This paper draws attention to the prospects of sea-based economy to promote Bangladesh in a middle-income country through the sustainable use of marine resources. About three-fourths of the earth is covered by the sea...This paper draws attention to the prospects of sea-based economy to promote Bangladesh in a middle-income country through the sustainable use of marine resources. About three-fourths of the earth is covered by the seas. It plays the vital role in two important functions from ancient time known as the means of communication and the source of huge living and non-living natural resources. At present, the countries are becoming very much concerned about their marine resources to resolve many of the present and future challenges of their economies. Generally for Bangladesh, ocean is contributing a significant role to its overall socio-economic progress through rising up the economic activities across the country and especially to the coastal zone at southern part. This paper investigates how much Bangladesh is capable to take of or handle the challenges to become a middle income country through the Sustainable Development Goals (SDGs). In addition, it has attempted with a closer-look to find out the barriers or limitations of these activities from different angles if exist.展开更多
BACKGROUND Human immunodeficiency virus(HIV)recency testing provides data that can be used to monitor the trend of new HIV infections.The effectiveness of using people identified with recent infection to identify part...BACKGROUND Human immunodeficiency virus(HIV)recency testing provides data that can be used to monitor the trend of new HIV infections.The effectiveness of using people identified with recent infection to identify partners with new HIV infection through partner notification services(PNS)is not well documented.AIM To determine the pooled prevalence of recency testing coverage,recent infection,reclassification(recent to longterm infection)and PNS cascade among newly diagnosed people living with HIV.METHODS PubMed,Cochrane Library and Embase were searched for articles published between January 2018 and November 2024.Studies were included if they reported recency coverage and/or PNS among people newly diagnosed with HIV and used recent infection testing algorithm(RITA).Recency coverage was defined as proportion of people tested using rapid testing for recent infection(RTRI)among those newly diagnosed with HIV.RITA further classifies RTRI results using viral load results(≥1000 copies/mL vs<1000 copies/mL)to confirm recency status.For studies with PNS,we evaluated the cascade:Number of partners elicited,successfully contacted,eligible for HIV testing,tested and HIV diagnosis.PNS effectiveness was measured by proportion of new HIV diagnoses from tested partners.Using random effects models,we computed the pooled estimate of recency outcomes and 95%confidence intervals(CIs).RESULTS Twenty-five studies from 17-low-and middle-income countries were included.Of 276315 newly diagnosed people living with HIV,79864 underwent RTRI with an overall pooled recency coverage of 87%(95%CI:67-96).The pooled prevalence of RTRI and RITA recency were 12%(95%CI:9-16)and 7%(95%CI:4-10),respectively.Pooled prevalence of RTRI reclassification was 34%(95%CI:22-49).Of the recent cases who agreed to PNS,253 partners were elicited with an estimated elicitation ratio of 1:1.6.Among partners elicited,99%were successfully contacted,75%were eligible for testing,68%tested for HIV,and 15%were diagnosed with HIV.CONCLUSION High recency testing coverage among newly diagnosed individuals demonstrates the feasibility of monitoring new HIV infections in LMIC.While PNS yielded moderate HIV diagnoses,its targeted approach remains a critical strategy for identifying undiagnosed cases.展开更多
The WHO declared the coronavirus disease 2019(COVID-19)outbreak as a public health emergency of international concern on January 30,2020,and then a pandemic on March 11,2020.COVID-19 affected over 200 countries and te...The WHO declared the coronavirus disease 2019(COVID-19)outbreak as a public health emergency of international concern on January 30,2020,and then a pandemic on March 11,2020.COVID-19 affected over 200 countries and territories worldwide,with 25,541,380 confirmed cases and 852,000 deaths associated with COVID-19 globally,as of September 1,2020.1 While facing such a public health emergency,hospitals were on the front line to deliver health care and psychological services.The early detection,diagnosis,reporting,isolation,and clinical management of patients during a public health emergency required the extensive involvement of hospitals in all aspects.The response capacity of hospitals directly determined the outcomes of the prevention and control of an outbreak.The COVID-19 pandemic has affected almost all nations and territories regardless of their development level or geographic location,although suitable risk mitigation measures differ between developing and developed countries.In low-and middle-income countries(LMICs),the consequences of the pandemic could be more complicated because incidence and mortality might be associated more with a fragile health care system and shortage of related resources.2-3 As evidenced by the situation in Bangladesh,India,Kenya,South Africa,and other LMICs,socioeconomic status(SES)disparity was a major factor in the spread of disease,potentially leading to alarmingly insufficient preparedness and responses in dealing with the COVID-19 pandemic.4 Conversely,the pandemic might also bring more unpredictable socioeconomic and long-term impacts in LMICs,and those with lower SES fare worse in these situations.This review aimed to summarize the responsibilities of and measures taken by hospitals in combatting the COVID-19 outbreak.Our findings are hoped to provide experiences,as well as lessons and potential implications for LMICs.展开更多
Little is known about the role of active school travel(AST)on mental health among adolescents.Thus,this study aimed to explore the AST-depression association among adolescents aged 12–15 years from 26 low-and middle-...Little is known about the role of active school travel(AST)on mental health among adolescents.Thus,this study aimed to explore the AST-depression association among adolescents aged 12–15 years from 26 low-and middle-income countries(LMICs).Data from the Global School-based Student Health Survey were analyzed in 51,702 adolescents[mean(SD)age 13.8(1.0)years;49.3%boys).Both depressive symptoms and AST were assessed by a single question self-reported measure,respectively.Participants who reported having 5 days or above were considered as AST.Multivariable logistic regression analysis(accounting for sampling weights)was performed while controlling for gender,age,physical activity,sedentary behavior,and food insecurity,and a countrywide meta-analysis was undertaken.The prevalence of depressive symptoms and AST were 30.1%and 37.0%,respectively.Compared with those not having AST,adolescents with AST were less likely to have self-reported depressive symptoms(OR=0.88,95%CI:0.85-0.93)regardless of gender.Countrywide meta-analysis demonstrated that having AST versus not having AST was associated with 12%lower odds for depressive symptoms(OR=0.88;95%CI:0.82-0.94)but with a moderate between-country heterogeneity(I^(2)=59.0%).Based on large samples of adolescents from LMICs,it would be expected that AST may play a critical role in preventing adolescent depression worldwide.However,it is necessary to consider more country-specific factors when implementing AST-related mental health interventions.Future studies should adopt the solid study design to confirm or negate our researchfindings.展开更多
In recent decades, the ecological environment has been increasingly challenged by the development of global industrialization and urbanization all over the world, even as global attention for health has raised dramati...In recent decades, the ecological environment has been increasingly challenged by the development of global industrialization and urbanization all over the world, even as global attention for health has raised dramatically. Common global environmental issues, such as air pollution and noise pollution, are associated with lasting impacts on health and contribute significantly to the overall burden of disease. Moreover, a global disparity exists between the burden of such environmental health issues and the global resources available to address this issue. To alleviate the environmental health impacts and ensure a sustainable future for human beings, China has made an important contribution to improving access to ecological protection, environmental governance, patriotic health campaigns, smart city construction, and so on. Experiences gained in China may be useful for some other countries, particularly the low- and middle-income countries with limited sources.展开更多
