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Climate change poses a significant threat to agriculture and livestock production in sub-Saharan Africa, a region heavily reliant on livestock for smallholder farmers' livelihoods. This systematic review investigates the potential of communally established cattle feedlots as a sustainable strategy to address the interconnected challenges of climate change resilience and food security in the area. The review focuses on the intensification of climate change, marked by rising temperatures and altered precipitation patterns, posing a direct threat to the livelihoods of millions in the region. Conducting a systematic literature review, we meticulously analyzed 72 articles that centered on communally established cattle feedlots in sub-Saharan Africa. The inclusion criteria considered studies within the context of climate change resilience and food security, utilizing both qualitative and quantitative methodologies. Published articles, grey literature, and relevant reports were systematically sourced from academic databases such as PubMed, Scopus, Google Scholar and Web of Science, complemented by manual searches of journals, conference proceedings, and organizational websites. The synthesis of findings reveals a nuanced landscape of successes and challenges associated with communal feedlots. Through a narrative synthesis, studies were categorized based on key themes, unraveling the impact of communal feedlots on livestock health, economic viability, and socio-economic dynamics. The review highlights the role of communal feedlots in mitigating climate-related shocks, enhancing livestock productivity, and fostering economic opportunities for smallholder farmers. However, challenges related to land tenure, community engagement, and resource allocation emerged as critical considerations. In conclusion, communally established cattle feedlots offer a holistic and sustainable approach to address climate change challenges in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Climate change poses a significant threat to agriculture and livestock production in sub-Saharan Africa, a region heavily reliant on livestock for smallholder farmers’ livelihoods. This systematic review investigates the potential of communally established cattle feedlots as a sustainable strategy to address the interconnected challenges of climate change resilience and food security in the area. The review focuses on the intensification of climate change, marked by rising temperatures and altered precipitation patterns, posing a direct threat to the livelihoods of millions in the region. Conducting a systematic literature review, we meticulously analyzed 72 articles that centered on communally established cattle feedlots in sub-Saharan Africa. The inclusion criteria considered studies within the context of climate change resilience and food security, utilizing both qualitative and quantitative methodologies. Published articles, grey literature, and relevant reports were systematically sourced from academic databases such as PubMed, Scopus, Google Scholar and Web of Science, complemented by manual searches of journals, conference proceedings, and organizational websites. The synthesis of findings reveals a nuanced landscape of successes and challenges associated with communal feedlots. Through a narrative synthesis, studies were categorized based on key themes, unraveling the impact of communal feedlots on livestock health, economic viability, and socio-economic dynamics. The review highlights the role of communal feedlots in mitigating climate-related shocks, enhancing livestock productivity, and fostering economic opportunities for smallholder farmers. However, challenges related to land tenure, community engagement, and resource allocation emerged as critical considerations. In conclusion, communally established cattle feedlots offer a holistic and sustainable approach to address climate change challenges in sub-Saharan Africa.

Background: Coronavirus disease-19 (COVID-19) is a potentially lethal infection caused by severe acute respiratory syndrome. Pregnancy is a state of partial immune suppression, which makes pregnant women more vulnerable to viral infections. COVID-19 pandemic presents many challenges in when it coexists with pregnancy in resource-poor countries with background ignorance and deficient health infrastructure. Materials and Methods: A literature search for studies on COVID-19 was performed using Google Scholar search database, PubMed, Medline, and ScienceDirect. The bibliographies of included studies were also searched for additional references. About 85 articles were identified. Twenty-five articles were considered suitable for review. Results: An extensive review of management of COVID-19 in pregnancy and challenges confronting its management in resource-poor countries was presented. These challenges included poor health infrastructure, poor testing capacity, and nonadherence or impracticable preventive measures including physical distancing, hand hygiene, inadequate personal protective equipment, and stigmatization. Specific challenges related to pregnancy were availability of blood and blood products, labor management, operative deliveries, and postdelivery management. Conclusions: Current evidence suggests that its pathogenesis, clinical manifestations, and management are influenced by pregnancy. The outcomes of pregnancy and COVID-19 are negatively influenced by similar problems of ignorance, poverty, and deficient health infrastructure. COVID-19, therefore, has the potential for worsening maternal mortality in low-resource nations.

Mass poisonings with diethylene glycol (DEG) usually ingested as an unintended component of pharmaceutical preparations have occurred in Nigeria, especially affecting children with nearly 100% mortality outcomes. Clearly, the unavailability of Specialty Toxicology laboratory testing facilities translates to non-diagnosis and therefore inappropriate management of these patients with resulting poor outcomes. In this case analysis, while utilizing a case report involving intentional DEG intoxication that we managed at the Mayo Clinic Health System in North-Western Wisconsin, we have demonstrated the utility of serial values of commonly available blood test parameters including serum bicarbonate and anion gap, blood ABG pH and CO2 values, together with the use of serum osmolality gap as surrogates to expedite early and appropriate treatment of such cases even in the absence of Toxicology confirmation of DEG as the poisoning agent. Based on the experience gained from this case report, we strongly recommend that the responsible governments in resource-challenged countries must ensure that these laboratory surrogate indices, at the minimum, become available in the hospitals. This would improve outcomes in general.

