Prevention, early identification, assessment and intervention in low- and middle-income countries | A Review | CHILD AND ADOLESCENT HEALTH AND DEVELOPMENT
Overview
Learning objectives
• Understand the mental health treatment gap in low-, middle- and high-income countries.
• Understand the principles and aims of the Mental Health Gap Action Prog...ramme.
• Acquire an introduction to mhGAP Intervention Guide (mhGAP-IG).
• Learn about mhGAP ToHP training methodology and what to expect from mhGAP ToHP
training.
• Prepare group training ground rules.
• Know the common presentations of mental, neurological and substance abuse (MNS)
conditions.
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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).
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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 ris...kiest 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.
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The global burden of disease due to mental disorders continues to rise, especially in low- and middle-income countries (LMIC). In addition to causing a large proportion of morbidity, mental disorder...s – especially severe mental disorders (SMD) – are linked with poorer health outcomes and increased mortality. SMD are defined as a group of conditions that include moderate to severe depression, bipolar disorder, and schizophrenia and other psychotic disorders. People with SMD have a two to three times higher average mortality compared to the general population, which translates to a 10-20 year reduction in life expectancy. While people with SMD do have higher rates of death due to unnatural causes (accidents, homicide, or suicide) than the general population, the
majority of deaths amongst people with SMD are attributable to physical health conditions, both
non-communicable and communicable.
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How should humanitarian organisations prepare and respond to COVID-19 in humanitarian settings in low- and middle-income countries?
This Rapid Learning Review outlines 14 actions, insights and id...eas for humanitarian actors to consider in their COVID-19 responses. It summarises and synthesises the best available knowledge and guidance for developing a health response to COVID-19 in low- and middle-income settings as at April 2020
The paper, supported by the UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator Mark Lowcock, will be updated throughout 2020 to reflect emerging knowledge and evidence on the most effective approaches to respond to the COVID-19 Pandemic.
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For most people in displacement contexts, there are simply not enough vaccines available in the places where they are hosted: 85% of refugees are hosted in lower- and middle-income countries, while ...in the first six months of this year 85% of vaccines went to wealthy countries; lower- and middle income countries have still received only a fraction of the vaccine doses they require.3 Shortages in these countries can also pose particular risks to vaccination campaigns aimed at displaced populations, as they can result in them being deprioritized.
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The availability of controlled medicines is crucial for patients requiring palliative care, pain relief and symptom management. Many individuals worldwide, especially in low- and middle-income count...ries, continue to experience limited access to these essential medicines. Enhancing access to controlled medicines is paramount in promoting universal health coverage. This report offers a detailed situational analysis of policies and programmes aimed at improving access to affordable, high-quality controlled medicines for pain management in the WHO South-East Asia Region. The report identifies the existing barriers, challenges and possible solutions to facilitate access to such medicines across all Member States.
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Over 90% of the morbidity and mortality related to chronic obstructive pulmonary disease (COPD) and asthma occurs in low-income and middle-income c...ountries (LMICs) due to well documented factors including decreased access to screening, trained health professionals, and therapies for disease management. Inhaler therapy (eg, aerosolised medications by inhalation, nebulisation, or propellant) is the mainstay of treatment for COPD and asthma. Adherence to maintenance medications for COPD and asthma results in improved lung function and quality of life, as well as decreased hospitalisation and mortality. WHO have included short-acting beta-agonists, long-acting muscarinic antagonists, and inhaled corticosteroids on the essential medications list, with a target goal of achieving 80% availability of these medications in public and private facilities. However, despite these efforts, accessibility, and affordability of medications for COPD and asthma remains scarce.
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Every year, around 830 000 children die from unintentional or "accidental" injuries. The vast majority of these injuries occur in low-income and middle-in...come countries. However, dozens of prevention strategies and programmes exist. If they were integrated into other child survival programmes and implemented on a larger scale, many of these deaths and much of the injury-related disability could be prevented.
The report documents the magnitude, risks and prevention measures for child injuries globally –particularly for drowning, burns, road traffic injuries, falls and poisoning.
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Poor quality health services are holding back progress on improving health in countries at all income levels.
Today, inaccurate diagnosis, medication errors, inappropriate or unnecessary treatment, inadequate or unsafe clinical facilities or pr...actices, or providers who lack adequate training and expertise prevail in all countries.
The situation is worst in low and middle-income countries where 10 percent of hospitalized patients can expect to acquire an infection during their stay, as compared to seven percent in high income countries. This is despite hospital acquired infections being easily avoided through better hygiene, improved infection control practices and appropriate use of antimicrobials.. At the same time, one in ten patients is harmed during medical treatment in high income countries.