In this article we aim to discuss the burden of hypertension in middle-income countries, the challenges andopportunities, identify some implementation gaps in some of the published initiatives and propose a few pillar...In this article we aim to discuss the burden of hypertension in middle-income countries, the challenges andopportunities, identify some implementation gaps in some of the published initiatives and propose a few pillars that could benefit an upstream population health and health promotion. One billion people suffer from hypertension worldwide; however, the prevalence of hypertension in low and middle-income countries is higher than that in the industrialized countries. Hypertension affects 45% of African adults aged 25 and above, compared to the 36% North American prevalence rate; moreover, the death rate from hypertension in LMICs is higher the than that of the European countries(141 vs 93 per 10000, respectively). The association between increased systolic blood pressure and income reversed between the early 80 s and the first decade of the 20 th century; the higher the per capita income the lower the risk of hypertension. Hence, unless an effective interventions, such as improving diagnosis and treatment, lowering salt intake, enhancing access and availability of fresh fruit and vegetable, and increasing leisure time physical activities are implemented, then low income countries epidemic is inevitable. In this article we aim to discuss the global burden of hypertension in low and middle-income countries, the gaps and challenges, identify the high-risk groups and propose a prevention and cost effective treatment strategic framework.展开更多
Surgical management of diseases is recognised as a major unmet need in low and middle-income countries(LMICs). Laparoscopic surgery has been present since the 1980 s and offers the benefit of minimising the morbidity ...Surgical management of diseases is recognised as a major unmet need in low and middle-income countries(LMICs). Laparoscopic surgery has been present since the 1980 s and offers the benefit of minimising the morbidity and potential mortality associated with laparotomies. Laparotomies are often carried out in LMICs for diagnosis and management, due to lack of radiological investigative and intervention options. The use of laparoscopy for diagnosis and treatment is globally variable, with highincome countries using laparoscopy routinely compared with LMICs. The specific advantages of minimally invasive surgery such as lower surgical site infections and earlier return to work are of great benefit for patients in LMICs, as time lost not working could result in a family not being able to sustain themselves. Laparoscopic surgery and training is not cheap. Cost is a major barrier to healthcare access for a significant population in LMICs. Therefore, cost is usually seen as a major barrier for laparoscopic surgery to be integrated into routine practice in LMICs. The aim of this review is to focus on the practice, training and safety of laparoscopic surgery in LMICs. In addition it highlights the barriers to progress in adopting laparoscopic surgery in LMICs and how to address them.展开更多
Background:Adolescents are highly vulnerable to depressive symptoms worldwide partially because of limited social supports.However,it still remains largely unknown regarding the associations between social support(s)a...Background:Adolescents are highly vulnerable to depressive symptoms worldwide partially because of limited social supports.However,it still remains largely unknown regarding the associations between social support(s)and depressive symptoms among adolescents living in low-and middle-income countries(LMICs).The aim of this study aimed to explore the associations between different types of social support and depressive symptoms in adolescents from LMICs.Methods:Data were retrieved from the Global School-based Health Survey(GSHS)in which 92,551 adolescents(50.6%females)were included with mean of 15.6 years.Depressive symptoms in the past one month as the dependent variable were measured in combination with social support(was measured by“During the past 30 days,how often were most of the students in your school kind and helpful?”).Multivariable logistic regression and meta-analysis of country-wise estimates were performed to investigate the associations between social support and depressive symptoms,and the heterogeneity of the associations across the countries,respectively.Results:The prevalence of depressive symptoms was 30.9%of adolescents from LMICs.Peer support and parental connectedness were two major factors that were significantly associated with depression symptoms in adolescents.However,the associations of peer support and parental connectedness with depressive symptoms were significant in males and females,respectively.The country-wise analysis indicated that varied inconsistency(small to large)across the associations of peer support and parental connectedness with depressive symptoms in adolescents.Conclusion:Results in this study provides multi-national evidence of the protective roles of social support against depressive symptoms among adolescents.However,the association between social support and depression symptoms may be moderated by sex and types of social support.Although we found that social sup-port may be an important protective factor against depressive symptoms in adolescents from LMICs,specifically designed interventions should be implemented based on sex difference and country difference.展开更多
Community health workers(CHWs)represent the backbone of primary health systems,especially in many low-and middle-income countries(LMICs).The coronavirus disease 2019(COVID-19)pandemic stretched health sys-tems and inc...Community health workers(CHWs)represent the backbone of primary health systems,especially in many low-and middle-income countries(LMICs).The coronavirus disease 2019(COVID-19)pandemic stretched health sys-tems and increased the workload for CHWs.The objective of this scoping review was to identify the mental health symptoms experienced among CHWs in LMICs during the COVID-19 pandemic.We searched PubMed for published literature,from January 1,2020 to December 31,2022 that focused on documenting the experiences of burnout,distress,and mental health symptoms among CHWs in LMICs.The quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Tool.Included studies were grouped into the follow-ing broad thematic categories:(1)symptoms experienced;(2)drivers of different mental health symptoms;and(3)strategies for coping with different symptoms.We identified 10 cross-sectional,qualitative,and observational studies from 11 LMICs in South and Southeast Asia,South America,and Eastern/Southern Africa that assessed the mental health burden CHWs faced during the pandemic.The studies identified disorders and symptoms such as depression,anxiety,fear,burnout,worsened stress,and fatigue.Contributing factors included increased work-load,financial constraints,and an understaffed and underequipped workplace.CHWs reported using different adaptive responses like humor,support from family and colleagues,denial,and substance use,and asked for recommended regular mental health checkups and counseling.More research and policies should be targeted to-wards promoting the mental wellbeing of CHWs to help ensure responsive and resilient health systems in LMICs in the face of future emerging public health threats.展开更多
Purpose:Little is known about the role of food insecurity(FIS)on depressive symptoms among adolescents.Thus,this study aimed to explore the association between FIS and depressive symptoms among adolescents aged 12–15...Purpose:Little is known about the role of food insecurity(FIS)on depressive symptoms among adolescents.Thus,this study aimed to explore the association between FIS and depressive symptoms among adolescents aged 12–15 years from low-and middle-income countries across the world.Methods:Data from the Global school-based Student Health Survey were analyzed in 51,702 adolescents[mean(SD)age 13.8(1.0)years;49.3% girls].Self-reported measures assessed depressive symptoms during the past 12 months,and food insecurity.Partici-pants reporting yes for depressive symptoms.FIS was categorized intofive levels,including‘never’,‘rarely’,‘some-times’,‘most of the time’and‘always’.Multivariable logistic regression analysis was performed,and a country-wise meta-analysis was undertaken to compare country difference in the associations between FIS and depressive symptoms.Results:The prevalence of depressive symptoms was 30.0%,respectively.Compared with those reporting never for FIS,adolescents with increased severity of FIS were more likely to report depressive symptoms regardless of gender.Country-wise meta-analysis demonstrated that having FIS versus not having FIS was asso-ciated with 60%greater odds for depressive symptoms(OR=1.60;95%CI:1.52–1.69)but with a moderate between-country heterogeneity(I^(2)=12.7%).Conclusion:The current study indicates that alleviating FIS may be an effective prevention against depressive symptoms among adolescents from LMICs.Future studies should adopt improved study design to confirm or negate our researchfindings,which informs more efficient public mental health interventions.展开更多
