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Sample records for eleven country review

  1. Planned, Motivated and Habitual Hygiene Behaviour: An Eleven Country Review

    ERIC Educational Resources Information Center

    Curtis, Valerie A.; Danquah, Lisa O.; Aunger, Robert V.

    2009-01-01

    Handwashing with soap (HWWS) may be one of the most cost-effective means of preventing infection in developing countries. However, HWWS is rare in these settings. We reviewed the results of formative research studies from 11 countries so as to understand the planned, motivated and habitual factors involved in HWWS. On average, only 17% of child…

  2. Mother-Infant Contingent Vocalizations in Eleven Countries

    PubMed Central

    Bornstein, Marc H.; Putnick, Diane L.; Cote, Linda R.; Haynes, O. Maurice; Suwalsky, Joan T.D.

    2015-01-01

    Mother-infant vocal interactions serve multiple functions in child development, but the community-common or community-specific nature of key features of their vocal interactions remains unclear. Here we examined rates, interrelations, and contingencies of vocal interactions in 684 mothers and their 5-month-old infants in diverse communities in 11 countries (Argentina, Belgium, Brazil, Cameroon, France, Israel, Italy, Japan, Kenya, South Korea, and United States). Rates of mothers’ and infants’ vocalizations varied widely across communities and were uncorrelated. However, collapsing across communities mothers vocalized to infants contingent on the offset of their infants’ nondistress vocalizing, infants vocalized contingent on the offset of their mothers’ vocalizing, and maternal and infant contingencies were significantly correlated, pointing to the beginnings of dyadic conversational turn taking. Despite broad differences in the overall talkativeness of mothers and infants, maternal and infant contingent vocal responsiveness is common across communities, supporting essential functions of turn-taking in early child socialization. PMID:26133571

  3. Consumption of fruits and vegetables among adolescents: a multi-national comparison of eleven countries in the Eastern Mediterranean Region.

    PubMed

    Al Ani, M F; Al Subhi, L K; Bose, S

    2016-03-28

    Regional cross-country profile of fruit and vegetable (F&V) consumption is lacking in the Eastern Mediterranean Region (EMR). This study examines the prevalence and differences of consuming F&V ≥5 times/d among adolescents in eleven EMR countries, and also describes differences in the proportions of taking F&V ≥5 times/d by sex, age and BMI. The study included 26 328 school adolescents (13-15 years) with complete data on consumption of F&V, age, sex, weight and height taken from the Global School-based Student Health Survey conducted in the EMR between 2005 and 2009. Overall, only 19·4 % of adolescents reported consuming F&V ≥5 times/d. The highest prevalence was reported in Djibouti (40·4 %) and the lowest was reported in Pakistan (10·0 %). Statistically significant differences in prevalence were observed across countries (P<0·05). With the exception of Oman, Libya and Djibouti, significantly more males than females ate F&V ≥5 times/d. Proportion of students consuming F&V ≥5 times/d also varied significantly in all counties based on BMI (P<0·0001), with students within normal BMI having the highest frequency. A negative trend was observed between age and the prevalence of taking F&V ≥5 times/d in most of the eleven EMR countries but Jordan, Djibouti and Morocco. The prevalence of adequate intake of F&V was low in the eleven EMR countries. There is a need for interventions to increase the prevalence of adolescents consuming F&V ≥5 times/d. Interventions should take into consideration psychosocial, environmental and socio-environmental factors influencing F&V intake within countries.

  4. Consumption of fruits and vegetables among adolescents: a multi-national comparison of eleven countries in the Eastern Mediterranean Region.

    PubMed

    Al Ani, M F; Al Subhi, L K; Bose, S

    2016-03-28

    Regional cross-country profile of fruit and vegetable (F&V) consumption is lacking in the Eastern Mediterranean Region (EMR). This study examines the prevalence and differences of consuming F&V ≥5 times/d among adolescents in eleven EMR countries, and also describes differences in the proportions of taking F&V ≥5 times/d by sex, age and BMI. The study included 26 328 school adolescents (13-15 years) with complete data on consumption of F&V, age, sex, weight and height taken from the Global School-based Student Health Survey conducted in the EMR between 2005 and 2009. Overall, only 19·4 % of adolescents reported consuming F&V ≥5 times/d. The highest prevalence was reported in Djibouti (40·4 %) and the lowest was reported in Pakistan (10·0 %). Statistically significant differences in prevalence were observed across countries (P<0·05). With the exception of Oman, Libya and Djibouti, significantly more males than females ate F&V ≥5 times/d. Proportion of students consuming F&V ≥5 times/d also varied significantly in all counties based on BMI (P<0·0001), with students within normal BMI having the highest frequency. A negative trend was observed between age and the prevalence of taking F&V ≥5 times/d in most of the eleven EMR countries but Jordan, Djibouti and Morocco. The prevalence of adequate intake of F&V was low in the eleven EMR countries. There is a need for interventions to increase the prevalence of adolescents consuming F&V ≥5 times/d. Interventions should take into consideration psychosocial, environmental and socio-environmental factors influencing F&V intake within countries. PMID:26817392

  5. Citizens' Access to Their Digital Health Data in Eleven Countries - A Comparative Study.

    PubMed

    Nohr, Christian; Wong, Ming Chao; Turner, Paul; Almond, Helen; Parv, Liisa; Gilstad, Heidi; Koch, Sabine; Harðardóttir, Guðrún Auður; Hyppönen, Hannele; Marcilly, Romaric; Sheik, Aziz; Day, Karen; Kushniruk, Andre

    2016-01-01

    Governments around the world are actively promoting citizens electronic access to their health data as one of a number of ways to respond to the challenges of health care delivery in the 21st century. While numerous approaches have been utilized it is evident from cross-country comparisons that there are different conceptualizations of: both the expected and desired roles for citizens in the management of their own health; the benefits that will be delivered by citizen access and how these benefits should be measured and benchmarked over-time. This paper presents comparative analyses of the methods by which citizens are provided with access to their own health data across 11 countries. The paper aims to stimulate debate on electronic citizen access to health data and the challenges of measuring benefit as well as reflection on capacity of different citizens to engage with e-health. PMID:27577472

  6. Citizens' Access to Their Digital Health Data in Eleven Countries - A Comparative Study.

    PubMed

    Nohr, Christian; Wong, Ming Chao; Turner, Paul; Almond, Helen; Parv, Liisa; Gilstad, Heidi; Koch, Sabine; Harðardóttir, Guðrún Auður; Hyppönen, Hannele; Marcilly, Romaric; Sheik, Aziz; Day, Karen; Kushniruk, Andre

    2016-01-01

    Governments around the world are actively promoting citizens electronic access to their health data as one of a number of ways to respond to the challenges of health care delivery in the 21st century. While numerous approaches have been utilized it is evident from cross-country comparisons that there are different conceptualizations of: both the expected and desired roles for citizens in the management of their own health; the benefits that will be delivered by citizen access and how these benefits should be measured and benchmarked over-time. This paper presents comparative analyses of the methods by which citizens are provided with access to their own health data across 11 countries. The paper aims to stimulate debate on electronic citizen access to health data and the challenges of measuring benefit as well as reflection on capacity of different citizens to engage with e-health.

  7. An analysis of survey data from eleven countries finds that 'satisfaction' with health system performance means many things.

    PubMed

    Papanicolas, Irene; Cylus, Jonathan; Smith, Peter C

    2013-04-01

    Measures of personal satisfaction with health systems play an increasingly important role in national and international performance assessments. Using data from the 2010 Commonwealth Fund International Health Policy Survey, we analyzed the determinants of personal perceptions of health system performance in eleven high-income countries. In most countries there was a clear relationship between overall satisfaction with the health system and perceptions of affordability and effectiveness of care, as well as ratings of one's regular doctor. There is some evidence that waiting times for appointments and diagnosis were widely associated with discontent, although respondents' perceptions of these factors explained relatively little of the observed variation in overall satisfaction across countries. We conclude that "satisfaction" appears to represent something different in each health system, and that policy makers can nevertheless use this type of analysis to determine priorities for improvement in their own country. Our findings also indicate that some of the keys to improving overall satisfaction with a health system may lie outside that system's direct control and are related to differences in expectations across countries and to other factors that influence perceptions, such as national political debates, reporting in the news media, and national cultures.

  8. Fourteen new species, one new genus, and eleven new country or state records for New World Lamiinae (Coleoptera, Cerambycidae).

    PubMed

    Martins, Ubirajara R; Santos-Silva, Antonio; Galileo, Maria Helena M

    2015-01-01

    Fourteen new species and one new genus are described from the New World in Lamiinae (Coleoptera: Cerambycidae): Bisaltes (Bisaltes) lingafelteri sp. nov., Trestonia skelleyi sp. nov. and Psapharochrus langeri sp. nov. from Bolivia; Eupogonius azteca sp. nov., Aegomorphus mexicanus sp. nov., Lamacoscylus albatus sp. nov., Lamacoscylus obscurus sp. nov. and Piruanycha wappesi sp. nov. from Mexico; Dolichestola egeri sp. nov. and Wappesellus cavus gen. nov., sp. nov. from Brazil (Rondônia); Scleronotus virgatus sp. nov. from Venezuela; Oreodera casariae sp. nov. from Panama; Alampyris bicolor sp. nov. from Costa Rica; and Emphytoeciosoma flava sp. nov. from Peru. Additionally, eleven new country/state records are established in Lamiinae: three for Peru; three for Bolivia; one for Mexico; one for Uruguay; and two for Brazil (Rondônia) (state records). Bisaltes (Bisaltes) lingafelteri, Eupogonius azteca, Aegomorphus mexicanus, Lamacoscylus albatus, Lamacoscylus obscurus, Piruanycha wappesi, Scleronotus virgatus, Alampyris bicolor, Emphytoeciosoma flava and Wappesellus are included in new or known keys. PMID:26249940

  9. Fourteen new species, one new genus, and eleven new country or state records for New World Lamiinae (Coleoptera, Cerambycidae).

    PubMed

    Martins, Ubirajara R; Santos-Silva, Antonio; Galileo, Maria Helena M

    2015-06-26

    Fourteen new species and one new genus are described from the New World in Lamiinae (Coleoptera: Cerambycidae): Bisaltes (Bisaltes) lingafelteri sp. nov., Trestonia skelleyi sp. nov. and Psapharochrus langeri sp. nov. from Bolivia; Eupogonius azteca sp. nov., Aegomorphus mexicanus sp. nov., Lamacoscylus albatus sp. nov., Lamacoscylus obscurus sp. nov. and Piruanycha wappesi sp. nov. from Mexico; Dolichestola egeri sp. nov. and Wappesellus cavus gen. nov., sp. nov. from Brazil (Rondônia); Scleronotus virgatus sp. nov. from Venezuela; Oreodera casariae sp. nov. from Panama; Alampyris bicolor sp. nov. from Costa Rica; and Emphytoeciosoma flava sp. nov. from Peru. Additionally, eleven new country/state records are established in Lamiinae: three for Peru; three for Bolivia; one for Mexico; one for Uruguay; and two for Brazil (Rondônia) (state records). Bisaltes (Bisaltes) lingafelteri, Eupogonius azteca, Aegomorphus mexicanus, Lamacoscylus albatus, Lamacoscylus obscurus, Piruanycha wappesi, Scleronotus virgatus, Alampyris bicolor, Emphytoeciosoma flava and Wappesellus are included in new or known keys.

  10. Summary of an eleven-country study of socio-legal measures to combat drug abuse and related crime.

    PubMed

    Asuni, T; Bruno, F

    1984-01-01

    In a comparative study of a group of experimental and control subjects in Argentina, Brazil, Costa Rica, Japan, Jordan, Italy, Malaysia, Singapore and the United States of America (State of New York), and of the results of independent studies conducted in Sweden and the United Kingdom of Great Britain and Northern Ireland, a rather close association was found to exist between drug abuse, criminal behaviour and social attitudes to such problems. Both drug abuse and the socio-legal systems varied greatly in the countries involved. No correlation was found between the level of foreseen or actual harshness of the socio-legal system and the level of seriousness of drug abuse and its associated criminality, but there was a significant correlation between knowledge of the law and the efficacy of the socio-legal system. In each country informal control systems, such as the family, church, school, neighbourhood and work environment, were active. Approximately one half of the subjects that were interviewed from countries with the most punitive socio-legal systems perceived informal controls as harsh and punitive while in the other countries such controls were generally perceived as positive. The study encouraged the review, testing and implementation of alternative measures to penal sanctions, particularly with a view to creating a genuine therapeutic approach to correcting the deviant behaviour of drug abusers.

  11. Occurrence of perchlorate in indoor dust from the United States and eleven other countries: implications for human exposure.

    PubMed

    Wan, Yanjian; Wu, Qian; Abualnaja, Khalid O; Asimakopoulos, Alexandros G; Covaci, Adrian; Gevao, Bondi; Johnson-Restrepo, Boris; Kumosani, Taha A; Malarvannan, Govindan; Moon, Hyo-Bang; Nakata, Haruhiko; Sinha, Ravindra K; Minh, Tu Binh; Kannan, Kurunthachalam

    2015-02-01

    Perchlorate is a widespread environmental contaminant and potent thyroid hormone disrupting compound. Despite this, very little is known with regard to the occurrence of this compound in indoor dust and the exposure of humans to perchlorate through dust ingestion. In this study, 366 indoor dust samples were collected from 12 countries, the USA, Colombia, Greece, Romania, Japan, Korea, Pakistan, Kuwait, Saudi Arabia, India, Vietnam, and China, during 2010-2014. Dust samples were extracted by 1% (v/v) methylamine in water. Analyte separation was achieved by an ion exchange (AS-21) column and analysis was performed by high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The overall concentrations of perchlorate in dust were in the range of 0.02-104μg/g (geometric mean: 0.41μg/g). The indoor dust samples from China contained the highest concentrations (geometric mean: 5.38μg/g). No remarkable differences in perchlorate concentrations in dust were found among various microenvironments (i.e., car, home, office, and laboratory). The estimated median daily intake (EDI) of perchlorate for toddlers through dust ingestion in the USA, Colombia, Greece, Romania, Japan, Korea, Pakistan, Kuwait, Saudi Arabia, India, Vietnam, and China was 1.89, 0.37, 1.71, 0.74, 4.90, 7.20, 0.60, 0.80, 1.55, 0.70, 2.15, and 21.3ng/kgbodyweight (bw)/day, respectively. Although high concentrations of perchlorate were measured in some dust samples, the contribution of dust to total perchlorate intake was <5% of the total perchlorate intake in humans. This is the first multinational survey on the occurrence of perchlorate in indoor dust.

  12. Occurrence of perchlorate in indoor dust from the United States and eleven other countries: implications for human exposure.

    PubMed

    Wan, Yanjian; Wu, Qian; Abualnaja, Khalid O; Asimakopoulos, Alexandros G; Covaci, Adrian; Gevao, Bondi; Johnson-Restrepo, Boris; Kumosani, Taha A; Malarvannan, Govindan; Moon, Hyo-Bang; Nakata, Haruhiko; Sinha, Ravindra K; Minh, Tu Binh; Kannan, Kurunthachalam

    2015-02-01

    Perchlorate is a widespread environmental contaminant and potent thyroid hormone disrupting compound. Despite this, very little is known with regard to the occurrence of this compound in indoor dust and the exposure of humans to perchlorate through dust ingestion. In this study, 366 indoor dust samples were collected from 12 countries, the USA, Colombia, Greece, Romania, Japan, Korea, Pakistan, Kuwait, Saudi Arabia, India, Vietnam, and China, during 2010-2014. Dust samples were extracted by 1% (v/v) methylamine in water. Analyte separation was achieved by an ion exchange (AS-21) column and analysis was performed by high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The overall concentrations of perchlorate in dust were in the range of 0.02-104μg/g (geometric mean: 0.41μg/g). The indoor dust samples from China contained the highest concentrations (geometric mean: 5.38μg/g). No remarkable differences in perchlorate concentrations in dust were found among various microenvironments (i.e., car, home, office, and laboratory). The estimated median daily intake (EDI) of perchlorate for toddlers through dust ingestion in the USA, Colombia, Greece, Romania, Japan, Korea, Pakistan, Kuwait, Saudi Arabia, India, Vietnam, and China was 1.89, 0.37, 1.71, 0.74, 4.90, 7.20, 0.60, 0.80, 1.55, 0.70, 2.15, and 21.3ng/kgbodyweight (bw)/day, respectively. Although high concentrations of perchlorate were measured in some dust samples, the contribution of dust to total perchlorate intake was <5% of the total perchlorate intake in humans. This is the first multinational survey on the occurrence of perchlorate in indoor dust. PMID:25461426

  13. Medication Errors in the Southeast Asian Countries: A Systematic Review

    PubMed Central

    Salmasi, Shahrzad; Khan, Tahir Mehmood; Hong, Yet Hoi; Ming, Long Chiau; Wong, Tin Wui

    2015-01-01

    Background Medication error (ME) is a worldwide issue, but most studies on ME have been undertaken in developed countries and very little is known about ME in Southeast Asian countries. This study aimed systematically to identify and review research done on ME in Southeast Asian countries in order to identify common types of ME and estimate its prevalence in this region. Methods The literature relating to MEs in Southeast Asian countries was systematically reviewed in December 2014 by using; Embase, Medline, Pubmed, ProQuest Central and the CINAHL. Inclusion criteria were studies (in any languages) that investigated the incidence and the contributing factors of ME in patients of all ages. Results The 17 included studies reported data from six of the eleven Southeast Asian countries: five studies in Singapore, four in Malaysia, three in Thailand, three in Vietnam, one in the Philippines and one in Indonesia. There was no data on MEs in Brunei, Laos, Cambodia, Myanmar and Timor. Of the seventeen included studies, eleven measured administration errors, four focused on prescribing errors, three were done on preparation errors, three on dispensing errors and two on transcribing errors. There was only one study of reconciliation error. Three studies were interventional. Discussion The most frequently reported types of administration error were incorrect time, omission error and incorrect dose. Staff shortages, and hence heavy workload for nurses, doctor/nurse distraction, and misinterpretation of the prescription/medication chart, were identified as contributing factors of ME. There is a serious lack of studies on this topic in this region which needs to be addressed if the issue of ME is to be fully understood and addressed. PMID:26340679

  14. Spinning-induced Rhabdomyolysis: Eleven Case Reports and Review of the Literature.

    PubMed

    Kim, Daejin; Ko, Eun-Jung; Cho, HyeJeong; Park, Su Hyung; Lee, Sang Hwan; Cho, Nam-Gil; Lee, So-Young; Jeong, Hye Yun; Yang, Dong Ho

    2015-12-01

    Non-traumatic exertional rhabdomyolysis (exRML) occurs in individuals with normal muscles when the energy supplied to the muscle is insufficient. Here, we report 11 cases of spinning-induced rhabdomyolysis and review related literature. Spinning is a kind of indoor bicycle sport. The 11 patients who were diagnosed with exRML and admitted to CHA Bundang Medical Center were female and their ages ranged from 15 to 46 years. Two to three days prior to the presentation, the patients had attended a spinning class for the first time. All the patients had been otherwise healthy without any known medical illnesses. They were successfully treated without any complications, except mild non-symptomatic hypocalcemia. However, in the literature, severe complications such as compartment syndrome or acute kidney injury had been reported in relation to exRML including spinning-induced rhabdomyolysis. This spinning exercise needs prior guidelines and specific warnings to prevent exertional rhabdomyolysis.

  15. Spinning-induced Rhabdomyolysis: Eleven Case Reports and Review of the Literature

    PubMed Central

    Kim, Daejin; Ko, Eun-Jung; Cho, HyeJeong; Park, Su Hyung; Lee, Sang Hwan; Cho, Nam-gil; Lee, So-Young; Jeong, Hye Yun

    2015-01-01

    Non-traumatic exertional rhabdomyolysis (exRML) occurs in individuals with normal muscles when the energy supplied to the muscle is insufficient. Here, we report 11 cases of spinning-induced rhabdomyolysis and review related literature. Spinning is a kind of indoor bicycle sport. The 11 patients who were diagnosed with exRML and admitted to CHA Bundang Medical Center were female and their ages ranged from 15 to 46 years. Two to three days prior to the presentation, the patients had attended a spinning class for the first time. All the patients had been otherwise healthy without any known medical illnesses. They were successfully treated without any complications, except mild non-symptomatic hypocalcemia. However, in the literature, severe complications such as compartment syndrome or acute kidney injury had been reported in relation to exRML including spinning-induced rhabdomyolysis. This spinning exercise needs prior guidelines and specific warnings to prevent exertional rhabdomyolysis. PMID:26848305

  16. Taxonomic review on the subgenus Tripodura Townes (Diptera: Chironomidae: Polypedilum) from China with eleven new species and a supplementary world checklist.

    PubMed

    Zhang, Ruilei; Song, Chao; Qi, Xin; Wang, Xinhua

    2016-01-01

    The subgenus Tripodura Townes of Polypedilum Kieffer from China including 26 species is reviewed. Eleven new species, named P. (T.) absensilobum Zhang & Wang sp. n., P. (T.) apiculusetosum Zhang & Wang sp. n., P. (T.) arcuatum Zhang & Wang sp. n., P. (T.) bilamella Zhang & Wang sp. n., P. (T.) conghuaense Zhang & Wang sp. n., P. (T.) dengae Zhang & Wang sp. n., P. (T.) mengmanense Zhang & Wang sp. n., P. (T.) napahaiense Zhang & Wang sp. n., P. (T.) parallelum Zhang & Wang sp. n., P. (T.) pollicium Zhang & Wang sp. n. and P. (T.) trapezium Zhang & Wang sp. n. are described and illustrated based on male imagines. Three species, P. (T.) quadriguttatum Kieffer, P. (T.) unifascia (Tokunaga) and P. (T.) udominutum Niitsuma are firstly recorded in China. A key to known male imagines of Chinese species and an updated world checklist of subgenus Tripodura are presented. PMID:27395703

  17. Factors Influencing Technology Planning in Developing Countries: A Literature Review

    ERIC Educational Resources Information Center

    Keengwe, Jared; Malapile, Sandy

    2014-01-01

    This article is a literature review concerning the factors that play an important role in the development of educational technology plans in the educational system of developing countries (DCs). Largely, the technology plans are influenced by factors that emanates from within the country (internal) and those outside of their borders (external).…

  18. Obesity and socioeconomic status in developing countries: a systematic review

    PubMed Central

    Dinsa, GD; Goryakin, Y; Fumagalli, E; Suhrcke, M

    2012-01-01

    Summary We undertook a systematic review of studies assessing the association between socioeconomic status (SES) and measured obesity in low- and middle-income countries (defined by the World Bank as countries with per capita income up to US$12,275) among children, men and women. The evidence on the subject has grown significantly since an earlier influential review was published in 2004. We find that in low-income countries or in countries with low human development index (HDI), the association between SES and obesity appears to be positive for both men and women: the more affluent and/or those with higher educational attainment tend to be more likely to be obese. However, in middle-income countries or in countries with medium HDI, the association becomes largely mixed for men and mainly negative for women. This particular shift appears to occur at an even lower level of per capita income than suggested by an influential earlier review. By contrast, obesity in children appears to be predominantly a problem of the rich in low- and middle-income countries. PMID:22764734

  19. Faunistic review of the cuckoo wasps of Fennoscandia, Denmark and the Baltic countries (Hymenoptera: Chrysididae).

    PubMed

    Paukkunen, Juho; Rosa, Paolo; Soon, Villu; Johansson, Niklas; Ødegaard, Frode

    2014-01-01

    A critical and annotated review of published records of the Chrysididae of the Nordic and Baltic countries and the Russian part of Fennoscandia is presented with some taxonomic and faunistic notes. A total of 73 species are listed from the region. Additionally, 17 species are deleted. Three species are recorded for the first time from Denmark, six species from Estonia, one from Finland, eleven from Latvia, four from Norway, one from Sweden and 15 from Russian Fennoscandia. Elampus foveatus and Chrysis pulcherrima are reported for the first time from the Nordic and Baltic countries. Lectotypes are designated for Hedychrum cupreum Dahlbom, 1845, Chrysis zetterstedti Dahlbom, 1845, Chrysis succincta var. chrysoprasina Trautmann, 1927, Chrysis succincta var. virideocincta Trautmann, 1927 and Chrysis succincta var. nordstromi Trautmann, 1927. Information and images of the holotypes of Hedychrum metallicum Dahlbom, 1854, Chrysis var. westerlundi Trautmann, 1927 are given. Chrysis integra Dahlbom, 1829 is found to be a new synonym of Hedychridium ardens (Coquebert, 1801) and Chrysis scintillans Valkeila, 1971 a new synonym of Chrysis solida Haupt, 1957. Chrysis terminata Dahlbom, 1854 is reported for the first time as the valid name for C. ignita Form A sensu Linsenmaier, 1959. PMID:25283536

  20. Faunistic review of the cuckoo wasps of Fennoscandia, Denmark and the Baltic countries (Hymenoptera: Chrysididae).

    PubMed

    Paukkunen, Juho; Rosa, Paolo; Soon, Villu; Johansson, Niklas; Ødegaard, Frode

    2014-09-19

    A critical and annotated review of published records of the Chrysididae of the Nordic and Baltic countries and the Russian part of Fennoscandia is presented with some taxonomic and faunistic notes. A total of 73 species are listed from the region. Additionally, 17 species are deleted. Three species are recorded for the first time from Denmark, six species from Estonia, one from Finland, eleven from Latvia, four from Norway, one from Sweden and 15 from Russian Fennoscandia. Elampus foveatus and Chrysis pulcherrima are reported for the first time from the Nordic and Baltic countries. Lectotypes are designated for Hedychrum cupreum Dahlbom, 1845, Chrysis zetterstedti Dahlbom, 1845, Chrysis succincta var. chrysoprasina Trautmann, 1927, Chrysis succincta var. virideocincta Trautmann, 1927 and Chrysis succincta var. nordstromi Trautmann, 1927. Information and images of the holotypes of Hedychrum metallicum Dahlbom, 1854, Chrysis var. westerlundi Trautmann, 1927 are given. Chrysis integra Dahlbom, 1829 is found to be a new synonym of Hedychridium ardens (Coquebert, 1801) and Chrysis scintillans Valkeila, 1971 a new synonym of Chrysis solida Haupt, 1957. Chrysis terminata Dahlbom, 1854 is reported for the first time as the valid name for C. ignita Form A sensu Linsenmaier, 1959.

