Background
Low- and middle-income countries now experience the highest prevalence and mortality rates of cardiovascular disease.
Main text
While improving the availability and delivery of proven, effective therapies will no doubt mitigate this burden, we posit that studies evaluating cardiovasc...ular disease risk factors, management strategies and service delivery, in diverse settings and diverse populations, are equally critical to improving outcomes in low- and middle-income countries. Focusing on examples drawn from four cardiovascular diseases — coronary artery disease, stroke, diabetes and kidney disease — we argue that ethnicity, culture and context matter in determining the risk factors for disease as well as the comparative effectiveness of medications and other interventions, particularly diet and lifestyle interventions.
Conclusion
We believe that a host of cohort studies and randomized control trials currently being conducted or planned in low- and middle-income countries, focusing on previously understudied race/ethnic groups, have the potential to increase knowledge about the cause(s) and management of cardiovascular diseases across the world.
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There is paucity of data on the burden and specific drivers operative in the pathogenesis of chronic obstructive pulmonary disease (COPD) in the African setting and populations. Lack of awareness and inadequate knowledge on the aetio-pathogenesis of... the disease together with inadequate capacity for COPD care contributes to preventive and management challenges. Thus, the majority of patients with COPD are misdiagnosed, misclassified and mismanaged or undertreated. With the struggling improvement in the quality of healthcare in Africa, studies conducted over the last 10 years indicates the rising trends in both the risk factors and the burden of COPD. The role of new risk factors such as indoor pollution, infections with human immunodeficiency virus (HIV) and pulmonary tuberculosis (TB), in the pathogenesis of COPD in Africa is increasingly being recognized. This literature review attempts to collect and synthesize information that could be useful in improving COPD care and informing the governments to take appropriate actions for prevention, diagnosis and management of COPD in Africa.
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The document "Pocketbook for Management of Diabetes in Childhood and Adolescence in Under-Resourced Countries" (2nd Edition) provides practical guidelines for managing diabetes in children and adolescents, particularly in resource-limited settings. ...It covers key topics like diagnosing and treating diabetes, managing diabetic ketoacidosis (DKA), insulin therapy, blood glucose monitoring, nutritional management, and dealing with complications. The pocketbook aims to support healthcare professionals in delivering effective diabetes care and improving outcomes for young patients in under-resourced areas.
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The document discusses the complexities of managing patients with COPD and multiple comorbidities, highlighting the importance of personalized care and the appropriate use of inhaled corticosteroids (ICS). It outlines common comorbidities, such as asthma, osteoporosis, and diabetes, and offers guida...nce on optimizing treatment regimens while minimizing risks and polypharmacy in primary care settings.
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Most of the global burden of sepsis occurs in low- and middle-income countries (LMICs), but the prevalence and etiology of sepsis in LMICs are not well understood. In particular, the lack of laboratory infrastructure in many LMICs has historically precluded an assessment of the pathogens leading to ...sepsis. A recent systematic review found that data describing antimicrobial resistance were absent for 43% of countries in Africa, and only two countries have national antimicrobial resistance plans. In addition, small studies have identified indiscriminate antibiotic use both in and out of hospital settings in sub-Saharan Africa. The absence of microbiological data and lack of antibiotic stewardship complicate sepsis management and almost certainly worsens outcomes, particularly in low-resource systems. The purpose of this study was to examine the prevalence, etiology, and outcomes of sepsis among a cohort of critically ill patients in a referral hospital of Malawi, with a focus on the prevalence of culture-confirmed bacteremia and urinary tract infections.
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Severe and difficult asthma in a low- and middle-income country (LMIC) can relate to lack of availability of basic medications; potentially reversible factors such as poor adherence or comorbidities such as obesity inhibiting a good response to treatment; and (rarely) true severe, therapy-resistant ...asthma. However, definitions of severity should encompass not merely doses of prescribed medication, but also underlying risk. The nature of asthmatic airway disease shows geographical variation, and LMIC asthma should not be assumed to be phenotypically the same as that in high-income countries (HICs). The first assessment step is to ensure another diagnosis is not being missed. Largely, political action is needed if children with asthma are to get access to basic medications. If a child is apparently not responding to low dose, simple medications, the next step is not to increase the dose but perform a detailed assessment of what factors (for example co-morbidities such as obesity, or social factors like poor adherence) are inhibiting a treatment response; in most cases, an underlying reason can be found. An assessment of risk of future severe asthma attacks, side-effects of medication and impaired lung development is also important. True severe, therapy-resistant asthma is rare and there are multiple underlying molecular pathologies. In HICs, steroid-resistant eosinophilia would be treated with omalizumab or mepolizumab, but the cost of these is prohibitive in LMICs, the biomarkers of successful therapy are likely only relevant to HICs. In LMICs, a raised blood eosinophil count may be due to parasites, so treating asthma based on the blood eosinophil count may not be appropriate in these settings.