Low-and middle-income countries(LMICs)bear the greater share of the global mental health burden but are ill-equipped to deal with it because of severe resource constraints leading to a large treatment gap.The remote p...Low-and middle-income countries(LMICs)bear the greater share of the global mental health burden but are ill-equipped to deal with it because of severe resource constraints leading to a large treatment gap.The remote provision of mental health services by digital means can effectively augment conventional services in LMICs to reduce the treatment gap.Digital psychiatry in LMICs has always lagged behind high-income countries,but there have been encouraging developments in the last decade.There is increasing research on the efficacy of digital psychiatric interventions.However,the evidence is not adequate to conclude that digital psychiatric interventions are invariably effective in LMICs.A striking development has been the rise in mobile and smartphone ownership in LMICs,which has driven the increasing use of mobile technologies to deliver mental health services.An innovative use of mobile technologies has been to optimize task-shifting,which involves delivering mental healthcare services in community settings using non-specialist health professionals.Emerging evidence from LMICs shows that it is possible to use digital tools to train non-specialist workers effectively and ensure that the psychosocial interventions they deliver are efficacious.Despite these promising developments,many barriers such as service costs,underdeveloped infrastructure,lack of trained professionals,and significant disparities in access to digital services impede the progress of digital psychiatry in LMICs.To overcome these barriers,digital psychiatric services in LMICs should address contextual factors influencing the delivery of digital services,ensure collaboration between different stakeholders,and focus on reducing the digital divide.展开更多
A novel coronavirus(severe acute respiratory syndrome coronavirus 2)first detected in Wuhan,China,has spread rapidly since December 2019,causing more than 1.4 million confirmed infections and 15000 fatalities(as of Ap...A novel coronavirus(severe acute respiratory syndrome coronavirus 2)first detected in Wuhan,China,has spread rapidly since December 2019,causing more than 1.4 million confirmed infections and 15000 fatalities(as of April 9,2020).The outbreak was declared a pandemic by the World Health Organization on March 11,2020.Isolation,quarantine,social distancing,and community containment measures were rapidly implemented in China,which helped in containing the disease.However,other low-and middle-income countries lack such extensive infrastructural capacities and resources.Cancer patients are particularly at high risk of infection and mortality due to immunosuppression.Hence self-quarantine is recommended for them.Additionally,it is becoming impossible to maintain the continuity of care when cancer patients have to avoid physical visits.Social media applications,e.g.,Facebook and WhatsApp,can provide educational group program and psychosocial support to these patients while maintain social distancing.We have analyzed their use in this review article and how it could change the follow-up of cancer patients during this pandemic.展开更多
Africa can be"left behind"after other advanced continents recover from the coronavirus disease 2019(COVID-19)pandemic as reflected by the global pandemic of HIV/MDS.In this paper,we summarize potentially ada...Africa can be"left behind"after other advanced continents recover from the coronavirus disease 2019(COVID-19)pandemic as reflected by the global pandemic of HIV/MDS.In this paper,we summarize potentially adaptable,effective and innovative strategies from China,Italy,and the U.S.The purpose is to help African countries with weaker healthcare systems better respond to the COVID-19 pandemic.China,being the first to report COVID-19 infection swiftly swung into anti-epidemic actions by the use of innovative risk communication and epidemic containment strategies.Italy and U.S.,the next rapidly hit countries after China,however,experienced sustained infections and deaths due to delayed and ineffective response.Many African countries responded poorly to the COVID-19 pandemic as evidenced by the limited capacity for public health surveillance,poor leadership,low education and socioeconomic status,among others.Experience from China,Italy and U.S.suggests that a better response to the COVID-19 pandemic in Mrica needs a strong public health leadership,proactive strategies,innovative risk communication about the pandemic,massive tests and isolation,and scaling-up community engagement.Lastly,African countries must collaborate with other countries to facilitate real-time information and experience exchange with other countries to avoid being left behind.展开更多
This comprehensive review addresses the global health challenge of disparities in pancreas transplant access,particularly in low-and middle-income countries(LMICs)compared to high-income countries.Despite advancements...This comprehensive review addresses the global health challenge of disparities in pancreas transplant access,particularly in low-and middle-income countries(LMICs)compared to high-income countries.Despite advancements in surgical techniques and immunosuppression for procedures like simultaneous pancreas-kidney,pancreas-after-kidney,and pancreas-transplant alone,LMICs face significant challenges,including limited infrastructure,financial constraints,and a shortage of skilled medical professionals.Donation after brain death remains constrained by sociocultural barriers.Region-specific analyses highlight progress in Latin America,Asia,Russia,and South Africa,showcasing the regional disparities in access and outcomes.Future prospects involve minimally invasive surgeries,telemedicine for enhanced post-operative care,international collaborations with organizations like the European Union of Medical Specialists,and robust funding networks to improve organ availability.In conclusion,the review underscores the importance of multifaceted strategies to address economic,sociocultural,and infrastructural barriers,aiming to improve accessibility,quality,and effectiveness of pancreas transplantation services in LMICs.展开更多
<strong>Background: </strong>Low and Middle-Income Countries (LMIC) account for 94% of maternal deaths annually. Interventions to reduce these deaths include;access to Emergency Obstetric Care (EmOC) and S...<strong>Background: </strong>Low and Middle-Income Countries (LMIC) account for 94% of maternal deaths annually. Interventions to reduce these deaths include;access to Emergency Obstetric Care (EmOC) and Skilled Birth Attendant (SBA) at childbirth. However, evidence indicates increasing access to EmOC, and SBA only does not translate into positive maternal and newborn outcome due to disrespectful care faced by women during labour. World Health Organization (WHO) guidelines emphasize on positive birth experience through Respectful Maternity Care (RMC). Therefore, this review aims to explore enablers and barriers to respectful maternity care in low and middle-income countries. <strong>Methods:</strong> We conducted an exhaustive literature search for studies that reported on enablers and barriers to respectful maternity care. Qualitative studies done in low and middle-income countries, published in English Language from the year 2000 to June 2020 were included in this study. Articles were screened by two researchers for eligibility and critical appraisal skills programme checklist was used to appraise the quality. The themes and quotes from the studies were extracted and synthesized using thematic synthesis. <strong>Results: </strong>The search strategy generated 14,190 articles and 54 studies met the inclusion criteria. Two main themes: interpersonal relationship and support, and privacy and confidential care were reported as both enablers and barriers to respectful maternity care. Strategies to promote RMC were: health education to pregnant women on care expected during labour, good communication between maternity staff and women, capacity building of staff on RMC and staff motivation. <strong>Conclusion:</strong> Respectful maternity care plays a big role in promoting health-seeking behaviours among pregnant women. However, women experience barriers ranging from provider behaviour, work environment and health system challenges. Ensuring a dignified and respectful working environment could contribute to an increase in health seeking-behaviours and consequently reduction of maternal mortality.展开更多