  1. Tuberculosis treatment outcome monitoring in European Union countries: systematic review

    PubMed Central

    van Hest, Rob; Ködmön, Csaba; Verver, Suzanne; Erkens, Connie G.M.; Straetemans, Masja; Manissero, Davide; de Vries, Gerard

    2013-01-01

    Treatment success measured by treatment outcome monitoring (TOM) is a key programmatic output of tuberculosis (TB) control programmes. We performed a systematic literature review on national-level TOM in the 30 European Union (EU)/European Economic Areas (EEA) countries to summarise methods used to collect and report data on TOM. Online reference bibliographic databases PubMed/MEDLINE and EMBASE were searched to identify relevant indexed and non-indexed literature published between January 2000 and August 2010. The search strategy resulted in 615 potentially relevant indexed citations, of which 27 full-text national studies (79 data sets) were included for final analysis. The selected studies were performed in 10 EU/EEA countries and gave a fragmented impression of TOM in the EU/EEA. Publication year, study period, sample size, databases, definitions, variables, patient and outcome categories, and population subgroups varied widely, portraying a very heterogeneous picture. This review confirmed previous reports of considerable heterogeneity in publications of TOM results across EU/EEA countries. PubMed/MEDLINE and EMBASE indexed studies are not a suitable instrument to measure representative TOM results for the 30 EU/EEA countries. Uniform and complete reporting to the centralised European Surveillance System will produce the most timely and reliable results of TB treatment outcomes in the EU/EEA. PMID:22790913

  2. Chest trauma experience over eleven-year period at al-mouassat university teaching hospital-Damascus: a retrospective review of 888 cases

    PubMed Central

    2012-01-01

    Background Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. In this study, we present our 11-year experience in the management and clinical outcome of 888 chest trauma cases as a result of blunt and penetrating injuries in our university hospital in Damascus, Syria. Methods We reviewed files of 888 consequent cases of chest trauma between January 2000 and January 2011. The mean age of our patients was 31 ± 17 years mostly males with blunt injuries. Patients were evaluated and compared according to age, gender, etiology of trauma, thoracic and extra-thoracic injuries, complications, and mortality. Results The leading cause of the trauma was violence (41%) followed by traffic accidents (33%). Pneumothorax (51%), Hemothorax (38%), rib fractures (34%), and lung contusion (15%) were the most common types of injury. Associated injuries were documented in 36% of patients (extremities 19%, abdomen 13%, head 8%). A minority of the patients required thoracotomy (5.7%), and tube thoracostomy (56%) was sufficient to manage the majority of cases. Mean hospital LOS was 4.5 ± 4.6 days. The overall mortoality rate was 1.8%, and morbidity (n = 78, 8.7%). Conclusions New traffic laws (including seat belt enforcement) reduced incidence and severity of chest trauma in Syria. Violence was the most common cause of chest trauma rather than road traffic accidents in this series, this necessitates epidemiologic or multi-institutional studies to know to which degree violence contributes to chest trauma in Syria. The number of fractured ribs can be used as simple indicator of the severity of trauma. And we believe that significant neurotrauma, traffic accidents, hemodynamic status and GCS upon arrival, ICU admission, ventilator use, and complication of therapy are predictors of dismal prognosis. PMID:22515842

  3. Lightcurve Results for Eleven Asteroids

    NASA Astrophysics Data System (ADS)

    Gartrelle, Gordon M.

    2012-04-01

    Differential photometry techniques were used to develop lightcurves, rotation periods and amplitudes for eleven main-belt asteroids: 833 Monica, 962 Aslog, 1020 Arcadia, 1082 Pirola, 1097 Vicia, 1122 Lugduna, 1145 Robelmonte, 1253 Frisia, 1256 Normannia, 1525 Savolinna, and 2324 Janice. Ground-based observations from Badlands Observatory (BLO) in Quinn, SD, as well as the University of North Dakota Observatory (UND) in Grand Forks, ND, provided the data for the project. A search of the asteroid lightcurve database (LCDB) did not reveal any previously reported results for seven of the eleven targets in this study.

  4. Energy policies of IEA countries: Norway, 1997 review

    SciTech Connect

    1997-12-29

    This IEA report provides a comprehensive, in-depth assessment of the energy policies of Norway, including recommendations on future policy developments. The report highlights the electricity sector, where the impressive reforms allow for all consumers to choose their supplier. The report describes in considerable detail the first international electricity spot and financial exchange market, and also covers the diversification of the fully hydro based system to bring on gas-fired generation. The report describes the significance of the North Sea petroleum resources whose production has placed Norway as the second largest oil exporting country after Saudi Arabia. Increased production has been facilitated by adapting the licensing regime to provide more incentives for investment and development. These achievements and suggested further steps are discussed here. The report also examines the pivotal position of Norwegian natural gas in the European market, a market which is poised for change, and calls for critical evaluation of the state`s role. It acknowledges that hydrocarbon developments in Norway have enhanced the security of supply for energy consuming countries. Other issues highlighted in the report include Norway`s position at the forefront on international efforts to respond to global environmental concerns. This report forms part of the a series of periodic in-depth reviews conducted and discussed by the IEA Member Countries on a four-year cycle.

  5. Cost of dengue outbreaks: literature review and country case studies

    PubMed Central

    2013-01-01

    Background Dengue disease surveillance and vector surveillance are presumed to detect dengue outbreaks at an early stage and to save – through early response activities – resources, and reduce the social and economic impact of outbreaks on individuals, health systems and economies. The aim of this study is to unveil evidence on the cost of dengue outbreaks. Methods Economic evidence on dengue outbreaks was gathered by conducting a literature review and collecting information on the costs of recent dengue outbreaks in 4 countries: Peru, Dominican Republic, Vietnam, and Indonesia. The literature review distinguished between costs of dengue illness including cost of dengue outbreaks, cost of interventions and cost-effectiveness of interventions. Results Seventeen publications on cost of dengue showed a large range of costs from 0.2 Million US$ in Venezuela to 135.2 Million US$ in Brazil. However, these figures were not standardized to make them comparable. Furthermore, dengue outbreak costs are calculated differently across the publications, and cost of dengue illness is used interchangeably with cost of dengue outbreaks. Only one paper from Australia analysed the resources saved through active dengue surveillance. Costs of vector control interventions have been reported in 4 studies, indicating that the costs of such interventions are lower than those of actual outbreaks. Nine papers focussed on the cost-effectiveness of dengue vaccines or dengue vector control; they do not provide any direct information on cost of dengue outbreaks, but their modelling methodologies could guide future research on cost-effectiveness of national surveillance systems. The country case studies – conducted in very different geographic and health system settings - unveiled rough estimates for 2011 outbreak costs of: 12 million US$ in Vietnam, 6.75 million US$ in Indonesia, 4.5 million US$ in Peru and 2.8 million US$ in Dominican Republic (all in 2012 US$). The proportions of the

  6. Diabetes Prevention Interventions in Latin American Countries: a Scoping Review.

    PubMed

    Heisler, Michele; Kaselitz, Elizabeth; Rana, Gurpreet K; Piette, John D

    2016-09-01

    Public policies, population health initiatives, and targeted behavioral change interventions for individuals at risk for developing diabetes are all essential for diabetes prevention in Latin American countries (LACs). This scoping review examines (1) the current evidence on diabetes prevention policies and interventions in LACs to identify components of effective diabetes prevention models in those countries and (2) effective diabetes prevention interventions targeting Latino populations in the USA to explore possible lessons from these interventions for LACs. Diabetes prevention programs in LACs evaluated to date consist of short-term health professional-led face-to-face behavioral counseling sessions. Intervention components of US-based programs for Latinos that might benefit diabetes prevention programs in Latin America include (1) deployment of community health workers ("promotoras") for diabetes screening and delivery of lifestyle modification programs, (2) multiple modes of program delivery beyond face-to-face sessions, (3) information technology to automate and enhance program delivery, (4) leveraging of pre-existing familial relationships to engage in and sustain lifestyle modifications, and (5) innovative environmental change strategies such as collaborations with local food stores and markets to promote healthy behaviors. PMID:27424069

  7. Diabetes Prevention Interventions in Latin American Countries: a Scoping Review.

    PubMed

    Heisler, Michele; Kaselitz, Elizabeth; Rana, Gurpreet K; Piette, John D

    2016-09-01

    Public policies, population health initiatives, and targeted behavioral change interventions for individuals at risk for developing diabetes are all essential for diabetes prevention in Latin American countries (LACs). This scoping review examines (1) the current evidence on diabetes prevention policies and interventions in LACs to identify components of effective diabetes prevention models in those countries and (2) effective diabetes prevention interventions targeting Latino populations in the USA to explore possible lessons from these interventions for LACs. Diabetes prevention programs in LACs evaluated to date consist of short-term health professional-led face-to-face behavioral counseling sessions. Intervention components of US-based programs for Latinos that might benefit diabetes prevention programs in Latin America include (1) deployment of community health workers ("promotoras") for diabetes screening and delivery of lifestyle modification programs, (2) multiple modes of program delivery beyond face-to-face sessions, (3) information technology to automate and enhance program delivery, (4) leveraging of pre-existing familial relationships to engage in and sustain lifestyle modifications, and (5) innovative environmental change strategies such as collaborations with local food stores and markets to promote healthy behaviors.

  8. Breastfeeding Promotion, Support and Protection: Review of Six Country Programmes

    PubMed Central

    Mangasaryan, Nune; Martin, Luann; Brownlee, Ann; Ogunlade, Adebayo; Rudert, Christiane; Cai, Xiaodong

    2012-01-01

    Reviews of programmes in Bangladesh, Benin, the Philippines, Sri Lanka, Uganda, and Uzbekistan sought to identify health policy and programmatic factors that influenced breastfeeding practices during a 10 to 15 year period. Exclusive breastfeeding rates and trends were analysed in six countries in general and from an equity perspective in two of them. Success factors and challenges were identified in countries with improved and stagnated rates respectively. The disaggregated data analysis showed that progress may be unequal in population subgroups, but if appropriately designed and implemented, a programme can become a “health equalizer” and eliminate discrepancies among different subgroups. Success requires commitment, supportive policies, and comprehensiveness of programmes for breastfeeding promotion, protection and support. Community-based promotion and support was identified as a particularly important component. Although health workers’ training on infant feeding support and counselling was prioritized, further improvement of interpersonal counselling and problem solving skills is needed. More attention is advised for pre-service education, including a stronger focus on clinical practice, to ensure knowledge and skills among all health workers. Large-scale communication activities played a significant role, but essential steps were often underemphasized, including identifying social norms and influencing factors, ensuring community participation, and testing of approaches and messages. PMID:23016128

  9. Factors affecting the use of prenatal care by non-western women in industrialized western countries: a systematic review

    PubMed Central

    2013-01-01

    Background Despite the potential of prenatal care for addressing many pregnancy complications and concurrent health problems, non-western women in industrialized western countries more often make inadequate use of prenatal care than women from the majority population do. This study aimed to give a systematic review of factors affecting non-western women’s use of prenatal care (both medical care and prenatal classes) in industrialized western countries. Methods Eleven databases (PubMed, Embase, PsycINFO, Cochrane, Sociological Abstracts, Web of Science, Women’s Studies International, MIDIRS, CINAHL, Scopus and the NIVEL catalogue) were searched for relevant peer-reviewed articles from between 1995 and July 2012. Qualitative as well as quantitative studies were included. Quality was assessed using the Mixed Methods Appraisal Tool. Factors identified were classified as impeding or facilitating, and categorized according to a conceptual framework, an elaborated version of Andersen’s healthcare utilization model. Results Sixteen articles provided relevant factors that were all categorized. A number of factors (migration, culture, position in host country, social network, expertise of the care provider and personal treatment and communication) were found to include both facilitating and impeding factors for non-western women’s utilization of prenatal care. The category demographic, genetic and pregnancy characteristics and the category accessibility of care only included impeding factors. Lack of knowledge of the western healthcare system and poor language proficiency were the most frequently reported impeding factors. Provision of information and care in women’s native languages was the most frequently reported facilitating factor. Conclusion The factors found in this review provide specific indications for identifying non-western women who are at risk of not using prenatal care adequately and for developing interventions and appropriate policy aimed at

  10. Ethical review of health research: a perspective from developing country researchers

    PubMed Central

    Hyder, A; Wali, S; Khan, A; Teoh, N; Kass, N; Dawson, L

    2004-01-01

    Background: Increasing collaboration between industrialised and developing countries in human research studies has led to concerns regarding the potential exploitation of resource deprived countries. This study, commissioned by the former National Bioethics Advisory Commission of the United States, surveyed developing country researchers about their concerns and opinions regarding ethical review processes and the performance of developing country and US international review boards (IRBs). Methods: Contact lists from four international organisations were used to identify and survey 670 health researchers in developing countries. A questionnaire with 169 questions explored issues of IRB review, informed consent, and recommendations. Results: The majority of the developing country researchers were middle aged males who were physicians and were employed by educational institutions, carrying out research on part time basis. Forty four percent of the respondents reported that their studies were not reviewed by a developing country IRB or Ministry of Health and one third of these studies were funded by the US. During the review process issues such as the need for local language consent forms and letters for approval, and confidentiality protection of participants were raised by US IRBs in significantly higher proportions than by host country IRBs. Conclusion: This survey indicates the need for the ethical review of collaborative research in both US and host countries. It also reflects a desire for focused capacity development in supporting ethical review of research. PMID:14872079

  11. Barriers to the Uptake of Eye Care Services in Developing Countries: A Systematic Review of Interventions

    ERIC Educational Resources Information Center

    Abdullah, Khadija Nowaira; Al-Sharqi, Omar Zayan; Abdullah, Muhammad Tanweer

    2013-01-01

    Objective: This research identifies effective and ineffective interventions for reducing barriers to the uptake of eye care services in developing countries. Design: Systematic literature review. Setting: Only research studies done in developing countries were included. Method: The review is restricted to English-language articles published…

  12. Thematic Review on Adult Learning: Finland. Country Note. Revised.

    ERIC Educational Resources Information Center

    Organisation for Economic Cooperation and Development, Paris (France).

    This country note analyzes main issues concerning adult learning and policy responses in Finland. Section 2 describes the political, economic, and social context in which adult learning fits. Sections 3-6 follow these four themes impinging on adult participation in learning: inadequate incentives and motivations; complex pathways between learning…

  13. Hantavirus in Indian Country: The First Decade in Review

    ERIC Educational Resources Information Center

    Pottinger, Richard

    2005-01-01

    Hantavirus, caused due to close contact with mice in a dwelling, first emerged in the spring of 1993 on the Navajo Reservation and although it is by no means an Indian disease, there are four times as many cases of hantavirus pulmonary syndrome (HPS) among non-Indians. Inadequate rural housing, especially common in western Indian Country,…

  14. OECD Review of Career Guidance Policies. Australia: Country Note.

    ERIC Educational Resources Information Center

    Organisation for Economic Cooperation and Development, Paris (France).

    Australia's career guidance system and policies were evaluated. The review team met with policymakers and guidance practitioners in four states and at the national level, conducted site visits to various career guidance providers in the public and private sectors, analyzed data from a national questionnaire, and reviewed pertinent documentation.…

  15. OECD Review of Career Guidance Policies. Denmark: Country Note.

    ERIC Educational Resources Information Center

    Organisation for Economic Cooperation and Development, Paris (France).

    Denmark's career guidance system and policies were evaluated. The review team met with policymakers and guidance practitioners in the public and private sectors, analyzed data from a national questionnaire, and reviewed pertinent documentation. The evaluation focused on the following areas: coordinating mechanisms; the role of Denmark's National…

  16. OECD Review of Career Guidance Policies. Norway: Country Note.

    ERIC Educational Resources Information Center

    Organisation for Economic Cooperation and Development, Paris (France).

    Norway's career guidance system and policies were evaluated. The review team met with policymakers and guidance practitioners in the public and private sectors, analyzed data from a national questionnaire, and reviewed pertinent documentation. The evaluation focused on the following areas: splitting educational/vocational guidance from personal…

  17. OECD Review of Career Guidance Policies. Germany: Country Note.

    ERIC Educational Resources Information Center

    Organisation for Economic Cooperation and Development, Paris (France).

    Germany's career guidance system and policies were evaluated. Data were collected through meetings with policymakers and guidance practitioners in the public and private sectors, an analysis of data from a national questionnaire, and a review of pertinent documentation. The evaluation focused on the following areas: reviewing the role of Germany's…

  18. Microgrid Policy Review of Selected Major Countries, Regions, and Organizations

    SciTech Connect

    Qu, Min; Marnay, Chris; Zhou, Nan

    2011-11-30

    This report collects and reviews policies and regulations related to microgrid development, and is intended as a reference. The material is divided into three parts under five dimensions: interconnection, RD&D, tariff policy, other policies, and recommendations.

  19. Improving mental health among people living with HIV: a review of intervention trials in low- and middle-income countries

    PubMed Central

    Sikkema, Kathleen J.; Dennis, Alexis C.; Watt, Melissa. H.; Choi, Karmel W.; Yemeke, Tatenda T.; Joska, John A.

    2015-01-01

    People living with HIV (PLWH) experience greater psychological distress than the general population. Evidence from high-incomes countries suggests that psychological interventions for PLWH can improve mental health symptoms, quality of life, and HIV care engagement. However, little is known about the effectiveness of mental health interventions for PLWH in low and middle-income countries (LMICs), where the large majority of PLWH reside. This systematized review aims to synthesize findings from mental health intervention trials with PLWH in LMICs to inform the delivery of mental health services in these settings. A systematic search strategy was undertaken to identify peer-reviewed published papers of intervention trials addressing negative psychological states or disorders (e.g., depression, anxiety) among PLWH in LMIC settings. Search results were assessed against pre-established inclusion and exclusion criteria. Data from papers meeting criteria were extracted for synthesis. Twenty-six papers, published between 2000 and 2014, describing 22 unique interventions were identified. Trials were implemented in sub-Saharan Africa (n=13), Asia (n=7), and the Middle East (n=2), and addressed mental health using a variety of approaches, including cognitive-behavioral (n=18), family-level (n=2), and pharmacological (n=2) treatments. Four randomized controlled trials reported significant intervention effects in mental health outcomes, and eleven preliminary studies demonstrated promising findings. Among the limited mental health intervention trials with PLWH in LMICs, few demonstrated efficacy. Mental health interventions for PLWH in LMICs must be further developed and adapted for resource-limited settings to improve effectiveness. PMID:26435843

  20. How is intensive care reimbursed? A review of eight European countries.

    PubMed

    Bittner, Martin-Immanuel; Donnelly, Maria; van Zanten, Arthur Rh; Andersen, Jakob Steen; Guidet, Bertrand; Trujillano Cabello, Jose Javier; Gardiner, Shane; Fitzpatrick, Gerard; Winter, Bob; Joannidis, Michael; Schmutz, Axel

    2013-01-01

    Reimbursement schemes in intensive care are more complex than in other areas of healthcare, due to special procedures and high care needs. Knowledge regarding the principles of functioning in other countries can lead to increased understanding and awareness of potential for improvement. This can be achieved through mutual exchange of solutions found in other countries. In this review, experts from eight European countries explain their respective intensive care unit reimbursement schemes. Important conclusions include the apparent differences in the countries' reimbursement schemes-despite all of them originating from a DRG system-, the high degree of complexity found, and the difficulties faced in several countries when collecting the data for this collaborative work. This review has been designed to assist the intensivist clinician and researcher in understanding neighbouring countries' approaches and in putting research into the context of a European perspective. In addition, steering committees and decision makers might find this a valuable source to compare different reimbursement schemes. PMID:24216146

  1. Privatization of veterinary services in developing countries: a review.

    PubMed

    Sen, A; Chander, M

    2003-06-01

    Increasing fiscal constraints on the government, a lackadaisical performance by public sector animal health and breeding services and pressure from donor partners have prompted the governments of various developing countries to rethink the role of the public sector in the provision of veterinary services. Various countries have started to implement, or have already implemented, privatization of some veterinary services. The results are mixed. It is established that private provision alone is not optimal, and a blend of private and public sector veterinary services is required to utilize the virtues of both. The privatization process has also begun in India. Certain state governments in India are pursuing a cost recovery approach and are encouraging private practitioners to cope with the financial constraints and to deliver broad and effective animal health and breeding services. This paper considers the global aspects of the privatization of veterinary services as well as the scenario in India, so as to gain an insight into the very complex and debatable issue of privatization of veterinary services.

  2. "The Country and the City" by Raymond Williams. Essay Review.

    ERIC Educational Resources Information Center

    Johnson, Jerry D.; Howley, Craig B.

    2000-01-01

    Reviews essays by Raymond Williams, which explain how, within the context of a 150-year literary history, rural stereotypes have been constructed and imbedded within a collective consciousness by a form of cultural colonization. Suggests that Williams' insights can help rural education researchers think outside the conventional wisdom that…

  3. Educational Access in South Africa. Country Analytic Review

    ERIC Educational Resources Information Center

    Motala, Shireen; Dieltens, Veerle; Carrim, Nazir; Kgobe, Paul; Moyo, George; Rembe, Symphorosa

    2007-01-01

    Meaningful access to education requires more than full enrolment; it requires high attendance rates, progression through grades with little or no repetition, and learning outcomes that confirm that basic skills are being mastered. This Review describes and explains patterns of access to schools in South Africa for children between the ages of 5…

  4. 76 FR 77299 - Generalized System of Preferences (GSP): Notice of Review of Certain Pending Country Practice...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-12

    ... a country practice petition related to the Republic of Georgia. (See 76 FR 67530.) FOR FURTHER... TRADE REPRESENTATIVE Generalized System of Preferences (GSP): Notice of Review of Certain Pending... available on the USTR Web site at...

  5. A systematic review of responsive feeding and child obesity in high-income countries

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Child overweight/obesity continues to be a serious public health problem in high-income countries. The current review had 3 goals: 1) to summarize the associations between responsive feeding and child weight status in high-income countries; 2) to describe existing responsive feeding measures; and 3)...

  6. Review of the current use and evaluation of cell substrates for producing biologicals in selected countries.

    PubMed

    Kang, Hye-Na; Xu, Miao; Rodríguez, Violeta Pérez; Mefed, Kirill; Hanada, Kentaro; Ahn, Kwang-Soo; Gangakhedkar, Shri Jayant; Pakzad, Saeed Reza; Prawahju, Elizabeth Ika; Lee, Naery; Phumiamorn, Supaporn; Nemec, Martin; Meng, Shufang; Knezevic, Ivana

    2015-05-01

    In 2010, the WHO guidance document for the evaluation of cell substrates for producing biologicals was replaced with updated recommendations and in May 2013 an implementation workshop on the new recommendations was held in Beijing, China. As part of this workshop, a survey of the use and evaluation of cell substrates for producing biologicals was undertaken and the information obtained was updated in June 2014. The purpose of survey was to capture the status of national requirements related to cell substrates in various countries with particular emphasis on whether or not the updated WHO recommendations had been, or were to be, incorporated into national requirements. This paper reports the outcome of the survey and is based on information provided by regulators in eleven countries. Since the publication of the updated WHO recommendations, several activities such as the implementation workshop and publications have been undertaken by the WHO. The aim of these activities, including the publication of this article, is to contribute to the implementation of WHO recommendations so as to reduce regulatory gaps between national requirements and globally agreed expectations.

