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We report existing evidence and gaps in neuropathic pain management in Saudi Arabia, the prevalence and patient management stages in diabetic peripheral neuropathy (DPN) and low back pain (LBP) with a neuropathic component. A semi-systematic approach was adopted to identify data on neuropathic pain. A structured search was conducted through MEDLINE, Embase, and BIOSIS databases to identify articles published in English between January 2010 and December 2019. Unstructured search was conducted through various sources including Google Scholar and Saudi Arabia's Ministry of Health website. Studies including populations ≥18 years and neuropathic pain were included; data gaps were supplemented with anecdotal data from local experts. Weighted or simple means were calculated for overall data; synthesized evidence was represented as an evidence gap map. Of 37 articles retrieved from structured search, none were eligible for final analyses. Thirteen articles from unstructured search and two anecdotal data sources were included for final analyses. The majority of articles included were of cross-sectional design (n = 10) in diabetes patients. The mean (range; number of articles) DPN prevalence was estimated as 33.6% (5.6%–65.3%; n = 8). Data on DPN patient management stages were limited; synthesized evidence indicated that 37.2% (0.41%–80.0%; n = 3) of patients had DPN awareness, 17.8% (n = 1) underwent screening, 22.4% (18.4%–65.3%; n = 2) had DPN diagnosis, and 45.1% (0.0%–62.7%; n = 2) received treatment for pain management. Data on LBP with neuropathic component were scarce (prevalence, 41.0% [n = 1]; diagnosis, 54.7% [n = 1]). Data are limited, so more studies are needed to accurately estimate the prevalence and stages of patient management for neuropathic pain in the country.

Objectives: Noncommunicable diseases (NCDs) are the leading cause of mortality in all Gulf Cooperation Council (GCC) member countries and place a substantial economic burden on the governments and people. The escalating demand for NCD-related health services takes an enormous toll on health systems in these countries. There is an urgent need to make significant advances in the healthcare infrastructure and develop strategies to overcome the NCD challenge. This review aims to provide the status of national healthcare systems and national NCD policies in GCC countries to highlight the challenges and identify opportunities towards strengthening NCD management and control. Methods: We searched the PubMed database, the World Health Organization, and the Ministry of Health websites of GCC countries to identify relevant information. Results: Future strategies and investments in healthcare infrastructure to overcome the NCD challenge include continuing high-level commitment towards multisectoral actions, redesigning healthcare delivery to advance universal healthcare coverage, enabling integration of healthcare services through organizational alignment to maintain care continuum, building the capacity of health workforce, developing effective treatment strategies through research based on local populations, integrating mental health into general public health policy, and lastly, establishing reliable NCD surveillance and monitoring programs. Conclusions: Measures to address NCDs must be continued with focus on health-in-all policies, and whole-of-government and whole-of-society approaches.

In South Asia, maternal and child undernutrition is common with consequences for short- and long-term health. In the MINIMat trial (Maternal and Infant Nutrition Interventions in Matlab) in Bangladesh 4436 pregnant women were allocated to early or later start of food supplements and different micronutrient alternatives. Children of mothers who received food supplementation from week 9 combined with multiple micronutrients showed a halved infant mortality rate. The early initiation of prenatal food supplementation reduced the risk of stunting up to five years and was associated with more favourable metabolic markers. The MINIMat study is run by icddr,b in Bangladesh and Uppsala University in collaboration with seven other universities. Twenty Ph.D. students have so far defended their theses and more than 100 scientific papers have been published.

Mental health disorders are a burgeoning global public health challenge, and disproportionately affect the poor. Low- and middle-income countries (LMICs) bear 80 % of the mental health disease burden. Stigma associated with mental health results in delayed help seeking, reduced access to health services, suboptimal treatment, poor outcomes and an increased risk of individuals' human rights violations. Moreover, widespread co-occurrence of physical comorbidities such as noncommunicable diseases with mental health disorders makes the treatment of both conditions challenging and worsens prognosis. This paper explores various aspects of stigma towards mental health with a focus on LMICs and assesses measures to increase help-seeking and access to and uptake of mental health services. Stigma impacts persons living with mental illness, their families and caregivers and healthcare professionals (mental health professionals, non-psychiatric specialists and general practitioners) imparting mental health care. Cultural, socio-economic and religious factors determine various aspects of mental health in LMICs, ranging from perceptions of health and illness, health seeking behavior, attitudes of the individuals and health practitioners and mental health systems. Addressing stigma requires comprehensive and inclusive mental health policies and legislations; sustainable and culturally-adapted awareness programs; capacity building of mental health workforce through task-shifting and interprofessional approaches; and improved access to mental health services by integration with primary healthcare and utilizing existing pathways of care. Future strategies targeting stigma reduction must consider the enormous physical comorbidity burden associated with mental health, prioritize workplace interventions and importantly, address the deterioration of population mental health from the COVID-19 pandemic.