Lynch Syndrome (LS) is associated with a genetic predisposition to colorectal, endometrial and multiple extracolonic cancers. The lifetime risk of developing endometrial and ovarian cancers is 40–62% and 4–12% respectively. The case is presented of a 56-year-old woman with a prior history of colorectal cancer who later developed endometrial carcinoma. Tumour immunohistochemistry showed microsatellite instability (MSI)-high, which is observed in 90% of LS-associated carcinomas. Germline molecular testing to confirm the diagnosis is not available in Zimbabwe. Her case is discussed together with the difficulties associated with the management of patients in Zimbabwe suspected to have LS. [ABSTRACT FROM AUTHOR]

Abstract Background In resource-poor settings, the provision of basic maternity care within health centres is often a challenge. Despite the difficulties, Nepal reduced its maternal mortality ratio by 80% from 850 to an estimated 170 per 100,000 live births between 1991 and 2011 to achieve Millennium Development Goal Five. One group that has been credited for this is community health workers, known as Female Community Health Volunteers (FCHVs), who form an integral part of the government healthcare system. This qualitative study explores the role of FCHVs in maternal healthcare provision in two regions: the Hill and Terai. Methods Between May 2014 and September 2014, 20 FCHVs, 11 health workers and 26 service users were purposefully selected and interviewed using semi-structured topic guides. In addition, four focus group discussions were held with 19 FCHVs. Data were analysed using thematic analysis. Results All study participants acknowledged the contribution of FCHVs in maternity care. All FCHVs reported that they shared key health messages through regularly held mothers’ group meetings and referred women for health checks. The main difference between the two study regions was the support available to FCHVs from the local health centres. With regular training and access to medical supplies, FCHVs in the hill villages reported activities such as assisting with childbirth, distributing medicines and administering pregnancy tests. They also reported use of innovative approaches to educate mothers. Such activities were not reported in Terai. In both regions, a lack of monetary incentives was reported as a major challenge for already overburdened volunteers followed by a lack of education for FCHVs. Conclusions Our findings suggest that the role of FCHVs varies according to the context in which they work. FCHVs, supported by government health centres with emphasis on the use of local approaches, have the potential to deliver basic maternity care and promote health-seeking behaviour so that serious delays in receiving healthcare can be minimised. However, FCHVs need to be reimbursed and provided with educational training to ensure that they can work effectively. The study underlines the relevance of community health workers in resource-poor settings.

Background: Most of the Nigerian studies on the determinants of diabetes self-management have focused on patient-related factors. There is no previous local study that examined the quality of diabetes self-management education provided by primary care physicians to people with diabetes mellitus. Methods: A descriptive cross-sectional study was conducted among 105 primary care physicians during a workshop. The quality of diabetes self-management education provided by the physicians was assessed using a self-designed scale of 39 Likert questions derived from American Association of Diabetes Educators seven domains of diabetes self-management. Cronbach’s reliability coefficient of each domain/subscale was ≥ 0.7. The data was analysed using the independent sample t-test and one-way ANOVA. Results: Over half of the physicians provided ‘inadequate quality’ diabetes self-management education in all the domains. Physicians had the highest mean score in the ‘taking medication’ domain (4.35 ± 0.59). The mean scores in the ‘problemsolving domain’ (3.63 ± 0.74) and the ‘being active domain’ (3.57 ± 0.71) were low. The quality of diabetes self-management education provided by the physicians was not associated with any of the physician characteristics. Conclusion: The quality of physicians’ communication of diabetes self-management was suboptimal in this study. The majority of the adequately communicated diabetes self-management behaviours were risk factors reduction related and disease-centred. Thus, training of primary care physicians on diabetes self-management education is recommended because of the key role these physicians play in diabetes management in resource-poor countries.

Surgical infections present a significant burden of disease globally. Management focuses on source control and appropriate antibiotic therapy. This remains a challenge in low- and middle-income settings, where access to surgical care and antibiotics is limited. This paper discusses the complex challenges facing the management of surgical infections in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Background: Most resource-poor countries are yet to develop standard hemophilia treatment center (HTC) despite improved outcome of health status of persons with hemophilia (PWH). Aim: This study aimed to evaluate the health status of PWH in Nigeria. Methodology: In this descriptive, cross-sectional study, modified prevalidated and pretested questionnaire (National health and Nutrition examination survey (NHANES) 2013 Health Status questionnaire (HSQ)) was consecutively administered to consenting PWH (pediatric and adult) attending the 2018 Annual General Meeting of the Haemophilia Foundation of Nigeria. The study's measurable outcome variables were calculated health status and its determinants. Association between the outcome variables and clinical characteristics of PWH was done using SPSS software version 22, and P < 0.05 was considered statistically significant. Results: Of the 36 PWH who participated in the survey, 50% had good health status, 38.9% had poor health status, while only 11.1% had excellent health status. A majority (88.9%) had access to HTC with <6 consultations in the past year. Nearly 47.2% were hospitalized for disease-related problem in the past year. There was nonsignificant difference between health status and disease type (P = 0.751) and severity (P = 0.086), treatment plan (0.496), type of treatment facility (P = 0.152), and access to a doctor (P = 0.67).Conclusion: Several PWH in resource-poor settings still suffer serious morbidity that impacts negatively on their health status. More robust (multicenter) research is needed to ascertain the true picture of health status of PWH in resource-poor countries. [ABSTRACT FROM AUTHOR]