  7. Review of the current use and evaluation of cell substrates for producing biologicals in selected countries.

    PubMed

    Kang, Hye-Na; Xu, Miao; Rodríguez, Violeta Pérez; Mefed, Kirill; Hanada, Kentaro; Ahn, Kwang-Soo; Gangakhedkar, Shri Jayant; Pakzad, Saeed Reza; Prawahju, Elizabeth Ika; Lee, Naery; Phumiamorn, Supaporn; Nemec, Martin; Meng, Shufang; Knezevic, Ivana

    2015-05-01

    In 2010, the WHO guidance document for the evaluation of cell substrates for producing biologicals was replaced with updated recommendations and in May 2013 an implementation workshop on the new recommendations was held in Beijing, China. As part of this workshop, a survey of the use and evaluation of cell substrates for producing biologicals was undertaken and the information obtained was updated in June 2014. The purpose of survey was to capture the status of national requirements related to cell substrates in various countries with particular emphasis on whether or not the updated WHO recommendations had been, or were to be, incorporated into national requirements. This paper reports the outcome of the survey and is based on information provided by regulators in eleven countries. Since the publication of the updated WHO recommendations, several activities such as the implementation workshop and publications have been undertaken by the WHO. The aim of these activities, including the publication of this article, is to contribute to the implementation of WHO recommendations so as to reduce regulatory gaps between national requirements and globally agreed expectations. PMID:25707711

  8. How is intensive care reimbursed? A review of eight European countries

    PubMed Central

    2013-01-01

    Reimbursement schemes in intensive care are more complex than in other areas of healthcare, due to special procedures and high care needs. Knowledge regarding the principles of functioning in other countries can lead to increased understanding and awareness of potential for improvement. This can be achieved through mutual exchange of solutions found in other countries. In this review, experts from eight European countries explain their respective intensive care unit reimbursement schemes. Important conclusions include the apparent differences in the countries’ reimbursement schemes-despite all of them originating from a DRG system-, the high degree of complexity found, and the difficulties faced in several countries when collecting the data for this collaborative work. This review has been designed to assist the intensivist clinician and researcher in understanding neighbouring countries’ approaches and in putting research into the context of a European perspective. In addition, steering committees and decision makers might find this a valuable source to compare different reimbursement schemes. PMID:24216146

  9. Barriers and Facilitators to HIV Testing in Migrants in High-Income Countries: A Systematic Review.

    PubMed

    Blondell, Sarah J; Kitter, Bryony; Griffin, Mark P; Durham, Jo

    2015-11-01

    Migrants, particularly from low- and middle-income countries, are at a heightened risk of adverse HIV outcomes. HIV testing may improve these outcomes. We reviewed and synthesised studies into migrants and HIV testing (outcome variable), published between January 1997 and April 2014. Papers using quantitative, qualitative and mixed methods designs, and samples with adult (≥18 years) migrants from low- and middle-income countries in high-income countries were included in the paper. Of 3155 papers retrieved, 31 met the inclusion criteria and are included in the review. A large number of barriers and facilitators to HIV testing were identified across the individual, social and structural levels. A number of study design and methodological issues, however, inhibited a comprehensive synthesis. There is no doubt that addressing HIV testing in migrants in high-income countries is complex; however, it has important implications for individual, community and population health, and a strong, empirically based response is warranted.

  10. Access to Orphan Drugs: A Comprehensive Review of Legislations, Regulations and Policies in 35 Countries

    PubMed Central

    Gammie, Todd

    2015-01-01

    Objective To review existing regulations and policies utilised by countries to enable patient access to orphan drugs. Methods A review of the literature (1998 to 2014) was performed to identify relevant, peer-reviewed articles. Using content analysis, we synthesised regulations and policies for access to orphan drugs by type and by country. Results Fifty seven articles and 35 countries were included in this review. Six broad categories of regulation and policy instruments were identified: national orphan drug policies, orphan drug designation, marketing authorization, incentives, marketing exclusivity, and pricing and reimbursement. The availability of orphan drugs depends on individual country’s legislation and regulations including national orphan drug policies, orphan drug designation, marketing authorization, marketing exclusivity and incentives such as tax credits to ensure research, development and marketing. The majority of countries (27/35) had in place orphan drug legislation. Access to orphan drugs depends on individual country’s pricing and reimbursement policies, which varied widely between countries. High prices and insufficient evidence often limit orphan drugs from meeting the traditional health technology assessment criteria, especially cost-effectiveness, which may influence access. Conclusions Overall many countries have implemented a combination of legislations, regulations and policies for orphan drugs in the last two decades. While these may enable the availability and access to orphan drugs, there are critical differences between countries in terms of range and types of legislations, regulations and policies implemented. Importantly, China and India, two of the largest countries by population size, both lack national legislation for orphan medicines and rare diseases, which could have substantial negative impacts on their patient populations with rare diseases. PMID:26451948

  11. Cost-effectiveness of human papillomavirus vaccination in low and middle income countries: a systematic review.

    PubMed

    Fesenfeld, Michaela; Hutubessy, Raymond; Jit, Mark

    2013-08-20

    The World Health Organization recommends establishing that human papillomavirus vaccination is cost-effective before vaccine introduction. We searched Pubmed, Embase and the Cochrane Library to 1 April 2012 for economic evaluations of human papillomavirus vaccination in low and middle income countries. We found 25 articles, but almost all low income countries and many middle income countries lacked country-specific studies. Methods, assumptions and consequently results varied widely, even for studies conducted for the same country. Despite the heterogeneity, most studies conclude that vaccination is likely to be cost-effective and possibly even cost saving, particularly in settings without organized cervical screening programmes. However, study uncertainty could be reduced by clarity about vaccine prices and vaccine delivery costs. The review supports extending vaccination to low income settings where vaccine prices are competitive, donor funding is available, cervical cancer burden is high and screening options are limited.

  12. Fuel properties of eleven vegetable oils

    SciTech Connect

    Goering, C.E.; Schwab, A.W.; Daugherty, M.J.; Pryde, E.H.; Keakin, A.J.

    1981-01-01

    Eleven vegetable oils that can be grown as domestic field crops were identified for inclusion in a comparative study. Sample lots of each oil were subjected to ASTM tests appropriate for diesel fuels. The tests identified some problem areas with vegetable oil fuels. The oil samples were also characterized chemically and certain fuel properties were correlated to chemical composition. 10 refs.

  13. The impact of migration on tuberculosis epidemiology and control in high-income countries: a review.

    PubMed

    Pareek, Manish; Greenaway, Christina; Noori, Teymur; Munoz, Jose; Zenner, Dominik

    2016-01-01

    Tuberculosis (TB) causes significant morbidity and mortality in high-income countries with foreign-born individuals bearing a disproportionate burden of the overall TB case burden in these countries. In this review of tuberculosis and migration we discuss the impact of migration on the epidemiology of TB in low burden countries, describe the various screening strategies to address this issue, review the yield and cost-effectiveness of these programs and describe the gaps in knowledge as well as possible future solutions.The reasons for the TB burden in the migrant population are likely to be the reactivation of remotely-acquired latent tuberculosis infection (LTBI) following migration from low/intermediate-income high TB burden settings to high-income, low TB burden countries.TB control in high-income countries has historically focused on the early identification and treatment of active TB with accompanying contact-tracing. In the face of the TB case-load in migrant populations, however, there is ongoing discussion about how best to identify TB in migrant populations. In general, countries have generally focused on two methods: identification of active TB (either at/post-arrival or increasingly pre-arrival in countries of origin) and secondly, conditionally supported by WHO guidance, through identifying LTBI in migrants from high TB burden countries. Although health-economic analyses have shown that TB control in high income settings would benefit from providing targeted LTBI screening and treatment to certain migrants from high TB burden countries, implementation issues and barriers such as sub-optimal treatment completion will need to be addressed to ensure program efficacy. PMID:27004556

  14. The impact of migration on tuberculosis epidemiology and control in high-income countries: a review.

    PubMed

    Pareek, Manish; Greenaway, Christina; Noori, Teymur; Munoz, Jose; Zenner, Dominik

    2016-01-01

    Tuberculosis (TB) causes significant morbidity and mortality in high-income countries with foreign-born individuals bearing a disproportionate burden of the overall TB case burden in these countries. In this review of tuberculosis and migration we discuss the impact of migration on the epidemiology of TB in low burden countries, describe the various screening strategies to address this issue, review the yield and cost-effectiveness of these programs and describe the gaps in knowledge as well as possible future solutions.The reasons for the TB burden in the migrant population are likely to be the reactivation of remotely-acquired latent tuberculosis infection (LTBI) following migration from low/intermediate-income high TB burden settings to high-income, low TB burden countries.TB control in high-income countries has historically focused on the early identification and treatment of active TB with accompanying contact-tracing. In the face of the TB case-load in migrant populations, however, there is ongoing discussion about how best to identify TB in migrant populations. In general, countries have generally focused on two methods: identification of active TB (either at/post-arrival or increasingly pre-arrival in countries of origin) and secondly, conditionally supported by WHO guidance, through identifying LTBI in migrants from high TB burden countries. Although health-economic analyses have shown that TB control in high income settings would benefit from providing targeted LTBI screening and treatment to certain migrants from high TB burden countries, implementation issues and barriers such as sub-optimal treatment completion will need to be addressed to ensure program efficacy.

  15. Childhood disability and socio-economic circumstances in low and middle income countries: systematic review

    PubMed Central

    2011-01-01

    Background The majority of children with disability live in low and middle income (LAMI) countries. Although a number of important reviews of childhood disability in LAMI countries have been published, these have not, to our knowledge, addressed the association between childhood disability and the home socio-economic circumstances (SEC). The objective of this study is to establish the current state of knowledge on the SECs of children with disability and their households in LAMI countries through a systematic review and quality assessment of existing research. Methods Electronic databases (MEDLINE; EMBASE; PUBMED; Web of Knowledge; PsycInfo; ASSIA; Virtual Health Library; POPLINE; Google scholar) were searched using terms specific to childhood disability and SECs in LAMI countries. Publications from organisations including the World Bank, UNICEF, International Monetary Fund were searched for. Primary studies and reviews from 1990 onwards were included. Studies were assessed for inclusion, categorisation and quality by 2 researchers. Results 24 primary studies and 13 reviews were identified. Evidence from the available literature on the association between childhood disability and SECs was inconsistent and inconclusive. Potential mechanisms by which poverty and low household SEC may be both a cause and consequence of disability are outlined in the reviews and the qualitative studies. The association of poor SECs with learning disability and behaviour problems was the most consistent finding and these studies had low/medium risk of bias. Where overall disability was the outcome of interest, findings were divergent and many studies had a high/medium risk of bias. Qualitative studies were methodologically weak. Conclusions This review indicates that, despite socially and biologically plausible mechanisms underlying the association of low household SEC with childhood disability in LAMI countries, the empirical evidence from quantitative studies is inconsistent and

  16. A comprehensive review of the epidemiology and disease burden of Influenza B in 9 European countries.

    PubMed

    Tafalla, Monica; Buijssen, Marleen; Geets, Régine; Vonk Noordegraaf-Schouten, Marije

    2016-04-01

    This review was undertaken to consolidate information on the epidemiology and burden of influenza B, as well as the circulation patterns of influenza B lineage in 9 European countries. Following a comprehensive search of peer-reviewed and gray literature sources, we found that published data on influenza B epidemiology and burden are scarce. Surveillance data show frequent co-circulation of both influenza B lineages during influenza seasons, but little is known about its impact, especially in adults and the clinical burden of influenza B remains unknown. Mismatch between the circulating influenza B lineage and vaccine recommendations has been seen in at least one influenza season in every country. Such observations could impact the effectiveness of seasonal influenza vaccination programs using trivalent vaccines, which contain only one influenza B lineage (B/Yamagata or B/Victoria) and highlight the need for local studies to better understand the epidemiology and burden of influenza B in these countries.

  17. A comprehensive review of the epidemiology and disease burden of Influenza B in 9 European countries.

    PubMed

    Tafalla, Monica; Buijssen, Marleen; Geets, Régine; Vonk Noordegraaf-Schouten, Marije

    2016-04-01

    This review was undertaken to consolidate information on the epidemiology and burden of influenza B, as well as the circulation patterns of influenza B lineage in 9 European countries. Following a comprehensive search of peer-reviewed and gray literature sources, we found that published data on influenza B epidemiology and burden are scarce. Surveillance data show frequent co-circulation of both influenza B lineages during influenza seasons, but little is known about its impact, especially in adults and the clinical burden of influenza B remains unknown. Mismatch between the circulating influenza B lineage and vaccine recommendations has been seen in at least one influenza season in every country. Such observations could impact the effectiveness of seasonal influenza vaccination programs using trivalent vaccines, which contain only one influenza B lineage (B/Yamagata or B/Victoria) and highlight the need for local studies to better understand the epidemiology and burden of influenza B in these countries. PMID:26890005

  18. International Quality Review and Distance Learning: Lessons from Five Countries. CHEA Occasional Paper

    ERIC Educational Resources Information Center

    Middlehurst, Robin; Woodfield, Steve

    2004-01-01

    This is a report on the quality review of distance learning in a sample of five countries. The report was commissioned by the Council for Higher Education Accreditation's (CHEA's) International Commission in order to understand better the nature of existing regulatory arrangements in the context of growth in electronically supported learning and…

  19. The Mass Media in Adult Education in the Developing Countries: A Literature Review.

    ERIC Educational Resources Information Center

    Gueulette, David G.

    This literature review is in the form of a critique of the typical approaches to education in developing countries and the lack of attention to broad-based ethical issues. It is stated that no one is willing to discuss the real implications of promoting education in any land. Questions of social upheaval or loss of traditional values caused by…

  20. 78 FR 33266 - Review of New Sources and Modifications in Indian Country

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-04

    ... Reservations FIP Federal Implementation Plan FR Federal Register GHG Greenhouse Gas GP General Permit HAPs... component of ``Review of New Sources and Modifications in Indian Country, Final Rule'' 76 FR 38747 (July 1...) final rule was published in the Federal Register on July 1, 2011 (76 FR 38748), pursuant to sections...

  1. Wellbeing Research in Developing Countries: Reviewing the Role of Qualitative Methods

    ERIC Educational Resources Information Center

    Camfield, Laura; Crivello, Gina; Woodhead, Martin

    2009-01-01

    The authors review the contribution of qualitative methods to exploring concepts and experiences of wellbeing among children and adults living in developing countries. They provide examples illustrating the potential of these methods for gaining a holistic and contextual understanding of people's perceptions and experiences. Some of these come…

  2. The Somalia Country Case Study. Mid-Decade Review of Progress towards Education for All.

    ERIC Educational Resources Information Center

    Bennaars, Gerard A.; Seif, Huda A.; Mwangi, Doris

    In 1995, the International Consultative Forum on Education for All commissioned case studies in developing countries as part of a mid-decade review of progress in expanding access to basic education. This paper examines the situation in Somalia, where civil war has completely destroyed the infrastructure of education. Part 1 summarizes Somalia's…

  3. Quality Review in Distance Learning: Policy and Practice in Five Countries

    ERIC Educational Resources Information Center

    Middlehurst, Robin; Woodfield, Steve

    2006-01-01

    This paper is a contribution to knowledge sharing in the field of distance learning. It presents and discusses the findings of a study on the quality review of distance learning in a sample of five countries. The study was commissioned by the Council for Higher Education Accreditation's (CHEA) International Commission in order to understand better…

  4. A review of the infection-associated cancers in North African countries.

    PubMed

    Hussein, Wafaa Mohamed; Anwar, Wagida A; Attaleb, Mohammed; Mazini, Loubna; Försti, Asta; Trimbitas, Roxana-Delia; Khyatti, Meriem

    2016-01-01

    Cancer is typically classified as a leading non-communicable disease; however, infectious agents, such as Helicobacter pylori (H. pylori), hepatitis B virus (HBV), hepatitis C virus (HCV) and human papilloma virus (HPV), contribute significantly to the pathogenesis of various cancers. Less developed countries, including countries of the North African (NA) region, endure the highest burden of infection-related cancers. The five most common infection-associated cancers in NA in order of incidence are bladder cancer, cervical cancer, liver cancer, stomach cancer, and nasopharyngeal carcinoma. This review aims to outline the epidemiologic pattern of infection-associated cancers in five NA countries (namely: Morocco, Algeria, Tunisia, Libya and Egypt) highlighting the similarities and differences across the region. The present study employed an initial literature review of peer-reviewed articles selected from PubMed, ScienceDirect and World Health Organization (WHO) databases based on key word searches without restriction on publication dates. Original research articles and reports written in French, as well as data from institutional reports and regional meeting abstracts were also included in this extensive review. Egypt, Libya, Tunisia, Algeria and Morocco were selected to be the focus of this review.

  5. A review of the infection-associated cancers in North African countries.

    PubMed

    Hussein, Wafaa Mohamed; Anwar, Wagida A; Attaleb, Mohammed; Mazini, Loubna; Försti, Asta; Trimbitas, Roxana-Delia; Khyatti, Meriem

    2016-01-01

    Cancer is typically classified as a leading non-communicable disease; however, infectious agents, such as Helicobacter pylori (H. pylori), hepatitis B virus (HBV), hepatitis C virus (HCV) and human papilloma virus (HPV), contribute significantly to the pathogenesis of various cancers. Less developed countries, including countries of the North African (NA) region, endure the highest burden of infection-related cancers. The five most common infection-associated cancers in NA in order of incidence are bladder cancer, cervical cancer, liver cancer, stomach cancer, and nasopharyngeal carcinoma. This review aims to outline the epidemiologic pattern of infection-associated cancers in five NA countries (namely: Morocco, Algeria, Tunisia, Libya and Egypt) highlighting the similarities and differences across the region. The present study employed an initial literature review of peer-reviewed articles selected from PubMed, ScienceDirect and World Health Organization (WHO) databases based on key word searches without restriction on publication dates. Original research articles and reports written in French, as well as data from institutional reports and regional meeting abstracts were also included in this extensive review. Egypt, Libya, Tunisia, Algeria and Morocco were selected to be the focus of this review. PMID:27512409

  6. Role of mobile phone technology in health education in Asian and African countries: a systematic review.

    PubMed

    Sahu, Madhusmita; Grover, Ashoo; Joshi, Ashish

    2014-01-01

    The objective of this systematic review was to explore the role of mobile phone technologies in delivering health education programs in Asian and African countries. The search engine used was Pubmed during 2008-2011. Randomised controlled trials or controlled studies that improved health outcomes through delivery of health educational interventions using cell phone or text messaging were included in the review. Results showed studies from six Asian and African countries including Philippines, China, Kenya, South Korea, Taiwan and India. Mobile phone technology has shown to improve health outcomes for chronic disease conditions such as diabetes, heart disease and hypertension. Additional conditions include obesity and cardiopulmonary resuscitation guidance. Other studies have shown improvement in self management of breast cancer and post-hospitalisation HIV and pharmaceutical care. Overall results of the present review showed that mobile phone technologies can be a possible solution to improve healthcare outcome.

  7. Dengue viral infections in Pakistan and other Asian countries: a comprehensive review.

    PubMed

    Zubair, Muhammad; Ashraf, Muhammad; Ahsan, Aitezaz; Nazir, Noor-Ul-Ain; Hanif, Hina; Khan, Haider Ali

    2016-07-01

    Infections due to Dengue virus are widespread throughout the world. Disease starts with mild flu like sickness to a severe intricate condition which results in the death of the patient. Dengue illness has high morbidity and mortality in Pakistan as well as in other Asian countries. The Review article is a discourse analysis that explores the facts about the history, emergence and impact of dengue in Pakistan and other Asian countries. Data was collected from internet sources, mainly using Science Direct and PubMed. The final literature was reviewed and summarised. About 150 articles were identified and 47 articles were shortlisted for final review. Aedesaegypti was found to be a major vector for the transmission and spread of dengue illness. Treatment comprises supportive therapy as no specific treatment was available. During the last couple of years, the incidence of dengue fever was extraordinary in metropolitan cities of Pakistan. PMID:27427141

  8. Interventions to Prevent Child Marriage Among Young People in Low- and Middle-Income Countries: A Systematic Review of the Published and Gray Literature.

    PubMed

    Kalamar, Amanda M; Lee-Rife, Susan; Hindin, Michelle J

    2016-09-01

    Child marriage, defined as marriage before the age of 18 years, is a human rights violation that can have lasting adverse educational and economic impacts. The objective of this review was to identify high-quality interventions and evaluations to decease child marriage in low- and middle-income countries. PubMed, Embase, PsycInfo, CINAHL Plus, Popline, and the Cochrane Databases were searched without language limitations for articles published through November 2015. Gray literature was searched by hand. Reference tracing was used, as well as the unpacking of systematic reviews. Retained articles were those that were evaluated as having high-quality interventions and evaluations using standardized scoring. Eleven high-quality interventions and evaluations were abstracted. Six found positive results in decreasing the proportion married or increasing age at marriage, one had both positive and negative findings, and four had no statistical impact on the proportion married or age at marriage. There is wide range of high-quality, impactful interventions included in this review which can inform researchers, donors, and policy makers about where to make strategic investments to eradicate marriage, a current target of the Sustainable Development Goals. Despite the cultural factors that promote child marriage, the diversity of interventions can allow decision makers to tailor interventions to the cultural context of the target population.

  9. Interventions to Prevent Child Marriage Among Young People in Low- and Middle-Income Countries: A Systematic Review of the Published and Gray Literature.

    PubMed

    Kalamar, Amanda M; Lee-Rife, Susan; Hindin, Michelle J

    2016-09-01

    Child marriage, defined as marriage before the age of 18 years, is a human rights violation that can have lasting adverse educational and economic impacts. The objective of this review was to identify high-quality interventions and evaluations to decease child marriage in low- and middle-income countries. PubMed, Embase, PsycInfo, CINAHL Plus, Popline, and the Cochrane Databases were searched without language limitations for articles published through November 2015. Gray literature was searched by hand. Reference tracing was used, as well as the unpacking of systematic reviews. Retained articles were those that were evaluated as having high-quality interventions and evaluations using standardized scoring. Eleven high-quality interventions and evaluations were abstracted. Six found positive results in decreasing the proportion married or increasing age at marriage, one had both positive and negative findings, and four had no statistical impact on the proportion married or age at marriage. There is wide range of high-quality, impactful interventions included in this review which can inform researchers, donors, and policy makers about where to make strategic investments to eradicate marriage, a current target of the Sustainable Development Goals. Despite the cultural factors that promote child marriage, the diversity of interventions can allow decision makers to tailor interventions to the cultural context of the target population. PMID:27562449

  10. Fuel properties of eleven vegetable oils

    SciTech Connect

    Goering, C.E.; Schwab, A.W.; Daugherty, M.J.; Pryde, E.H.; Heakin, A.J.

    1982-01-01

    Eleven vegetable oils that can be grown as domestic field crops were identified for inclusion in a comparative study of chemical and fuel properties. Sample lots of each oil were subjected to ASTM tests appropriate for diesel fuels. The tests identified some problem areas with vegetable oil fuels. The oil samples were also characterized chemically and certain fuel properties were correlated to chemical compositions. (Refs. 11).

  11. Critical thinking dispositions of nursing students in Asian and non-Asian countries: a literature review.

    PubMed

    Salsali, Mahvash; Tajvidi, Mansooreh; Ghiyasvandian, Shahrzad

    2013-11-01

    Critical thinking disposition represents an inclination of a person to use possessed skills in relation to critical thinking. The trend of critical thinking has been described as inner motivation to solve problems and make decisions by thinking. In nursing as a practical profession, the concept of critical thinking dispositions is important component in helping to manage complex health situations and to deal with patient issues effectively. Willingness to think critically is a prerequisite for safe and subtly performance. The results of studies show critical thinking dispositions of nursing students in Asian countries are different from non-Asian countries. Aim of this literature review was to compare critical thinking dispositions of nursing students in Asian and non-Asian countries. Literature review was done in English and Persian databases. The results showed of the 795 articles published in English and Persian language that studied critical thinking, 73 ones studied critical thinking skills and dispositions in nursing education, and relationship between teaching methods and critical thinking skills and dispositions in nursing education of different countries. Fifteen of seventy three articles assessed critical thinking dispositions in nursing students. Limited studies showed that the Asian nursing students had mostly undermining score of the critical thinking dispositions, while non-Asian countries tend to positive scores. The reasons for these differences could be due to issues such as environmental, educational methods and cultural differences. However, future studies should measure critical thinking disposition by discipline-based tools.