The Coronavirus 2019 (COVID-19) pandemic has widespread implications for clinical practice of otolaryngologists in clinics and hospitals. With various reports of otolaryngology practitioners catching infection, a prof...The Coronavirus 2019 (COVID-19) pandemic has widespread implications for clinical practice of otolaryngologists in clinics and hospitals. With various reports of otolaryngology practitioners catching infection, a profound structural reorganization of ENT services in the clinic is mandatory for protecting both patients and healthcare workers. The present study focused on quantifying the cost involved in reorganizing the otolaryngology out-patient services in a third world country during the ongoing Covid-19 pandemic. Though the pandemic has increased the cost of running of an otolaryngology practice world over, the impact is huge in India as penetration of health insurance/social security is minimal. As out of pocket expenditure forms a significant proportion of healthcare spending by majority in India, any transfer of additional cost incurred because of Covid-19 pandemic to the patient will burn a bigger hole in their pocket.展开更多
Objective The treatment of Wilms’tumor(WT)in children largely relies on a multidisciplinary strategy.In the absence of an appropriate multidisciplinary team,we reviewed the data of children with WT to determine their...Objective The treatment of Wilms’tumor(WT)in children largely relies on a multidisciplinary strategy.In the absence of an appropriate multidisciplinary team,we reviewed the data of children with WT to determine their outcomes.The primary goal of the study was to highlight the role that a pediatric oncologist plays in the management of WT in low-and middle-income countries,taking into account the variety of initial treatments available,the lack of multidisciplinary care,and management strategies to overcome obstacles.Methods Retrospective recruitment was used to identify patients,aged 18 years or under,with WT diagnosis,in a major tertiary hospital in Iraq between January 2014 and December 2021.Initially,patients were treated with a pretreatment biopsy,preoperative chemotherapy,or upfront nephrectomy.Results In this study,54 patients were enrolled.The median age was 3.3 years.The numbers of patients with stages I and III are 24(44%)and 12(22%),respectively.Seven patients had pretreatment biopsies.In 23 patients,upfront nephrectomy was performed.The histology of only two patients was unfavorable.In 20 patients,intraoperative complications were not disclosed.The mean 3-year estimated event-free survival was 64%(standard deviation 6.6%)and the mean overall survival was 76%(standard deviation 6.8%).There was a significant statistical difference according to stages of disease(p<0.001).Compared with the extended study until December 2021,the overall survival of the previous study from January 2014 to December 2017 was only 40%.Conclusion Promising results for pediatric WT can be attained in low-and middle-income nations.Acquiring an evidence-based strategy tailored to a low-and middle-income country and a multidisciplinary approach may escalate the outcome.展开更多
A contextual review of models for chronic care was done to develop a context-adapted chronic care model-based service delivery model for chronic conditions including diabetes.The Philippines was used as the setting of...A contextual review of models for chronic care was done to develop a context-adapted chronic care model-based service delivery model for chronic conditions including diabetes.The Philippines was used as the setting of a low-to-middle-income country.A context-based narrative review of existing models for chronic care was conducted.A situational analysis was done at thegrassroots level,involving the leaders and members of the community,the patients,the local health system and the healthcare providers.A second analysis making use of certain organizational theories was done to explore on improving feasibility and acceptability of organizing care for chronic conditions.The analyses indicated that care for chronic conditions may be introduced,considering the needs of people with diabetes in particular and the community in general as recipients of care,and the issues and factors that may affect the healthcare workers and the health system as providers of this care.The context-adapted chronic care model-based service delivery model was constructed accordingly.Key features are:incorporation of chronic care in the health system's services; assimilation of chronic care delivery with the other responsibilities of the healthcare workers but with redistribution of certain tasks; and ensuring that the recipients of care experience the whole spectrum of basic chronic care that includes education and promotion in the general population,risk identification,screening,counseling including self-care development,and clinical management of the chronic condition and any co-morbidities,regardless of level of control of the condition.This way,low-to-middle income countries can introduce and improve care for chronic conditions without entailing much additional demand on their limited resources.展开更多
Most countries have made little progress in achieving the Sustainable Development Goal(SDG)target 3.4,which calls for a reduction in premature mortality from non-communicable diseases(NCDs)by a third from 2015 to 2030...Most countries have made little progress in achieving the Sustainable Development Goal(SDG)target 3.4,which calls for a reduction in premature mortality from non-communicable diseases(NCDs)by a third from 2015 to 2030.In this Health Policy paper,we synthesise the evidence related to interventions that can reduce premature mortality from the major NCDs over the next decade and that are feasible to implement in countries at all levels of income.Our recommendations are intended as generic guidance to help 123 low-income and middle-income countries meet SDG target 3.4;country-level applications require additional analyses and consideration of the local implementation and utilisation context.Protecting current investments and scaling up these interventions is especially crucial in the context of COVID-19-related health system disruptions.展开更多
Objective:This study aimed to assess breast cancer(BC)awareness among reproductive women in low-and middle-income countries(LMICs),identify influencing factors,and propose feasible interventions or programs.Methods:We...Objective:This study aimed to assess breast cancer(BC)awareness among reproductive women in low-and middle-income countries(LMICs),identify influencing factors,and propose feasible interventions or programs.Methods:We followed a 5-step process using a modified version of Arksey and O’Malley framework methodology.A comprehensive search was conducted on the Embase,PubMed,and CINAHL electronic databases for literature published within 10 years(from 2012 to 2022).Results:Thirty-three papers published between 2012 and 2020,spanning 18 countries,were included.Of these,45.6%described a good level of knowledge,while 24.2%reported that women at reproductive ages had good awareness.Twelve influencing factors were identified in 3 categories:socio-demographic(family history,personal history,marital status,age,religion,income status,living place,and occupation),personal(self-efficacy,education,and perceived level),and external(advertisements promoting awareness).Educational programs were recommended in most(>72%)of the included studies.Conclusions:While most studies reported high levels of knowledge and awareness,some found low prevalence among certain groups.Factors affecting knowledge and awareness were classified into socio-demographic,personal,and external categories,with socio-demographic factors such as age,education,income,and marital status being the most frequently cited.The studies recommended implementing educational programs,health prevention strategies,and social interventions to increase BC knowledge and awareness.展开更多
文摘This paper draws attention to the prospects of sea-based economy to promote Bangladesh in a middle-income country through the sustainable use of marine resources. About three-fourths of the earth is covered by the seas. It plays the vital role in two important functions from ancient time known as the means of communication and the source of huge living and non-living natural resources. At present, the countries are becoming very much concerned about their marine resources to resolve many of the present and future challenges of their economies. Generally for Bangladesh, ocean is contributing a significant role to its overall socio-economic progress through rising up the economic activities across the country and especially to the coastal zone at southern part. This paper investigates how much Bangladesh is capable to take of or handle the challenges to become a middle income country through the Sustainable Development Goals (SDGs). In addition, it has attempted with a closer-look to find out the barriers or limitations of these activities from different angles if exist.