Introductions: Digitization could be incorporated in rural areas of resource‐poor countries because information gathered by nurses working on‐site could be better used. Background: For effective management of community health information, the usage and maintenance of digital records are important. Digitization of information provides essential information for informing health policy. Aim: To develop a sustainable database to effectively collect and manage community health information and nursing practice. Methods: This study used a mixed method design. Phase 1 involved the development of a database system through repeated systematic focus group discussions with community health nurses. Phase 2 involved a practical trial examination of the developed system with both objective and subjective evaluations. Results: A nursing database system was developed with templates designed for the major health problems of communities. The templates were composed of multiple‐choice items and a free‐text field that allowed records to be more detailed than handwritten records and maintained in standardized formats. This enables accumulation of data that were less likely to be influenced by the variance of ability in each nurse. Discussion and conclusion: A multifaceted evaluation of the database system suggested that it could improve the efficiency of information management and contribute to the improvement of nursing care quality through standardization of the recording pattern. Implications for nursing and health policy: The nursing database will enable high‐quality information storage that will potentially better inform health and healthcare policies as well as enable visualization of data concerning nursing care challenges and activities within the relevant communities. This information is essential for policy development and implementation in areas of human and fiscal resource allocations and meeting training/education needs. [ABSTRACT FROM AUTHOR]

Background: Most of the Nigerian studies on the determinants of diabetes self-management have focused on patient-related factors. There is no previous local study that examined the quality of diabetes self-management education provided by primary care physicians to people with diabetes mellitus. Methods: A descriptive cross-sectional study was conducted among 105 primary care physicians during a workshop. The quality of diabetes self-management education provided by the physicians was assessed using a self-designed scale of 39 Likert questions derived from American Association of Diabetes Educators seven domains of diabetes self-management. Cronbach's reliability coefficient of each domain/subscale was ≥ 0.7. The data was analysed using the independent sample t-test and one-way ANOVA. Results: Over half of the physicians provided ‘inadequate quality’ diabetes self-management education in all the domains. Physicians had the highest mean score in the ‘taking medication’ domain (4.35 ± 0.59). The mean scores in the ‘problem-solving domain’ (3.63 ± 0.74) and the ‘being active domain’ (3.57 ± 0.71) were low. The quality of diabetes self-management education provided by the physicians was not associated with any of the physician characteristics. Conclusion: The quality of physicians’ communication of diabetes self-management was suboptimal in this study. The majority of the adequately communicated diabetes self-management behaviours were risk factors reduction related and disease-centred. Thus, training of primary care physicians on diabetes self-management education is recommended because of the key role these physicians play in diabetes management in resource-poor countries. [ABSTRACT FROM AUTHOR]

Background: In resource-poor settings, the provision of basic maternity care within health centres is often a challenge. Despite the difficulties, Nepal reduced its maternal mortality ratio by 80% from 850 to an estimated 170 per 100,000 live births between 1991 and 2011 to achieve Millennium Development Goal Five. One group that has been credited for this is community health workers, known as Female Community Health Volunteers (FCHVs), who form an integral part of the government healthcare system. This qualitative study explores the role of FCHVs in maternal healthcare provision in two regions: the Hill and Terai.Methods: Between May 2014 and September 2014, 20 FCHVs, 11 health workers and 26 service users were purposefully selected and interviewed using semi-structured topic guides. In addition, four focus group discussions were held with 19 FCHVs. Data were analysed using thematic analysis.Results: All study participants acknowledged the contribution of FCHVs in maternity care. All FCHVs reported that they shared key health messages through regularly held mothers' group meetings and referred women for health checks. The main difference between the two study regions was the support available to FCHVs from the local health centres. With regular training and access to medical supplies, FCHVs in the hill villages reported activities such as assisting with childbirth, distributing medicines and administering pregnancy tests. They also reported use of innovative approaches to educate mothers. Such activities were not reported in Terai. In both regions, a lack of monetary incentives was reported as a major challenge for already overburdened volunteers followed by a lack of education for FCHVs.Conclusions: Our findings suggest that the role of FCHVs varies according to the context in which they work. FCHVs, supported by government health centres with emphasis on the use of local approaches, have the potential to deliver basic maternity care and promote health-seeking behaviour so that serious delays in receiving healthcare can be minimised. However, FCHVs need to be reimbursed and provided with educational training to ensure that they can work effectively. The study underlines the relevance of community health workers in resource-poor settings. [ABSTRACT FROM AUTHOR]

Aims Unrepaired clefts still regularly occur in resource-poor countries as a result of limited health-care access. The purpose of the present study was to report resonance, airflow and articulation characteristics following delayed (≥ 8 years) primary palatal closure. Methods Fifteen Ugandan participants with cleft (lip and) palate (CP ± L) were included as well as 15 age- and gender-matched Ugandan subjects without clefts. Palatal closure was performed at a mean age of 15;10 years using the Sommerlad technique. Speech evaluations were carried out on a single occasion postoperatively (mean age: 18;10 years). Resonance and nasal airflow were perceptually evaluated and detailed phonetic and phonological assessments were carried out. Additionally, nasalance values were determined. Results Nasal emission occurred postoperatively in only 27% (4/15) of the patients, whereas resonance disorders and articulation errors were prevalent in 87% (13/15) of the patient group. Compared with the control group, a significantly higher prevalence of hypernasality and significantly higher nasalance values for all oral and oronasal speech samples were obtained in the CP ± L group. Moreover, significantly smaller consonant inventories and significantly more phonetic and phonological disorders were observed. Conclusions Delayed palatal repair (≥ 8 years) seems to be insufficient to eliminate nasal airflow errors, resonance abnormalities, and articulation disorders. In order to prevent patients’ late presentation at specialized centers, the availability of high quality surgical cleft palate treatment should increase as well as people’s awareness of the possibility and importance of early surgical intervention. Moreover, speech therapy following delayed palatal closure would be beneficial. Furthermore, a standardized and validated protocol for speech assessment in future studies is advocated. [ABSTRACT FROM AUTHOR]

