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Kiran T Thakur, Alexandra Boubour, Deanna Saylor, Mitashee Das, David R Bearden, Gretchen L Birbeck
: Neurological conditions associated with HIV remain major contributors to morbidity and mortality and are increasingly recognized in the aging population on long-standing combination antiretroviral therapy (cART). Importantly, growing evidence shows that the CNS may serve as a reservoir for viral replication, which has major implications for HIV eradication strategies. Though there has been major progress in the last decade in our understanding of the pathogenesis, burden, and impact of neurological conditions associated with HIV infection, significant scientific gaps remain...
March 15, 2018: AIDS
Faye M Evans, Juan C Duarte, Carolina Haylock Loor, Wayne Morriss
There is an urgent need to train more anesthesia providers in low- and middle-income countries (LMICs). There is also a need to provide more educational opportunities in subspecialty areas of anesthetic practice such as trauma management, pain management, obstetric anesthesia, and pediatric anesthesia. Together, these subspecialty areas make up a large proportion of the clinical workload in LMICs. In these countries, the quality of education may be variable, there may be few teachers, and opportunities for continued learning and mentorship are rare...
April 2018: Anesthesia and Analgesia
Brian Custer, Shimian Zou, Simone A Glynn, Julie Makani, Claude Tayou Tagny, Magdy El Ekiaby, Ester C Sabino, Nabajyoti Choudhury, Diana Teo, Kenrad Nelson, Emmanuel Peprah, LeShawndra Price, Michael M Engelgau
In April 2017, a workshop sponsored by the National Heart, Lung, and Blood Institute, Division of Blood Diseases and Resources, and the Center for Translation Research and Implementation Science was held to discuss blood availability and transfusion safety in low- and middle-income countries (LMICs). The purpose of the workshop was to identify research opportunities for implementation science (IS) to improve the availability of safe blood and blood components and transfusion practices in LMICs. IS describes the late stages of the translational research spectrum and studies optimal and sustainable strategies to deliver proven-effective interventions...
March 14, 2018: Transfusion
Louis M Katz, John J Donnelly, Christopher J Gresens, Jerry A Holmberg, James MacPherson, Peter J K Zacharias, Jean Stanley, Christine Bales
On March 24, 2017, more than 90 experts in blood safety and international development from blood centers, industry, government, and international and nongovernmental organizations gathered in Arlington, Virginia, for the Third International Blood Safety Forum, cosponsored by America's Blood Centers and Global Healing. This report summarizes presentations and major conclusions. The meeting explored ways to increase access to affordable, safe blood for low- and lower-middle-income countries (LMICs) in an era when funding from the US President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund has been redirected from preventing the spread of human immunodeficiency virus (HIV) to diagnosing and treating the 25 million-plus people living with HIV in LMICs...
March 14, 2018: Transfusion
Yang Bai, Hannelore Bové, Tim S Nawrot, Benoit Nemery
BACKGROUND: Carbon load in airway macrophages (AM) has been proposed as an internal marker to assess long-term exposure to combustion-derived pollutant particles. However, it is not known how this biomarker is affected by changes in exposure. We studied the clearance kinetics of black carbon (BC) in AM, obtained by sputum induction, in a one-year panel study. METHODS: AM BC was measured 8 times with 6 weeks intervals in healthy young subjects: 15 long-term residents in Leuven, Belgium (BE, mean annual PM10 20-30 μg/m3 ) and 30 newcomers having arrived recently (< 3 weeks) in Leuven from highly polluted cities (mean annual PM10  > 50 μg/m3 ) in low and middle-income countries (LMIC, n = 15), or from low to moderately polluted cities in high-income countries (HIC, n = 15)...
March 14, 2018: Particle and Fibre Toxicology
Yvette Efevbera, Dana C McCoy, Alice J Wuermli, Theresa S Betancourt
Limited evidence describes promoting development and reducing violence in low- and middle-income countries (LMICs), a missed opportunity to protect children and promote development and human capital. This study presents a systematic literature review of integrated early childhood development plus violence prevention (ECD+VP) interventions in LMICs. The search yielded 5,244 unique records, of which N = 6 studies met inclusion criteria. Interventions were in Chile, Jamaica, Lebanon, Mexico, Mozambique, and Turkey...
March 2018: New Directions for Child and Adolescent Development
Mackensie A Yore, Matthew C Strehlow, Lily D Yan, Elizabeth A Pirrotta, Joan L Woods, Koy Somontha, Yim Sovannra, Lauren Auerbach, Rebecca Backer, Christophe Grundmann, Swaminatha V Mahadevan
BACKGROUND: Emergency medicine is a young specialty in many low- and middle-income countries (LMICs). Although many patients seeking emergency or acute care are children, little information is available about the needs and current treatment of this group in LMICs. In this observational study, we sought to describe characteristics, chief complaints, management, and outcomes of children presenting for unscheduled visits to two Cambodian public hospitals. METHODS: Children enrolled in the study presented without appointment for treatment at one of two Cambodian public referral hospitals during a 4-week period in 2012...