文摘BACKGROUND Human immunodeficiency virus(HIV)recency testing provides data that can be used to monitor the trend of new HIV infections.The effectiveness of using people identified with recent infection to identify partners with new HIV infection through partner notification services(PNS)is not well documented.AIM To determine the pooled prevalence of recency testing coverage,recent infection,reclassification(recent to longterm infection)and PNS cascade among newly diagnosed people living with HIV.METHODS PubMed,Cochrane Library and Embase were searched for articles published between January 2018 and November 2024.Studies were included if they reported recency coverage and/or PNS among people newly diagnosed with HIV and used recent infection testing algorithm(RITA).Recency coverage was defined as proportion of people tested using rapid testing for recent infection(RTRI)among those newly diagnosed with HIV.RITA further classifies RTRI results using viral load results(≥1000 copies/mL vs<1000 copies/mL)to confirm recency status.For studies with PNS,we evaluated the cascade:Number of partners elicited,successfully contacted,eligible for HIV testing,tested and HIV diagnosis.PNS effectiveness was measured by proportion of new HIV diagnoses from tested partners.Using random effects models,we computed the pooled estimate of recency outcomes and 95%confidence intervals(CIs).RESULTS Twenty-five studies from 17-low-and middle-income countries were included.Of 276315 newly diagnosed people living with HIV,79864 underwent RTRI with an overall pooled recency coverage of 87%(95%CI:67-96).The pooled prevalence of RTRI and RITA recency were 12%(95%CI:9-16)and 7%(95%CI:4-10),respectively.Pooled prevalence of RTRI reclassification was 34%(95%CI:22-49).Of the recent cases who agreed to PNS,253 partners were elicited with an estimated elicitation ratio of 1:1.6.Among partners elicited,99%were successfully contacted,75%were eligible for testing,68%tested for HIV,and 15%were diagnosed with HIV.CONCLUSION High recency testing coverage among newly diagnosed individuals demonstrates the feasibility of monitoring new HIV infections in LMIC.While PNS yielded moderate HIV diagnoses,its targeted approach remains a critical strategy for identifying undiagnosed cases.
基金supported by the National Natural Science Foundation of China(No.72042014).
文摘The WHO declared the coronavirus disease 2019(COVID-19)outbreak as a public health emergency of international concern on January 30,2020,and then a pandemic on March 11,2020.COVID-19 affected over 200 countries and territories worldwide,with 25,541,380 confirmed cases and 852,000 deaths associated with COVID-19 globally,as of September 1,2020.1 While facing such a public health emergency,hospitals were on the front line to deliver health care and psychological services.The early detection,diagnosis,reporting,isolation,and clinical management of patients during a public health emergency required the extensive involvement of hospitals in all aspects.The response capacity of hospitals directly determined the outcomes of the prevention and control of an outbreak.The COVID-19 pandemic has affected almost all nations and territories regardless of their development level or geographic location,although suitable risk mitigation measures differ between developing and developed countries.In low-and middle-income countries(LMICs),the consequences of the pandemic could be more complicated because incidence and mortality might be associated more with a fragile health care system and shortage of related resources.2-3 As evidenced by the situation in Bangladesh,India,Kenya,South Africa,and other LMICs,socioeconomic status(SES)disparity was a major factor in the spread of disease,potentially leading to alarmingly insufficient preparedness and responses in dealing with the COVID-19 pandemic.4 Conversely,the pandemic might also bring more unpredictable socioeconomic and long-term impacts in LMICs,and those with lower SES fare worse in these situations.This review aimed to summarize the responsibilities of and measures taken by hospitals in combatting the COVID-19 outbreak.Our findings are hoped to provide experiences,as well as lessons and potential implications for LMICs.
基金supported by the National Social Science Foundation(18BTY011)Brendon Stubbs is supported by a Clinical Lectureship(ICA-CL-2017-03-001)jointly funded by Health Education England(HEE)and the National Institute for Health Research(NIHR)+1 种基金Brendon Stubbs is part funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust.Brendon Stubbs also holds active grants with the Medical Research Council(GCRF and multimorbidity calls)and Guys and St Thomas Charity(GSTT).Brendon Stubbs has received consultancy fees from ASICS Europe BV.The views expressed are those of the author(s)and not necessarily those of the(partner organization),the NHS,the NIHR,the Department of Health and Social Care,the MRC or GSTTZD’s contribution was supported by the Hungarian National Research,Development and Innovation Office(KKP126835,ELTE Thematic Excellence Programme 2020,KP2020-IKA-05).
