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Publication Years
1337
2474
194
3
2
Category
1149
361
330
228
141
49
31
3
3
Toolboxes
437
391
322
221
207
205
201
147
142
128
116
79
64
56
47
42
32
26
14
8
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3
1
As countries like the United States pass temporary legislation to cushion the massive blow that is on the horizon that is about to hit many of their citizens – poor and not poor – it is importan
...
t to think about the tools available to governments of low-income countries, what kind of preparations they might consider, and what type of scal burden they face for social protection programs that can be nanced through their own budgets and grants from international development institutions like the World Bank.
more
It is of utmost importance to low-income countries and some lower-
...
middle income nations in the time of the SDG period that they are not on course to accomplish the health-related SDG 3 and its targets until 2030. If we honestly intend to support this goal and realize it for the people living in the regions that are facing the lowest survival chances, we also need to recognize that these countries are far from being in a position to raise the necessary resources solely with their own means.
more
Bioethics - Medical, Ethical and Legal Perspectives
There’s evidence that implementing the four medical ethics principles may be challenging especially in low
...
income country contexts with extreme resource scarcity and limited capacity to facilitate deliberations on the different ethical dilemmas. These challenges can partly be explained by the social, economic, and political contexts in which the decisions are made, as well as the limited time, training and guidance to facilitate ethical decision making. Based on current literature, and using the example of bedside rationing; this chapter synthesizes the challenges clinicians face when operationalizing the four principle; identifying the opportunities to address them. We suggest that clinicians’ ability to implement the four principles are constrained by meso‐ and macro‐level decision making as well as their lack of training, explicit guidelines, and peer support. To ameliorate this situation, current efforts to strengthen the clinicians’ capacity to make ethical decisions should be complimented with developing of context relevant guidelines for ethical clinical decision making. The renewed global commitment to the sustainable development goals and universal healthcare coverage should be recognized as an opportunity to leverage resources and champion the integration of equity and justice as a core value in resource allocation at the bedside, meso-, macro- and global levels.
more
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.
more
For the primary health worker in a low/middle-income country (LMIC) setting, delivering quality primary care is challenging. This is often complica
...
ted by clinical guidance that is out of date, inconsistent and informed by evidence from high-income countries that ignores LMIC resource constraints and burden of disease. The Knowledge Translation Unit (KTU) of the University of Cape Town Lung Institute has developed, implemented and evaluated a health systems intervention in South Africa, and localised it to Botswana, Nigeria, Ethiopia and Brazil, that simplifies and standardises the care delivered by primary health workers while strengthening the system in which they work. At the core of this intervention, called Practical Approach to Care Kit (PACK), is a clinical decision support tool, the PACK guide. This paper describes the development of the guide over an 18-year period and explains the design features that have addressed what the patient, the clinician and the health system need from clinical guidance, and have made it, in the words of a South African primary care nurse, ‘A tool for every day for every patient’. It describes the lessons learnt during the development process that the KTU now applies to further development, maintenance and in-country localisation of the guide: develop clinical decision support in context first, involve local stakeholders in all stages, leverage others’ evidence databases to remain up to date and ensure content development, updating and localisation articulate with implementation.
more
The compendium provides guidance on low-cost handwashing facilities that can be widely used in low and
...
middle-income countries. We hope that this can be shared extensively as governments and agencies tackle the crisis in low and middle-income countries where handwashing facilities are urgently needed in households, communities, schools and healthcare facilities.
The compendium includes information and further reading on: handwashing facilities – including facilities that are accessible for all, environmental cues to reinforce handwashing behaviours, physical distancing hygiene promotion.
more
Development assistance for health (DAH) is an important part of financing healthcare in low- and middle-
...
income countries. We estimated the gross disbursement of DAH of the 29 Development Assistance Committee (DAC) member countries of the Organisation for Economic Co-operation and Development (OECD) for 2011–2019; and clarified its flows, including aid type,
channel, target region, and target health focus area. Data from the OECD iLibrary were used. The DAH definition was based on the OECD sector classification. For core funding to non-healthspecific multilateral agencies, we estimated DAH and its flows based on the OECD methodology for
calculating imputed multilateral official development assistance (ODA).
more
Background
Asthma remains highly prevalent, with more severe symptoms in low-income to middle-income
...
countries (LMICs) compared with high-income countries. Identifying risk factors for severe asthma symptoms can assist with improving outcomes. We aimed to determine the prevalence, severity and risk factors for asthma in adolescents in an LMIC.