March 13, 2018: International Journal of Emergency Medicine
Homero Martinez, Aliki P Weakland, Lynn B Bailey, Lorenzo D Botto, Luz Maria De-Regil, Kenneth H Brown
As infectious disease control programs achieve increasing success, further reductions in child mortality in low- and middle-income countries (LMICs) will require focused prevention strategies for birth defects and other noninfectious diseases. Neural tube defects (NTDs) can cause early death or lifelong disability. Preventing NTDs provides a feasible, significant opportunity to decrease the toll of birth defects and contribute to further reducing child mortality globally. The Micronutrient Forum convened a technical consultation on Folate Status in Women and Neural Tube Defects Prevention to develop a roadmap to inform and prioritize investments in NTD prevention in LMICs; help guide implementation efforts in terms of the feasibility of interventions and the potential for acceleration; and identify research and knowledge gaps...
February 2018: Annals of the New York Academy of Sciences
Marianna Purgato, Alden L Gross, Theresa Betancourt, Paul Bolton, Chiara Bonetto, Chiara Gastaldon, James Gordon, Paul O'Callaghan, Davide Papola, Kirsi Peltonen, Raija-Leena Punamaki, Justin Richards, Julie K Staples, Johanna Unterhitzenberger, Mark van Ommeren, Joop de Jong, Mark J D Jordans, Wietse A Tol, Corrado Barbui
BACKGROUND: Results from studies evaluating the effectiveness of focused psychosocial support interventions in children exposed to traumatic events in humanitarian settings in low-income and middle-income countries have been inconsistent, showing varying results by setting and subgroup (eg, age or gender). We aimed to assess the effectiveness of these interventions, and to explore which children are likely to benefit most. METHODS: We did a systematic review and meta-analysis of individual participant data (IPD) from 3143 children recruited to 11 randomised controlled trials of focused psychosocial support interventions versus waiting list...
April 2018: Lancet Global Health
Ali Judd, Mary-Ann Davies
PURPOSE OF REVIEW: To summarize evidence for health outcomes among adolescents and young people living with HIV (AYLHIV) who have transitioned to adult care/adulthood, views of AYLHIV and providers on the transition process, and the effect of adolescent and youth friendly services (AYFS) on outcomes. RECENT FINDINGS: A total of 43 studies were identified [n = 13 high-income countries (HICs), n = 30 low-/middle-income countries (LMICs)]. In HICs, around 75% of patients were retained in care at approximately 4 years posttransition...
March 9, 2018: Current Opinion in HIV and AIDS
Mirembe Mandy, Moffat Nyirenda
Low- and middle-income countries (LMICs), particularly those in sub-Saharan Africa, are experiencing rapid increases in the prevalence of non-communicable diseases (NCDs), which may not be fully explained by urbanization and associated traditional risk factors such as tobacco smoking, excessive alcohol consumption, poor diet or physical inactivity. In this commentary, we draw attention to the concept of Developmental Origins of Health and Disease (DOHaD), where environmental insults in early life can contribute to long-term risk of NCDs, the impact of which would be particularly important in LMICs where poverty, malnutrition, poor sanitation and infections are still prevalent...
March 8, 2018: International Health
Patrick M Newman, Molly F Franke, Jafet Arrieta, Hector Carrasco, Patrick Elliott, Hugo Flores, Alexandra Friedman, Sophia Graham, Luis Martinez, Lindsay Palazuelos, Kevin Savage, Hayley Tymeson, Daniel Palazuelos
Background: Non-communicable diseases (NCDs) contribute greatly to morbidity and mortality in low-income and middle-income countries (LMICs). Community health workers (CHWs) may improve disease control and medication adherence among patients with NCDs in LMICs, but data are lacking. We assessed the impact of a CHW-led intervention on disease control and adherence among patients with diabetes and/or hypertension in Chiapas, Mexico. Methods: We conducted a prospective observational study among adult patients with diabetes and/or hypertension, in the context of a stepped-wedge roll-out of a CHW-led intervention...
2018: BMJ Global Health
Obieze Chiemeka Nwanna-Nzewunwa, Marquise Kouo Ngamby, Elinor Shetter, Georges Alain Etoundi Mballa, Isabelle Feldhaus, Martin Ekeke Monono, Adnan A Hyder, Rochelle Dicker, Kent A Stevens, Catherine Juillard
INTRODUCTION: About 54% of deaths in low- and middle-income countries (LMICs) are attributable to lack of prehospital care. The single largest contributor to the disability-adjusted life years due to poor prehospital care is injury. Despite having disproportionately high injury burdens, most LMIC trauma systems have little prehospital organization. An understanding of existing prehospital care patterns in LMICs is warranted as a precursor to strengthening prehospital systems. METHODS: In this retrospective pilot study, we collected demographic and injury characteristics, therapeutic itinerary, and transport data of patients that were captured by the trauma registry at the Central Hospital of Yaoundé (CHY) from April 15, 2009 to October 15, 2009...