文摘Little is known about the role of active school travel(AST)on mental health among adolescents.Thus,this study aimed to explore the AST-depression association among adolescents aged 12–15 years from 26 low-and middle-income countries(LMICs).Data from the Global School-based Student Health Survey were analyzed in 51,702 adolescents[mean(SD)age 13.8(1.0)years;49.3%boys).Both depressive symptoms and AST were assessed by a single question self-reported measure,respectively.Participants who reported having 5 days or above were considered as AST.Multivariable logistic regression analysis(accounting for sampling weights)was performed while controlling for gender,age,physical activity,sedentary behavior,and food insecurity,and a countrywide meta-analysis was undertaken.The prevalence of depressive symptoms and AST were 30.1%and 37.0%,respectively.Compared with those not having AST,adolescents with AST were less likely to have self-reported depressive symptoms(OR=0.88,95%CI:0.85-0.93)regardless of gender.Countrywide meta-analysis demonstrated that having AST versus not having AST was associated with 12%lower odds for depressive symptoms(OR=0.88;95%CI:0.82-0.94)but with a moderate between-country heterogeneity(I^(2)=59.0%).Based on large samples of adolescents from LMICs,it would be expected that AST may play a critical role in preventing adolescent depression worldwide.However,it is necessary to consider more country-specific factors when implementing AST-related mental health interventions.Future studies should adopt the solid study design to confirm or negate our researchfindings.
基金This work was supported by the National Key Research and Development Program of China(No.2016YFC0206500)the National Research Program for Key Issues in Air Pollution Control of China(No.DQGG0401).
文摘In recent decades, the ecological environment has been increasingly challenged by the development of global industrialization and urbanization all over the world, even as global attention for health has raised dramatically. Common global environmental issues, such as air pollution and noise pollution, are associated with lasting impacts on health and contribute significantly to the overall burden of disease. Moreover, a global disparity exists between the burden of such environmental health issues and the global resources available to address this issue. To alleviate the environmental health impacts and ensure a sustainable future for human beings, China has made an important contribution to improving access to ecological protection, environmental governance, patriotic health campaigns, smart city construction, and so on. Experiences gained in China may be useful for some other countries, particularly the low- and middle-income countries with limited sources.
文摘In this article we aim to discuss the burden of hypertension in middle-income countries, the challenges andopportunities, identify some implementation gaps in some of the published initiatives and propose a few pillars that could benefit an upstream population health and health promotion. One billion people suffer from hypertension worldwide; however, the prevalence of hypertension in low and middle-income countries is higher than that in the industrialized countries. Hypertension affects 45% of African adults aged 25 and above, compared to the 36% North American prevalence rate; moreover, the death rate from hypertension in LMICs is higher the than that of the European countries(141 vs 93 per 10000, respectively). The association between increased systolic blood pressure and income reversed between the early 80 s and the first decade of the 20 th century; the higher the per capita income the lower the risk of hypertension. Hence, unless an effective interventions, such as improving diagnosis and treatment, lowering salt intake, enhancing access and availability of fresh fruit and vegetable, and increasing leisure time physical activities are implemented, then low income countries epidemic is inevitable. In this article we aim to discuss the global burden of hypertension in low and middle-income countries, the gaps and challenges, identify the high-risk groups and propose a prevention and cost effective treatment strategic framework.
文摘Surgical management of diseases is recognised as a major unmet need in low and middle-income countries(LMICs). Laparoscopic surgery has been present since the 1980 s and offers the benefit of minimising the morbidity and potential mortality associated with laparotomies. Laparotomies are often carried out in LMICs for diagnosis and management, due to lack of radiological investigative and intervention options. The use of laparoscopy for diagnosis and treatment is globally variable, with highincome countries using laparoscopy routinely compared with LMICs. The specific advantages of minimally invasive surgery such as lower surgical site infections and earlier return to work are of great benefit for patients in LMICs, as time lost not working could result in a family not being able to sustain themselves. Laparoscopic surgery and training is not cheap. Cost is a major barrier to healthcare access for a significant population in LMICs. Therefore, cost is usually seen as a major barrier for laparoscopic surgery to be integrated into routine practice in LMICs. The aim of this review is to focus on the practice, training and safety of laparoscopic surgery in LMICs. In addition it highlights the barriers to progress in adopting laparoscopic surgery in LMICs and how to address them.
基金supported by National Natural Science Foundation of China(31871115).
文摘Background:Adolescents are highly vulnerable to depressive symptoms worldwide partially because of limited social supports.However,it still remains largely unknown regarding the associations between social support(s)and depressive symptoms among adolescents living in low-and middle-income countries(LMICs).The aim of this study aimed to explore the associations between different types of social support and depressive symptoms in adolescents from LMICs.Methods:Data were retrieved from the Global School-based Health Survey(GSHS)in which 92,551 adolescents(50.6%females)were included with mean of 15.6 years.Depressive symptoms in the past one month as the dependent variable were measured in combination with social support(was measured by“During the past 30 days,how often were most of the students in your school kind and helpful?”).Multivariable logistic regression and meta-analysis of country-wise estimates were performed to investigate the associations between social support and depressive symptoms,and the heterogeneity of the associations across the countries,respectively.Results:The prevalence of depressive symptoms was 30.9%of adolescents from LMICs.Peer support and parental connectedness were two major factors that were significantly associated with depression symptoms in adolescents.However,the associations of peer support and parental connectedness with depressive symptoms were significant in males and females,respectively.The country-wise analysis indicated that varied inconsistency(small to large)across the associations of peer support and parental connectedness with depressive symptoms in adolescents.Conclusion:Results in this study provides multi-national evidence of the protective roles of social support against depressive symptoms among adolescents.However,the association between social support and depression symptoms may be moderated by sex and types of social support.Although we found that social sup-port may be an important protective factor against depressive symptoms in adolescents from LMICs,specifically designed interventions should be implemented based on sex difference and country difference.
基金supported by grants from the National Institute of Mental Health(U19MH113211-01)and the Harvard Global Health Institute Burke Fellowship.
文摘Community health workers(CHWs)represent the backbone of primary health systems,especially in many low-and middle-income countries(LMICs).The coronavirus disease 2019(COVID-19)pandemic stretched health sys-tems and increased the workload for CHWs.The objective of this scoping review was to identify the mental health symptoms experienced among CHWs in LMICs during the COVID-19 pandemic.We searched PubMed for published literature,from January 1,2020 to December 31,2022 that focused on documenting the experiences of burnout,distress,and mental health symptoms among CHWs in LMICs.The quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Tool.Included studies were grouped into the follow-ing broad thematic categories:(1)symptoms experienced;(2)drivers of different mental health symptoms;and(3)strategies for coping with different symptoms.We identified 10 cross-sectional,qualitative,and observational studies from 11 LMICs in South and Southeast Asia,South America,and Eastern/Southern Africa that assessed the mental health burden CHWs faced during the pandemic.The studies identified disorders and symptoms such as depression,anxiety,fear,burnout,worsened stress,and fatigue.Contributing factors included increased work-load,financial constraints,and an understaffed and underequipped workplace.CHWs reported using different adaptive responses like humor,support from family and colleagues,denial,and substance use,and asked for recommended regular mental health checkups and counseling.More research and policies should be targeted to-wards promoting the mental wellbeing of CHWs to help ensure responsive and resilient health systems in LMICs in the face of future emerging public health threats.