  12. Systematic reviews addressing identified health policy priorities in Eastern Mediterranean countries: a situational analysis

    PubMed Central

    2014-01-01

    Background Systematic reviews can offer policymakers and stakeholders concise, transparent, and relevant evidence pertaining to pressing policy priorities to help inform the decision-making process. The production and the use of systematic reviews are specifically limited in the Eastern Mediterranean region. The extent to which published systematic reviews address policy priorities in the region is still unknown. This situational analysis exercise aims at assessing the extent to which published systematic reviews address policy priorities identified by policymakers and stakeholders in Eastern Mediterranean region countries. It also provides an overview about the state of systematic review production in the region and identifies knowledge gaps. Methods We conducted a systematic search of the Health System Evidence database to identify published systematic reviews on policy-relevant priorities pertaining to the following themes: human resources for health, health financing, the role of the non-state sector, and access to medicine. Priorities were identified from two priority-setting exercises conducted in the region. We described the distribution of these systematic reviews across themes, sub-themes, authors’ affiliations, and countries where included primary studies were conducted. Results Out of the 1,045 systematic reviews identified in Health System Evidence on selected themes, a total of 200 systematic reviews (19.1%) addressed the priorities from the Eastern Mediterranean region. The theme with the largest number of systematic reviews included was human resources for health (115) followed by health financing (33), access to medicine (27), and role of the non-state sector (25). Authors based in the region produced only three systematic reviews addressing regional priorities (1.5%). Furthermore, no systematic review focused on the Eastern Mediterranean region. Primary studies from the region had limited contribution to systematic reviews; 17 systematic reviews

  13. mHealth Interventions in Low and Middle-Income Countries: A Systematic Review

    PubMed Central

    Hurt, Kathryn; Walker, Rebekah J.; Campbell, Jennifer A.; Egede, Leonard E.

    2016-01-01

    The purpose of this review was to determine whether mHealth interventions were effective in low- and middle-income countries in order to create a baseline for the evidence to support mHealth in developing countries. Studies were identified by searching Medline on 02 October 2014 for articles published in the English language between January 2000 and September 2014. Inclusion criteria were: 1) written in English, 2) completion of an mHealth intervention in a low or middle-income country, 3) measurement of patient outcomes, and 4) participants 18 years of age or older. 7,920 titles were reviewed and 7 were determined eligible based on inclusion criteria. Interventions included a cluster randomized trial, mixed methods study, retrospective comparison of an opt-in text message program, a two-arm proof of concept, single arm trial, a randomized trial, and a single subject design. Five out of seven of the studies showed significant difference between the control and intervention. Currently there is little evidence on mHealth interventions in developing countries, and existing studies are very diverse; however initial studies show changes in clinical outcomes, adherence, and health communication, including improved communication with providers, decrease in travel time, ability to receive expert advice, changes in clinical outcomes, and new forms of cost-effective education. While this initial review is promising, more evidence is needed to support and direct system-level resource investment.

  14. Acculturation and obesity among migrant populations in high income countries – a systematic review

    PubMed Central

    2013-01-01

    Background There is evidence to suggest that immigrant populations from low or medium-income countries to high income countries show a significant change in obesogenic behaviors in the host society, and that these changes are associated with acculturation. However, the results of studies vary depending on how acculturation is measured. The objective of this study is to systematically review the evidence on the relationship between acculturation - as measured with a standardized acculturation scale - and overweight/obesity among adult migrants from low/middle countries to high income countries. Methods A systematic review of relevant studies was undertaken using six EBSCOhost databases and following the Centre for Reviews and Dissemination’s Guidance for Undertaking Reviews in Health Care. Results The initial search identified 1135 potentially relevant publications, of which only nine studies met the selection criteria. All of the studies were from the US with migrant populations from eight different countries. Six studies employed bi-directional acculturation scales and three used uni-directional scales. Six studies indicated positive general associations between higher acculturation and body mass index (BMI), and three studies reported that higher acculturation was associated with lower BMI, as mainly among women. Conclusion Despite the small number of studies, a number of potential explanatory hypotheses were developed for these emerging patterns. The ‘Healthy Migrant Effect’ may diminish with greater acculturation as the host culture potentially promotes more unhealthy weight gain than heritage cultures. This appears particularly so for men and a rapid form of nutrition transition represents a likely contributor. The inconsistent results observed for women may be due to the interplay of cultural influences on body image, food choices and physical activity. That is, the Western ideal of a slim female body and higher values placed on physical activity and

  15. Socioeconomic status and obesity in adult populations of developing countries: a review.

    PubMed Central

    Monteiro, Carlos A.; Moura, Erly C.; Conde, Wolney L.; Popkin, Barry M.

    2004-01-01

    A landmark review of studies published prior to 1989 on socioeconomic status (SES) and obesity supported the view that obesity in the developing world would be essentially a disease of the socioeconomic elite. The present review, on studies conducted in adult populations from developing countries, published between 1989 and 2003, shows a different scenario for the relationship between SES and obesity. Although more studies are necessary to clarify the exact nature of this relationship, particularly among men, three main conclusions emerge from the studies reviewed: 1. Obesity in the developing world can no longer be considered solely a disease of groups with higher SES. 2. The burden of obesity in each developing country tends to shift towards the groups with lower SES as the country's gross national product (GNP) increases. 3. The shift of obesity towards women with low SES apparently occurs at an earlier stage of economic development than it does for men. The crossover to higher rates of obesity among women of low SES is found at a GNP per capita of about US$ 2500, the mid-point value for lower-middle-income economies. The results of this review reinforce the urgent need to: include obesity prevention as a relevant topic on the public health agenda in developing countries; improve the access of all social classes in these countries to reliable information on the determinants and consequences of obesity; and design and implement consistent public actions on the physical, economic, and sociocultural environment that make healthier choices concerning diet and physical activity feasible for all. A significant step in this direction was taken with the approval of the Global Strategy on Diet, Physical Activity and Health by the World Health Assembly in May 2004. PMID:15654409

  16. Refugee experiences of general practice in countries of resettlement: a literature review

    PubMed Central

    Cheng, I-Hao; Drillich, Ann; Schattner, Peter

    2015-01-01

    Background Refugees and asylum seekers often struggle to use general practice services in resettlement countries. Aim To describe and analyse the literature on the experiences of refugees and asylum seekers using general practice services in countries of resettlement. Design and setting Literature review using systematic search and narrative data extraction and synthesis methodologies. International, peer-reviewed literature published in English language between 1990 and 2013. Method Embase, Ovid MEDLINE, PsycINFO, CSA Sociological Abstracts, and CINAHL databases were searched using the terms: refugee, asylum seeker, experience, perception, doctor, physician, and general practitioner. Titles, abstracts and full texts were reviewed and were critically appraised. Narrative themes describing the refugee or asylum seeker’s personal experiences of general practice services were identified, coded, and analysed. Results From 8722 papers, 85 were fully reviewed and 23 included. These represented the experiences of approximately 864 individuals using general practice services across 11 countries. Common narrative themes that emerged were: difficulties accessing general practice services, language barriers, poor doctor–patient relationships, and problems with the cultural acceptability of medical care. Conclusion The difficulties refugees and asylum seekers experience accessing and using general practice services could be addressed by providing practical support for patients to register, make appointments, and attend services, and through using interpreters. Clinicians should look beyond refugee stereotypes to focus on the needs and expectations of the individual. They should provide clear explanations about unfamiliar clinical processes and treatments while offering timely management. PMID:25733438

  17. [Health economic evaluation of human papillomavirus vaccines in the developing countries: systematic reviews].

    PubMed

    Song, Xiaobin; Mao, Fanzhen; Zhou, Zi; Zhao, Qinjian; Fang, Ya

    2016-01-01

    Cervical carcinoma has brought huge burden on patients, especially in developing countries. Preventive vaccines could effectively reduce the incidence of cervical carcinoma. The high prices were one of the most difficult problem in introducing the vaccine in developing countries, so the cost-effectiveness and health financing of the vaccines should be carefully studied before incorporated into the national immunization program. Thus, researchers used mathematical models to predict the effects of HPV vaccines and to study the cost- effectiveness. In order to understand the current situation on the cost-effectiveness of HPV vaccines in the developing countries, a systematic searching of literature from PubMed, Elsevier Science Direct, Medline, ProQuest, CNKI and Wangfang Data was performed, this study aims to conduct a systematic review from aspects of project source, first author, research areas, research perspectives, prevention strategies, vaccine characteristics, cost-effectiveness.

  18. The Impact of Mobile Health Interventions on Chronic Disease Outcomes in Developing Countries: A Systematic Review

    PubMed Central

    Lee, Allison G.; Willner, Jonathan M.; Jahangir, Eiman; Ciapponi, Agustín; Rubinstein, Adolfo

    2014-01-01

    Abstract Introduction: Rates of chronic diseases will continue to rise in developing countries unless effective and cost-effective interventions are implemented. This review aims to discuss the impact of mobile health (m-health) on chronic disease outcomes in low- and middle-income countries (LMIC). Materials and Methods: Systematic literature searches were performed using CENTRAL, MEDLINE, EMBASE, and LILACS databases and gray literature. Scientific literature was searched to identify controlled studies evaluating cell phone voice and text message interventions to address chronic diseases in adults in low- or middle-income countries. Outcomes measured included morbidity, mortality, hospitalization rates, behavioral or lifestyle changes, process of care improvements, clinical outcomes, costs, patient–provider satisfaction, compliance, and health-related quality of life (HRQoL). Results: From the 1,709 abstracts retrieved, 163 articles were selected for full text review, including 9 randomized controlled trials with 4,604 participants. Most of the studies addressed more than one outcome. Of the articles selected, six studied clinical outcomes, six studied processes of care, three examined healthcare costs, and two examined HRQoL. M-health positively impacted on chronic disease outcomes, improving attendance rates, clinical outcomes, and HRQoL, and was cost-effective. Conclusions: M-health is emerging as a promising tool to address access, coverage, and equity gaps in developing countries and low-resource settings. The results for m-health interventions showed a positive impact on chronic diseases in LMIC. However, a limiting factor of this review was the relatively small number of studies and patients enrolled, highlighting the need for more rigorous research in this area in developing countries. PMID:24205809

  19. Brain Gains: a literature review of medical missions to low and middle-income countries

    PubMed Central

    2012-01-01

    Background Healthcare professionals’ participation in short-term medical missions to low and middle income countries (LMIC) to provide healthcare has become common over the past 50 years yet little is known about the quantity and quality of these missions. The aim of this study was to review medical mission publications over 25 years to better understand missions and their potential impact on health systems in LMICs. Methods A literature review was conducted by searching Medline for articles published from 1985–2009 about medical missions to LMICs, revealing 2512 publications. Exclusion criteria such as receiving country and mission length were applied, leaving 230 relevant articles. A data extraction sheet was used to collect information, including sending/receiving countries and funding source. Results The majority of articles were descriptive and lacked contextual or theoretical analysis. Most missions were short-term (1 day – 1 month). The most common sending countries were the U.S. and Canada. The top destination country was Honduras, while regionally Africa received the highest number of missions. Health care professionals typically responded to presenting health needs, ranging from primary care to surgical relief. Cleft lip/palate surgeries were the next most common type of care provided. Conclusions Based on the articles reviewed, there is significant scope for improvement in mission planning, monitoring and evaluation as well as global and/or national policies regarding foreign medical missions. To promote optimum performance by mission staff, training in such areas as cross-cultural communication and contextual realities of mission sites should be provided. With the large number of missions conducted worldwide, efforts to ensure efficacy, harmonisation with existing government programming and transparency are needed. PMID:22643123

  20. Prevalence of Gastrointestinal Pathogens In Developed and Developing Countries: Systematic Review and Meta-Analysis

    PubMed Central

    Fletcher, Stephanie M.; McLaws, Mary-Louise; Ellis, John T.

    2013-01-01

    Diarrhoeal illness is a leading cause of child mortality and morbidity worldwide. There are no precise or current estimates of the types and prevalence of pathogens associated with diarrheal illnesses in developed and developing settings. This systematic review assessed data from 60 studies published in the English language from five developing regions and developed countries worldwide to provide regional estimates of enteric pathogens affecting children. The random-effect method was used to establish the weighted average prevalence of pathogens in adults and children for each region. Significantly more pathogens were reported by studies from developing regions compared with Organisation for Economic Co-operation and Development countries (P<0.016). The identification rates of pathogens from community based and hospital based studies were similar (58.5% and 58.1% respectively, P<0.619). The overall detection of enteric pathogens in developing countries was higher in adults (74.8%; 95% CI 63.1-83.8%) compared with children (56.7%; 95% CI 53.0-60.4%) (P<0.001). Rotavirus was the most frequently detected pathogen in all regions with the highest rate, 24.8% (95% CI 18.0-33.1%), detected in the developed countries. This systematic review is the first to provide an estimate of the prevalence of enteric pathogens associated with diarrhoeal illnesses in adults and children in developed and developing settings. While pathogen detection rate is greater in developing regions the consistently high prevalence of rotavirus in both developed and developing settings underscores the urgent need for access to rotavirus vaccines. Increased travel between developing and developed countries increases disease risk, and hence developed countries have a vested interest in supporting vaccine accessibility in developing settings. PMID:25170480

  1. HIV testing and counselling for migrant populations living in high-income countries: a systematic review

    PubMed Central

    Monge, Susana; Azcoaga, Amaya; Rio, Isabel; Hernando, Victoria; Gonzalez, Cristina; Alejos, Belen; Caro, Ana Maria; Perez-Cachafeiro, Santiago; Ramirez-Rubio, Oriana; Bolumar, Francisco; Noori, Teymur; Del Amo, Julia

    2013-01-01

    Background: The barriers to HIV testing and counselling that migrants encounter can jeopardize proactive HIV testing that relies on the fact that HIV testing must be linked to care. We analyse available evidence on HIV testing and counselling strategies targeting migrants and ethnic minorities in high-income countries. Methods: Systematic literature review of the five main databases of articles in English from Europe, North America and Australia between 2005 and 2009. Results: Of 1034 abstracts, 37 articles were selected. Migrants, mainly from HIV-endemic countries, are at risk of HIV infection and its consequences. The HIV prevalence among migrants is higher than the general population’s, and migrants have higher frequency of delayed HIV diagnosis. For migrants from countries with low HIV prevalence and for ethnic minorities, socio-economic vulnerability puts them at risk of acquiring HIV. Migrants have specific legal and administrative impediments to accessing HIV testing—in some countries, undocumented migrants are not entitled to health care—as well as cultural and linguistic barriers, racism and xenophobia. Migrants and ethnic minorities fear stigma from their communities, yet community acceptance is key for well-being. Conclusions: Migrants and ethnic minorities should be offered HIV testing, but the barriers highlighted in this review may deter programs from achieving the final goal, which is linking migrants and ethnic minorities to HIV clinical care under the public health perspective. PMID:23002238

  2. Partner notification for sexually transmitted infections in developing countries: a systematic review

    PubMed Central

    2010-01-01

    Background The feasibility and acceptability of partner notification (PN) for sexually transmitted infections (STIs) in developing countries was assessed through a comprehensive literature review, to help identify future intervention needs. Methods The Medline, Embase, and Google Scholar databases were searched to identify studies published between January 1995 and December 2007 on STI PN in developing countries. A systematic review of the research extracted information on: (1) willingness of index patients to notify partners; (2) the proportion of partners notified or referred; (3) client-reported barriers in notifying partners; (4) infrastructure barriers in notifying partners; and (5) PN approaches that were evaluated in developing countries. Results Out of 609 screened articles, 39 met our criteria. PN outcome varied widely and was implemented more often for spousal partners than for casual or commercial partners. Reported barriers included sociocultural factors such as stigma, fear of abuse for having an STI, and infrastructural factors related to the limited number of STD clinics, and trained providers and reliable diagnostic methods. Client-oriented counselling was found to be effective in improving partner referral outcomes. Conclusions STD clinics can improve PN with client-oriented counselling, which should help clients to overcome perceived barriers. The authors speculate that well-designed PN interventions to evaluate the impact on STI prevalence and incidence along with cost-effectiveness components will motivate policy makers in developing countries to allocate more resources towards STI management. PMID:20082718

  3. Eleven theses of general systems theory (GST)

    SciTech Connect

    Waelchli, F.

    1992-12-31

    This paper chronicles an effort to distill and order (for purposes of discussion and elaboration) frequently mentioned and significant ideas encountered in the literature of General Systems theory (GST). The product is a set of eleven theses, representing the author`s selection and collation of seminal and recurrent GST themes. The author argues that attention to theory could aid the effort to develop practical applications of systems thinking. (Remember that a thesis is a statement or assertion, offered originally without proof, as the basis for an argument, discussion, or empirical test). 10 refs.

  4. Rotational Spectroscopy Unveils Eleven Conformers of Adrenaline

    NASA Astrophysics Data System (ADS)

    Cabezas, C.; Cortijo, V.; Mata, S.; Lopez, J. C.; Alonso, J. L.

    2013-06-01

    Recent improvements in our LA-MB-FTMW instrumentation have allowed the characterization of eleven and eight conformers for the neurotransmitters adrenaline and noradrenaline respectively. The observation of this rich conformational behavior is in accordance with the recent observation of seven conformers for dopamine and in sharp contrast with the conformational reduction proposed for catecholamines. C. Cabezas, I. Peña, J. C. López, J. L. Alonso J. Phys. Chem. Lett. 2013, 4, 486. H. Mitsuda, M. Miyazaki, I. B. Nielsen, P. Carcabal,C. Dedonder, C. Jouvet, S. Ishiuchi, M. Fujii J. Phys. Chem. Lett. 2010, 1, 1130.

  5. Measuring quality of mental health care: a review of initiatives and programs in selected countries.

    PubMed

    Spaeth-Rublee, Brigitta; Pincus, Harold Alan; Huynh, Phuong Trang

    2010-09-01

    This review article presents a systematic review of grey literature describing current initiatives that assess the quality of mental health care in 12 countries, as collected by the International Initiative for Mental Health Leadership.There have been increased efforts in many countries to develop and implement mental health indicator schemes to measure and monitor the quality of mental health care at the national and subnational level. Most mental health indicator sets are part of larger health policy initiatives at the national and (or) provincial or state level, with indicators and domains regularly reviewed and revised. The indicator sets described in health care quality initiatives vary widely in their scope, intended use, and degree of development, and they often cut across a broad range of domains, reflecting not only a country's specific health system and how it is organized and structured but also the implementation of such schemes (that is, collection and analysis of data) and the sociopolitical realities that determine mental health priorities.

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

    PubMed

    Iemmi, Valentina; Bantjes, Jason; Coast, Ernestina; Channer, Kerrie; Leone, Tiziana; McDaid, David; Palfreyman, Alexis; Stephens, Bevan; Lund, Crick

    2016-08-01

    Suicide is the 15th leading cause of death worldwide, with over 75% of suicides occurring in low-income and middle-income countries. Nonetheless, evidence on the association between suicide and poverty in low-income and middle-income countries is scarce. We did a systematic review to understand the association between suicidal ideations and behaviours and economic poverty in low-income and middle-income countries. We included studies testing the association between suicidal ideations and behaviours and economic poverty in low-income and middle-income countries using bivariate or multivariate analysis and published in English between January, 2004, and April, 2014. We identified 37 studies meeting these inclusion criteria. In 18 studies reporting the association between completed suicide and poverty, 31 associations were explored. The majority reported a positive association. Of the 20 studies reporting on the relationship between non-fatal suicidal ideations and behaviours and poverty, 36 associations were explored. Again, almost all studies reported a positive association. However, when considering each poverty dimension separately, we found substantial variations. These findings show a consistent trend at the individual level indicating that poverty, particularly in the form of worse economic status, diminished wealth, and unemployment is associated with suicidal ideations and behaviours. At the country level, there are insufficient data to draw clear conclusions. Available data show a potential benefit in addressing economic poverty within suicide prevention strategies, with particular attention to both chronic poverty and acute economic events. PMID:27475770

  7. Achieving Resource Conservation in Electronic Waste Management: A Review of Options Available to Developing Countries

    NASA Astrophysics Data System (ADS)

    Chidi Nnorom, Innocent; Osibanjo, Oladele; Onyedikachi Nnorom, Stanley

    Large quantities of waste electronic devices (e-waste) at their end-of-life, generated internally or imported illegally from developed countries, are currently being managed in the developing countries, through low-end means such as crude backyard recycling and disposal at unlined landfills or open dumps. The extension of the lifespan of electronic devices through reuse options such as repair, reconditioning and remanufacturing should be a priority in the management of electronic waste in developing countries considering the near absence of state-of-the-art recycling facilities in these countries. Life extension through product and component reuse is especially critical to electronic products because in recent years, electronics have increased in technological complexity, with new product innovations and ever shortening product life expectancy. For many products, environmentalists assume that reuse is environmentally beneficial because it replaces the manufacturing and purchase of new goods. However, on the contrary, manufacturers may oppose this type of reuse for the same reason. There is an urgent need to control the trans-boundary movement of electronic scrap especially to countries without established recycling facilities. Importations of secondhand electronics make such devices available to those who cannot afford new products. However, an international method of testing and certification is needed to ensure that exported secondhand devices are functional. Establishment of formal recycling facilities for e-waste in the developing countries will ensure resource reutilization with both economical and ecological gains. This study reviews options available in working towards eco-efficient management of e-waste in developing countries in the light of the present low-end management practices.

  8. Biosecurity measures for backyard poultry in developing countries: a systematic review

    PubMed Central

    2012-01-01

    Background Poultry represents an important sector in animal production, with backyard flocks representing a huge majority, especially in the developing countries. In these countries, villagers raise poultry to meet household food demands and as additional sources of incomes. Backyard production methods imply low biosecurity measures and high risk of infectious diseases, such as Newcastle disease or zoonosis such as Highly Pathogenic Avian Influenza (HPAI). We reviewed literature on biosecurity practices for prevention of infectious diseases, and published recommendations for backyard poultry and assessed evidence of their impact and feasibility, particularly in developing countries. Documents were sourced from the Food and Agriculture Organization (FAO) website, and from Pubmed and Google databases. Results A total of 62 peer-reviewed and non-referred documents were found, most of which were published recently (after 2004) and focused on HPAI/H5N1-related biosecurity measures (64%). Recommendations addressed measures for flock management, feed and water management, poultry trade and stock change, poultry health management and the risk to humans. Only one general guideline was found for backyard poultry-related biosecurity; the other documents were drawn up for specific developing settings and only engaged their authors (e.g. consultants). These national guidelines written by consultants generated recommendations regarding measures derived from the highest standards of commercial poultry production. Although biosecurity principles of isolation and containment are described in most documents, only a few documents were found on the impact of measures in family poultry settings and none gave any evidence of their feasibility and effectiveness for backyard poultry. Conclusions Given the persistent threat posed by HPAI/H5N1 to humans in developing countries, our findings highlight the importance of encouraging applied research toward identifying sustained and adapted

  9. Provider payment in community-based health insurance schemes in developing countries: a systematic review

    PubMed Central

    Robyn, Paul Jacob; Sauerborn, Rainer; Bärnighausen, Till

    2013-01-01

    Objectives Community-based health insurance (CBI) is a common mechanism to generate financial resources for health care in developing countries. We review for the first time provider payment methods used in CBI in developing countries and their impact on CBI performance. Methods We conducted a systematic review of the literature on provider payment methods used by CBI in developing countries published up to January 2010. Results Information on provider payment was available for a total of 32 CBI schemes in 34 reviewed publications: 17 schemes in South Asia, 10 in sub-Saharan Africa, 4 in East Asia and 1 in Latin America. Various types of provider payment were applied by the CBI schemes: 17 used fee-for-service, 12 used salaries, 9 applied a coverage ceiling, 7 used capitation and 6 applied a co-insurance. The evidence suggests that provider payment impacts CBI performance through provider participation and support for CBI, population enrolment and patient satisfaction with CBI, quantity and quality of services provided and provider and patient retention. Lack of provider participation in designing and choosing a CBI payment method can lead to reduced provider support for the scheme. Conclusion CBI schemes in developing countries have used a wide range of provider payment methods. The existing evidence suggests that payment methods are a key determinant of CBI performance and sustainability, but the strength of this evidence is limited since it is largely based on observational studies rather than on trials or on quasi-experimental research. According to the evidence, provider payment can affect provider participation, satisfaction and retention in CBI; the quantity and quality of services provided to CBI patients; patient demand of CBI services; and population enrollment, risk pooling and financial sustainability of CBI. CBI schemes should carefully consider how their current payment methods influence their performance, how changes in the methods could improve

  10. Interprofessional Education for Whom? — Challenges and Lessons Learned from Its Implementation in Developed Countries and Their Application to Developing Countries: A Systematic Review

    PubMed Central

    Sunguya, Bruno F.; Hinthong, Woranich; Jimba, Masamine; Yasuoka, Junko

    2014-01-01

    Background Evidence is available on the potential efficacy of interprofessional education (IPE) to foster interprofessional cooperation, improve professional satisfaction, and improve patient care. While the intention of the World Health Organization (WHO) is to implement IPE in all countries, evidence comes from developed countries about its efficiency, challenges, and barriers to planning and implementing IPE. We therefore conducted this review to examine challenges of implementing IPE to suggest possible pathways to overcome the anticipated challenges in developing countries. Methods We searched for literatures on IPE in PubMed/MEDLINE, CINAHL, PsycINFO, and ERIC databases. We examined challenges or barriers and initiatives to overcome them so as to suggest methods to solve the anticipated challenges in developing countries. We could not conduct a meta-analysis because of the qualitative nature of the research question and the data; instead we conducted a meta-narrative of evidence. Results A total of 40 out of 2,146 articles were eligible for analyses in the current review. Only two articles were available from developing countries. Despite the known benefits of IPE, a total of ten challenges or barriers were common based on the retrieved evidence. They included curriculum, leadership, resources, stereotypes and attitudes, variety of students, IPE concept, teaching, enthusiasm, professional jargons, and accreditation. Out of ten, three had already been reported in developing countries: IPE curriculum, resource limitations, and stereotypes. Conclusion This study found ten important challenges on implementing IPE. They are curriculum, leadership, resources, stereotypes, students' diversity, IPE concept, teaching, enthusiasm, professional jargons, and accreditation. Although only three of them are already experienced in developing countries, the remaining seven are potentially important for developing countries, too. By knowing these challenges and barriers in

  11. Mapping ergonomics application to improve SMEs working condition in industrially developing countries: a critical review.