Methods
A cross-sectional survey using the Global Asthma Network written and video questionnaires was conducted in adolescents aged 13 and 14 from randomly selected schools in Durban, South Africa, between May 2019 and June 2021.
Results
A total of 3957 adolescents (51.9% female) were included. The prevalence of lifetime, current and severe asthma was 24.6%, 13.7% and 9.1%, respectively. Of those with current and severe asthma symptoms; 38.9% (n=211/543) and 40.7% (n=147/361) had doctor-diagnosed asthma; of these, 72.0% (n=152/211) and 70.7% (n=104/147), respectively, reported using inhaled medication in the last 12 months. Short-acting beta agonists (80.4%) were more commonly used than inhaled corticosteroids (13.7%). Severe asthma was associated with: fee-paying school quintile (adjusted OR (CI)): 1.78 (1.27 to 2.48), overweight (1.60 (1.15 to 2.22)), exposure to traffic pollution (1.42 (1.11 to 1.82)), tobacco smoking (2.06 (1.15 to 3.68)), rhinoconjunctivitis (3.62 (2.80 to 4.67)) and eczema (2.24 (1.59 to 3.14)), all p<0.01.
Conclusion
Asthma prevalence in this population (13.7%) is higher than the global average (10.4%). Although common, severe asthma symptoms are underdiagnosed and associated with atopy, environmental and lifestyle factors. Equitable access to affordable essential controller inhaled medicines addressing the disproportionate burden of asthma is needed in this setting.
more
Accessed: 02.05.2020
The COVID-19 Hygiene Hub is a free service to help actors in low- and middle-in
...
come countries rapidly share, design, and adapt evidence-based hygiene interventions to combat COVID-19.
more
INTRODUCTION: Health service use among the public can decline during outbreaks and had been predicted among low and
...
middle-income countries during the COVID-19 pandemic. In March 2020, the government of the Democratic Republic of the Congo (DRC) started implementing public health measures across Kinshasa, including strict lock-down measures in the Gombe health zone.
METHODS: Using monthly time series data from the DRC Health Management Information System (January 2018 to December 2020) and interrupted time series with mixed effects segmented Poisson regression models, we evaluated the impact of the pandemic on the use of essential health services (outpatient visits, maternal health, vaccinations, visits for common infectious diseases and non-communicable diseases) during the first wave of the pandemic in Kinshasa. Analyses were stratified by age, sex, health facility and lockdown policy (i.e, Gombe vs other health zones).
RESULTS: Health service use dropped rapidly following the start of the pandemic and ranged from 16% for visits for hypertension to 39% for visits for diabetes. However, reductions were highly concentrated in Gombe (81% decline in outpatient visits) relative to other health zones. When the lock-down was lifted, total visits and visits for infectious diseases and non-communicable diseases increased approximately twofold. Hospitals were more affected than health centres. Overall, the use of maternal health services and vaccinations was not significantly affected.
CONCLUSION: The COVID-19 pandemic resulted in important reductions in health service utilizsation in Kinshasa, particularly Gombe. Lifting of lock-down led to a rebound in the level of health service use but it remained lower than pre-pandemic levels.
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This document provides information for WHO Member States, particularly low-income and middle-
...
income countries, to strengthen preparedness and response plans with regard to the social and mental health consequences of biological and chemical attacks.
more
Child and adolescent mental health policy in South Africa: history, current policy development and implementation, and policy analysis
S. Mokitimi; M. Schneider; P. J. de Vries
International Journal of Mental Health Systems; BioMed Central
(2018)
CC
Mental health problems represent the greatest global burden of disease among children and adolescents. There is, however, lack of policy development and implementation for child
...
and adolescent mental health (CAMH), particularly in low- and middle-income countries (LMICs) where children and adolescents represent up to 50% of populations. South Africa, an upper-middle income country is often regarded as advanced in health and social policy-making and implementation in comparison to other LMICs. It is, however, not clear whether this is the case for CAMH.
more
Official development assistance (ODA) is one of the most important means for donor countries to foster diplomatic relations with low- and
...
middle-income countries and contribute to the welfare of the international community.Objective: This study estimated the sectoral allocation of
more
Under- and over-diagnosis of COPD: a global perspective
Ho T., Cusack R.P., Chaudhary N. et al.