文摘Purpose:Little is known about the role of food insecurity(FIS)on depressive symptoms among adolescents.Thus,this study aimed to explore the association between FIS and depressive symptoms among adolescents aged 12–15 years from low-and middle-income countries across the world.Methods:Data from the Global school-based Student Health Survey were analyzed in 51,702 adolescents[mean(SD)age 13.8(1.0)years;49.3% girls].Self-reported measures assessed depressive symptoms during the past 12 months,and food insecurity.Partici-pants reporting yes for depressive symptoms.FIS was categorized intofive levels,including‘never’,‘rarely’,‘some-times’,‘most of the time’and‘always’.Multivariable logistic regression analysis was performed,and a country-wise meta-analysis was undertaken to compare country difference in the associations between FIS and depressive symptoms.Results:The prevalence of depressive symptoms was 30.0%,respectively.Compared with those reporting never for FIS,adolescents with increased severity of FIS were more likely to report depressive symptoms regardless of gender.Country-wise meta-analysis demonstrated that having FIS versus not having FIS was asso-ciated with 60%greater odds for depressive symptoms(OR=1.60;95%CI:1.52–1.69)but with a moderate between-country heterogeneity(I^(2)=12.7%).Conclusion:The current study indicates that alleviating FIS may be an effective prevention against depressive symptoms among adolescents from LMICs.Future studies should adopt improved study design to confirm or negate our researchfindings,which informs more efficient public mental health interventions.
文摘Low-and middle-income countries(LMICs)bear the greater share of the global mental health burden but are ill-equipped to deal with it because of severe resource constraints leading to a large treatment gap.The remote provision of mental health services by digital means can effectively augment conventional services in LMICs to reduce the treatment gap.Digital psychiatry in LMICs has always lagged behind high-income countries,but there have been encouraging developments in the last decade.There is increasing research on the efficacy of digital psychiatric interventions.However,the evidence is not adequate to conclude that digital psychiatric interventions are invariably effective in LMICs.A striking development has been the rise in mobile and smartphone ownership in LMICs,which has driven the increasing use of mobile technologies to deliver mental health services.An innovative use of mobile technologies has been to optimize task-shifting,which involves delivering mental healthcare services in community settings using non-specialist health professionals.Emerging evidence from LMICs shows that it is possible to use digital tools to train non-specialist workers effectively and ensure that the psychosocial interventions they deliver are efficacious.Despite these promising developments,many barriers such as service costs,underdeveloped infrastructure,lack of trained professionals,and significant disparities in access to digital services impede the progress of digital psychiatry in LMICs.To overcome these barriers,digital psychiatric services in LMICs should address contextual factors influencing the delivery of digital services,ensure collaboration between different stakeholders,and focus on reducing the digital divide.
文摘A novel coronavirus(severe acute respiratory syndrome coronavirus 2)first detected in Wuhan,China,has spread rapidly since December 2019,causing more than 1.4 million confirmed infections and 15000 fatalities(as of April 9,2020).The outbreak was declared a pandemic by the World Health Organization on March 11,2020.Isolation,quarantine,social distancing,and community containment measures were rapidly implemented in China,which helped in containing the disease.However,other low-and middle-income countries lack such extensive infrastructural capacities and resources.Cancer patients are particularly at high risk of infection and mortality due to immunosuppression.Hence self-quarantine is recommended for them.Additionally,it is becoming impossible to maintain the continuity of care when cancer patients have to avoid physical visits.Social media applications,e.g.,Facebook and WhatsApp,can provide educational group program and psychosocial support to these patients while maintain social distancing.We have analyzed their use in this review article and how it could change the follow-up of cancer patients during this pandemic.
文摘Africa can be"left behind"after other advanced continents recover from the coronavirus disease 2019(COVID-19)pandemic as reflected by the global pandemic of HIV/MDS.In this paper,we summarize potentially adaptable,effective and innovative strategies from China,Italy,and the U.S.The purpose is to help African countries with weaker healthcare systems better respond to the COVID-19 pandemic.China,being the first to report COVID-19 infection swiftly swung into anti-epidemic actions by the use of innovative risk communication and epidemic containment strategies.Italy and U.S.,the next rapidly hit countries after China,however,experienced sustained infections and deaths due to delayed and ineffective response.Many African countries responded poorly to the COVID-19 pandemic as evidenced by the limited capacity for public health surveillance,poor leadership,low education and socioeconomic status,among others.Experience from China,Italy and U.S.suggests that a better response to the COVID-19 pandemic in Mrica needs a strong public health leadership,proactive strategies,innovative risk communication about the pandemic,massive tests and isolation,and scaling-up community engagement.Lastly,African countries must collaborate with other countries to facilitate real-time information and experience exchange with other countries to avoid being left behind.
文摘This comprehensive review addresses the global health challenge of disparities in pancreas transplant access,particularly in low-and middle-income countries(LMICs)compared to high-income countries.Despite advancements in surgical techniques and immunosuppression for procedures like simultaneous pancreas-kidney,pancreas-after-kidney,and pancreas-transplant alone,LMICs face significant challenges,including limited infrastructure,financial constraints,and a shortage of skilled medical professionals.Donation after brain death remains constrained by sociocultural barriers.Region-specific analyses highlight progress in Latin America,Asia,Russia,and South Africa,showcasing the regional disparities in access and outcomes.Future prospects involve minimally invasive surgeries,telemedicine for enhanced post-operative care,international collaborations with organizations like the European Union of Medical Specialists,and robust funding networks to improve organ availability.In conclusion,the review underscores the importance of multifaceted strategies to address economic,sociocultural,and infrastructural barriers,aiming to improve accessibility,quality,and effectiveness of pancreas transplantation services in LMICs.