Supplementary file. (DOCX 17 kb)

Study timeline. (PDF 182 kb)

Spirit checklist. (DOC 112 kb)

The global landscape of molecular testing is rapidly changing, with the recent publication of the International Association for the Study of Lung Cancer (IASLC)/College of American Pathologists (CAP) guidelines and the ALK Atlas. The IASLC/CAP guidelines recommend that tumors from patients with non-small cell lung cancer (NSCLC) be tested for ALK rearrangements in addition to epidermal growth factor receptor (EGFR) mutations. The spur for this recommendation is the availability of novel therapies that target these rearrangements. This article is based on coverage of a Pfizer-sponsored National Working Group Meeting on ALK Diagnostics in Lung Cancer, held around the 15th World Lung Cancer Conference, in Sydney on October 31, 2013. It is based on the presentations given by the authors at the meeting and the discussion that ensued. The content for this article was discussed and agreed on by the authors.

This paper reports on a population-based sample survey of 2,289 children aged less than five years (under-five children) conducted in 2000 as a baseline for the Bangladesh component of the Multi-country Evaluation (MCE) of the Integrated Management of Childhood Illness strategy. Of interest were rates and differentials by sex and socioeconomic status for three aspects of child health in rural Bangladesh: morbidity and hospitalizations, including severity of illness; care-seeking for childhood illness; and home-care for illness. The survey was carried out among a population of about 380,000 in Matlab upazila (subdistrict). Generic MCE Household Survey tools were adapted, translated, and pretested. Trained interviewers conducted the survey in the study areas. In total, 2,289 under-five children were included in the survey. Results showed a very high prevalence of illness among Bangladeshi children, with over two-thirds reported to have had at least one illness during the two weeks preceding the survey. Most sick children in this population had multiple symptoms, suggesting that the use of the IMCI clinical guidelines will lead to improved quality of care. Contrary to expectations, there were no significant differences in the prevalence of illness either by sex or by socioeconomic status. About one-third of the children with a reported illness did not receive any care outside the home. Of those for whom outside care was sought, 42% were taken to a village doctor. Only 8% were taken to an appropriate provider, i.e. a health facility, a hospital, a doctor, a paramedic, or a community-based health worker. Poorer children than less-poor children were less likely to be taken to an appropriate healthcare provider. The findings indicated that children with severe illness in the least poor households were three times more likely to seek care from a trained provider than children in the poorest households. Any evidence of gender inequities in child healthcare, either in terms of prevalence of illness or care-seeking patterns, was not found. Care-seeking patterns were associated with the perceived severity of illness, the presence of danger signs, and the duration and number of symptoms. The results highlight the challenges that will need to be addressed as IMCI is implemented in health facilities and extended to address key family and community practices, including extremely low rates of use of the formal health sector for the management of sick children. Child health planners and researchers must find ways to address the apparent population preference for untrained and traditional providers which is determined by various factors, including the actual and perceived quality of care, and the differentials in care-seeking practices that discriminate against the poorest households.

The global landscape of molecular testing is rapidly changing, with the recent publication of the International Association for the Study of Lung Cancer (IASLC)/College of American Pathologists (CAP) guidelines and the ALK Atlas. The IASLC/CAP guidelines recommend that tumors from patients with non-small cell lung cancer (NSCLC) be tested for ALK rearrangements in addition to epidermal growth factor receptor (EGFR) mutations. The spur for this recommendation is the availability of novel therapies that target these rearrangements. This article is based on coverage of a Pfizer-sponsored National Working Group Meeting on ALK Diagnostics in Lung Cancer, held around the 15th World Lung Cancer Conference, in Sydney on October 31, 2013. It is based on the presentations given by the authors at the meeting and the discussion that ensued. The content for this article was discussed and agreed on by the authors.

Growth patterns in early life are associated with later health. The effect of nutrition during in utero development on later body composition is unclear. We evaluated whether prenatal early invitation to food and/or multiple micronutrient supplementation (MMS) in pregnancy has an effect on offspring body composition at 54 months of age. In Maternal and Infant Nutrition Interventions in Matlab trial (ISRCTN16581394) in Bangladesh, 4436 pregnant women were randomised into six equally sized groups: double‐masked supplementation with capsules of either 30 mg Fe and 400 μg folic acid, or 60 mg Fe and 400 μg folic acid, or MMS (15 micronutrients), was combined with a randomised early invitation (around 9 weeks) or a usual invitation (around 20 weeks) to start food supplementation (608 kcal 6 days per week). At 54 months, the body composition of the offspring was assessed by leg‐to‐leg bioelectrical impedance analysis. Of the 3267 live singletons with birth anthropometry, 2290 children were measured at 54 months, representing 70% of the live births. There was no interaction between the food and micronutrient supplementation on body composition outcomes. There were no significant differences in a range of anthropometric and body composition measurements, including weight, height, mid‐upper arm circumference, head circumference, skinfold thickness, and fat mass and fat‐free mass between the different prenatal food and micronutrient groups using an intention‐to‐treat analysis. This analysis shows that early invitation to food supplementation and MMS provided to rural Bangladeshi women during pregnancy did not affect offspring body composition at 54 months of age.