Pregnancy is a normal, healthy state that most women are desirous for at some point in their lives. Sadly, this life-affirming process carries serious risks of death and disability for both mother and offspring. It is estimated that about 830 women die from pregnancy or pregnancy related complications each year. Almost all of these deaths occur in resource-poor countries, and most of them are preventable. Reducing maternal mortality is an ongoing challenge, and care providers, researchers and policy makers must not only identify the key barriers to accessing quality health care, but commit to making maternal health a priority. [ABSTRACT FROM AUTHOR]

To determine the magnitude of risk factors and causes of premature mortality associated with epilepsy in low- and middle-income countries ( LMICs). We conducted a systematic search of the literature reporting mortality and epilepsy in the World Bank-defined LMICs. We assessed the quality of the studies based on representativeness; ascertainment of cases, diagnosis, and mortality; and extracted data on standardized mortality ratios ( SMRs) and mortality rates in people with epilepsy. We examined risk factors and causes of death. The annual mortality rate was estimated at 19.8 (range 9.7-45.1) deaths per 1,000 people with epilepsy with a weighted median SMR of 2.6 (range 1.3-7.2) among higher-quality population-based studies. Clinical cohort studies yielded 7.1 (range 1.6-25.1) deaths per 1,000 people. The weighted median SMRs were 5.0 in male and 4.5 in female patients; relatively higher SMRs within studies were measured in children and adolescents, those with symptomatic epilepsies, and those reporting less adherence to treatment. The main causes of death in people with epilepsy living in LMICs include those directly attributable to epilepsy, which yield a mean proportional mortality ratio ( PMR) of 27.3% (range 5-75.5%) derived from population-based studies. These direct causes comprise status epilepticus, with reported PMRs ranging from 5 to 56.6%, and sudden unexpected death in epilepsy (SUDEP), with reported PMRs ranging from 1 to 18.9%. Important causes of mortality indirectly related to epilepsy include drowning, head injury, and burns. Epilepsy in LMICs has a significantly greater premature mortality, as in high-income countries, but in LMICs the excess mortality is more likely to be associated with causes attributable to lack of access to medical facilities such as status epilepticus, and preventable causes such as drowning, head injuries, and burns. This excess premature mortality could be substantially reduced with education about the risk of death and improved access to treatments, including AEDs. [ABSTRACT FROM AUTHOR]

Introduction: Numbers of hematopoietic cell transplants continue to increase globally but most of this activity is in resource-rich countries. Limitations to increasing transplant activity in resource-poor countries include lack of sophisticated personnel and infrastructure, complexity in identifying and accessing donors, unavailability of some new drugs and high cost., Areas Covered: We searched the biomedical literature for hematopoietic cell transplants and resource-rich and resource-poor countries. Recent advances which potentially make transplants more accessible in resource-poor countries include: (1) outpatient transplants; (2) grafts stored at 4°C; (3) less intensive pretransplant conditioning; (4) use of generic drugs; (5) less complex and costly donor access; and (6) increased collaboration with transplant centers in resource-rich countries., Expert Opinion: We reviewed publications on the limitations and solutions discussed above. Paradoxically, most data we analyzed originate from resource-rich countries. We found no convincing epidemiological data to support a recent increased transplant rate in resource-poor countries yet but hope to see increases soon.

Background: Current evidence suggests that palliative care education can improve preregistration nursing students' competencies in palliative care. However, it is not known whether these competencies are translated into students' practice in the care of patients who are approaching the end of life. This paper seeks to contribute to the palliative care evidence base by examining how nursing students in receipt of education report transfer of learning to practice, and what the barriers and facilitators may be, in a resource-poor country. Methods: We utilised focus groups and individual critical incident interviews to explore nursing students' palliative care learning transfer. Three focus groups, consisting of 23 participants and 10 individual critical incident interviews were conducted with preregistration nursing student who had attended a palliative care course in Cameroon and had experience caring for a patient approaching the end of life. Data was analysed thematically, using the framework approach. Results: The results suggest that nursing students in receipt of palliative care education can transfer their learning to practice. Students reported recognizing patients with palliative care needs, providing patients with physical, psychosocial and spiritual support and communicating patient information to the wider care team. They did however perceive some barriers to this transfer which were either related to themselves, qualified nurses, the practice setting or family caregivers and patients. Conclusion: The findings from this study suggest that nursing student in receipt of palliative care education can use their learning in practice to provide care to patients and their families approaching the end of life. Nevertheless, these findings need to be treated with some caution given the self-reported nature of the data. Demonstrating the link between preregistration palliative care education and patient care is vital to ensuring that newly acquired knowledge and skills are translated and embedded into clinical practice. This study also has implications for advocating for palliative care policies and adequately preparing clinical placement sites for students' learning and transfer of learning. [ABSTRACT FROM AUTHOR]