    PubMed

    Hermawati, Setia; Lawson, Glyn; Sutarto, Auditya Purwandini

    2014-01-01

    In industrially developing countries (IDC), small and medium enterprises (SMEs) account for the highest proprotion of employment. Unfortunately, the working conditions in SMEs are often very poor and expose employees to a potentially wide range of health and safety risks. This paper presents a comprehensive review of 161 articles related to ergonomics application in SMEs, using Indonesia as a case study. The aim of this paper is to investigate the extent of ergonomics application and identify areas that can be improved to promote effective ergonomics for SMEs in IDC. The most urgent issue found is the need for adopting participatory approach in contrast to the commonly implemented top-down approach. Some good practices in ergonomics application were also revealed from the review, e.g. a multidisciplinary approach, unsophisticated and low-cost solutions, and recognising the importance of productivity. The review also found that more work is still required to achieve appropriate cross-cultural adaptation of ergonomics application.

  12. Mapping ergonomics application to improve SMEs working condition in industrially developing countries: a critical review.

    PubMed

    Hermawati, Setia; Lawson, Glyn; Sutarto, Auditya Purwandini

    2014-01-01

    In industrially developing countries (IDC), small and medium enterprises (SMEs) account for the highest proprotion of employment. Unfortunately, the working conditions in SMEs are often very poor and expose employees to a potentially wide range of health and safety risks. This paper presents a comprehensive review of 161 articles related to ergonomics application in SMEs, using Indonesia as a case study. The aim of this paper is to investigate the extent of ergonomics application and identify areas that can be improved to promote effective ergonomics for SMEs in IDC. The most urgent issue found is the need for adopting participatory approach in contrast to the commonly implemented top-down approach. Some good practices in ergonomics application were also revealed from the review, e.g. a multidisciplinary approach, unsophisticated and low-cost solutions, and recognising the importance of productivity. The review also found that more work is still required to achieve appropriate cross-cultural adaptation of ergonomics application. PMID:25216158

  13. Diarrhea incidence in low- and middle-income countries in 1990 and 2010: a systematic review

    PubMed Central

    2012-01-01

    Background Diarrhea is recognized as a leading cause of morbidity and mortality among children under 5 years of age in low- and middle-income countries yet updated estimates of diarrhea incidence by age for these countries are greatly needed. We conducted a systematic literature review to identify cohort studies that sought to quantify diarrhea incidence among any age group of children 0-59 mo of age. Methods We used the Expectation-Maximization algorithm as a part of a two-stage regression model to handle diverse age data and overall incidence rate variation by study to generate country specific incidence rates for low- and middle-income countries for 1990 and 2010. We then calculated regional incidence rates and uncertainty ranges using the bootstrap method, and estimated the total number of episodes for children 0-59 mo of age in 1990 and 2010. Results We estimate that incidence has declined from 3.4 episodes/child year in 1990 to 2.9 episodes/child year in 2010. As was the case previously, incidence rates are highest among infants 6-11 mo of age; 4.5 episodes/child year in 2010. Among these 139 countries there were nearly 1.9 billion episodes of childhood diarrhea in 1990 and nearly 1.7 billion episodes in 2010. Conclusions Although our results indicate that diarrhea incidence rates may be declining slightly, the total burden on the health of each child due to multiple episodes per year is tremendous and additional funds are needed to improve both prevention and treatment practices in low- and middle-income countries. PMID:22436130

  14. A Systematic Review of Radiotherapy Capacity in Low- and Middle-Income Countries

    PubMed Central

    Grover, Surbhi; Xu, Melody J.; Yeager, Alyssa; Rosman, Lori; Groen, Reinou S.; Chackungal, Smita; Rodin, Danielle; Mangaali, Margaret; Nurkic, Sommer; Fernandes, Annemarie; Lin, Lilie L.; Thomas, Gillian; Tergas, Ana I.

    2015-01-01

    Objectives: The cancer burden in low- and middle-income countries (LMIC) is substantial. The purpose of this study was to identify and describe country and region-specific patterns of radiotherapy (RT) facilities in LMIC. Methods: A systematic review of the literature was undertaken. A search strategy was developed to include articles on radiation capacity in LMIC from the following databases: PubMed, Embase, CINAHL Plus, Global Health, and the Latin American and Caribbean System on Health Sciences Information. Searches included all literature up to April 2013. Results: A total of 49 articles were included in the review. Studies reviewed were divided into one of four regions: Africa, Asia, Eastern Europe, and South America. The African continent has the least amount of resources for RT. Furthermore, a wide disparity exists, as 60% of all machines on the continent are concentrated in Egypt and South Africa while 29 countries in Africa are still lacking any RT resource. A significant heterogeneity also exists across Southeast Asia despite a threefold increase in megavoltage teletherapy machines from 1976 to 1999, which corresponds with a rise in economic status. In LMIC of the Americas, only Uruguay met the International Atomic Energy Agency recommendations of 4 MV/million population, whereas Bolivia and Venezuela had the most radiation oncologists (>1 per 1000 new cancer cases). The main concern with the review of RT resources in Eastern Europe was the lack of data. Conclusion: There is a dearth of publications on RT therapy infrastructure in LMIC. However, based on limited published data, availability of RT resources reflects the countries’ economic status. The challenges to delivering radiation in the discussed regions are multidimensional and include lack of physical resources, lack of human personnel, and lack of data. Furthermore, access to existing RT and affordability of care remains a large problem. PMID:25657930

  15. Review: Sustainability of crossbreeding in developing countries; definitely not like crossing a meadow….

    PubMed

    Leroy, G; Baumung, R; Boettcher, P; Scherf, B; Hoffmann, I

    2016-02-01

    Crossbreeding, considering either terminal or rotational crossing, synthetic breed creation or breed replacement, is often promoted as an efficient strategy to increase farmers' income through the improvement of productivity of local livestock in developing countries. Sustainability of crossbreeding is however frequently challenged by constraints such as poor adaptation to the local environment or lack of logistic support. In this review, we investigate factors that may influence the long-term success or the failure of crossbreeding programs, based on the scientific literature and country reports submitted for The Second Report on the State of the World's Animal Genetic Resources for Food and Agriculture. Crossbreeding activities vary widely across species and countries. Its sustainability is dependent on different prerequisites such as continual access to adequate breeding stock (especially after the end of externally funded crossbreeding projects), the opportunity of improved livestock to express their genetic potential (e.g. through providing proper inputs) and integration within a reliable market chain. As formal crossbreeding programs are often associated with adoption of other technologies, they can be a catalyst for innovation and development for smallholders. Given the increasing global demand for animal products, as well as the potential environmental consequences of climate change, there is a need for practical research to improve the implementation of long-term crossbreeding programs in developing countries.

  16. The economic impact of infertility on women in developing countries ‑ a systematic review

    PubMed Central

    Dyer, S.J.; Patel, M.

    2012-01-01

    Background: It is the responsibility of health systems to provide quality health care and to protect consumers against impoverishing health costs. In the case of infertility in developing countries, quality care is often lacking and treatment costs are usually covered by patients. Additional financial hardship may be caused by various social consequences. The economic implications of infertility and its treatment have not been systematically explored. Methods: A systematic MEDLINE search was conducted to identify English language publications providing original data from developing countries on out-of-pocket payment (OoPP) for infertility treatment and on other economic consequences of involuntary childlessness. Findings: Twenty one publications were included in this review. Information on OoPP was scant but suggests that infertility treatment is associated with a significant risk of catastrophic expenditure, even for basic or ineffective interventions. Other economic disadvantages, which may be profound, are caused by loss of access to child labour and support, divorce, as well as customary laws or negative attitudes which discriminate against infertile individuals. Women in particular are affected. Conclusion: Pertinent data on OoPP and other economic disadvantages of infertility in developing countries are limited. According to the evidence available, infertility may cause impoverishing health costs as well as economic instability or deprivation secondary to social consequences. Health systems in developing countries do not appear to meet their responsibilities vis-à-vis infertile patients. PMID:24753897

  17. Country Review of Energy-Efficiency Financial Incentives in the Residential Sector

    SciTech Connect

    Can, Stephane de la Rue du; Shah, Nihar; Phadke, Amol

    2011-07-13

    A large variety of energy-efficiency policy measures exist. Some are mandatory, some are informative, and some use financial incentives to promote diffusion of efficient equipment. From country to country, financial incentives vary considerably in scope and form, the type of framework used to implement them, and the actors that administer them. They range from rebate programs administered by utilities under an Energy-Efficiency Resource Standards (EERS) regulatory framework (California, USA) to the distribution of Eco-points rewarding customers for buying highly efficient appliances (Japan). All have the primary objective of transforming the current market to accelerate the diffusion of efficient technologies by addressing up-front cost barriers faced by consumers; in most instances, efficient technologies require a greater initial investment than conventional technologies. In this paper, we review the different market transformation measures involving the use of financial incentives in the countries belonging to the Major Economies Forum. We characterize the main types of measures, discuss their mechanisms, and provide information on program impacts to the extent that ex-ante or ex-post evaluations have been conducted. Finally, we identify best practices in financial incentive programs and opportunities for coordination between Major Economies Forum countries as envisioned under the Super Efficient Appliance Deployment (SEAD) initiative.

  18. Immunisation coverage in rural–urban migrant children in low and middle-income countries (LMICs): a systematic review and meta-analysis

    PubMed Central

    Awoh, Abiyemi Benita; Plugge, Emma

    2016-01-01

    Background The majority of children who die from vaccine-preventable diseases (VPDs) live in low-income and-middle-income countries (LMICs). With the rapid urbanisation and rural–urban migration ongoing in LMICs, available research suggests that migration status might be a determinant of immunisation coverage in LMICs, with rural–urban migrant (RUM) children being less likely to be immunised. Objectives To examine and synthesise the data on immunisation coverage in RUM children in LMICs and to compare coverage in these children with non-migrant children. Methods A multiple database search of published and unpublished literature on immunisation coverage for the routine Expanded Programme on Immunisation (EPI) vaccines in RUM children aged 5 years and below was conducted. Following a staged exclusion process, studies that met the inclusion criteria were assessed for quality and data extracted for meta-analysis. Results Eleven studies from three countries (China, India and Nigeria) were included in the review. There was substantial statistical heterogeneity between the studies, thus no summary estimate was reported for the meta-analysis. Data synthesis from the studies showed that the proportion of fully immunised RUM children was lower than the WHO bench-mark of 90% at the national level. RUMs were also less likely to be fully immunised than the urban-non-migrants and general population. For the individual EPI vaccines, all but two studies showed lower immunisation coverage in RUMs compared with the general population using national coverage estimates. Conclusions This review indicates that there is an association between rural–urban migration and immunisation coverage in LMICs with RUMs being less likely to be fully immunised than the urban non-migrants and the general population. Specific efforts to improve immunisation coverage in this subpopulation of urban residents will not only reduce morbidity and mortality from VPDs in migrants but will also reduce

  19. Review and analysis of quality healthcare system enhancement in developing countries.

    PubMed

    Kurji, Zohra; Premani, Zahra Shaheen; Mithani, Yasmin

    2015-07-01

    Quality has multidimensional perspectives. It is a continuous and dynamic process. A systematic search of national and international literature was conducted from peer-reviewed databases MEDLINE, CINAHL and PubMed during January to July 2012. There are many frameworks to assess and measure quality. All frameworks give some levels in which quality could be assessed. Therefore, multiple frameworks should be used for measuring quality based on the situation and environment. Measuring quality is very important for primary healthcare programme, especially for developing countries because if we will not do quality assessment, our resources will not be utilised effectively and people may divert to curative services. Thus, in developing countries where healthcare system needs to optimise resources for increased population coverage and scale up the care, quality approaches can suggest workable solutions to using resources appropriately. PMID:26160090

  20. Assessing health system performance in developing countries: a review of the literature.

    PubMed

    Kruk, Margaret Elizabeth; Freedman, Lynn P

    2008-03-01

    With the setting of ambitious international health goals and an influx of additional development assistance for health, there is growing interest in assessing the performance of health systems in developing countries. This paper proposes a framework for the assessment of health system performance and reviews the literature on indicators currently in use to measure performance using online medical and public health databases. This was complemented by a review of relevant books and reports in the grey literature. The indicators were organized into three categories: effectiveness, equity, and efficiency. Measures of health system effectiveness were improvement in health status, access to and quality of care and, increasingly, patient satisfaction. Measures of equity included access and quality of care for disadvantaged groups together with fair financing, risk protection and accountability. Measures of efficiency were appropriate levels of funding, the cost-effectiveness of interventions, and effective administration. This framework and review of indicators may be helpful to health policy makers interested in assessing the effects of different policies, expenditures, and organizational structures on health outputs and outcomes in developing countries.

  1. Variability in melanoma post-treatment surveillance practices by country and physician specialty: A systematic review

    PubMed Central

    Cromwell, Kate D.; Ross, Merrick I.; Xing, Yan; Gershenwald, Jeffrey E.; Royal, Richard E.; Lucci, Anthony; Lee, Jeffrey E.; Cormier, Janice N.

    2013-01-01

    Background There are no evidence-based guidelines for surveillance of patients with melanoma following surgical treatment. We performed a systematic review to identify current stage-specific surveillance practices for patients with melanoma by country and physician specialty. Methods Three major medical indices, MEDLINE, the Cochrane Library database, and Scopus, were reviewed to identify articles published in January 1970 to October 2011 that included detailed information about surveillance of patients with melanoma after initial surgical treatment. Data on surveillance intervals and recommended evaluation were extracted and categorized by country and, when reported, physician specialty. Results One hundred four articles from 10 countries and 4 physician specialties (dermatology, surgical oncology, medical oncology, and general practice) met the inclusion criteria, including 43 providing specific patient-level data. The articles showed wide variation with respect to surveillance intervals and recommended evaluations. Variation was greatest for patients with stage I disease, for whom follow-up frequency ranged from 1 to 6 visits per year during years 1 and 2 after treatment. All 4 physician specialties agreed that for years 1–3, the follow-up frequency should be 4 times per year for all patients. For years 4 and 5, surgical oncologists recommended 2 follow-up visits per year, whereas general practitioners, dermatologists, and medical oncologists recommended 4 visits per year. Recommended imaging and laboratory evaluations were most intense in the United Kingdom and most minimalist in The Netherlands. While general practitioners did not recommend routine laboratory or imaging tests for surveillance, all other specialties utilized both in their surveillance practice. Self skin-examination was recommended for surveillance in all countries and by all practitioner specialties. Conclusions There is significant intercountry and interspecialty variation in surveillance

  2. A review of data needed to parameterize a dynamic model of measles in developing countries

    PubMed Central

    2010-01-01

    Background Dynamic models of infection transmission can project future disease burden within a population. Few dynamic measles models have been developed for low-income countries, where measles disease burden is highest. Our objective was to review the literature on measles epidemiology in low-income countries, with a particular focus on data that are needed to parameterize dynamic models. Methods We included age-stratified case reporting and seroprevalence studies with fair to good sample sizes for mostly urban African and Indian populations. We emphasized studies conducted before widespread immunization. We summarized age-stratified attack rates and seroprevalence profiles across these populations. Using the study data, we fitted a "representative" seroprevalence profile for African and Indian settings. We also used a catalytic model to estimate the age-dependent force of infection for individual African and Indian studies where seroprevalence was surveyed. We used these data to quantify the effects of population density on the basic reproductive number R0. Results The peak attack rate usually occurred at age 1 year in Africa, and 1 to 2 years in India, which is earlier than in developed countries before mass vaccination. Approximately 60% of children were seropositive for measles antibody by age 2 in Africa and India, according to the representative seroprevalence profiles. A statistically significant decline in the force of infection with age was found in 4 of 6 Indian seroprevalence studies, but not in 2 African studies. This implies that the classic threshold result describing the critical proportion immune (pc) required to eradicate an infectious disease, pc = 1-1/R0, may overestimate the required proportion immune to eradicate measles in some developing country populations. A possible, though not statistically significant, positive relation between population density and R0 for various Indian and African populations was also found. These populations also

  3. Asylum Seekers, Violence and Health: A Systematic Review of Research in High-Income Host Countries

    PubMed Central

    Hossain, Mazeda; Kiss, Ligia; Zimmerman, Cathy

    2013-01-01

    We performed a systematic review of literature on violence and related health concerns among asylum seekers in high-income host countries. We extracted data from 23 peer-reviewed studies. Prevalence of torture, variably defined, was above 30% across all studies. Torture history in clinic populations correlated with hunger and posttraumatic stress disorder, although in small, nonrepresentative samples. One study observed that previous exposure to interpersonal violence interacted with longer immigration detention periods, resulting in higher depression scores. Limited evidence suggests that asylum seekers frequently experience violence and health problems, but large-scale studies are needed to inform policies and services for this vulnerable group often at the center of political debate. PMID:23327250

  4. The impact of socioeconomic status on foodborne illness in high income countries: A systematic review

    PubMed Central

    Newman, K. L.; Leon, J. S.; Rebolledo, P. A.; Scallan, E.

    2015-01-01

    SUMMARY Foodborne illness is a major cause of morbidity and loss of productivity in developed nations. Though low socioeconomic status (SES) is generally associated with negative health outcomes, its impact on foodborne illness is poorly understood. We conducted a systematic review to examine the association between SES and laboratory-confirmed illness caused by eight important foodborne pathogens. We completed this systematic review using PubMed for all papers published between 1 January 1980 and 1 January 2013 that measured the association between foodborne illness and SES in highly developed countries and identified 16 studies covering 4 pathogens. The effect of SES varied across pathogens: the majority of identified studies for Campylobacter, salmonellosis, and E. coli infection showed an association between high SES and illness. The single study of listeriosis showed illness was associated with low SES. A reporting bias by SES could not be excluded. SES should be considered when targeting consumer level public health interventions for foodborne pathogens. PMID:25600652

  5. "Profits before people"? A systematic review of the health and safety impacts of privatising public utilities and industries in developed countries.

    PubMed

    Egan, Matt; Petticrew, Mark; Ogilvie, David; Hamilton, Val; Drever, Frances

    2007-10-01

    Debates on government privatisation policies have often focused on the alleged effects of privatisation on health and safety. A systematic review (through Quality of Reporting of Meta-analysis) of the effects of privatising industries and utilities on the health (including injuries) of employees and the public was conducted. The data sources were electronic databases (medical, social science and economic), bibliographies and expert contacts. Experimental and quasi-experimental studies were sought, dating from 1945, from any Organisation for Economic Cooperation and Development member country (in any language) that evaluated the health outcomes of such interventions. Eleven highly heterogeneous studies that evaluated the health impacts of privatisation of building, water, paper, cement, bus, rail, mining, electric and gas companies were identified. The most robust study found increases in the measures of stress-related ill health among employees after a privatisation intervention involving company downsizing. No robust evidence was found to link privatisation with increased injury rates for employees or customers. In conclusion, public debates on the health and safety implications of privatisation have a poor empirical base, which policy makers and researchers need to address. Some evidence suggests that adverse health outcomes could result from redundancies associated with privatisation.

  6. [National health research systems in Latin America: a 14-country review].

    PubMed

    Alger, Jackeline; Becerra-Posada, Francisco; Kennedy, Andrew; Martinelli, Elena; Cuervo, Luis Gabriel

    2009-11-01

    This article discusses the main features of the national health research systems (NHRS) of Argentina, Bolivia, Brazil, Chile, Costa Rica, Cuba, Ecuador, El Salvador, Honduras, Panama, Paraguay, Peru, Uruguay, and Venezuela, based on documents prepared by their country experts who participated in the First Latin American Conference on Research and Innovation for Health held in April 2008, in Rio de Janeiro, Brazil. The review also includes sources cited in the reports, published scientific papers, and expert opinion, as well as regional secondary sources. Six countries reported having formal entities for health research governance and management: Brazil and Costa Rica's entities are led by their ministries of health; while Argentina, Cuba, Ecuador, and Venezuela have entities shared by their ministries of health and ministries of science and technology. Brazil and Ecuador each reported having a comprehensive national policy devoted specifically to health science, technology, and innovation. Argentina, Brazil, Costa Rica, Cuba, Ecuador, Panama, Paraguay, Peru, and Venezuela reported having established health research priorities. In conclusion, encouraging progress has been made, despite the structural and functional heterogeneity of the study countries' NHRS and their disparate levels of development. Instituting good NHRS governance/management is of utmost importance to how efficiently ministries of health, other government players, and society-at-large can tackle health research.

  7. Patients’ management of type 2 diabetes in Middle Eastern countries: review of studies

    PubMed Central

    Alsairafi, Zahra Khalil; Taylor, Kevin Michael Geoffrey; Smith, Felicity J; Alattar, Abdulnabi T

    2016-01-01

    The increased prevalence of diabetes in Middle Eastern countries is a health policy priority. Important risk factors for diabetes have been identified. Lifestyle interventions and adherence to medications are central to disease prevention and management. This review focuses on the management of type 2 diabetes mellitus in Middle Eastern countries. The aim is to identify the ways in which knowledge, health beliefs, and social and cultural factors influence adherence to medication and lifestyle measures. Thirty-four studies were identified following a systematic search of the literature. The studies describe the influence of knowledge, health beliefs, culture, and lifestyle on the management of type 2 diabetes mellitus in the Middle East. Findings indicate a lack of health knowledge about diabetes among populations, which has implications for health behaviors, medication adherence, and treatment outcomes. Many identified health beliefs and cultural lifestyle factors, such as religious beliefs, beliefs about fasting during Ramadan, and sedentary lifestyles played a role in patients’ decisions. For better management of this disease, a collaborative approach between patients, their families, health care professionals, and governments should be adopted. Implementing behavioral strategies and psychological interventions that incorporate all health care professionals in the management process have been shown to be effective methods. Such services help patients change their behavior. However, the utilization of such services and interventions is still limited in Arabian countries. Physicians in the Middle East are the health care professionals most involved in the care process. PMID:27354775

  8. Economic efficiency of countries' clinical review processes and competitiveness on the market of human experimentation.

