure (62.0% vs. 2.9%, p = 0.001), PICC placement (71.1% vs. 25.7%, p < 0.001), early initiation of enteral feeding (54.5% vs. 20.0%, p < 0.001), and lower rates of electrolyte disturbances (53.7% vs. 85.7%, p = 0.001). Mortality decreased from 34.3% before 2002 to 24.8% (p =.27) after 2002 despite an increase in the complex gastroschisis rate from 11.4% to 15.7% during the same period. Gastroschisis outcomes in a middle-income country can be gradually improved through targeted interventions and management protocols. Therapeutic. III. [ABSTRACT FROM AUTHOR]

Abstract Background Planning and monitoring vaccine introduction and effectiveness relies on strong vaccine-preventable disease (VPD) surveillance. In low and middle-income countries (LMICs) especially, cost is a commonly reported barrier to VPD surveillance system maintenance and performance; however, it is rarely calculated or assessed. This review describes and compares studies on the availability of cost information for VPD surveillance systems in LMICs to facilitate the design of future cost studies of VPD surveillance. Methods PubMed, Web of Science, and EconLit were used to identify peer-reviewed articles and Google was searched for relevant grey literature. Studies selected described characteristics and results of VPD surveillance systems cost studies performed in LMICs. Studies were categorized according to the type of VPD surveillance system, study aim, the annual cost of the system, and per capita costs. Results Eleven studies were identified that assessed the cost of VPD surveillance systems. The studies assessed systems from six low-income countries, two low-middle-income countries, and three middle-income countries. The majority of the studies (n = 7) were conducted in sub-Saharan Africa and fifteen distinct VPD surveillance systems were assessed across the studies. Most studies aimed to estimate incremental costs of additional surveillance components and presented VPD surveillance system costs as mean annual costs per resource category, health structure level, and by VPD surveillance activity. Staff time/personnel cost represents the largest cost driver, ranging from 21% to 61% of total VPD surveillance system costs across nine studies identifying a cost driver. Conclusions This review provides a starting point to guide LMICs to invest and advocate for more robust VPD surveillance systems. Critical gaps were identified including limited information on the cost of laboratory surveillance, challenges with costing shared resources, and missing data on capital costs. Appropriate guidance is needed to guide LMICs conducting studies on VPD surveillance system costs. [ABSTRACT FROM AUTHOR]

Background: Gestational weight gain (GWG) is a crucial determinant of maternal and child outcomes yet remains an underused target for antenatal interventions in low- and middle-income countries (LMICs)., Objective: This systematic review aims to identify and summarize educational, behavioral, nutritional, and medical interventions on GWG from randomized controlled trials conducted in LMICs., Methods: Randomized controlled trials that documented the effects of antenatal interventions on GWG in LMICs will be included. The interventions of interest will be educational, behavioral, nutritional, or medical. A systematic literature search will be conducted using PubMed, Embase, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library from the inception of each database through October 2022 (with an updated search in January 2024). A total of 2 team members will independently perform the screening of studies and data extraction. A narrative synthesis of all the included studies will be provided. The risk of bias will be assessed using the Cochrane Risk of Bias tool. The certainty of the evidence for each homogeneous group of interventions will be assessed using the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach. A narrative synthesis of the included studies will be conducted to summarize mean differences (with 95% CIs) for continuous outcomes and risk ratios, rate ratios, hazard ratios, or odds ratios (with 95% CIs) for dichotomous or categorical outcomes. Available information on the costs of interventions will also be summarized to facilitate the adoption and scale-up of effective GWG interventions., Results: The development of the research questions, search strategy, and search protocol was started on September 20, 2022. The database searches and the importation of the identified records into Covidence were performed on October 7, 2022. As of September 2023, the title and abstract screening was ongoing. The target completion time of this systematic review is April 2024., Conclusions: Without effective interventions to manage GWG, the potential to improve maternal and child health through optimal GWG remains unrealized in LMICs. This systematic review will inform the design and implementation of antenatal interventions to prevent inadequate and excessive GWG in resource-limited settings., Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42022366354; https://www.crd.york.ac.uk/prospero/display&#95;record.php?RecordID=366354., International Registered Report Identifier (irrid): PRR1-10.2196/48234., (©Dongqing Wang, Christine H Nguyen, Wafaie W Fawzi. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 08.11.2023.)

Abstract: Objectives: Quality of life and psychological well‐being are important patient‐centered outcomes, which are useful in evaluation of cancer care delivery. However, evidence from low‐income and middle‐income countries remains scarce. We assessed health‐related quality of life (HRQoL) and prevalence of psychological distress (anxiety or depression), as well as their predictors, among cancer survivors in a middle‐income setting. Methods: Through the Association of Southeast Asian Nations Costs in Oncology study, 1490 newly diagnosed cancer patients were followed‐up in Malaysia for 1 year. Health‐related quality of life was assessed by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ‐C30) and EuroQol‐5 (EQ‐5D) dimension questionnaires at baseline, 3 and 12 months. Psychological distress was assessed by using Hospital Anxiety and Depression Scale. Data were modeled by using general linear and logistic regressions analyses. Results: One year after diagnosis, the mean EORTC QLQ‐C30 Global Health score of the cancer survivors remained low at 53.0 over 100 (SD 21.4). Fifty‐four percent of survivors reported at least moderate levels of anxiety, while 27% had at least moderate levels of depression. Late stage at diagnosis was the strongest predictor of low HRQoL. Increasing age, being married, high‐income status, hospital type, presence of comorbidities, and chemotherapy administration were also associated with worse HRQoL. The significant predictors of psychological distress were cancer stage and hospital type. Conclusion: Cancer survivors in this middle‐income setting have persistently impaired HRQoL and high levels of psychological distress. Development of a holistic cancer survivorship program addressing wider aspects of well‐being is urgently needed in our settings. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess umbilical artery lactate levels and perinatal outcomes among women with and without HIV infection. Methods: The present prospective cohort study recruited women planning to undergo vaginal delivery at Kalafong Hospital, South Africa, between March 3 and November 12, 2014. Umbilical artery lactate levels were measured and perinatal outcome data were recorded. Outcome analyses were stratified by maternal HIV status, and a subgroup analysis was performed where women with a CD4 count below 350 × 106 cells/L were compared with women without HIV. Results: In total, 936 women with singleton fetuses were enrolled. Maternal HIV status was available for 897 (95.8%) participants, of whom 202 (21.6%) had HIV infections. Overall, 186 (92.1%) women with HIV infections received prophylaxis or treatment. There was no difference between participants with and without HIV infections in the preterm delivery rate (P=0.770), mode of delivery (P=0.354), neonatal resuscitation rate (P=0.717), 1‐ or 5‐minute Apgar scores below 7 (P=0.353), or the rate of having an umbilical artery lactate level above 5.45 mmol/L (P=0.301). Similarly, there were no differences in outcomes in the subgroup analysis of women with a CD4 count below 350 × 106 cells/L. Conclusion: Umbilical artery lactate levels and perinatal outcomes were found to be comparable between patients with and without HIV infections in a South African setting. [ABSTRACT FROM AUTHOR]

Developing Asia has undergone a dramatic shift over the past five decades from a region of mainly low-income economies toward one that is largely middle income. The region faces the challenge of moving further to high income particularly because, as this study shows, it takes longer for economies to move from upper middle to high income than shifting from lower middle to upper middle income. The study finds that developing Asian economies transformed more quickly than the rest of the world, whether the transition is from lower middle to upper middle income or from upper middle to high income. [ABSTRACT FROM AUTHOR]