Background We undertook a modified systematic review of research regarding educational approaches to and effectiveness of pre-registration palliative care nursing, to inform the development of a short course in palliative care for pre-registration nursing students in Cameroon. The aim of this review was to examine educational approaches applied to pre-registration palliative care nursing education and their effectiveness, and to discuss implications for the development of palliative care curricula in resource-poor countries. Method A modified systematic review of research on palliative care educational interventions, conducted with pre-registration student nurses was undertaken. Relevant literature was gathered from CINAHL, EMBASE, MEDLINE and PsychINFO databases for the period 2000-2013. Inclusion was limited to studies of educational interventions evaluating the effectiveness and outcomes of palliative and end of life care education with pre-registration student nurses. Results 17 studies were found, all of which were conducted in resource-rich countries: United States of America, Canada, Australia, and United Kingdom. Palliative care nursing education at pre- registration level is either delivered as a discrete course within the curriculum or palliative care content is embedded into other nursing specialty courses throughout the wider curriculum. Palliative care education is delivered to students at a variety of stages in their nursing program, using a mix of both didactic and experiential educational strategies. Course facilitators span palliative care specialists, educators who have attended 'train-the-trainer' courses in palliative care, and nurses with hospice experience. Education is underpinned by transformative and experiential learning theories and reported as effective in improving students' attitudes towards care of the dying. Conclusion The educational strategies identified in this review may be applicable to resource-poor countries. However, there are challenges in transferability because of the lack of availability of specialist palliative care practitioners who can serve as educators, specialist palliative care units/institutions for experiential learning, funds to design and use high fidelity simulations, and palliative care textbooks and other educational materials. There is thus a need for innovative educational strategies that can bridge these barriers in resource-poor countries. There is also a need for further research into how palliative care education impacts on pre- registration student nurses' knowledge and practice. [ABSTRACT FROM AUTHOR]

Until very recently, the problem of infertility in developing countries has been ignored at all levels of healthcare management. Because many preventable or treatable diseases still claim millions of lives, and due to limited resources, provision of infertility care is not on the resource allocation agenda at all, prevention of sexually transmitted diseases remaining the number one priority. Tubal infertility due to sexually transmitted diseases, unsafe abortion and post-partum pelvic infections is the main cause of infertility. Most cases are only treatable with assisted reproduction technology, which are either unavailable or too costly. In December 2007, an expert meeting was organized in Arusha, Tanzania by the Walking Egg non-profit organization in co-operation with ESHRE. The meeting was the start of a global project aimed at increasing diagnostic and therapeutic options for childless couples in resource-poor countries. From the start, the Walking Egg Project has approached this problem in a multidisciplinary and global manner. It gathers medical, social, ethical, epidemiological, juridical and economic scientists to discuss and work together towards its goal. The final objective of the Walking Egg Project is the implementation of infertility services in many developing countries, preferably integrated in existing family planning and mother care services. [ABSTRACT FROM AUTHOR]

It is now around 30 years since the discovery of HIV, the virus that causes AIDS. More than 70 million people have been infected in that time and around 35 million have died. The majority of those currently living with HIV/AIDS are in low- and middle-income countries, with sub-Saharan Africa bearing a disproportionate burden of the global disease. In high-income countries, the introduction of antiretroviral therapy (ART) has drastically reduced the morbidity and mortality associated with HIV. Patients on ART are now predicted to have near-normal life expectancy and the role of treatment is increasingly recognized in preventing new infections. In low- and middle-income countries, treatment is now more widely available and around half of those who need ART are currently receiving it. Early diagnosis of HIV is essential if ART is to be optimally implemented. Lab-based diagnostics for screening, diagnosis, treatment initiation, and the monitoring of treatment efficacy are critical in managing the disease and reducing the number of new infections each year. The introduction of point-of-care HIV rapid tests has transformed the epidemic, particularly in low- and middle-income countries. For the first time, these point-of-care tests allow for the rapid identification of infected individuals outside the laboratory who can undergo counseling and treatment and, in the case of pregnant women, allow the timely initiation of ART to reduce the risk of vertical transmission. Although survival is markedly improved with ART even in the absence of laboratory monitoring, long-term management of people living with HIV on ART, and their partners, is essential to ensure successful viral suppression. The burden of disease in many resource-poor settings with high HIV prevalence has challenged the ability of local laboratories to effectively monitor those on ART. Diagnostics used to initiate and monitor treatment are now moving out of the laboratory and into the field. These new point-of-care tests for viral load and CD4 are poised to further transform the disease and shift the treatment paradigm in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Objective: This review examines the best available evidence on the aetiology of childhood acute non-traumatic coma in resource-poor countries (RPCs), discusses the challenges associated with management, and explores strategies to address them. Methods: Publications in English and French which reported on studies on the aetiology of childhood non-traumatic coma in RPCs are reviewed. Primarily, the MEDLINE database was searched using the keywords coma, unconsciousness, causality, aetiology, child, malaria cerebral, meningitis, encephalitis, Africa, Asia, and developing countries. Results: 14 records were identified for inclusion in the review. Cerebral malaria (CM) was the commonest cause of childhood coma in most of the studies conducted in Africa. Acute bacterial meningitis (ABM) was the second most common known cause of coma in seven of the African studies. Of the studies in Asia, encephalitides were the commonest cause of coma in two studies in India, and ABM was the commonest cause of coma in Pakistan. Streptococcus pneumoniae was the most commonly isolated organism in ABM. Japanese encephalitis, dengue fever and enteroviruses were the viral agents most commonly isolated. Conclusion: Accurate diagnosis of the aetiology of childhood coma in RPCs is complicated by overlap in clinical presentation, limited diagnostic resources, disease endemicity and co-morbidity. For improved outcomes, studies are needed to further elucidate the aetiology of childhood coma in RPCs, explore simple and practical diagnostic tools, and investigate the most appropriate specific and supportive interventions to manage and prevent infectious encephalopathies. [ABSTRACT FROM AUTHOR]

