17,857 research outputs found

    Weak surveillance and policy attention to cancer in global health: the example of Mozambique

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    Cancer is an emerging public health problem in sub-Saharan Africa due to population growth, ageing and westernisation of lifestyles. The increasing burden of cancer calls for urgent policy attention to develop cancer prevention and control programmes. Cancer surveillance is an essential prerequisite. Only one in five low-income and middle-income countries have the necessary data to drive policy and reduce the cancer burden. In this piece, we use data from Mozambique over a 50-year period to illustrate cancer epidemiological trends in low-income and middle-income countries to hypothesise potential circumstances and factors that could explain changes in cancer burden and to discuss surveillance weaknesses and potential improvements. Like many low-income and middle-income countries, Mozambique faces the dual challenge of a still high morbidity and mortality due to infectious diseases in rural areas and increased incidence of cancers associated with westernisation of lifestyles in urban areas, as well as a rise of cancers related to the HIV epidemic. An increase in cancer burden and changes in the cancer profile should be expected in coming years. The Mozambican healthcare and health-information systems, like in many other low-income and middle-income countries, are not prepared to face this epidemiological transition, which deserves increasing policy attention

    Contribution of suicide and injuries to pregnancy-related mortality in low-income and middle-income countries: a systematic review and meta-analysis.

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    BACKGROUND: Although suicide is one of the leading causes of deaths in young women in low-income and middle-income countries, the contribution of suicide and injuries to pregnancy-related mortality remains unknown. METHODS: We did a systematic review to identify studies reporting the proportion of pregnancy-related deaths attributable to suicide or injuries, or both, in low-income and middle-income countries. We used a random-effects meta-analysis to calculate the pooled prevalence of pregnancy-related deaths attributable to suicide, stratified by WHO region. To account for the possible misclassification of suicide deaths as injuries, we calculated the pooled prevalence of deaths attributable to injuries, and undertook a sensitivity analysis reclassifying the leading methods of suicides among women in low-income and middle-income countries (burns, poisoning, falling, or drowning) as suicide. FINDINGS: We identified 36 studies from 21 countries. The pooled total prevalence across the regions was 1路00% for suicide (95% CI 0路54-1路57) and 5路06% for injuries (3路72-6路58). Reclassifying the leading suicide methods from injuries to suicide increased the pooled prevalence of pregnancy-related deaths attributed to suicide to 1路68% (1路09-2路37). Americas (3路03%, 1路20-5路49), the eastern Mediterranean region (3路55%, 0路37-9路37), and the southeast Asia region (2路19%, 1路04-3路68) had the highest prevalence for suicide, with the western Pacific (1路16%, 0路00-4路67) and Africa (0路65%, 0路45-0路88) regions having the lowest. INTERPRETATION: The available data suggest a modest contribution of injuries and suicide to pregnancy-related mortality in low-income and middle-income countries with wide regional variations. However, this study might have underestimated suicide deaths because of the absence of recognition and inclusion of these causes in eligible studies. We recommend that injury-related and other co-incidental causes of death are included in the WHO definition of maternal mortality to promote measurement and effective intervention for reduction of maternal mortality in low-income and middle-income countries. FUNDING: National Institute of Mental Health

    Cryptococcal meningitis: improving access to essential antifungal medicines in resource-poor countries

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    Cryptococcal meningitis is the leading cause of adult meningitis in sub-Saharan Africa, and contributes up to 20% of AIDS-related mortality in low-income and middle-income countries every year. Antifungal treatment for cryptococcal meningitis relies on three old, off-patent antifungal drugs: amphotericin B deoxycholate, flucytosine, and fluconazole. Widely accepted treatment guidelines recommend amphotericin B and flucytosine as first-line induction treatment for cryptococcal meningitis. However, flucytosine is unavailable in Africa and most of Asia, and safe amphotericin B administration requires patient hospitalisation and careful laboratory monitoring to identify and treat common side-effects. Therefore, fluconazole monotherapy is widely used in low-income and middle-income countries for induction therapy, but treatment is associated with significantly increased rates of mortality. We review the antifungal drugs used to treat cryptococcal meningitis with respect to clinical effectiveness and access issues specific to low-income and middle-income countries. Each drug poses unique access challenges: amphotericin B through cost, toxic effects, and insufficiently coordinated distribution; flucytosine through cost and scarcity of registration; and fluconazole through challenges in maintenance of local stocks-eg, sustainability of donations or insufficient generic supplies. We advocate ten steps that need to be taken to improve access to safe and effective antifungal therapy for cryptococcal meningitis

    Protecting children in low-income and middle-income countries from COVID-19

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    CITATION: Ahmed, S. et al. 2020. Protecting children in low-income and middle-income countries from COVID-19. BMJ Global Health, 5:e002844. doi:10.1136/bmjgh-2020-002844.The original publication is available at https://gh.bmj.comA saving grace of the COVID-19 pandemic in high-income and upper middle-income countries has been the relative sparing of children. As the disease spreads across low-income and middle-income countries (LMICs), long-standing system vulnerabilities may tragically manifest, and we worry that children will be increasingly impacted, both directly and indirectly. Drawing on our shared child pneumonia experience globally, we highlight these potential impacts on children in LMICs and propose actions for a collective response.https://gh.bmj.com/content/5/5/e002844.abstractPublisher's versio