Context Nutritional insult in fetal life and small size at birth are common in low-income countries and are associated with serious health consequences. Objectives To test the hypothesis that prenatal multiple micronutrient supplementation (MMS) and an early invitation to food supplementation would increase maternal hemoglobin level and birth weight and decrease infant mortality, and to assess whether a combination of these interventions would further enhance these outcomes. Design, Setting, and Participants A randomized trial with a factorial design in Matlab, Bangladesh, of 4436 pregnant women, recruited between November 11, 2001, and October 30, 2003, with follow-up until June 23, 2009. Interventions Participants were randomized into 6 groups; a double-masked supplementation with capsules of 30 mg of iron and 400 μg of folic acid, 60 mg of iron and 400 μg of folic acid, or MMS containing a daily allowance of 15 micronutrients, including 30 mg of iron and 400 μg of folic acid, was combined with food supplementation (608 kcal 6 days per week) randomized to either early invitation (9 weeks' gestation) or usual invitation (20 weeks' gestation). Main Outcome Measures Maternal hemoglobin level at 30 weeks' gestation, birth weight, and infant mortality. Under 5-year mortality was also assessed. Results Adjusted maternal hemoglobin level at 30 weeks' gestation was 115.0 g/L (95% CI, 114.4-115.5 g/L), with no significant differences among micronutrient groups. Mean maternal hemoglobin level was lower in the early vs usual invitation groups (114.5 vs 115.4 g/L; difference, −0.9 g/L; 95% CI, −1.7 to −0.1; P = .04). There were 3625 live births out of 4436 pregnancies. Mean birth weight among 3267 singletons was 2694 g (95% CI, 2680-2708 g), with no significant differences among groups. The early invitation with MMS group had an infant mortality rate of 16.8 per 1000 live births vs 44.1 per 1000 live births for usual invitation with 60 mg of iron and 400 μg of folic acid (hazard ratio [HR], 0.38; 95% CI, 0.18-0.78). Early invitation with MMS group had an under 5-year mortality rate of 18 per 1000 live births (54 per 1000 live births for usual invitation with 60 mg of iron and 400 μg of folic acid; HR, 0.34; 95% CI, 0.18-0.65). Usual invitation with MMS group had the highest incidence of spontaneous abortions and the highest infant mortality rate. Conclusion Among pregnant women in poor communities in Bangladesh, treatment with multiple micronutrients, including iron and folic acid combined with early food supplementation, vs a standard program that included treatment with iron and folic acid and usual food supplementation, resulted in decreased childhood mortality. Trial Registration isrctn.org Identifier: ISRCTN16581394

The door-to-door distribution of contraceptives and information on maternal and child health and family planning (MCH-FP) services, through bimonthly visits to eligible couples by trained fieldworkers, has been instrumental in increasing the contraceptive prevalence rate and immunization coverage in Bangladesh. The doorstep delivery strategy, however, is labour-intensive and costly. More cost-effective service delivery strategies are needed, not only for family planning services but also for a broader package of reproductive and other essential health services. Against this backdrop, operations research was conducted by the Centre for Health and Population Research at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) from January 1996 to May 1997, in collaboration with government agencies and a leading national nongovernmental organization, with a view to developing and field-testing alternative approaches to the delivery of MCH-FP services in urban areas. Two alternative strategies featuring the withdrawal of home-based distribution and the delivery of basic health care from fixed-site facilities were tested in two areas of Dhaka. The clinic-based service delivery strategy was found to be a feasible alternative to the resource-intensive doorstep system in urban Dhaka. It did not adversely affect programme performance and it allowed the needs of clients to be addressed holistically through a package of essential health and family planning services.