Background: Malaria control has been dramatically scaled up the past decade, mainly thanks to increasing international donor financing since 2003. This study assessed progress up to 2010 towards global malaria impact targets, in relation to Global Fund, other donor and domestic malaria programme financing over 2003 to 2009. Methods: Assessments used domestic malaria financing reported by national programmes, and Global Fund/OECD data on donor financing for 90 endemic low- and middle-income countries, WHO estimates of households owning one or more insecticide-treated mosquito net (ITN) for countries in sub-Saharan Africa, and WHO-estimated malaria case incidence and deaths in countries outside sub-Saharan Africa. Results: Global Fund and other donor funding is concentrated in a subset of the highest endemic African countries. Outside Africa, donor funding is concentrated in those countries with highest malaria mortality and case incidence rates over the years 2000 to 2003. ITN coverage in 2010 in Africa, and declines in case and death rates per person at risk over 2004 to 2010 outside Africa, were greatest in countries with highest donor funding per person at risk, and smallest in countries with lowest donor malaria funding per person at risk. Outside Africa, all-source malaria programme funding over 2003 to 2009 per case averted ($56-5,749) or per death averted ($58,000-3,900,000) over 2004 to 2010 tended to be lower (more favourable) in countries with higher donor malaria funding per person at risk. Conclusions: Increases in malaria programme funding are associated with accelerated progress towards malaria control targets. Associations between programme funding per person at risk and ITN coverage increases and declines in case and death rates suggest opportunities to maximize the impact of donor funding, by strategic re-allocation to countries with highest continued need. [ABSTRACT FROM AUTHOR]

BACKGROUND Not being able to procreate has severe social and economic repercussions in resource-poor countries. The purpose of this research was to explore the consequences of female and/or male factor infertility for men and women in Rwanda. METHODS Both quantitative and qualitative methods were used. Couples presenting with female and/or male factor infertility problems at the infertility clinic of the Kigali University Teaching Hospital (n= 312), and fertile controls who recently delivered (n= 312), were surveyed about domestic violence, current and past relationships and sexual functioning. In addition, five focus group discussions were held with a subsample of survey participants, who were either patients diagnosed with female- or male-factor fertility or their partners. RESULTS Domestic violence, union dissolutions and sexual dysfunction were reported more frequently in the survey by infertile than fertile couples. The psycho-social consequences suffered by infertile couples in Rwanda are severe and similar to those reported in other resource-poor countries. Although women carry the largest burden of suffering, the negative repercussions of infertility for men, especially at the level of the community, are considerable. Whether the infertility was caused by a female factor or male factor was an important determinant for the type of psycho-social consequences suffered. CONCLUSIONS In Rwanda, as in other resource-poor countries, infertility causes severe suffering. There is an urgent need to recognize infertility as a serious reproductive health problem and to put infertility care on the public health agenda. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study examines perceptions of infertility causes, treatment-seeking behaviour and factors associated with seeking medical care in an urban infertile population in Rwanda, as well as the response of health providers. [ABSTRACT FROM PUBLISHER]

To cite this article: Int J Dent Hygiene 8, 2010; 159–168 DOI: 10.1111/j.1601-5037.2010.00461.x Priebe SL, Aleksejūnienė J, Zed C, Dharamsi S, Thinh DHQ, Hong NT, Cuc TTK, Thao NTP. Oral squamous cell carcinoma and cultural oral risk habits in Vietnam. Objectives: In South-Central Asia, 80% of head and neck cancers are found in the oral cavity and oropharynx. In Vietnam, oral cancer is often not being detected until people experience debilitating circumstances to normal oral function. The aims of the study were to explore the patterns of oral squamous cell carcinoma (OSCC) and its risk indicators, the structure of oral health care in Vietnam and trends in prevalence of cultural risk habits in southern Vietnamese patients. Materials and Methods: A retrospective clinical study was performed from 1 July 2005 to 1 April 2006 at Ho Chi Minh City Oncology hospital in Vietnam. Of the 161 cases, 147 subjects were diagnosed with OSCC, including 100 male and 47 female adults aged 24–85 years. Data were collected by a structured interview and clinical examination. Results: Over 40% of the women with OSCC reported chewing betel quid and the most prevalent risk habit in males was smoking (91.0%). Daily alcohol use was reported by 79.0% of males and 2.1% of females. Two-thirds of the cases of OSCC were diagnosed at the 2nd and 3rd stage of cancer. The more advanced stages of cancer were observed in males than in females. The prevalence of tobacco and alcohol use in males with OSCC was higher in this study than in the previous Vietnamese studies. Conclusion: High frequency of risk habits in both genders was reported in OSCC Vietnamese patients. A trend of increased tobacco and alcohol use was observed in male OSCC patients. A lower prevalence of later staging in Vietnam was observed in this study than in earlier studies. [ABSTRACT FROM AUTHOR]