    PubMed

    Ippoliti, Roberto

    2013-01-01

    Clinical research is a specific phase of pharmaceutical industry's production process in which companies test candidate drugs on patients to collect clinical evidence about safety and effectiveness. Information is essential to obtain manufacturing authorization from the national drug agency and, in this way, make profits on the market. Considering this activity, however, the public stakeholder has to face a conflict of interests. On the one side, there is society's necessity to make advances in medicine and, of course, to promote pharmaceutical companies' investments in this specific phase (new generation). On the other side, there is the duty to protect patients involved in these experimental treatments (old generation). To abide by this moral duty, a protection system was developed through the years, based on two legal institutions: informed consent and institutional review board. How should an efficient protection system that would take human experimentation into account be shaped? Would it be possible for the national protection system of patients' rights to affect the choice of whether to develop a clinical trial in a given country or not? Looking at Europe and considering a protection system that is shaped around institutional review boards, this article is an empirical work that tries to give answers to these open questions. It shows how a protection system that can minimize the time necessary to start a trial can positively affect pharmaceutical clinical research, that is, the choice of pharmaceutical companies to start innovative medical treatments in a given country. PMID:23337226

  9. Behaviour change techniques and contraceptive use in low and middle income countries: a review.

    PubMed

    Phiri, Mwelwa; King, R; Newell, J N

    2015-01-01

    We aimed to identify effective behaviour change techniques to increase modern contraceptive use in low and middle income countries (LMICs). Literature was identified in Global Health, Web of Science, MEDLINE, PsycINFO and Popline, as well as peer reviewed journals. Articles were included if they were written in English, had an outcome evaluation of contraceptive use, modern contraceptive use, contraceptive initiation/uptake, contraceptive adherence or continuation of contraception, were a systematic review or randomised controlled trial, and were conducted in a low or middle income country. We assessed the behaviour change techniques used in each intervention and included a new category of male partner involvement. We identified six studies meeting the inclusion criteria. The most effective interventions were those that involve male partner involvement in the decision to initiate contraceptive use. The findings also suggest that providing access to contraceptives in the community promotes their use. The interventions that had positive effects on contraceptive use used a combination of behaviour change techniques. Performance techniques were not used in any of the interventions. The use of social support techniques, which are meant to improve wider social acceptability, did not appear except in two of the interventions. Our findings suggest that when information and contraceptives are provided, contraceptive use improves. Recommendations include reporting of behaviour change studies to include more details of the intervention and techniques employed. There is also a need for further research to understand which techniques are especially effective. PMID:26519159

  10. A systematic review of economic evaluation studies of tuberculosis control in high-income countries.

    PubMed

    Verdier, J E; de Vlas, S J; Baltussen, R; Richardus, J H

    2011-12-01

    Tuberculosis (TB) is a leading cause of death in developing countries and an important health threat in the industrialised world. Ideally, interventions in TB control are effective, acceptable and economically attractive. This review summarises all economic evaluation studies of TB control in high-income countries over the last 20 years. We provide indications on the relative economic attractiveness of TB interventions based on the reported conclusions. A total of 118 studies using different economic evaluation methodologies on a wide range of TB interventions are included. Most studies (70%) were from North America, and about half (47%) concerned interventions among the general population. Even though the large majority of studies (85%) aimed at preventing active TB disease, 44% of these ignored the prevention of secondary infections, thereby under- estimating the benefits of the intervention. Choosing a health care instead of a societal perspective (92% vs. 8%) further underestimated the benefits. Moreover, 74 studies (62%) disregarded discounting, and for 9 of them this led to overestimated future costs. In all, 66% of the studies reported conclusions favouring the evaluated intervention, which is modest given that a publishing bias towards favourable results is to be expected. In conclusion, we demonstrate that many studies in this review have put the evaluated TB intervention at a disadvantage by the choice of methodology, i. e., underestimating benefits and overestimating costs. This may have led to an overly conservative approach to the introduction of new interventions in TB control.

  11. Wastewater treatment performance efficiency of constructed wetlands in African countries: a review.

    PubMed

    Mekonnen, Andualem; Leta, Seyoum; Njau, Karoli Nicholas

    2015-01-01

    In Africa, different studies have been conducted at different scales to evaluate wastewater treatment efficiency of constructed wetland. This paper aims to review the treatment performance efficiency of constructed wetland used in African countries. In the reviewed papers, the operational parameters, size and type of wetland used and the treatment efficiency are assessed. The results are organized and presented in six tables based on the type of wetland and wastewater used in the study. The results of the review papers indicated that most of the studies were conducted in Tanzania, Egypt and Kenya. In Kenya and Tanzania, different full-scale wetlands are widely used in treating wastewater. Among wetland type, horizontal subsurface flow wetlands were widely studied followed by surface flow and hybrid wetlands. Most of the reported hybrid wetlands were in Kenya. The results of the review papers indicated that wetlands are efficient in removing organic matter (biochemical oxygen demand and chemical oxygen demand) and suspended solids. On the other hand, nutrient removal efficiency appeared to be low.

  12. What Is the Role of Informal Healthcare Providers in Developing Countries? A Systematic Review

    PubMed Central

    Sudhinaraset, May; Ingram, Matthew; Lofthouse, Heather Kinlaw; Montagu, Dominic

    2013-01-01

    Informal health care providers (IPs) comprise a significant component of health systems in developing nations. Yet little is known about the most basic characteristics of performance, cost, quality, utilization, and size of this sector. To address this gap we conducted a comprehensive literature review on the informal health care sector in developing countries. We searched for studies published since 2000 through electronic databases PubMed, Google Scholar, and relevant grey literature from The New York Academy of Medicine, The World Bank, The Center for Global Development, USAID, SHOPS (formerly PSP-One), The World Health Organization, DFID, Human Resources for Health Global Resource Center. In total, 334 articles were retrieved, and 122 met inclusion criteria and chosen for data abstraction. Results indicate that IPs make up a significant portion of the healthcare sector globally, with almost half of studies (48%) from Sub-Saharan Africa. Utilization estimates from 24 studies in the literature of IP for healthcare services ranged from 9% to 90% of all healthcare interactions, depending on the country, the disease in question, and methods of measurement. IPs operate in a variety of health areas, although baseline information on quality is notably incomplete and poor quality of care is generally assumed. There was a wide variation in how quality of care is measured. The review found that IPs reported inadequate drug provision, poor adherence to clinical national guidelines, and that there were gaps in knowledge and provider practice; however, studies also found that the formal sector also reported poor provider practices. Reasons for using IPs included convenience, affordability, and social and cultural effects. Recommendations from the literature amount to a call for more engagement with the IP sector. IPs are a large component of nearly all developing country health systems. Research and policies of engagement are needed. PMID:23405101

  13. Kerosene: a review of household uses and their hazards in low- and middle-income countries.

    PubMed

    Lam, Nicholas L; Smith, Kirk R; Gauthier, Alison; Bates, Michael N

    2012-01-01

    Kerosene has been an important household fuel since the mid-19th century. In developed countries its use has greatly declined because of electrification. However, in developing countries, kerosene use for cooking and lighting remains widespread. This review focuses on household kerosene uses, mainly in developing countries, their associated emissions, and their hazards. Kerosene is often advocated as a cleaner alternative to solid fuels, biomass and coal, for cooking, and kerosene lamps are frequently used when electricity is unavailable. Globally, an estimated 500 million households still use fuels, particularly kerosene, for lighting. However, there are few studies, study designs and quality are varied, and results are inconsistent. Well-documented kerosene hazards are poisonings, fires, and explosions. Less investigated are exposures to and risks from kerosene's combustion products. Some kerosene-using devices emit substantial amounts of fine particulates, carbon monoxide (CO), nitric oxides (NO(x)), and sulfur dioxide (SO(2)). Studies of kerosene used for cooking or lighting provide some evidence that emissions may impair lung function and increase infectious illness (including tuberculosis), asthma, and cancer risks. However, there are few study designs, quality is varied, and results are inconsistent. Considering the widespread use in the developing world of kerosene, the scarcity of adequate epidemiologic investigations, the potential for harm, and the implications for national energy policies, researchers are strongly encouraged to consider collecting data on household kerosene uses in studies of health in developing countries. Given the potential risks of kerosene, policymakers may consider alternatives to kerosene subsidies, such as shifting support to cleaner technologies for lighting and cooking.

  14. KEROSENE: A REVIEW OF HOUSEHOLD USES AND THEIR HAZARDS IN LOW- AND MIDDLE-INCOME COUNTRIES

    PubMed Central

    Lam, Nicholas L.; Smith, Kirk R.; Gauthier, Alison; Bates, Michael N.

    2013-01-01

    Kerosene has been an important household fuel since the mid-19th century. In developed countries its use has greatly declined because of electrification. However, in developing countries, kerosene use for cooking and lighting remains widespread. This review focuses on household kerosene uses, mainly in developing countries, their associated emissions, and their hazards. Kerosene is often advocated as a cleaner alternative to solid fuels, biomass and coal, for cooking, and kerosene lamps are frequently used when electricity is unavailable. Globally, an estimated 500 million households still use fuels, particularly kerosene, for lighting. However, there are few studies, study designs and quality are varied, and results are inconsistent. Well-documented kerosene hazards are poisonings, fires, and explosions. Less investigated are exposures to and risks from kerosene’s combustion products. Some kerosene-using devices emit substantial amounts of fine particulates, carbon monoxide (CO), nitric oxides (NOx), and sulfur dioxide (SO2). Studies of kerosene used for cooking or lighting provide some evidence that emissions may impair lung function and increase infectious illness (including tuberculosis), asthma, and cancer risks. However, there are few study designs, quality is varied, and results are inconsistent. Considering the widespread use in the developing world of kerosene, the scarcity of adequate epidemiologic investigations, the potential for harm, and the implications for national energy policies, researchers are strongly encouraged to consider collecting data on household kerosene uses in studies of health in developing countries. Given the potential risks of kerosene, policymakers may consider alternatives to kerosene subsidies, such as shifting support to cleaner technologies for lighting and cooking. PMID:22934567

  15. The Diet of Preschool Children in the Mediterranean Countries of the European Union: A Systematic Review

    PubMed Central

    Pereira-da-Silva, Luís; Rêgo, Carla; Pietrobelli, Angelo

    2016-01-01

    This systematic review discusses data on the dietary intake of preschool children living in the Mediterranean countries of the European Union, including the comparison with a Mediterranean-like diet and the association with nutritional status. Specifically, data from the multinational European Identification and Prevention on Dietary and life style induced health effects in children and infants (IDEFICS) study and national studies, such as the Estudo do Padrão Alimentar e de Crescimento Infantil (EPACI) study and Geração XXI cohort in Portugal, ALimentando la SAlud del MAñana (ALSALMA) study in Spain, Étude des Déterminants pré-et postnatals précoces du développement et de la santé de l’ENfant (EDEN) cohort in France, Nutrintake 636 study in Italy, and Growth, Exercise and Nutrition Epidemiological Study in preSchoolers (GENESIS) cohort in Greece, were analyzed. In the majority of countries, young children consumed fruit and vegetables quite frequently, but also consumed sugared beverages and snacks. High energy and high protein intakes mainly from dairy products were found in the majority of countries. The majority of children also consumed excessive sodium intake. Early high prevalence of overweight and obesity was found, and both early consumption of energy-dense foods and overweight seemed to track across toddler and preschool ages. Most children living in the analyzed countries showed low adherence to a Mediterranean-like diet, which in turn was associated with being overweight/obese. Unhealthier diets were associated with lower maternal educational level and parental unemployment. Programs promoting adherence of young children to the traditional Mediterranean diet should be part of a multi-intervention strategy for the prevention and treatment of pediatric overweight and obesity. PMID:27338427

  16. The Diet of Preschool Children in the Mediterranean Countries of the European Union: A Systematic Review.

    PubMed

    Pereira-da-Silva, Luís; Rêgo, Carla; Pietrobelli, Angelo

    2016-06-08

    This systematic review discusses data on the dietary intake of preschool children living in the Mediterranean countries of the European Union, including the comparison with a Mediterranean-like diet and the association with nutritional status. Specifically, data from the multinational European Identification and Prevention on Dietary and life style induced health effects in children and infants (IDEFICS) study and national studies, such as the Estudo do Padrão Alimentar e de Crescimento Infantil (EPACI) study and Geração XXI cohort in Portugal, ALimentando la SAlud del MAñana (ALSALMA) study in Spain, Étude des Déterminants pré-et postnatals précoces du développement et de la santé de l'ENfant (EDEN) cohort in France, Nutrintake 636 study in Italy, and Growth, Exercise and Nutrition Epidemiological Study in preSchoolers (GENESIS) cohort in Greece, were analyzed. In the majority of countries, young children consumed fruit and vegetables quite frequently, but also consumed sugared beverages and snacks. High energy and high protein intakes mainly from dairy products were found in the majority of countries. The majority of children also consumed excessive sodium intake. Early high prevalence of overweight and obesity was found, and both early consumption of energy-dense foods and overweight seemed to track across toddler and preschool ages. Most children living in the analyzed countries showed low adherence to a Mediterranean-like diet, which in turn was associated with being overweight/obese. Unhealthier diets were associated with lower maternal educational level and parental unemployment. Programs promoting adherence of young children to the traditional Mediterranean diet should be part of a multi-intervention strategy for the prevention and treatment of pediatric overweight and obesity.

  17. Review of the regulation and safety assessment of food substances in various countries and jurisdictions

    PubMed Central

    Magnuson, Bernadene; Munro, Ian; Abbot, Peter; Baldwin, Nigel; Lopez-Garcia, Rebeca; Ly, Karen; McGirr, Larry; Roberts, Ashley; Socolovsky, Susan

    2013-01-01

    This review compares the regulations, definitions and approval processes for substances intentionally added to or unintentionally present in human food in the following specific countries/jurisdictions: Argentina, Australia, Brazil, Canada, China, the European Union, Japan, Mexico, New Zealand, and the United States. This includes direct food additives, food ingredients, flavouring agents, food enzymes and/or processing aids, food contact materials, novel foods, and nanoscale materials for food applications. The regulatory authority of each target jurisdiction/country uses its own regulatory framework and although the definitions, regulations and approval processes may vary among all target countries, in general there are many similarities. In all cases, the main purpose of each authority is to establish a regulatory framework and maintain/enforce regulations to ensure that food consumed and sold within its respective countries is safe. There is a move towards harmonisation of food regulations, as illustrated by Australia and New Zealand and by Mercosur. The European Union has also established regulations, which are applicable for all member states, to establish a common authorisation procedure for direct food additives, flavourings and enzymes. Although the path for approval of different categories of food additives varies from jurisdiction to jurisdiction, there are many commonalities in terms of the data requirements and considerations for assessment of the safety of use of food additives, including the use of positive lists of approved substances, pre-market approval, and a separation between science and policy decisions. The principles applied are largely reflective of the early work by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) committees and JECFA assessments of the safety of food additives for human and animal foods. PMID:23781843

  18. The Diet of Preschool Children in the Mediterranean Countries of the European Union: A Systematic Review.

    PubMed

    Pereira-da-Silva, Luís; Rêgo, Carla; Pietrobelli, Angelo

    2016-01-01

    This systematic review discusses data on the dietary intake of preschool children living in the Mediterranean countries of the European Union, including the comparison with a Mediterranean-like diet and the association with nutritional status. Specifically, data from the multinational European Identification and Prevention on Dietary and life style induced health effects in children and infants (IDEFICS) study and national studies, such as the Estudo do Padrão Alimentar e de Crescimento Infantil (EPACI) study and Geração XXI cohort in Portugal, ALimentando la SAlud del MAñana (ALSALMA) study in Spain, Étude des Déterminants pré-et postnatals précoces du développement et de la santé de l'ENfant (EDEN) cohort in France, Nutrintake 636 study in Italy, and Growth, Exercise and Nutrition Epidemiological Study in preSchoolers (GENESIS) cohort in Greece, were analyzed. In the majority of countries, young children consumed fruit and vegetables quite frequently, but also consumed sugared beverages and snacks. High energy and high protein intakes mainly from dairy products were found in the majority of countries. The majority of children also consumed excessive sodium intake. Early high prevalence of overweight and obesity was found, and both early consumption of energy-dense foods and overweight seemed to track across toddler and preschool ages. Most children living in the analyzed countries showed low adherence to a Mediterranean-like diet, which in turn was associated with being overweight/obese. Unhealthier diets were associated with lower maternal educational level and parental unemployment. Programs promoting adherence of young children to the traditional Mediterranean diet should be part of a multi-intervention strategy for the prevention and treatment of pediatric overweight and obesity. PMID:27338427

  19. Review of the regulation and safety assessment of food substances in various countries and jurisdictions.

    PubMed

    Magnuson, Bernadene; Munro, Ian; Abbot, Peter; Baldwin, Nigel; Lopez-Garcia, Rebeca; Ly, Karen; McGirr, Larry; Roberts, Ashley; Socolovsky, Susan

    2013-01-01

    This review compares the regulations, definitions and approval processes for substances intentionally added to or unintentionally present in human food in the following specific countries/jurisdictions: Argentina, Australia, Brazil, Canada, China, the European Union, Japan, Mexico, New Zealand, and the United States. This includes direct food additives, food ingredients, flavouring agents, food enzymes and/or processing aids, food contact materials, novel foods, and nanoscale materials for food applications. The regulatory authority of each target jurisdiction/country uses its own regulatory framework and although the definitions, regulations and approval processes may vary among all target countries, in general there are many similarities. In all cases, the main purpose of each authority is to establish a regulatory framework and maintain/enforce regulations to ensure that food consumed and sold within its respective countries is safe. There is a move towards harmonisation of food regulations, as illustrated by Australia and New Zealand and by Mercosur. The European Union has also established regulations, which are applicable for all member states, to establish a common authorisation procedure for direct food additives, flavourings and enzymes. Although the path for approval of different categories of food additives varies from jurisdiction to jurisdiction, there are many commonalities in terms of the data requirements and considerations for assessment of the safety of use of food additives, including the use of positive lists of approved substances, pre-market approval, and a separation between science and policy decisions. The principles applied are largely reflective of the early work by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) committees and JECFA assessments of the safety of food additives for human and animal foods.

  20. Solid waste management in European countries: a review of systems analysis techniques.

    PubMed

    Pires, Ana; Martinho, Graça; Chang, Ni-Bin

    2011-04-01

    In the past few decades, solid waste management systems in Europe have involved complex and multi-faceted trade-offs among a plethora of technological alternatives, economic instruments, and regulatory frameworks. These changes resulted in various environmental, economic, social, and regulatory impacts in waste management practices which not only complicate regional policy analysis, but also reshape the paradigm of global sustainable development. Systems analysis, a discipline that harmonizes these integrated solid waste management strategies, has been uniquely providing interdisciplinary support for decision making in this area. Systems engineering models and system assessment tools, both of which enrich the analytical framework of waste management, were designed specifically to handle particular types of problems. Though how to smooth out the barriers toward achieving appropriate systems synthesis and integration of these models and tools to aid in the solid waste management schemes prevalent in European countries still remains somewhat uncertain. This paper conducts a thorough literature review of models and tools illuminating possible overlapped boundaries in waste management practices in European countries and encompassing the pros and cons of waste management practices in each member state of the European Union. Whereas the Southern European Union (EU) countries need to develop further measures to implement more integrated solid waste management and reach EU directives, the Central EU countries need models and tools with which to rationalize their technological choices and management strategies. Nevertheless, considering systems analysis models and tools in a synergistic way would certainly provide opportunities to develop better solid waste management strategies leading to conformity with current standards and foster future perspectives for both the waste management industry and government agencies in European Union.

  1. Cytotoxicity potentials of eleven Bangladeshi medicinal plants.

    PubMed

    Khatun, Amina; Rahman, Mahmudur; Haque, Tania; Rahman, Md Mahfizur; Akter, Mahfuja; Akter, Subarna; Jhumur, Afrin

    2014-01-01

    Various forms of cancer are rising all over the world, requiring newer therapy. The quest of anticancer drugs both from natural and synthetic sources is the demand of time. In this study, fourteen extracts of different parts of eleven Bangladeshi medicinal plants which have been traditionally used for the treatment of different types of carcinoma, tumor, leprosy, and diseases associated with cancer were evaluated for their cytotoxicity for the first time. Extraction was conceded using methanol. Phytochemical groups like reducing sugars, tannins, saponins, steroids, gums, flavonoids, and alkaloids were tested using standard chromogenic reagents. Plants were evaluated for cytotoxicity by brine shrimp lethality bioassay using Artemia salina comparing with standard anticancer drug vincristine sulphate. All the extracts showed potent to moderate cytotoxicity ranging from LC50 2 to 115 µg/mL. The highest toxicity was shown by Hygrophila spinosa seeds (LC50 = 2.93 µg/mL) and the lowest by Litsea glutinosa leaves (LC50 = 114.71 µg/mL) in comparison with standard vincristine sulphate (LC50 = 2.04 µg/mL). Among the plants, the plants traditionally used in different cancer and microbial treatments showed highest cytotoxicity. The results support their ethnomedicinal uses and require advanced investigation to elucidate responsible compounds as well as their mode of action. PMID:25431796

  2. Cytotoxicity Potentials of Eleven Bangladeshi Medicinal Plants

    PubMed Central

    Haque, Tania; Akter, Mahfuja; Akter, Subarna; Jhumur, Afrin

    2014-01-01

    Various forms of cancer are rising all over the world, requiring newer therapy. The quest of anticancer drugs both from natural and synthetic sources is the demand of time. In this study, fourteen extracts of different parts of eleven Bangladeshi medicinal plants which have been traditionally used for the treatment of different types of carcinoma, tumor, leprosy, and diseases associated with cancer were evaluated for their cytotoxicity for the first time. Extraction was conceded using methanol. Phytochemical groups like reducing sugars, tannins, saponins, steroids, gums, flavonoids, and alkaloids were tested using standard chromogenic reagents. Plants were evaluated for cytotoxicity by brine shrimp lethality bioassay using Artemia salina comparing with standard anticancer drug vincristine sulphate. All the extracts showed potent to moderate cytotoxicity ranging from LC50 2 to 115 µg/mL. The highest toxicity was shown by Hygrophila spinosa seeds (LC50 = 2.93 µg/mL) and the lowest by Litsea glutinosa leaves (LC50 = 114.71 µg/mL) in comparison with standard vincristine sulphate (LC50 = 2.04 µg/mL). Among the plants, the plants traditionally used in different cancer and microbial treatments showed highest cytotoxicity. The results support their ethnomedicinal uses and require advanced investigation to elucidate responsible compounds as well as their mode of action. PMID:25431796

  3. Discovery of eleven new ZZ Ceti stars

    NASA Astrophysics Data System (ADS)

    Castanheira, B. G.; Kepler, S. O.; Mullally, F.; Winget, D. E.; Koester, D.; Voss, B.; Kleinman, S. J.; Nitta, A.; Eisenstein, D. J.; Napiwotzki, R.; Reimers, D.

    2006-04-01

    We report the discovery of eleven new ZZ Cetis using telescopes at OPD (Observatório do Pico dos Dias/LNA) in Brazil, the 4.1 m SOAR (Southern Astrophysical Research) telescope at Cerro Pachon, Chile, and the 2.1 m Otto Struve telescope at McDonald observatory. The candidates were selected from the SDSS (Sloan Digital Sky Survey) and SPY (ESO SN Ia progenitor survey), based on their Teff obtained from optical spectra fitting. This selection criterion yields the highest success rate of detecting new ZZ Cetis, above 90% in the Teff range from 12 000 to 11 000 K. We also report on a DA not observed to vary, with a Teff placing the star close to the blue edge of the instability strip. Among our new pulsators, one is slightly cooler than this star for which pulsations were not detected. Our observations are an important constraint on the location of the blue edge of the ZZ Ceti instability strip. Partially based on observations at Observatório do Pico dos Dias/LNA, the Southern Astrophysical Research telescope, a collaboration between CNPq-Brazil, NOAO, UNC and MSU, and McDonald Observatory of the University of Texas at Austin.

  4. The efficiency of health care production in OECD countries: A systematic review and meta-analysis of cross-country comparisons.

    PubMed

    Varabyova, Yauheniya; Müller, Julia-Maria

    2016-03-01

    There has been an ongoing interest in the analysis and comparison of the efficiency of health care systems using nonparametric and parametric applications. The objective of this study was to review the current state of the literature and to synthesize the findings on health system efficiency in OECD countries. We systematically searched five electronic databases through August 2014 and identified 22 studies that analyzed the efficiency of health care production at the country level. We summarized these studies with view on their sample, methods, and utilized variables. We developed and applied a checklist of 14 items to assess the quality of the reviewed studies along four dimensions: reporting, external validity, bias, and power. Moreover, to examine the internal validity of findings we meta-analyzed the efficiency estimates reported in 35 models from ten studies. The qualitative synthesis of the literature indicated large differences in study designs and methods. The meta-analysis revealed low correlations between country rankings suggesting a lack of internal validity of the efficiency estimates. In conclusion, methodological problems of existing cross-country comparisons of the efficiency of health care systems draw into question the ability of these comparisons to provide meaningful guidance to policy-makers.