文摘<strong>Background: </strong>Low and Middle-Income Countries (LMIC) account for 94% of maternal deaths annually. Interventions to reduce these deaths include;access to Emergency Obstetric Care (EmOC) and Skilled Birth Attendant (SBA) at childbirth. However, evidence indicates increasing access to EmOC, and SBA only does not translate into positive maternal and newborn outcome due to disrespectful care faced by women during labour. World Health Organization (WHO) guidelines emphasize on positive birth experience through Respectful Maternity Care (RMC). Therefore, this review aims to explore enablers and barriers to respectful maternity care in low and middle-income countries. <strong>Methods:</strong> We conducted an exhaustive literature search for studies that reported on enablers and barriers to respectful maternity care. Qualitative studies done in low and middle-income countries, published in English Language from the year 2000 to June 2020 were included in this study. Articles were screened by two researchers for eligibility and critical appraisal skills programme checklist was used to appraise the quality. The themes and quotes from the studies were extracted and synthesized using thematic synthesis. <strong>Results: </strong>The search strategy generated 14,190 articles and 54 studies met the inclusion criteria. Two main themes: interpersonal relationship and support, and privacy and confidential care were reported as both enablers and barriers to respectful maternity care. Strategies to promote RMC were: health education to pregnant women on care expected during labour, good communication between maternity staff and women, capacity building of staff on RMC and staff motivation. <strong>Conclusion:</strong> Respectful maternity care plays a big role in promoting health-seeking behaviours among pregnant women. However, women experience barriers ranging from provider behaviour, work environment and health system challenges. Ensuring a dignified and respectful working environment could contribute to an increase in health seeking-behaviours and consequently reduction of maternal mortality.
文摘The Coronavirus 2019 (COVID-19) pandemic has widespread implications for clinical practice of otolaryngologists in clinics and hospitals. With various reports of otolaryngology practitioners catching infection, a profound structural reorganization of ENT services in the clinic is mandatory for protecting both patients and healthcare workers. The present study focused on quantifying the cost involved in reorganizing the otolaryngology out-patient services in a third world country during the ongoing Covid-19 pandemic. Though the pandemic has increased the cost of running of an otolaryngology practice world over, the impact is huge in India as penetration of health insurance/social security is minimal. As out of pocket expenditure forms a significant proportion of healthcare spending by majority in India, any transfer of additional cost incurred because of Covid-19 pandemic to the patient will burn a bigger hole in their pocket.
文摘Objective The treatment of Wilms’tumor(WT)in children largely relies on a multidisciplinary strategy.In the absence of an appropriate multidisciplinary team,we reviewed the data of children with WT to determine their outcomes.The primary goal of the study was to highlight the role that a pediatric oncologist plays in the management of WT in low-and middle-income countries,taking into account the variety of initial treatments available,the lack of multidisciplinary care,and management strategies to overcome obstacles.Methods Retrospective recruitment was used to identify patients,aged 18 years or under,with WT diagnosis,in a major tertiary hospital in Iraq between January 2014 and December 2021.Initially,patients were treated with a pretreatment biopsy,preoperative chemotherapy,or upfront nephrectomy.Results In this study,54 patients were enrolled.The median age was 3.3 years.The numbers of patients with stages I and III are 24(44%)and 12(22%),respectively.Seven patients had pretreatment biopsies.In 23 patients,upfront nephrectomy was performed.The histology of only two patients was unfavorable.In 20 patients,intraoperative complications were not disclosed.The mean 3-year estimated event-free survival was 64%(standard deviation 6.6%)and the mean overall survival was 76%(standard deviation 6.8%).There was a significant statistical difference according to stages of disease(p<0.001).Compared with the extended study until December 2021,the overall survival of the previous study from January 2014 to December 2017 was only 40%.Conclusion Promising results for pediatric WT can be attained in low-and middle-income nations.Acquiring an evidence-based strategy tailored to a low-and middle-income country and a multidisciplinary approach may escalate the outcome.
基金Supported by The Belgian Directorate for Development Cooperation through the Institute of Tropical Medicine,Antwerp
文摘A contextual review of models for chronic care was done to develop a context-adapted chronic care model-based service delivery model for chronic conditions including diabetes.The Philippines was used as the setting of a low-to-middle-income country.A context-based narrative review of existing models for chronic care was conducted.A situational analysis was done at thegrassroots level,involving the leaders and members of the community,the patients,the local health system and the healthcare providers.A second analysis making use of certain organizational theories was done to explore on improving feasibility and acceptability of organizing care for chronic conditions.The analyses indicated that care for chronic conditions may be introduced,considering the needs of people with diabetes in particular and the community in general as recipients of care,and the issues and factors that may affect the healthcare workers and the health system as providers of this care.The context-adapted chronic care model-based service delivery model was constructed accordingly.Key features are:incorporation of chronic care in the health system's services; assimilation of chronic care delivery with the other responsibilities of the healthcare workers but with redistribution of certain tasks; and ensuring that the recipients of care experience the whole spectrum of basic chronic care that includes education and promotion in the general population,risk identification,screening,counseling including self-care development,and clinical management of the chronic condition and any co-morbidities,regardless of level of control of the condition.This way,low-to-middle income countries can introduce and improve care for chronic conditions without entailing much additional demand on their limited resources.
文摘Most countries have made little progress in achieving the Sustainable Development Goal(SDG)target 3.4,which calls for a reduction in premature mortality from non-communicable diseases(NCDs)by a third from 2015 to 2030.In this Health Policy paper,we synthesise the evidence related to interventions that can reduce premature mortality from the major NCDs over the next decade and that are feasible to implement in countries at all levels of income.Our recommendations are intended as generic guidance to help 123 low-income and middle-income countries meet SDG target 3.4;country-level applications require additional analyses and consideration of the local implementation and utilisation context.Protecting current investments and scaling up these interventions is especially crucial in the context of COVID-19-related health system disruptions.
文摘Objective:This study aimed to assess breast cancer(BC)awareness among reproductive women in low-and middle-income countries(LMICs),identify influencing factors,and propose feasible interventions or programs.Methods:We followed a 5-step process using a modified version of Arksey and O’Malley framework methodology.A comprehensive search was conducted on the Embase,PubMed,and CINAHL electronic databases for literature published within 10 years(from 2012 to 2022).Results:Thirty-three papers published between 2012 and 2020,spanning 18 countries,were included.Of these,45.6%described a good level of knowledge,while 24.2%reported that women at reproductive ages had good awareness.Twelve influencing factors were identified in 3 categories:socio-demographic(family history,personal history,marital status,age,religion,income status,living place,and occupation),personal(self-efficacy,education,and perceived level),and external(advertisements promoting awareness).Educational programs were recommended in most(>72%)of the included studies.Conclusions:While most studies reported high levels of knowledge and awareness,some found low prevalence among certain groups.Factors affecting knowledge and awareness were classified into socio-demographic,personal,and external categories,with socio-demographic factors such as age,education,income,and marital status being the most frequently cited.The studies recommended implementing educational programs,health prevention strategies,and social interventions to increase BC knowledge and awareness.