With 700 000 to 1.5 million new cases annually, congenital syphilis remains a major infectious cause of morbidity and mortality in neonates, infants and children in resource-poor countries. We therefore analyzed the extent of congenital syphilis in the pediatric patient population at our rural hospital in Tanzania. For this retrospective analysis, from January 1, 1998 to August 31, 2000, all cases of congenital syphilis were collected from the medical records of the neonatal and pediatric department at Haydom Lutheran Hospital in rural northern Tanzania. Age, sex, weight, clinical signs and symptoms, venereal disease research laboratory (VDRL) results of mother and/or child, hemoglobin concentration, treatment, and outcome were recorded and analyzed. Fourteen neonates and infants were included. The earlier the diagnosis, the more it rested on maternal data because the presentation of neonatal congenital syphilis resembled neonatal sepsis. Syphilitic skin lesions were only seen in the post-neonatal age group. VDRL results were positive in 11 of the 14 mothers, and in 4 of the infants. Anemia was common in older infants. No patient showed signs of central nervous system involvement. Two patients died, and the remaining were cured after standard treatment with procaine penicillin. Highlighting the variable picture of congenital syphilis, this report demonstrates how difficult it is to make a correct diagnosis by solely history and clinical presentation in a resource-poor setting. Hence false-positive and false-negative diagnoses are common, and clinicians have to maintain a high index of suspicion in diagnosing congenital syphilis. Therefore, an important approach to control and finally eliminate congenital syphilis as a major public health problem will be universal on-site syphilis screening of all pregnant women at their first antenatal visit and immediate treatment for those who test positive. [ABSTRACT FROM AUTHOR]

We design a mobile diagnostic laboratory model that overcomes cost and complexity barriers to implementing ‘individual-centered three tests’ in monitoring HIV patients in resource-poor settings: the ‘Mobile Life Box’. We previously described a ‘three-test’ combo kit model for improving HIV patient monitoring standards in resource-poor settings: SMARThivPack. SMARThivPack model overcomes primary barriers such as technology cost and complexity. However, SMARThivPack model does not address secondary barriers such as refrigerators, power supply, internet connection and waste management systems. Previously developed mobile laboratory systems overcome the secondary barriers, and Partec mobile CD4 counting laboratory demonstrated the feasibility of mobile HIV patient monitoring in resource-poor settings. Here we describe a model diagnostic laboratory system that extends mobile HIV patient monitoring, from a ‘single’ CD4 test, to ‘three’ CD4, viral load and pharmacoresistance tests. [ABSTRACT FROM AUTHOR]

Background and Objective Haemorrhage from ruptured ectopic pregnancy is a major cause of maternal death in Africa. The experience in three hospitals in salvaging intraperitoneal blood with a perforated metallic conical funnel is reported. Method The blood was transfused back to the patient immediately after salvaging. Data were collected concerning the patient, her clinical state and haemoglobin levels throughout her stay in hospital, the diagnosis, the transfusion, and the complications encountered. Results Two hundred and twelve patients were reported prospectively. The preoperative haemoglobin level was 70·6 ± 18·7 g/l ( n = 132). After transfusion of 681 ± 389 ml ( n = 212) of salvaged blood, haemoglobin levels reached 84·7 ± 10·5 g/l ( n = 23) 6 days postoperatively. Twenty-two patients, half of whom had a life-threatening haemodynamic state, were also given donor blood. Twenty patients still had severe anaemia on leaving hospital (blood haemoglobin < 70 g/l). No untoward outcomes attributable to the reinfusion were seen. Conclusion The surgical treatment of ruptured ectopic pregnancy with intraperitoneal haemorrhage was rendered safe and efficient with this new salvaging equipment. [ABSTRACT FROM AUTHOR]

Abstract: Infertility is a central issue in the lives of many couples who suffer from it. In resource-poor countries the problem of childlessness is even more pronounced compared with Western societies owing to different sociocultural circumstances. It often leads to severe psychological, social, and economic suffering, and access to infertility treatment is often limited to certain procedures and certain costumers. The issue of infertility in resource-poor countries is underestimated and neglected, not only by local governments but also by the international nonprofit organizations. Simplification of the diagnostic and therapeutic procedures, minimizing the complication rate, and incorporating fertility centers into existing reproductive healthcare programs are essential measures to take in resource-poor countries if infertility treatment is to be accessible for a large part of the population. For reasons of social justice, a search for strategies to implement simplified methods of infertility diagnosis and treatment in resource-poor countries is urgently warranted. [Copyright &y& Elsevier]

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Until the 1980s, little attention had been accorded to endemic Kaposi's sarcoma (KS), a neoplasm noted in several parts of Southern Europe and the African continent but with relatively slow progression, except in children and young adults. Furthermore, therapeutic approaches based on surgery, radiation and topical treatment were of limited efficacy, mostly used to overcome the disabling and stigmatizing effects of the disease. With the emergence of the HIV/AIDS epidemic, and the profound impact of KS on AIDS-related mortality, the pathogenesis of KS has been better studied, and the realisation that a virus (KS-associated Herpesvirus or Human Herpesvirus 8, or KSHV/HHV-8), combined with immunosuppression and cytokine-induced growth, was responsible for the development of this disease has led to novel therapeutic approaches. These are unfortunately still highly toxic, require careful monitoring, and are expensive, thus limiting their use in most parts of Africa. However, the use of highly active antiretroviral therapy (HAART), which has led to a considerable decline in KS incidence in populations of industrialized countries, constitutes the best hope for the control of this stigmatizing and lethal disease in Africa. Trials comparing different regimens of antiretroviral drugs in combination with systemic chemotherapeutic agents are urgently needed. [ABSTRACT FROM AUTHOR]