Antimicrobial resistance of Shigella isolates in Bangladesh, during 2001-2002, was studied and compared with that of 1991-1992 to identify the changes in resistance patterns and trends. A significant increase in resistance to trimethoprim-sulphamethoxazole (from 52% to 72%, p0.01) and nalidixic acid (from 19% to 51%, p0.01) was detected. High, but unchanged, resistance to tetracycline, ampicillin, and chloramphenicol, low resistance to mecillinam (resistance 3%, intermediate 3%), and to emergence of resistance to azithromycin (resistance 16%, intermediate 62%) and ceftriaxone/cefixime (2%) were detected in 2001-2002. Of 266 recent isolates, 63% were resistant toor =3 anti-Shigella drugs (multidrug-resistant [MDR]) compared to 52% of 369 strains (p0.007) in 1991-1992. Of 154 isolates tested by E-test in 2001-2002, 71% were nalidixic acid-resistant (minimum inhibitory concentration [MIC]or =32 microg/mL) and had 10-fold higher MIC90 (0.25 microg/mL) to ciprofloxacin than that of nalidixic acid-susceptible strains exhibiting decreased ciprofloxacin susceptibility, which were detected as ciprofloxacin-susceptible and nalidixic acid-resistant by the disc-diffusion method. These strains were frequently associated with MDR traits. High modal MICs were observed to azithromycin (MIC 6 microg/mL) and nalidixic acid (MIC 128 micdrog/mL) and low to ceftriaxone (MIC 0.023 microg/mL). Conjugative R-plasmids-encoded extended-spectrum beta-lactamase was responsible for resistance to ceftriaxone/cefixime. The growing antimicrobial resistance of Shigella is worrying and mandates monitoring of resistance. Pivmecillinam or ciprofloxacin might be considered for treating shigellosis with caution.

OBJECTIVE: The multi-country evaluation of Integrated Management of Childhood Illness (IMCI) effectiveness, cost and impact (MCE) is a global evaluation to determine the impact of IMCI on health outcomes and its cost-effectiveness. MCE studies are under way in Bangladesh, Brazil, Peru, Uganda and the United Republic of Tanzania. The objective of this analysis from the Bangladesh MCE study was to describe the quality of care delivered to sick children under 5 years old in first-level government health facilities, to inform government planning of child health programmes. METHODS: Generic MCE Health Facility Survey tools were adapted, translated and pre-tested. Medical doctors trained in IMCI and these tools conducted the survey in all 19 health facilities in the study areas. The data were collected using observations, exit interviews, inventories and interviews with facility providers. FINDINGS: Few of the sick children seeking care at these facilities were fully assessed or correctly treated, and almost none of their caregivers were advised on how to continue the care of the child at home. Over one-third of the sick children whose care was observed were managed by lower-level workers who were significantly more likely than higher-level workers to classify the sick child correctly and to provide correct information on home care to the caregiver. CONCLUSION: These results demonstrate an urgent need for interventions to improve the quality of care provided for sick children in first-level facilities in Bangladesh, and suggest that including lower-level workers as targets for IMCI case-management training may be beneficial. The findings suggest that the IMCI strategy offers a promising set of interventions to address the child health service problems in Bangladesh.

Članak daje pregled teoretskih i praktičnih pristupa postavljanju prioriteta prilikom ulaganja u istraživanje dječjega globalnog zdravlja. Daje i pregled prijašnjih pokušaja razvitka odgovarajućih alata i postupaka u području ulaganja u istraživanja o zdravlju. Napravljen je kratak pregled najvažnijih teoretskih postavki prema kojima bi se trebalo ravnati u postupku određivanja prioriteta. On je pokazao da će se različiti pristupi u postavljanju prioriteta, poput medicinskoga, gospodarskoga, zakonskoga, etičkoga, društvenoga, političkoga, pragmatičnoga, filozofskoga, onoga od poslodavaca i svih drugih nužno sukobiti. Posebno smo raspravili aktualne pravce istraživanja u području globalnoga dječjega zdravlja i njihov odnos prema Milenijskom cilju br. 4 organizacije Ujedinjenih naroda (UN), koji je da se između 1990. i 2015. dječja smrtnost smanji za dvije trećine. Procijenjena su postignuća pristupa koji su bili ranije primjenjivani i prikazane njihove prednosti i mane. Navedeni su razlozi organizacije Inicijativa za dječje zdravlje i prehranu (engl., Child Health and Nutrition Research Initiative) za stvaranje nove metodologije određivanja prioriteta u ulaganju u zdravstvena istraživanja i navedeni su razlozi za njezinu primjenu u području globalnoga dječjega zdravlja. Da bi se mogli obuhvatiti svi kutovi iz kojih je moguće promatrati prioritete ulaganja u istraživanja zdravlja nuždan je interdisciplinarni pristup. Određivanje prioriteta traži da njihovo stvaranje bude javno, jasno i sustavno i da u obzir uzme mnogobrojna gledišta i nastavi se na prednosti prethodnih pristupa., This article reviews theoretical and practical approaches to priority setting in global child health research investments. It also provides an overview of previous attempts to develop appropriate tools and methodologies to define priorities in health research investments. A brief review of the most important theoretical concepts that should govern priority setting processes is undertaken, showing how different perspectives, such as medical, economical, legal, ethical, social, political, rational, philosophical, stakeholder driven, and others will necessarily conflict each other in determining priorities. We specially address present research agenda in glob