March 10, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Kenneth Munge, Stephen Mulupi, Edwine W Barasa, Jane Chuma
BACKGROUND: Purchasing refers to the process by which pooled funds are paid to providers in order to deliver a set of health care interventions. Very little is known about purchasing arrangements in low- and middle-income countries (LMICs), and certainly not in Kenya. This study aimed to critically analyse purchasing arrangements in Kenya, using the National Hospital Insurance Fund (NHIF) as a case study. METHODS: We applied a principal-agent relationship framework, which identifies three pairs of principal-agent relationships (government-purchaser, purchaser-provider, and citizen-purchaser) and specific actions required within them to achieve strategic purchasing...
July 18, 2017: International Journal of Health Policy and Management
Sikhumbuzo A Mabunda, Leslie London, David Pienaar
BACKGROUND: A comprehensive primary healthcare (PHC) approach requires clear referral and continuity of care pathways. South Africa is a lower-middle income country (LMIC) that lacks data on the role of intermediate care (IC) services in the health system. This study described the model of service provision at one facility in Cape Town, including reason for admission, the mix of services and skills provided and needed, patient satisfaction, patient outcome and articulation with other services across the spectrum of care...
May 14, 2017: International Journal of Health Policy and Management
Melaku Haile Likka, Dejene Melese Handalo, Yetnayet Abebe Weldsilase, Shimeles Ololo Sinkie
The objective of this systematic review is to identify, appraise and synthesize evidence to establish the effectiveness of community-based health insurance (CBHI) schemes in enhancing the utilization of healthcare services among their members in low- and middle-income countries (LMICs).Specifically, the review objective is to determine if individuals or households enrolled in CBHI schemes in LMICs utilize healthcare services (outpatient visits, hospital admissions, emergency visits, maternal and child healthcare services, or any other services involving the schemes) more frequently than those not included in CBHI schemes...
March 2018: JBI Database of Systematic Reviews and Implementation Reports
Abdul Momin Kazi, Murtaza Ali, Khurram Zubair, Hussain Kalimuddin, Abdul Nafey Kazi, Saleem Perwaiz Iqbal, Jean-Paul Collet, Syed Asad Ali
BACKGROUND: Improved routine immunization (RI) coverage is recommended as the priority public health strategy to decrease vaccine-preventable diseases and eradicate polio in Pakistan and worldwide. OBJECTIVE: The objective of this study was to ascertain whether customized, automated, one-way text messaging (short message service, SMS) reminders delivered to caregivers via mobile phones when a child is due for an RI visit can improve vaccination uptake and timelines in Pakistan...
March 7, 2018: JMIR Public Health and Surveillance
Elizabeth A Ashley, Judith Recht, Arlene Chua, David Dance, Mehul Dhorda, Nigel V Thomas, Nisha Ranganathan, Paul Turner, Philippe J Guerin, Nicholas J White, Nicholas P Day
Low- and middle-income countries (LMICs) shoulder the bulk of the global burden of infectious diseases and drug resistance. We searched for supranational networks performing antimicrobial resistance (AMR) surveillance in LMICs and assessed their organization, methodology, impacts and challenges. Since 2000, 72 supranational networks for AMR surveillance in bacteria, fungi, HIV, TB and malaria have been created that have involved LMICs, of which 34 are ongoing. The median (range) duration of the networks was 6 years (1-70) and the number of LMICs included was 8 (1-67)...
March 5, 2018: Journal of Antimicrobial Chemotherapy
S A Darfour-Oduro, J E Andrade, D S Grigsby-Toussaint
Background: Inadequate physical activity (PA) and consumption of fruits and vegetables (FV) are known risk factors for non-communicable diseases (NCDs). Consequently, the World Health Organization (WHO) encourages the development of policies to increase PA and FV consumption. We reviewed available policies between 2004 and 2013 to increase FV consumption and PA from a convenience sample of 49 LMICs. Method: Information on national policies were obtained from government ministries involved with the formulation of nutrition and PA policies, WHO databases and from PubMed and Scopus...
March 3, 2018: Journal of Public Health
Dennis Waithaka, Benjamin Tsofa, Edwine Barasa
Background : Decentralization of health systems has made sub-national/regional healthcare systems the backbone of healthcare delivery. These regions are tasked with the difficult responsibility of determining healthcare priorities and resource allocation amidst scarce resources. We aimed to review empirical literature that evaluated priority setting practice at the meso level of health systems. Methods : We systematically searched PubMed, ScienceDirect and Google scholar databases and supplemented these with manual searching for relevant studies, based on the reference list of selected papers...
2018: Wellcome Open Research
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