Because of the paucity of plasma HIV RNA viral load (VL) tests in resource-poor settings, the CD4+ T cell count is often used as the sole laboratory marker to evaluate the effectiveness of antiretroviral therapy (ART) in HIV-infected patients. In untreated patients, the level of activated T cells is positively correlated with VL and represents a prognostic marker of HIV infection. However, little is known about its value to predict early drug failure, taking into account the relatively high non-specific immune activation background observed in many resource-limited tropical countries. We assessed the use of immune activation markers (expression of CD38 and/or human leucocyte antigen-DR on CD8+ lymphocytes) to predict virological response to ART in a cohort of HIV-1 infected patients in Abidjan, Côte d’Ivoire. Correlations between VL, absolute CD4+ T cell counts and immune activation levels were examined in 111 HIV patient samples at baseline and after 6 and 12 months of therapy. The percentage of CD38+ CD8+ T cells appeared to be the best correlate of VL. In contrast, changes in CD4+ T cell counts provided a poor correlate of virological response to ART. Unfortunately, CD38+ CD8+ percentages lacked specificity for the determination of early virological drug failure and did not appear to be reliable surrogates of RNA viral load. CD38+ CD8+ T cell percentages may, rather, provide a sensitive estimate of the overall immune recovery, and be a useful extra laboratory parameter to CD4 counts that would contribute to improve the clinical management of HIV-infected people when VL testing facilities are lacking. [ABSTRACT FROM AUTHOR]

Abstract: Despite the recommendation of the World Health Organization (WHO) to provide the first hepatitis B vaccine dose at birth (within 24h), there are epidemiological, economic and logistical reasons why this may not be the best approach for home births in Africa. The WHO policy presupposes that the epidemiology of hepatitis B infection in Africa is similar to the rest of the world and that the organizational, infrastructural and financial support is adequate. While babies born in health facilities may be relatively easy to immunize at birth, health systems and infrastructures in many resource-poor countries in Africa would be severely challenged, if required to reach home deliveries within 24h of birth. [Copyright &y& Elsevier]

The number of children accompanying their parents in international travel is increasing steadily, and with the rising global migration, children more frequently accompany their parents or caregivers for visiting friends or relatives (VFR). As compared to travel for tourism, VFR children are at higher risk of acquiring local diseases, as they more often stay in rural areas in resource-poor locations, have longer periods of visit, are less likely to attend pre-travel consultations, and less frequently adhere to recommended precautions. Travelers's diarrhea (TD) is the most common travel-associated illnesses in children. This review updates the existing knowledge on TD in children, regarding its distinctive epidemiology, risk factors, preventive measures, clinical manifestations, complications, causative microorganisms and management. Despite the limited focused research on pediatric TD, which challenges the formulation of children-oriented evidence-based guidelines, practical recommendations are suggested. [ABSTRACT FROM AUTHOR]

Women in low- and middle-income countries have high rates of perinatal depression. As smartphones become increasingly accessible around the world, there is an opportunity to explore innovative mHealth tools for the prevention, screening, and management of perinatal depression. We completed a scoping review of the literature pertaining to the use of mobile phone technologies for perinatal depression in low-and middle-income countries. PubMed CINHAL, and Google Scholar databases were searched, generating 423 results. 12 articles met our inclusion criteria. Two of the 12 articles reviewed mobile phone applications. The remaining 9 articles were study protocols or descriptive/intervention studies. Our results reveal that minimal literature is currently available on the use of mobile health for perinatal depression in low- and middle-income countries. We found four articles that present the results of an intervention that were delivered through mobile phones for the treatment of perinatal depressive symptoms and an additional qualitative study describing the perceptions of mothers receiving cognitive behavioral therapy via telephones. These studies demonstrated that depressive symptoms improved after the interventions. There is potential to improve the quality of mHealth interventions, specifically mobile phone applications for perinatal depressive symptoms and depression, through meaningful collaborative work between healthcare professionals and application developers.

Background: The majority of blood transfusion safety strategies recommended by the WHO for resource-poor countries focus mainly on reducing the risk of transfusion-transmitted infections (TTIs). Other technologies such as leucocyte reduction may represent complementary strategies for improving transfusion safety., Objective: To evaluate the role of using leucocyte reduced blood in a resource-poor country., Methods: Pre-storage leucocyte reduced (LR) red blood cells (RBCs) were specially prepared for the Tissue Oxygenation by Transfusion in severe Anaemia and Lactic acidosis (TOTAL) study, at the Uganda Blood Transfusion Services from February 2013 through May 2015. Quality control tests were performed to evaluate the procedure, and the incremental cost of an LR-RBC unit was estimated., Results: A total of 608 RBCs units were leucocyte reduced. Quality control tests were performed on 55 random RBCs units. The median (IQR) residual leucocyte count was 4 (0·5-10) WBC/uL, equivalent to 1·8x106 WBC per unit. The estimated incremental unit cost of leucocyte reduction was $37 USD per LR RBC unit., Conclusion: Leucocyte reduction of blood in a resource-poor country is doable although relatively costly. As such, its value in resource-poor countries should be weighed against other transfusion safety propositions., (© 2020 Dhabangi A et al.)