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Child Friendly Spaces (CFSs) are used by humanitarian agencies as a means to promote protection and psychosocial wellbeing for children in emergency settings. World Vision International together with Columbia University is conducting a series of stu...dies to investigate the effectiveness of CFSs in various humanitarian contexts in order to document evidence of the positive effects they have in relation to child wellbeing and protection, to identify good practice in their design and implementation and to develop improved monitoring and evaluation approaches for CFSs. The case studies have so far all been focused on refugee settings and while internally displaced populations (IDPs) share many of the circumstances and challenges of refugees it was decided that CFSs operating in IDP settings warrant a particular investigation in order to assess their relevance and effectiveness in promoting child protection and psychosocial wellbeing. This report thus presents the findings from an IDP focused study on CFS effectiveness in three camps near Goma, eastern Democratic Republic of Congo (DRC).
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This toolkit is intended to support GBV staff to build disability inclusion into their work, and to strengthen the capacity of GBV practitioners to use a survivor-centered approach when providing services to survivors with disabilities.
The tools are designed to complement existing guidelines, prot...ocols and tools for GBV prevention and response, and should not be used in isolation from these. GBV practitioners are encouraged to adapt the tools to their individual programs and contexts, and to integrate pieces into standard GBV tools and resources.
You can download from English, French and Arabic Version
http://www.womensrefugeecommission.org/research-resources/building-capacity-for-disability-inclusion-in-gender-based-violence-gbv-programming-in-humanitarian-settings-overview/
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This toolkit is intended to support GBV staff to build disability inclusion into their work, and to strengthen the capacity of GBV practitioners to use a survivor-centered approach when providing services to survivors with disabilities.
The tools are designed to complement existing guidelines, prot...ocols and tools for GBV prevention and response, and should not be used in isolation from these. GBV practitioners are encouraged to adapt the tools to their individual programs and contexts, and to integrate pieces into standard GBV tools and resources.
You can download from English, French and Arabic Version
http://www.womensrefugeecommission.org/research-resources/building-capacity-for-disability-inclusion-in-gender-based-violence-gbv-programming-in-humanitarian-settings-overview/
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The tools are designed to complement existing guidelines, protocols and tools for GBV prevention and response, and should not be used in isolation from these. GBV practitioners are encouraged to adapt the tools to their individual programs and contexts, and to integrate pieces into standard GBV tool...s and resources.
You can download from English, French and Arabic Version
http://www.womensrefugeecommission.org/research-resources/building-capacity-for-disability-inclusion-in-gender-based-violence-gbv-programming-in-humanitarian-settings-overview/
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Despite the increasing population of refugees stuck in protracted situations and our awareness of the vulnerability of children and adolescents growing in up these contexts, relatively little is known about community based child protection mechanisms (CBCPMs) in refugee communities. CBCPMs, defined ...broadly, include all groups or networks that respond to and prevent problems of child protection and vulnerable children. These mechanisms may include family supports, peer group supports, and community groups such as primary and secondary schools, non-formal education and vocational training structures, women’s groups, religious groups, and youth groups, as well as traditional community processes, government mechanisms, and mechanisms initiated by international or domestic non-governmental organisations (NGOs). In diverse contexts, CBCPMs represent front-line, day-to-day efforts to protect children from exploitation, abuse, violence, and neglect and to promote children’s well being. This study, together with a parallel study conducted among the urban refugee population in Uganda, is the first study of CBCPMs undertaken in refugee settings.
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Meeting the rehabilitation needs of people affected by leprosy and promoting quality of life.
This brief report examines the extent to which community-based treatment and integration support are provided for people living with mental illness across 15 selected Asia-Pacific economies. Some of the key findings are discussed in light of the diversity of economies and cultural contexts.
BJPSYCH... INTERNATIONALVOLUME 15 NUMBER 4 NOVEMBER 201
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