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Info from and between Mental Health Workers, NGO's, Institutes, Service Users and others who are interested in improving Mental Health in Low and Middle Income Countries
This year’s MPI results show that more than two-thirds of the multidimensionally poor—886 millionpeople—live in middle-income countries. A further 440 million live in low-...e-to-highlight medbox">income countries. In both groups, data show, simple national averagescan hide enormous inequality inpatterns of povertywithin countries. For instance, in Uganda 55 percentof the population experience multidimensional poverty—similartotheaverage in Sub-Saharan Africa. But Kampala, the capital city, has an MPI rate of sixpercent, whileinthe Karamojaregion, the MPI soars to 96 percent—meaningthat partsof Ugandaspan the extremes of Sub-Saharan Africa.There is even inequality under the same roof. In South Asia, for example, almost a quarter ofchildren under five live in households where at least one child in the household is malnourished but at least one child is not.
There is also inequality among the poor. Findings of the2019 global MPI paint a detailed picture of the many differences in how-and how deeply -people experience poverty. Deprivationsamong the poor varyenormously: in general, higher MPI valuesgo hand in hand with greater variationin the intensity of poverty. Results also show that children suffer poverty more intensely than adults and are more likely to be deprived in all 10 of the MPI indicators, lackingessentialssuch as clean water, sanitation, adequate nutrition or primary education
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This brief considers the rationale for shielding individuals at high risk of severe disease or death from COVID-19 in low- and middleincome countries. It provides an overview of proposed approaches to shielding, discusses the categories of individua...ls who may be identified for shielding, and outlines the likely difficulties of these measures and ways to mitigate them.
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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 agencie...s 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.
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The objective of this project was to list the medical devices required to provide the essential reproductive, maternal, newborn and child health interventions defined by existing WHO guidelines and publications, in order to improve access to these devices in low- and ...ght medbox">middle-income countries, support quality of care, and strengthen health-care system. The medical devices are allocated across the reproductive, maternal, newborn and child health continuum of care according to the level of health-care delivery.
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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 governmen...t 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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Pregnancy and childbirth during adolescence profoundly affects the lives of millions of girls worldwide, and is a leading cause of maternal mortality and morbidity, and infant and child mortality. Every year, an estimated 21 million girls aged 15–19 years old in low- and ...highlight medbox">middle-income countries become pregnant, and approximately 12 million give birth.
For many adolescent girls, the ability to control their sexual lives remains limited. Long-standing gender inequalities and discrimination, marginalization, harmful social and gender norms, and denial of rights, compounded by poverty and violence, render them vulnerable to early pregnancy, HIV and other health threats. Lack of age-appropriate sexual and reproductive health and rights (SRHR) information and services create additional barriers to care and support; as a result, adolescent girls who become pregnant are much more likely to go on to have rapid repeated births.
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Cardiovascular diseases, principally ischemic heart disease (IHD), are the most important cause of death and disability in the majority of low- and lower-middle-income countries (LLMICs). In these c...ountries, IHD mortality rates are significantly greater in individuals of a low socioeconomic status (SES).
Three important focus areas for decreasing IHD mortality among those of low SES in LLMICs are (1) acute coronary care; (2) cardiac rehabilitation and secondary prevention; and (3) primary prevention. Greater mortality in low SES patients with acute coronary syndrome is due to lack of awareness of symptoms in patients and primary care physicians, delay in reaching healthcare facilities, non-availability of thrombolysis and coronary revascularization, and the non-affordability of expensive medicines (statins, dual anti-platelets, renin-angiotensin system blockers). Facilities for rapid diagnosis and accessible and affordable long-term care at secondary and tertiary care hospitals for IHD care are needed. A strong focus on the social determinants of health (low education, poverty, working and living conditions), greater healthcare financing, and efficient primary care is required. The quality of primary prevention needs to be improved with initiatives to eliminate tobacco and trans-fats and to reduce the consumption of alcohol, refined carbohydrates, and salt along with the promotion of healthy foods and physical activity. Efficient primary care with a focus on management of blood pressure, lipids and diabetes is needed. Task sharing with community health workers, electronic decision support systems, and use of fixed-dose combinations of blood pressure-lowering drugs and statins can substantially reduce risk factors and potentially lead to large reductions in IHD. Finally, training of physicians, nurses, and health workers in IHD prevention should be strengthened.
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Direct acting antivirals (DAAs) have revolutionized treatment for hepatitis C. Combi-
nations of DAAs can cure infection with HCV in 12 weeks, are highly effective and
have limited side-effects. Affordability of DAAs has improved significantly, but access remains lim-
i...ted. Initially, due to their high prices, affordability of DAAs was limited in high-, middle- and low-
income countries alike. Now there is a divide between those countries where, because of intellectual
property barriers, prices have remained (very) high and other countries where generics are, or can be,
available at much lower prices. The result is a dual market
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