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
In many low- and middle-income countries, there is a wide gap between evidencebased recommendations and current practice. Treatment of major CVD risk factors remains suboptimal, and only a minority of patients who are treated reach their target levels for blood pressure, blood sugar and blood choles...terol.
In other areas, overtreatment can occur with the use of non-evidence-based
protocols. The aim of using standard treatment protocols is to improve the quality
of clinical care, reduce clinical variability and simplify the treatment options,
particularly in primary health care. Standard treatment protocols can be developed by preparing new national treatment guidelines or by adapting or adopting international guidelines.
The Evidence-based protocols module uses hypertension and diabetes screening
and treatment as an entry point to control cardiovascular risk factors, prevent target organ damage, and reduce premature morbidity and mortality. A comprehensive risk- based approach for integrated management of hypertension, diabetes, and high cholesterol is included in the Risk-based CVD management module.
This module includes clinical practice points and sample protocols for:
1. hypertension detection and treatment
2. type 2 diabetes detection and treatment
3. identifying basic emergencies – care and referral.
HEARTS emphasizes adaptation, dissemination, and use of a standardized set of
simple clinical-management protocols, which should be drug- and dose-specific,
and include a core set of medications. The simpler the protocols and management tools, the more likely they are to be used correctly, and the higher the likelihood that a programme will achieve its goals.
more
Overcoming barriers in low- and middle-income countries
For the first time, this year’s report includes information on hepatitis C diagnostics. With a focus on selected countries with diverse HCV epidemics, the report provides updates on the various dimensions of access to HCV diagnostics and pha...rmaceutical products, including product pricing, the regulatory environment and patent status, which together shape the national hepatitis response in different settings. It highlights key areas for action by ministries of health and other government decision-makers, pharmaceutical manufacturers and technical partners.
more
Donor financing to low- and middle-income countries for reproductive, maternal, newborn, and child health increased substantially from 2008 to 2013. However, increased spending by donors might not improve outcomes, if funds are delivered in ways that undermine countries’ public financial managemen...t systems and incur high transaction costs for project implementation
more
Deliberations about an affordable national health insurance for the low-income workforce in Namibia
Robust clinical research capacity in low- and middle-income countries is key to stemming the spread of epidemics, according to a new report from the International Vaccines Task Force (IVTF). The report lays out how to develop the political support, financing and coordination required to build this c...apacity as a crucial component of global epidemic preparedness. The IVTF was convened by the World Bank Group (WBG) and the Coalition for Epidemic Preparedness Innovations (CEPI) in October 2017.
more
Globally, in low-income countries, the average newborn mortality rate is 27 deaths per 1,000 births, the report says. In high-income countries, that rate is 3 deaths per 1,000. Newborns from the riskiest places to give birth are up to 50 times more likely to die than those from the safest places.
...>
The report also notes that 8 of the 10 most dangerous places to be born are in sub-Saharan Africa, where pregnant women are much less likely to receive assistance during delivery due to poverty, conflict and weak institutions. If every country brought its newborn mortality rate down to the high-income average by 2030, 16 million lives could be saved.
More than 80 per cent of newborn deaths are due to prematurity, complications during birth or infections such as pneumonia and sepsis, the report says. These deaths can be prevented with access to well-trained midwives, along with proven solutions like clean water, disinfectants, breastfeeding within the first hour, skin-to-skin contact and good nutrition.
more
The Republic of the Union of Myanmar is at a historic moment, with a new civilian government assuming power in 2016. The country graduated to lower-middle-income status in 2015, and has made significant progress in reducing poverty, improving food security and addressing malnutrition.
The remai...ning challenges to food and nutrition security and achievement of Sustainable Development Goal 2 targets include continued population displacements resulting from conflict, vulnerability to extreme weather events, poverty, limited social protection coverage, high malnutrition and persistent gender inequalities.
more
The growing challenges for people in low and middle-income countries to access new medicines.
Analysis 58
The RehApp is specifically designed for fieldworkers in low-and middle-income countries and aims to enhance their capacity to work with people with disabilities within the community: assess their abilities and inabilities, design rehabilitation interventions, provide care and support and refer appro...priately. It consists of different chapters – covering various types of impairments – organised according to the International Classification of Functioning, Disability and Health, commonly known as the ICF.
The RehApp is available for free, and once downloaded, it can be used in any setting without internet access. It is currently available in English, French, Nepali, and Portuguese. Several chapters area also available in Amharic, Burmese, Khmer, Spanish, Tajik and Vietnamese. The App is available for Apple and for Android.
more
the Principles for Dose-Sharing provide a framework for higher-income economies to make additional volumes secured via bilateral deals available through the Facility primarily to AMC participants, on an equitable basis. These principles outline that such doses must be safe and effective, available a...s early as possible and should be available in substantive volumes as early as possible in 2021 to enable rapid and flexible deployment by the Facility – supporting the overall goal of equitable access.
18 Dec 2020
more
Injection practices worldwide and especially in low- and middle-income countries (LMICs) include multiple, avoidable unsafe practices that ultimately lead to the large-scale transmission of bloodborne viruses among patients, health care providers and the community at large.
For the primary health worker in a low/middle-income country (LMIC) setting, delivering quality primary care is challenging. This is often complicated 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
Since Sri Lanka tranisitioned to an upper -middle-income country in 2019, it is no longer eligible for concessional donor aid for health. Experiences of how donor trnaisitons in the health sector were managed in Sri Lanka offer valuable insights to mitigate negatvie impacts of donor exits. In this s...tudy, we seek to understand preferences of in-country stakeholders for potentioal policy options to manage donor tranisitions
more
Tracking development assistance for health for low- and middle-income countries gives policy makers information about spending patterns and potential improvements in resource allocation. We tracked the flows of development assistance and explored the relationship between national income, disease bur...den, and assistance
more
To help adapt cardiovascular disease risk prediction approaches to low-income and middle-income countries, WHO has convened an effort to develop, evaluate, and illustrate revised risk models. Here, we report the derivation, validation, and illustration of the revised WHO cardiovascular disease risk ...prediction charts that have been adapted to the circumstances of 21 global regions.
more
What is already known about this topic?
Roughly 80% of the global disease burden caused by diabetes comes from low-and-middle income countries, and 60% of diabetics are located in Asia; 6 of the top 10 countries with the highest prevalence of diabetes are in Asia.
The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014.
The global prevalence of diabetes* among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014.
Diabetes prevalence has been rising more rapidly in middle- and low-income countries.
Dia...betes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.
In 2012, an estimated 1.5 million deaths were directly caused by diabetes and another 2.2 million deaths were attributable to high blood glucose.
Almost half of all deaths attributable to high blood glucose occur before the age of 70 years.
WHO projects that diabetes will be the 7th leading cause of death in 2030
Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes.
Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications.
more
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.
more
Best Practice for the Care of Patients with Tuberculosis: a Guide for Low-Income CountriesThe practical aspects of TB patient care from the onset of symptoms to the completion of treatment are covered in this guide.