  5. Antiretroviral Therapy and Pregnancy Outcomes in Developing Countries: A Systematic Review

    PubMed Central

    Alemu, Fekadu Mazengia; Yalew, Alemayehu Worku; Fantahun, Mesganaw; Ashu, Eta Ebasi

    2015-01-01

    Background: Despite significant efforts to understand adverse pregnancy outcome in women receiving Antiretroviral Therapy (ART), ART-related adverse birth outcomes are still poorly understood. We systematically review ART-related adverse birth outcomes among HIV-infected pregnant women; we also review the covariates associated with adverse birth outcomes in the aforementioned group. Methods: The main source for our systematic review was electronic bibliographic databases. Databases such as MEDLINE, PubMed, EMBASE and AIDSLINE were searched. Furthermore, search engines such as Google and Google Scholar were specifically searched for gray literature. Methodological quality of available literature was assessed using the Newcastle - Ottawa Quality Assessment Scale & M. Hewitt guideline. We examined a total of 1,124 papers and reviewed the studies using the PICOT criteria which stands for Patient (population), Intervention (or “Exposure”), Comparison, Outcome and Type of study. Finally, 32 methodologically fit studies were retained and included in our review. Results: Frequently observed adverse birth outcomes included low birth weight (LBW), Preterm Birth (PB), Small for Gestational Age (SGA), while still birth and congenital anomalies were infrequent. Type of regimen such as Protease Inhibitor (PI) based regimens and timing of initiation of ART are some of the factors associated with adverse pregnancy outcomes. Covariates principally included malnutrition and other co-morbidities such as malaria and HIV. Conclusions and Public Health Implications: There is growing evidence in published literature suggesting that ART might be causing adverse birth outcomes among pregnant women in developing countries. There is a need to consider regimen types for HIV-infected pregnant women. There is need to design large cohort studies.

  6. Student Standardised Testing: Current Practices in OECD Countries and a Literature Review. OECD Education Working Papers, No. 65

    ERIC Educational Resources Information Center

    Morris, Allison

    2011-01-01

    This report discusses the most relevant issues concerning student standardised testing in which there are no-stakes for students ("standardised testing") through a literature review and a review of the trends in standardised testing in OECD countries. Unlike standardised tests in which there are high-stakes for students, no-stakes implies that…

  7. Motivation and retention of health workers in developing countries: a systematic review

    PubMed Central

    Willis-Shattuck, Mischa; Bidwell, Posy; Thomas, Steve; Wyness, Laura; Blaauw, Duane; Ditlopo, Prudence

    2008-01-01

    Background A key constraint to achieving the MDGs is the absence of a properly trained and motivated workforce. Loss of clinical staff from low and middle-income countries is crippling already fragile health care systems. Health worker retention is critical for health system performance and a key problem is how best to motivate and retain health workers. The authors undertook a systematic review to consolidate existing evidence on the impact of financial and non-financial incentives on motivation and retention. Methods Four literature databases were searched together with Google Scholar and 'Human Resources for Health' on-line journal. Grey literature studies and informational papers were also captured. The inclusion criteria were: 1) article stated clear reasons for implementing specific motivations to improve health worker motivation and/or reduce medical migration, 2) the intervention recommended can be linked to motivation and 3) the study was conducted in a developing country and 4) the study used primary data. Results Twenty articles met the inclusion criteria. They consisted of a mixture of qualitative and quantitative studies. Seven major motivational themes were identified: financial rewards, career development, continuing education, hospital infrastructure, resource availability, hospital management and recognition/appreciation. There was some evidence to suggest that the use of initiatives to improve motivation had been effective in helping retention. There is less clear evidence on the differential response of different cadres. Conclusion While motivational factors are undoubtedly country specific, financial incentives, career development and management issues are core factors. Nevertheless, financial incentives alone are not enough to motivate health workers. It is clear that recognition is highly influential in health worker motivation and that adequate resources and appropriate infrastructure can improve morale significantly. PMID:19055827

  8. Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries

    PubMed Central

    Nosratnejad, Shirin; Rashidian, Arash; Dror, David Mark

    2016-01-01

    Objective Access to healthcare is mostly contingent on out-of-pocket spending (OOPS) by health seekers, particularly in low- and middle-income countries (LMICs). This would require many LMICs to raise enough funds to achieve universal health insurance coverage. But, are individuals or households willing to pay for health insurance, and how much? What factors positively affect WTP for health insurance? We wanted to examine the evidence for this, through a review of the literature. Methods We systematically searched databases up to February 2016 and included studies of individual or household WTP for health insurance. Two authors appraised the identified studies. We estimated the WTP as a percentage of GDP per capita, and adjusted net national income per capita of each country. We used meta-analysis to calculate WTP means and confidence intervals, and vote-counting to identify the variables that more often affected WTP. Result 16 studies (21 articles) from ten countries met the inclusion criteria. The mean WTP of individuals was 1.18% of GDP per capita and 1.39% of adjusted net national income per capita. The corresponding figures for households were 1.82% and 2.16%, respectively. Increases in family size, education level and income were consistently correlated with higher WTP for insurance, and increases in age were correlated with reduced WTP. Conclusions The WTP for healthcare insurance among rural households in LMICs was just below 2% of the GPD per capita. The findings demonstrate that in moving towards universal health coverage in LMICs, governments should not rely on households' premiums as a major financing source and should increase their fiscal capacity for an equitable health care system using other sources. PMID:27362356

  9. High acceptance of urine source separation in seven European countries: a review.

    PubMed

    Lienert, Judit; Larsen, Tove A

    2010-01-15

    Urine source separation (NoMix-technology) is a promising innovation aiming at a resource-oriented, decentralized approach in urban water management. However, NoMix-technology has a sensitive end-point: people's bathrooms. NoMix-technology is increasingly applied in European pilot projects, but the success from a user point-of-view has rarely been systematically monitored. We aim at closing this gap. We review surveys on acceptance, including reuse of human urine as fertilizer, from 38 NoMix-projects in 7 Northern and Central European countries with 2700 respondents. Additionally, we identify explanatory variables with logistic regression of a representative Swiss library survey. NoMix-technology is well accepted; around 80% of users liked the idea, 75-85% were satisfied with design, hygiene, smell, and seating comfort of NoMix-toilets, 85% regarded urine-fertilizers as good idea (50% of farmers), and 70% would purchase such food. However, 60% of users encountered problems; NoMix-toilets need further development. We found few differences among countries, but systematic differences between public and private settings, where people seem more critical. Information was positively correlated with acceptance, and, e.g., a good mood or environmentally friendly behavior. For future success of NoMix-projects, we recommend authorities follow an integral strategy. Lay people will then find the NoMix-concept appealing and support this promising bathroom innovation. PMID:20000706

  10. Mechanisation of large-scale agricultural fields in developing countries - a review.

    PubMed

    Onwude, Daniel I; Abdulstter, Rafia; Gomes, Chandima; Hashim, Norhashila

    2016-09-01

    Mechanisation of large-scale agricultural fields often requires the application of modern technologies such as mechanical power, automation, control and robotics. These technologies are generally associated with relatively well developed economies. The application of these technologies in some developing countries in Africa and Asia is limited by factors such as technology compatibility with the environment, availability of resources to facilitate the technology adoption, cost of technology purchase, government policies, adequacy of technology and appropriateness in addressing the needs of the population. As a result, many of the available resources have been used inadequately by farmers, who continue to rely mostly on conventional means of agricultural production, using traditional tools and equipment in most cases. This has led to low productivity and high cost of production among others. Therefore this paper attempts to evaluate the application of present day technology and its limitations to the advancement of large-scale mechanisation in developing countries of Africa and Asia. Particular emphasis is given to a general understanding of the various levels of mechanisation, present day technology, its management and application to large-scale agricultural fields. This review also focuses on/gives emphasis to future outlook that will enable a gradual, evolutionary and sustainable technological change. The study concludes that large-scale-agricultural farm mechanisation for sustainable food production in Africa and Asia must be anchored on a coherent strategy based on the actual needs and priorities of the large-scale farmers. © 2016 Society of Chemical Industry.

  11. Mechanisation of large-scale agricultural fields in developing countries - a review.

    PubMed

    Onwude, Daniel I; Abdulstter, Rafia; Gomes, Chandima; Hashim, Norhashila

    2016-09-01

    Mechanisation of large-scale agricultural fields often requires the application of modern technologies such as mechanical power, automation, control and robotics. These technologies are generally associated with relatively well developed economies. The application of these technologies in some developing countries in Africa and Asia is limited by factors such as technology compatibility with the environment, availability of resources to facilitate the technology adoption, cost of technology purchase, government policies, adequacy of technology and appropriateness in addressing the needs of the population. As a result, many of the available resources have been used inadequately by farmers, who continue to rely mostly on conventional means of agricultural production, using traditional tools and equipment in most cases. This has led to low productivity and high cost of production among others. Therefore this paper attempts to evaluate the application of present day technology and its limitations to the advancement of large-scale mechanisation in developing countries of Africa and Asia. Particular emphasis is given to a general understanding of the various levels of mechanisation, present day technology, its management and application to large-scale agricultural fields. This review also focuses on/gives emphasis to future outlook that will enable a gradual, evolutionary and sustainable technological change. The study concludes that large-scale-agricultural farm mechanisation for sustainable food production in Africa and Asia must be anchored on a coherent strategy based on the actual needs and priorities of the large-scale farmers. © 2016 Society of Chemical Industry. PMID:26940194

  12. Coping with a diagnosis of breast cancer-literature review and implications for developing countries.

    PubMed

    Al-Azri, Mohammed; Al-Awisi, Huda; Al-Moundhri, Mansour

    2009-01-01

    Breast cancer is the most common cancer affecting women worldwide. Women are at an increased risk of developing both physical and psychological morbidity after diagnosis; however, many use different strategies to cope with the disease. The aim of this article is to review the available literature on the impact of breast cancer diagnoses and the strategies used by women to cope with this disease. The implications of these emerging findings are extrapolated within the context of health services provided in developing countries. Electronic databases were used to search the relevant literature. The findings showed that women who were diagnosed with breast cancer are at risk of developing several psychological morbidities such as depression, anxiety, fatigue, negative thoughts, suicidal thoughts, fear of dying, sense of aloneness, sexual and body images problems, as well as an overall decrease in the quality of life. Several strategies are used by women with breast cancer to cope with the disease, including positive cognitive restructuring, wishful thinking, emotional expression, disease acceptance, increased religious practice, family and social support, and yoga and exercise. Breast cancer diagnoses have been associated with several devastating psychological consequences; however, many women have used different coping strategies to adjust their lives accordingly. Healthcare professionals in developing countries, who work with women with breast cancer, should be aware of the different coping mechanisms that women use when diagnosed with cancer. Integrating a coping strategy into the treatment regimen would constitute an important milestone in the palliative care of patients with breast cancer. PMID:19686231

  13. Conflict in Neighboring Countries, a Great Risk for Malaria Elimination in Southwestern Iran: Narrative Review Article.

    PubMed

    Molaee Zadeh, Maryam; Shahandeh, Khandan; Bigdeli, Shahla; Basseri, Hamid Reza

    2014-12-01

    The intensity of the conflict such as war is one of the determinants of the flow of migrants and refuges with consequence of introducing infectious disease to other countries. This paper investigates the relationship between malaria incidence and forced immigration due to war from neighboring countries in Dezful district, southwestern Iran. All available data and accessible archived documentary records on malaria cases in the period 1988-2011 in Dezful Health Centers were reviewed. Retrospective analysis of routine surveillance data from the Health authority of Dezful district was conducted to assess the trend of malaria incidence and prevalence in the last two decades. Malaria transmission dynamics was described using surveillance indicators viz, Annual Parasite Incidence (API), Slide Positivity Rate (SPR), Annual Blood Examination Rate (ABER) and based on personal information of patients. Two peaks of malaria incidence occurred during past two decades. The first one arisen by Iran-Iraq war due to residential instability in Dezful while the API reached to 8 per 1000. The second peak happened after to civil war of Afghanistan began which caused large immigrates moved into the study area. During the second peak, API reached 1.7 per 1000 at maximum and the majority of patients were immigrants. This study describes the linkage between incidence and prevalence of malaria and immigration due to civil conflict. Therefore, malaria screening of immigrants and early warning programme are effective to prevent outbreak of disease in a potential risk area such Dezful. PMID:26171354

  14. Research on psychosocial aspects of epilepsy in Arab countries: a review of literature.

    PubMed

    Al-Khateeb, Jamal M; Al-Khateeb, Anas J

    2014-02-01

    This study reviewed research conducted on the psychological aspects of epilepsy in Arab countries. Several databases (Medline, PubMed, Science Direct, Springer Link, and PsycInfo) were searched using the following two sets of search words: (1) Arab, Jordan, Lebanon, United Arab Emirates (UAE), Bahrain, Qatar, Kuwait, Oman, Saudi Arabia, Syria, Iraq, Egypt, Yemen, Tunisia, Libya, Morocco, Algiers, Palestine, Mauritania, Djibouti, Sudan, Comoros, and Somalia; and (2) epilepsy, seizure disorders, and convulsive disorders. Fifty-one studies were conducted in 12 Arab states. Social/emotional, employment, and other problems; knowledge and attitudes; and quality of life (QOL) were the most commonly measured parameters of psychosocial aspects of epilepsy in Arab countries. Results revealed elevated levels of depression and anxiety, a decline in cognitive function, various behavioral problems, sexual dysfunction, and underemployment among persons with epilepsy (PWE). Misconceptions about epilepsy were found to be prevalent. While many studies reported limited knowledge of epilepsy, some studies found an average knowledge. Negative attitudes toward epilepsy were reported in most studies, and moderately positive attitudes were reported in some studies. Finally, PWE showed low overall QOL scores in the majority of studies.

  15. Antibiotic resistance of Vibrio parahaemolyticus and Vibrio vulnificus in various countries: A review.

    PubMed

    Elmahdi, Sara; DaSilva, Ligia V; Parveen, Salina

    2016-08-01

    Vibrio parahaemolyticus and Vibrio vulnificus are the leading causes of seafood associated infections and mortality in the United States. The main syndromes caused by these pathogens are gastroenteritis, wound infections, and septicemia. This article reviewed the antibiotic resistance profile of V. parahaemolyticus and V. vulnificus in the United States and other countries including Italy, Brazil, Philippines, Malaysia, Thailand, China, India, Iran, South Africa and Australia. The awareness of antimicrobial resistance of these two pathogens is not as well documented as other foodborne bacterial pathogens. Vibrio spp. are usually susceptible to most antimicrobials of veterinary and human significance. However, many studies reported that V. vulnificus and V. parahaemolyticus showed multiple-antibiotic resistance due to misuse of antibiotics to control infections in aquaculture production. In addition, both environmental and clinical isolates showed similar antibiotic resistance profiles. Most frequently observed antibiotic resistance profiles involved ampicillin, penicillin and tetracycline regardless of the countries. The presence of multiple-antibiotic resistant bacteria in seafood and aquatic environments is a major concern in fish and shellfish farming and human health.

  16. Research on psychosocial aspects of epilepsy in Arab countries: a review of literature.

    PubMed

    Al-Khateeb, Jamal M; Al-Khateeb, Anas J

    2014-02-01

    This study reviewed research conducted on the psychological aspects of epilepsy in Arab countries. Several databases (Medline, PubMed, Science Direct, Springer Link, and PsycInfo) were searched using the following two sets of search words: (1) Arab, Jordan, Lebanon, United Arab Emirates (UAE), Bahrain, Qatar, Kuwait, Oman, Saudi Arabia, Syria, Iraq, Egypt, Yemen, Tunisia, Libya, Morocco, Algiers, Palestine, Mauritania, Djibouti, Sudan, Comoros, and Somalia; and (2) epilepsy, seizure disorders, and convulsive disorders. Fifty-one studies were conducted in 12 Arab states. Social/emotional, employment, and other problems; knowledge and attitudes; and quality of life (QOL) were the most commonly measured parameters of psychosocial aspects of epilepsy in Arab countries. Results revealed elevated levels of depression and anxiety, a decline in cognitive function, various behavioral problems, sexual dysfunction, and underemployment among persons with epilepsy (PWE). Misconceptions about epilepsy were found to be prevalent. While many studies reported limited knowledge of epilepsy, some studies found an average knowledge. Negative attitudes toward epilepsy were reported in most studies, and moderately positive attitudes were reported in some studies. Finally, PWE showed low overall QOL scores in the majority of studies. PMID:24210464

  17. Multiple Functions of Ten-eleven Translocation 1 during Tumorigenesis

    PubMed Central

    Tian, Yi-Ping; Zhu, Yi-Min; Sun, Xiao-Hui; Lai, Mao-De

    2016-01-01

    Objective: Aberrant expression of ten-eleven translocation 1 (TET1) plays a critical role in tumor development and progression. We systematically summarized the latest research progress on the role and mechanisms of TET1 in cancer biology. Data Sources: Relevant articles published in English from 1980 to April 2016 were selected from the PubMed database. The terms “ten-eleven translocation 1,” “5mC,” “5hmC,” “microRNA,” “hypoxia,” and “embryonic stem cell” were used for the search. Study Selection: Articles focusing on the role and mechanism of TET1 in tumor were reviewed, including clinical and basic research articles. Results: TET proteins, the key enzymes converting 5-methylcytosine to 5-hydroxymethylcytosine, play vital roles in DNA demethylation regulation. Recent studies have shown that loss of TET1 is associated with tumorigenesis and can be used as a potential biomarker for cancer therapy, which indicates that TET1 serves as tumor suppressor gene. Moreover, besides its dioxygenase activity, TET1 could induce epithelial-mesenchymal transition and act as a coactivator to regulate gene transcription, such as developmental regulator in embryonic stem cells (ESCs) and hypoxia-responsive gene in cancer. The regulation of TET1 is also correlated with microRNA in a posttranscriptional modification process. Hence, it is complex but critical to comprehend the mechanisms of TET1 in the biology of ESCs and cancer. Conclusions: TET1 not only serves as a demethylation enzyme but also plays multiple roles during tumorigenesis and progression. More studies should be carried out to elucidate the exact mechanisms of TET1 and its associations with cancer before considering it as a therapeutic tool. PMID:27411465

  18. Evidence based review of type 2 diabetes prevention and management in low and middle income countries

    PubMed Central

    Afable, Aimee; Karingula, Nidhi Shree

    2016-01-01

    AIM: To identify the newest approaches to type 2 diabetes (T2DM) prevention and control in the developing world context. METHODS: We conducted a systematic review of published studies of diabetes prevention and control programs in low and middle-income countries, as defined by the World Bank. We searched PubMed using Medical Subject Headings terms. Studies needed to satisfy four criteria: (1) Must be experimental; (2) Must include patients with T2DM or focusing on prevention of T2DM; (3) Must have a lifestyle intervention component; (4) Must be written in English; and (5) Must have measurable outcomes related to diabetes. RESULTS: A total of 66 studies from 20 developing countries were gathered with publication dates through September 2014. India contributed the largest number of trials (11/66). Of the total 66 studies reviewed, all but 3 studies reported evidence of favorable outcomes in the prevention and control of type 2 diabetes. The overwhelming majority of studies reported on diabetes management (56/66), and among these more than half were structured lifestyle education programs. The evidence suggests that lifestyle education led by allied health professionals (nurses, pharmacists) were as effective as those led by physicians or a team of clinicians. The remaining diabetes management interventions focused on diet or exercise, but the evidence to recommend one approach over another was weak. CONCLUSION: Large experimental diabetes prevention/control studies of dietary and exercise interventions are lacking particularly those that consider quality rather than quantity of carbohydrates and alternative exercise. PMID:27226816

  19. Catchments of general practice in different countries--a literature review.

    PubMed

    Allan, Donald P

    2014-08-29

    The purpose of this paper is to review the current research on catchment areas of private general practices in different developed countries because healthcare reform, including primary health care, has featured prominently as an important political issue in a number of developed countries. The debates around health reform have had a significant health geographic focus. Conceptually, GP catchments describe the distribution, composition and profile of patients who access a general practitioner or a general practice (i.e. a site or facility comprising one or more general practitioners). Therefore, GP catchments provide important information into the geographic variation of access rates, utilisation of services and health outcomes by all of the population or different population groups in a defined area or aggregated area.This review highlights a wide range of diversity in the literature as to how GP catchments can be described, the indicators and measures used to frame the scale of catchments. Patient access to general practice health care services should be considered from a range of locational concepts, and not necessarily constrained by their place of residence. An analysis of catchment patterns of general practitioners should be considered as dynamic and multi-perspective. Geographic information systems provide opportunities to contribute valuable methodologies to study these relationships. However, researchers acknowledge that a conceptual framework for the analysis of GP catchments requires access to real world data. Recent studies have shown promising developments in the use of real world data, especially from studies in the UK. Understanding the catchment profiles of individual GP surgeries is important if governments are serious about patient choice being a key part of proposed primary health reforms. Future health planning should incorporate models of GP catchments as planning tools, at the micro level as well as the macro level, to assist policies on the

  20. Epidemiology of irritable bowel syndrome in the former communist countries from Eastern Europe: a systematic review

    PubMed Central

    RUSU, FLAVIU; DUMITRASCU, DAN L.

    2015-01-01

    Background and aim The irritable bowel syndrome (IBS) is a functional gastrointestinal disorder frequently encountered in clinical practice in Eastern Europe. Epidemiological data are diverging on this condition. Our objective was to assess the prevalence of IBS in the former communist countries from Eastern Europe (EE). Methods We performed a systematic review study using data from PubMed. Many languages, some having only local spreading, are spoken in EE, so we decided to look only for papers indexed in PubMed, which have at least an English summary or title. We searched PubMed using the following keywords: irritable bowel syndrome, functional digestive disorders, prevalence, EE. Only relevant studies were selected for analysis. Results From more than 4000 papers retrieved by this search, we identified a few papers appropriate to this survey. The spectrum of prevalence values is wide in IBS. Prevalence of IBS varies in different studies from 28% in a Croatian study, to 14% in Romania. Most studies report a higher prevalence in females. Stressful events are linked to the impairment of symptoms. Anxiety and depression are common in IBS patients, showing similar expression of functional symptoms. Quality of life is impaired. The role of abuse (physical, sexual) is not commonly investigated and when it was, the importance of this factor was revealed to be much less important than in Western Europe or North America. General practitioners seem to be well trained to recognize IBS, to make correct interpretations of the disease and to use the correct therapy. It seems that the Rome criteria are known and applied by general practitioners. Several epidemiological studies on IBS exist in most EE countries. Usually they look for self-reporting symptoms, or reports from endoscopy units. Psychosomatic approach of IBS was taken into consideration in several countries (Poland, Hungary, Romania), mainly by psychologists and psychotherapists rather than by gastroenterologists

  1. Economic analyses of breast cancer control in low- and middle-income countries: a systematic review

    PubMed Central

    2013-01-01

    Background To support the development of global strategies against breast cancer, this study reviews available economic evidence on breast cancer control in low- and middle-income countries (LMICs). Methods A systematic article search was conducted through electronic scientific databases, and studies were included only if they concerned breast cancer, used original data, and originated from LMICs. Independent assessment of inclusion criteria yielded 24 studies that evaluated different kinds of screening, diagnostic, and therapeutic interventions in various age and risk groups. Studies were synthesized and appraised through the use of a checklist, designed for evaluating economic analyses. Results The majority of these studies were of poor quality, particularly in examining costs. Studies demonstrated the economic attractiveness of breast cancer screening strategies, and of novel treatment and diagnostic interventions. Conclusions This review shows that the evidence base to guide strategies for breast cancer control in LMICs is limited and of poor quality. The limited evidence base suggests that screening strategies may be economically attractive in LMICs – yet there is very little evidence to provide specific recommendations on screening by mammography versus clinical breast examination, the frequency of screening, or the target population. These results demonstrate the need for more economic analyses that are of better quality, cover a comprehensive set of interventions and result in clear policy recommendations. PMID:23566447

  2. Challenges in visceral leishmaniasis control and elimination in the developing countries: A review.

    PubMed

    Hailu, Tadesse; Yimer, Mulat; Mulu, Wondemagegn; Abera, Bayeh

    2016-01-01

    Leishmaniasis is a disease caused by an obligate intracellular protozoan that affects animals and human. Transmission is zoonotic and/or anthroponotic through the bite of an infected female sandfly. Control and elimination of visceral leishmaniasis (VL) require proper case detection, identification of reservoir hosts, and launching of effective vector control strategies in endemic areas. The aim of this review was to highlight the challenges in VL control in developing countries. Literatures pertaining to VL burden, diagnosis, prevention and control from the year 1969 to 2014 were systematically reviewed from PubMed, Scopus, Medline and Google scholar sources during July 2015. Poor vector control strategies, limited diagnostic services, drugs, treatments and lack of community awareness are the most important challenges in VL control and elimination especially in endemic areas. Absence of highly sensitive and specific tests, lack of trained man power, and community awareness are the major challenges in VL control. Therefore, proper case diagnosis, community mobilization and launching of effective vector control strategies in endemic areas are vital. PMID:27681541