    Alcohol burden in low-income and middle-income countries

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    Child maltreatment in low- and middle-income countries overburdens health systems, compromises education, perpetuates gender inequalities and slows down development. Research suggests that parenting programmes are effective for the early prevention of child maltreatment. However, wide deployment in LMICs where violence towards children is high is yet to take place. In this overview article, we identify some critical challenges that LMICs currently face in ensuring the sustained implementation of parenting programmes for the early prevention of child maltreatment. The article is structured in three main sections: (1) a brief review of the effectiveness of parenting programmes for preventing child maltreatment; (2) a discussion of the critical challenges in LMICs for the widespread and sustained implementation of parenting programmes; and (3) we propose recommendations to promote effective implementation in these countries. We also suggest a series of steps to overcome these challenges, such as investing on capacity-building for sustainability

    Suicide and poverty in low-income and middle-income countries: a systematic review

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    Suicide is the 15th leading cause of death worldwide, with over 75% of suicides occurring in low- and middle-income countries where most of the world鈥檚 poor live. Nonetheless, evidence on the relationship between suicide and poverty in low- and middle-income countries is limited. We conducted a systematic review to understand the relationship between suicidal ideations and behaviours (SIB) and economic poverty in low- and middle-income countries. We identified 37 studies meeting inclusion criteria. In 18 studies reporting the relationship between completed suicide and poverty, 31 relationships were explored. The majority reported a positive association. Of the 20 studies reporting on the relationship between non-fatal SIB and poverty, 36 relationships were explored. Again, the majority of studies reported a positive relationship. However, when considering each poverty dimension separately, we found substantial variations. Findings suggest a relatively consistent trend at the individual level indicating that poverty, particularly in the form of worse economic status, diminished wealth and unemployment is associated with SIB. At the country level, there are insufficient data to draw clear conclusions. Available evidence suggests potential benefits in addressing economic poverty within suicide prevention strategies, with attention to both chronic poverty and acute economic events

    Prev Chronic Dis

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    This study investigated whether the relationship between body mass index (BMI) and poor self-rated health differed by sex in low-income countries and middle-income countries. We analyzed data from the World Health Survey (2002-2004) on 160,099 participants from 49 low-income and middle-income countries by using random-intercept multilevel logistic regressions. We found a U-shaped relationship between BMI and poor self-rated health among both sexes in both low-income and middle-income countries, but the relationship differed by sex in strength and direction between low-income countries and middle-income countries. Differential perception of body weight and general health might explain some of the observed sex differences.26292064PMC455610

    Exposing and addressing tobacco industry conduct in low-income and middle-income countries

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    The tobacco industry's future depends on increasing tobacco use in low-income and middle-income countries (LMICs), which face a growing burden of tobacco-related disease, yet have potential to prevent full-scale escalation of this epidemic. To drive up sales the industry markets its products heavily, deliberately targeting non-smokers and keeps prices low until smoking and local economies are sufficiently established to drive prices and profits up. The industry systematically flaunts existing tobacco control legislation and works aggressively to prevent future policies using its resource advantage to present highly misleading economic arguments, rebrand political activities as corporate social responsibility, and establish and use third parties to make its arguments more palatable. Increasingly it is using domestic litigation and international arbitration to bully LMICs from implementing effective policies and hijacking the problem of tobacco smuggling for policy gain, attempting to put itself in control of an illegal trade in which there is overwhelming historical evidence of its complicity. Progress will not be realised until tobacco industry interference is actively addressed as outlined in Article 5.3 of the Framework Convention on Tobacco Control. Exemplar LMICs show this action can be achieved and indicate that exposing tobacco industry misconduct is an essential first step

    The true cost of malaria 鈥 how to make the Asia-Pacific malaria free by 2030

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    [Extract] Strengthening a country's health system is one of the best ways to invest in human and economic development. For the Asia-Pacific, eliminating malaria is a particularly prudent investment, Geoff Clark writes. The link between the health of a society and the strength of its economy is clear. As documented in the influential report Global health 2035: a world converging within a generation, the returns on investing in health are impressive. Reductions in mortality account for about 11 per cent of recent economic growth in low-income and middle-income countries, as measured in their national income accounts. Between 2000 and 2011, about 24 per cent of the growth in full income in low-income and middle-income countries resulted from the value of additional life years gained

    The role and challenges of cluster randomised trials for global health

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    Evaluating whether an intervention works when trialled in groups of individuals can pose complex challenges for clinical research. Cluster randomised controlled trials involve the random allocation of groups or clusters of individuals to receive an intervention, and they are commonly used in global health research. In this paper, we describe the potential reasons for the increasing popularity of cluster trials in low-income and middle-income countries. We also draw on key areas of global health research for an assessment of common trial planning practices, and we address their methodological shortcomings and pitfalls. Lastly, we discuss alternative approaches for population-level intervention trials that could be useful for research undertaken in low-income and middle-income countries for situations in which the use of cluster randomisation might not be appropriate
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