Breathe, part of the European Respiratory Society (ERS)
(2019)
CC2
The article "Under- and over-diagnosis of COPD: a global perspective" reviews the worldwide variation in the prevalence of chronic obstructive pulmonary disease (COPD) and issues related to its misd
...
iagnosis. It highlights that COPD is under-diagnosed due to factors such as limited access to spirometry and variable diagnostic criteria, especially in low- and middle-income countries. Conversely, over-diagnosis often results from reliance on non-standard criteria or inadequate spirometry use. The article discusses key risk factors, including age, gender, exposure to pollutants, and comorbidities, and emphasizes the need for standardized diagnostic practices to better address and manage COPD globally.
more
Non-communicable diseases (NCDs) account for 72% of all deaths globally and this proportion is growing. Greatest increases in NCD mortality are seen in low-
...
income and middle-income countries (LMICs). Places that only a generation ago knew famine are
today experiencing epidemics of obesity, diabetes, cardiovascular disease, and cancer. These epidemics reduce human capital in developing countries and their economic costs are so great that they threaten to slow and even undercut trajectories of economic and social development.
more
The aim of the WHO QualityRights tool kit is to support countries in assessing and
improving the quality and human rights of their mental health
...
and social care facilities.
The tool kit is based on an extensive international review by people with mental disabilities
and their organizations. It has been pilot-tested in low-, middle- and high-income
countries and is designed to be applied in all of these resource settings.
In this tool kit, the term ‘people with mental disabilities’ can include those with mental,
neurological or intellectual impairments and those with substance use disorders.
more
Neonatal tetanus (NT), a severe newborn illness from the toxigenic strains of Clostridium tetani, persists in middle- and low-
...
income countries due to non-sterile childbirth practices. Unlike smallpox and polio, tetanus cannot be eradicated: Clostridium tetani spores exist in the environment, and animal reservoirs. However, elimination as a public health issue is achievable through widespread tetanus vaccination, clean deliveries, and proper umbilical cord care. The goal of eliminating maternal and neonatal tetanus (MNT) as a public health problem is considered met when all municipalities in a country have an annual incidence rate of NT of less than 1 case per 1000 live births. The Region of the Americas achieved the maternal and neonatal tetanus elimination (MNTE) target in 2017 when elimination was validated in the Republic of Haiti. Yet maintaining this progress requires continued efforts. High vaccination coverage, booster doses in countries lacking them, hygienic practices, and strong maternal and child health services are key. The Pan American Health Organization’s (PAHO) integrated maternal and neonatal immunization platform further strengthens this fight against early childhood diseases.
more
Inequality of access to palliative care and symptom relief is one of the greatest disparities in global health care (1). Currently, there is avoidable suffering on a massive scale due to lack of access to palliative care
...
and symptom relief in low- and middle-income countries (LMICs) (1). Yet basic palliative care that can prevent or relieve most suffering due to serious or life-threatening health conditions can be taught easily to generalist clinicians, can be provided in the community and requires only simple, inexpensive medicines and equipment. For these reasons, the World Health Assembly (WHA) resolved that palliative care is "an ethical responsibility of health systems"(2). Further, most patients who need palliative care are at home and prefer to remain there. Thus, it is imperative that palliative care be provided in the community as part of primary care. This document was written to assist ministries of health and health care planners, implementers and managers to integrate palliative care and symptom control into primary health care (PHC).
more
An evidence-informed approach for non-formal, out-of-school CSE programmes that aims to reach young people from left-behind populations
This guidance is intended to assist anyone designing and/or implementing CSE in out-of-school settings, especial
...
ly in low- and middle-income countries. This includes international and national civil-society organizations, community-based organizations, government departments, UN agencies, health authorities, non-formal education authorities and youth development authorities. It is also intended for anyone else involved in the design, delivery and evaluation of sexuality education programmes out of school, especially those working with the specific groups of young people addressed in the guidance.
more