  3. A Systematic Literature Review of the Information-Seeking Behavior of Dentists in Developed Countries.

    PubMed

    Isham, Amy; Bettiol, Silvana; Hoang, Ha; Crocombe, Leonard

    2016-05-01

    Understanding the information-seeking behavior of dentists may inform ways to increase the dentist uptake of evidence-based research for clinical decision making and the practice of evidence-based dentistry, but no systematic review of dentist information-seeking behavior has been conducted. This review aimed to synthesize the best available evidence on where and how dentists seek information. A literature search of Web of Science, Scopus, PubMed, and reference lists of English language studies from the Organization for Economic Cooperation and Development countries of dentists' information-seeking behavior published between 2002 and 2014 was conducted. Selected articles were assessed using mixed methods analysis, and the data extracted were thematically synthesized. Nine studies met the inclusion criteria, and four main themes were identified: dentists' difficulty translating evidence-based resources into clinical practice; dentists' preference for face-to-face meetings, collegial discussion, and print materials over evidence-based resources; dentists' perceptions of the validity of evidence-based resources and the role of specialist and experienced dentists as information sources for general and less experienced dentists; and differences between early and late adopters of research evidence. Dentists in these studies tended to adopt new materials/techniques after discussion with a colleague, a dental specialist, or a respected dental expert. These dentists also reported lacking time, experience, skills, and confidence to find and use evidence-based resources. Many of the dentists studied were cautious about making decisions based on documentary sources like literature reviews and preferred to seek advice from an experienced or specialist colleague or to participate in face-to-face meetings. PMID:27139208

  4. The Recognition of and Care Seeking Behaviour for Childhood Illness in Developing Countries: A Systematic Review

    PubMed Central

    Geldsetzer, Pascal; Williams, Thomas Christie; Kirolos, Amir; Mitchell, Sarah; Ratcliffe, Louise Alison; Kohli-Lynch, Maya Kate; Bischoff, Esther Jill Laura; Cameron, Sophie; Campbell, Harry

    2014-01-01

    Background Pneumonia, diarrhoea, and malaria are among the leading causes of death in children. These deaths are largely preventable if appropriate care is sought early. This review aimed to determine the percentage of caregivers in low- and middle-income countries (LMICs) with a child less than 5 years who were able to recognise illness in their child and subsequently sought care from different types of healthcare providers. Methods and Findings We conducted a systematic literature review of studies that reported recognition of, and/or care seeking for episodes of diarrhoea, pneumonia or malaria in LMICs. The review is registered with PROSPERO (registration number: CRD42011001654). Ninety-one studies met the inclusion criteria. Eighteen studies reported data on caregiver recognition of disease and seventy-seven studies on care seeking. The median sensitivity of recognition of diarrhoea, malaria and pneumonia was low (36.0%, 37.4%, and 45.8%, respectively). A median of 73.0% of caregivers sought care outside the home. Care seeking from community health workers (median: 5.4% for diarrhoea, 4.2% for pneumonia, and 1.3% for malaria) and the use of oral rehydration therapy (median: 34%) was low. Conclusions Given the importance of this topic to child survival programmes there are few published studies. Recognition of diarrhoea, malaria and pneumonia by caregivers is generally poor and represents a key factor to address in attempts to improve health care utilisation. In addition, considering that oral rehydration therapy has been widely recommended for over forty years, its use remains disappointingly low. Similarly, the reported levels of care seeking from community health workers in the included studies are low even though global action plans to address these illnesses promote community case management. Giving greater priority to research on care seeking could provide crucial evidence to inform child mortality programmes. PMID:24718483

  5. Socioeconomic status and response to antiretroviral therapy in high-income countries: a literature review.

    PubMed

    Burch, Lisa S; Smith, Colette J; Phillips, Andrew N; Johnson, Margaret A; Lampe, Fiona C

    2016-05-15

    It has been shown that socioeconomic factors are associated with the prognosis of several chronic diseases; however, there is no recent systematic review of their effect on HIV treatment outcomes. We aimed to review the evidence regarding the existence of an association of socioeconomic status with virological and immunological response to antiretroviral therapy (ART). We systematically searched the current literature using the database PubMed. We identified and summarized original research studies in high-income countries that assessed the association between socioeconomic factors (education, employment, income/financial status, housing, health insurance, and neighbourhood-level socioeconomic factors) and virological response, immunological response, and ART nonadherence among people with HIV-prescribed ART. A total of 48 studies met the inclusion criteria (26 from the United States, six Canadian, 13 European, and one Australian), of which 14, six, and 35 analysed virological, immunological, and ART nonadherence outcomes, respectively. Ten (71%), four (67%), and 23 (66%) of these studies found a significant association between lower socioeconomic status and poorer response, and none found a significant association with improved response. Several studies showed that adjustment for nonadherence attenuated the association between socioeconomic status and ART response. Our review provides strong support that socioeconomic disadvantage is associated with poorer response to ART. However, most studies have been conducted in settings such as the United States without universal free healthcare access. Further study in settings with free access to ART could help assess the impact of socioeconomic status on ART outcomes and the mechanisms by which it operates. PMID:26919732

  6. A Systematic Literature Review of the Information-Seeking Behavior of Dentists in Developed Countries.

    PubMed

    Isham, Amy; Bettiol, Silvana; Hoang, Ha; Crocombe, Leonard

    2016-05-01

    Understanding the information-seeking behavior of dentists may inform ways to increase the dentist uptake of evidence-based research for clinical decision making and the practice of evidence-based dentistry, but no systematic review of dentist information-seeking behavior has been conducted. This review aimed to synthesize the best available evidence on where and how dentists seek information. A literature search of Web of Science, Scopus, PubMed, and reference lists of English language studies from the Organization for Economic Cooperation and Development countries of dentists' information-seeking behavior published between 2002 and 2014 was conducted. Selected articles were assessed using mixed methods analysis, and the data extracted were thematically synthesized. Nine studies met the inclusion criteria, and four main themes were identified: dentists' difficulty translating evidence-based resources into clinical practice; dentists' preference for face-to-face meetings, collegial discussion, and print materials over evidence-based resources; dentists' perceptions of the validity of evidence-based resources and the role of specialist and experienced dentists as information sources for general and less experienced dentists; and differences between early and late adopters of research evidence. Dentists in these studies tended to adopt new materials/techniques after discussion with a colleague, a dental specialist, or a respected dental expert. These dentists also reported lacking time, experience, skills, and confidence to find and use evidence-based resources. Many of the dentists studied were cautious about making decisions based on documentary sources like literature reviews and preferred to seek advice from an experienced or specialist colleague or to participate in face-to-face meetings.

  7. Influence of mhealth interventions on gender relations in developing countries: a systematic literature review

    PubMed Central

    2013-01-01

    Introduction Research has shown that mHealth initiatives, or health programs enhanced by mobile phone technologies, can foster women’s empowerment. Yet, there is growing concern that mobile-based programs geared towards women may exacerbate gender inequalities. Methods A systematic literature review was conducted to examine the empirical evidence of changes in men and women’s interactions as a result of mHealth interventions. To be eligible, studies had to have been published in English from 2002 to 2012, conducted in a developing country, included an evaluation of a mobile health intervention, and presented findings on resultant dynamics between women and men. The search strategy comprised four electronic bibliographic databases in addition to a manual review of the reference lists of relevant articles and a review of organizational websites and journals with recent mHealth publications. The methodological rigor of selected studies was appraised by two independent reviewers who also abstracted data on the study’s characteristics. Iterative thematic analyses were used to synthesize findings relating to gender-transformative and non-transformative experiences. Results Out of the 173 articles retrieved for review, seven articles met the inclusion criteria and were retained in the final analysis. Most mHealth interventions were SMS-based and conducted in sub-Saharan Africa on topics relating to HIV/AIDS, sexual and reproductive health, health-based microenterprise, and non-communicable diseases. Several methodological limitations were identified among eligible quantitative and qualitative studies. The current literature suggests that mobile phone programs can influence gender relations in meaningfully positive ways by providing new modes for couple’s health communication and cooperation and by enabling greater male participation in health areas typically targeted towards women. MHealth initiatives also increased women’s decision-making, social status, and

  8. Research on workplace health promotion in the Nordic countries: a literature review, 1986-2008.

    PubMed

    Torp, Steffen; Eklund, Leena; Thorpenberg, Stefan

    2011-09-01

    Workplace health promotion may include approaches focusing on behavioral change among employees and approaches with a holistic system-oriented thinking aiming at changing the physical, social and organizational factors of a setting. This literature review aimed to identify studies on workplace health promotion in the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden), to describe when, where and how the studies were performed and to further analyze the use of settings approaches and empowerment processes. Using scientific literature databases, we found 1809 hits when searching for Nordic studies published from 1986 to 2008 with the search term health promotion. Of these, 116 studies were related to workplace health promotion and 33 included interventions. We used content analysis to analyze the abstracts of all articles and the full articles of the intervention studies. Most studies were performed in Sweden and Finland. The focus was mainly on behavioral change rather than on holistic health promotion as defined by the Ottawa Charter for Health Promotion. This was especially obvious for the intervention studies. In addition to the intervention studies using non-settings approaches with top-down driven behavioral change, we identified studies with participatory settings approaches aimed at changing the setting. We categorized relatively few studies as having a non-participatory settings approach. The studies aiming specifically at improving employees' empowerment were evenly distributed between the categories market-oriented persuasion of empowerment, therapeutic empowerment and empowerment as a liberal management strategy. More studies on workplace health promotion using empowering and participatory settings approaches are needed in the Nordic countries, and a more theory-based approach towards this research field is needed.

  9. Emergency care in 59 low- and middle-income countries: a systematic review

    PubMed Central

    Abujaber, Samer; Makar, Maggie; Stoll, Samantha; Kayden, Stephanie R; Wallis, Lee A; Reynolds, Teri A

    2015-01-01

    Abstract Objective To conduct a systematic review of emergency care in low- and middle-income countries (LMICs). Methods We searched PubMed, CINAHL and World Health Organization (WHO) databases for reports describing facility-based emergency care and obtained unpublished data from a network of clinicians and researchers. We screened articles for inclusion based on their titles and abstracts in English or French. We extracted data on patient outcomes and demographics as well as facility and provider characteristics. Analyses were restricted to reports published from 1990 onwards. Findings We identified 195 reports concerning 192 facilities in 59 countries. Most were academically-affiliated hospitals in urban areas. The median mortality within emergency departments was 1.8% (interquartile range, IQR: 0.2–5.1%). Mortality was relatively high in paediatric facilities (median: 4.8%; IQR: 2.3–8.4%) and in sub-Saharan Africa (median: 3.4%; IQR: 0.5–6.3%). The median number of patients was 30 000 per year (IQR: 10 296–60 000), most of whom were young (median age: 35 years; IQR: 6.9–41.0) and male (median: 55.7%; IQR: 50.0–59.2%). Most facilities were staffed either by physicians-in-training or by physicians whose level of training was unspecified. Very few of these providers had specialist training in emergency care. Conclusion Available data on emergency care in LMICs indicate high patient loads and mortality, particularly in sub-Saharan Africa, where a substantial proportion of all deaths may occur in emergency departments. The combination of high volume and the urgency of treatment make emergency care an important area of focus for interventions aimed at reducing mortality in these settings. PMID:26478615

  10. Etiology of Severe Febrile Illness in Low- and Middle-Income Countries: A Systematic Review

    PubMed Central

    Prasad, Namrata; Murdoch, David R.; Reyburn, Hugh; Crump, John A.

    2015-01-01

    Background With apparent declines in malaria worldwide during the last decade and more widespread use of malaria rapid diagnostic tests, healthcare workers in low-resource areas face a growing proportion of febrile patients without malaria. We sought to describe current knowledge and identify information gaps of the etiology severe febrile illness in low-and middle-income countries. Methods and Findings We conducted a systematic review of studies conducted in low-and-middle income countries 1980–2013 that prospectively assessed consecutive febrile patients admitted to hospital using rigorous laboratory-based case definitions. We found 45 eligible studies describing 54,578 patients; 9,771 (17.9%) had a positive result for ≥1 pathogen meeting diagnostic criteria. There were no eligible studies identified from Southern and Middle Africa, Eastern Asia, Oceania, Latin American and Caribbean regions, and the European region. The median (range) number of diagnostic tests meeting our confirmed laboratory case definitions was 2 (1 to 11) per study. Of diagnostic tests, 5,052 (10.3%) of 49,143 had confirmed bacterial or fungal bloodstream infection; 709 (3.8%) of 18,142 had bacterial zoonosis; 3,488 (28.5%) of 12,245 had malaria; and 1,804 (17.4%) of 10,389 had a viral infection. Conclusions We demonstrate a wide range of pathogens associated with severe febrile illness and highlight the substantial information gaps regarding the geographic distribution and role of common pathogens. High quality severe febrile illness etiology research that is comprehensive with respect to pathogens and geographically representative is needed. PMID:26126200

  11. Molecular insight into heart development and congenital heart disease: An update review from the Arab countries.

    PubMed

    Aburawi, Elhadi H; Aburawi, Hanan E; Bagnall, Keith M; Bhuiyan, Zahurul A

    2015-05-01

    Congenital heart defect (CHD) has a major influence on affected individuals as well as on the supportive and associated environment such as the immediate family. Unfortunately, CHD is common worldwide with an incidence of approximately 1% and consequently is a major health concern. The Arab population has a high rate of consanguinity, fertility, birth, and annual population growth, in addition to a high incidence of diabetes mellitus and obesity. All these factors may lead to a higher incidence and prevalence of CHD within the Arab population than in the rest of the world, making CHD of even greater concern. Sadly, most Arab countries lack appropriate public health measures directed toward the control and prevention of congenital malformations and so the importance of CHD within the population remains unknown but is thought to be high. In approximately 85% of CHD patients, the multifactorial theory is considered as the pathologic basis. The genetic risk factors for CHD can be attributed to large chromosomal aberrations, copy number variations (CNV) of particular regions in the chromosome, and gene mutations in specific nuclear transcription pathways and in the genes that are involved in cardiac structure and development. The application of modern molecular biology techniques such as high-throughput nucleotide sequencing and chromosomal array and methylation array all have the potential to reveal more genetic defects linked to CHD. Exploring the genetic defects in CHD pathology will improve our knowledge and understanding about the diverse pathways involved and also about the progression of this disease. Ultimately, this will link to more efficient genetic diagnosis and development of novel preventive therapeutic strategies, as well as gene-targeted clinical management. This review summarizes our current understanding of the molecular basis of normal heart development and the pathophysiology of a wide range of CHD. The risk factors that might account for the high

  12. Quality Improvement for Cardiovascular Disease Care in Low- and Middle-Income Countries: A Systematic Review

    PubMed Central

    Lee, Edward S.; Vedanthan, Rajesh; Jeemon, Panniyammakal; Kamano, Jemima H.; Kudesia, Preeti; Rajan, Vikram; Engelgau, Michael; Moran, Andrew E.

    2016-01-01

    Background The majority of global cardiovascular disease (CVD) burden falls on people living in low- and middle-income countries (LMICs). In order to reduce preventable CVD mortality and morbidity, LMIC health systems and health care providers need to improve the delivery and quality of CVD care. Objectives As part of the Disease Control Priorities Three (DCP3) Study efforts addressing quality improvement, we reviewed and summarized currently available evidence on interventions to improve quality of clinic-based CVD prevention and management in LMICs. Methods We conducted a narrative review of published comparative clinical trials that evaluated efficacy or effectiveness of clinic-based CVD prevention and management quality improvement interventions in LMICs. Conditions selected a priori included hypertension, diabetes, hyperlipidemia, coronary artery disease, stroke, rheumatic heart disease, and congestive heart failure. MEDLINE and EMBASE electronic databases were systematically searched. Studies were categorized as occurring at the system or patient/provider level and as treating the acute or chronic phase of CVD. Results From 847 articles identified in the electronic search, 49 met full inclusion criteria and were selected for review. Selected studies were performed in 19 different LMICs. There were 10 studies of system level quality improvement interventions, 38 studies of patient/provider interventions, and one study that fit both criteria. At the patient/provider level, regardless of the specific intervention, intensified, team-based care generally led to improved medication adherence and hypertension control. At the system level, studies provided evidence that introduction of universal health insurance coverage improved hypertension and diabetes control. Studies of system and patient/provider level acute coronary syndrome quality improvement interventions yielded inconclusive results. The duration of most studies was less than 12 months. Conclusions The

  13. Effects of the Global Financial Crisis on Health in High-Income Oecd Countries: A Narrative Review.

    PubMed

    Karanikolos, Marina; Heino, Pia; McKee, Martin; Stuckler, David; Legido-Quigley, Helena

    2016-01-01

    A growing body of evidence documents how economic crises impact aspects of health across countries and over time. We performed a systematic narrative review of the health effects of the latest economic crisis based on studies of high-income countries. Papers published between January 2009 and July 2015 were selected based on review of titles and abstracts, followed by a full text review conducted by two independent reviewers. Ultimately, 122 studies were selected and their findings summarized. The review finds that the 2008 financial crisis had negative effects on mental health, including suicide, and to a varying extent on some non-communicable and communicable diseases and access to care. Although unhealthy behaviors such as hazardous drinking and tobacco use appeared to decline during the crisis, there have been increases in some groups, typically those already at greatest risk. The health impact was greatest in countries that suffered the largest economic impact of the crisis or prolonged austerity. The Great Recessions in high-income countries have had mixed impacts on health. They tend to be worse when economic impacts are more severe, prolonged austerity measures are implemented, and there are pre-existing problems of substance use among vulnerable groups. PMID:27076651

  14. Effects of the Global Financial Crisis on Health in High-Income Oecd Countries: A Narrative Review.

    PubMed

    Karanikolos, Marina; Heino, Pia; McKee, Martin; Stuckler, David; Legido-Quigley, Helena

    2016-01-01

    A growing body of evidence documents how economic crises impact aspects of health across countries and over time. We performed a systematic narrative review of the health effects of the latest economic crisis based on studies of high-income countries. Papers published between January 2009 and July 2015 were selected based on review of titles and abstracts, followed by a full text review conducted by two independent reviewers. Ultimately, 122 studies were selected and their findings summarized. The review finds that the 2008 financial crisis had negative effects on mental health, including suicide, and to a varying extent on some non-communicable and communicable diseases and access to care. Although unhealthy behaviors such as hazardous drinking and tobacco use appeared to decline during the crisis, there have been increases in some groups, typically those already at greatest risk. The health impact was greatest in countries that suffered the largest economic impact of the crisis or prolonged austerity. The Great Recessions in high-income countries have had mixed impacts on health. They tend to be worse when economic impacts are more severe, prolonged austerity measures are implemented, and there are pre-existing problems of substance use among vulnerable groups.

  15. Review: Lead exposure in battery manufacturing and recycling in developing countries and among children in nearby communities.

    PubMed

    Gottesfeld, Perry; Pokhrel, Amod K

    2011-09-01

    The battery industry is the largest consumer of lead, using an estimated 80% of the global lead production. The industry is also rapidly expanding in emerging market countries. A review of published literature on exposures from lead-acid battery manufacturing and recycling plants in developing countries was conducted. The review included studies from 37 countries published from 1993 to 2010 and excluded facilities in developed countries, such as the United States and those in Western Europe, except for providing comparisons to reported findings. The average worker blood lead level (BLL) in developing countries was 47 μg/dL in battery manufacturing plants and 64 μg/dL in recycling facilities. Airborne lead concentrations reported in battery plants in developing countries averaged 367 μg/m3, which is 7-fold greater than the U.S. Occupational Safety and Health Administration's 50 μg/m3 permissible exposure limit. The geometric mean BLL of children residing near battery plants in developing countries was 19 μg/dL, which is about 13-fold greater than the levels observed among children in the United States. The blood lead and airborne lead exposure concentrations for battery workers were substantially higher in developing countries than in the United States. This disparity may worsen due to rapid growth in lead-acid battery manufacturing and recycling operations worldwide. Given the lack of regulatory and enforcement capacity in most developing countries, third-party certification programs may be the only viable option to improve conditions.

  16. Systematic Review of Abstinence-Plus HIV Prevention Programs in High-Income Countries

    PubMed Central

    Underhill, Kristen; Operario, Don; Montgomery, Paul

    2007-01-01

    Background Abstinence-plus (comprehensive) interventions promote sexual abstinence as the best means of preventing HIV, but also encourage condom use and other safer-sex practices. Some critics of abstinence-plus programs have suggested that promoting safer sex along with abstinence may undermine abstinence messages or confuse program participants; conversely, others have suggested that promoting abstinence might undermine safer-sex messages. We conducted a systematic review to investigate the effectiveness of abstinence-plus interventions for HIV prevention among any participants in high-income countries as defined by the World Bank. Methods and Findings Cochrane Collaboration systematic review methods were used. We included randomized and quasi-randomized controlled trials of abstinence-plus programs for HIV prevention among any participants in any high-income country; trials were included if they reported behavioural or biological outcomes. We searched 30 electronic databases without linguistic or geographical restrictions to February 2007, in addition to contacting experts, hand-searching conference abstracts, and cross-referencing papers. After screening 20,070 abstracts and 325 full published and unpublished papers, we included 39 trials that included approximately 37,724 North American youth. Programs were based in schools (10), community facilities (24), both schools and community facilities (2), health care facilities (2), and family homes (1). Control groups varied. All outcomes were self-reported. Quantitative synthesis was not possible because of heterogeneity across trials in programs and evaluation designs. Results suggested that many abstinence-plus programs can reduce HIV risk as indicated by self-reported sexual behaviours. Of 39 trials, 23 found a protective program effect on at least one sexual behaviour, including abstinence, condom use, and unprotected sex (baseline n = 19,819). No trial found adverse program effects on any behavioural outcome

  17. Seasonal variation of fecal contamination in drinking water sources in developing countries: a systematic review.

    PubMed

    Kostyla, Caroline; Bain, Rob; Cronk, Ryan; Bartram, Jamie

    2015-05-01

    Accounting for fecal contamination of drinking water sources is an important step in improving monitoring of global access to safe drinking water. Fecal contamination varies with time while its monitoring is often infrequent. We sought to understand seasonal trends in fecal contamination to guide best practices to capture seasonal variation and ascertain the extent to which the results of a single sample may overestimate compliance with health guidelines. The findings from 22 studies from developing countries written in English and identified through a systematic review were analyzed. Fecal contamination in improved drinking water sources was shown to follow a statistically significant seasonal trend of greater contamination during the wet season (p<0.001). This trend was consistent across fecal indicator bacteria, five source types, twelve Köppen-Geiger climate zones, and across both rural and urban areas. Guidance on seasonally representative water quality monitoring by the World Health Organization and national water quality agencies could lead to improved assessments of access to safe drinking water. PMID:25676921

  18. Behavioural change, indoor air pollution and child respiratory health in developing countries: a review.

    PubMed

    Barnes, Brendon R

    2014-04-25

    Indoor air pollution caused by the indoor burning of solid biomass fuels has been associated with Acute Respiratory Infections such as pneumonia amongst children of less than five years of age. Behavioural change interventions have been identified as a potential strategy to reduce child indoor air pollution exposure, yet very little is known about the impact of behavioural change interventions to reduce indoor air pollution. Even less is known about how behaviour change theory has been incorporated into indoor air pollution behaviour change interventions. A review of published studies spanning 1983-2013 suggests that behavioural change strategies have the potential to reduce indoor air pollution exposure by 20%-98% in laboratory settings and 31%-94% in field settings. However, the evidence is: (1) based on studies that are methodologically weak; and (2) have little or no underlying theory. The paper concludes with a call for more rigorous studies to evaluate the role of behavioural change strategies (with or without improved technologies) to reduce indoor air pollution exposure in developing countries as well as interventions that draw more strongly on existing behavioural change theory and practice.

  19. Seasonal variation of fecal contamination in drinking water sources in developing countries: a systematic review.

    PubMed

    Kostyla, Caroline; Bain, Rob; Cronk, Ryan; Bartram, Jamie

    2015-05-01

    Accounting for fecal contamination of drinking water sources is an important step in improving monitoring of global access to safe drinking water. Fecal contamination varies with time while its monitoring is often infrequent. We sought to understand seasonal trends in fecal contamination to guide best practices to capture seasonal variation and ascertain the extent to which the results of a single sample may overestimate compliance with health guidelines. The findings from 22 studies from developing countries written in English and identified through a systematic review were analyzed. Fecal contamination in improved drinking water sources was shown to follow a statistically significant seasonal trend of greater contamination during the wet season (p<0.001). This trend was consistent across fecal indicator bacteria, five source types, twelve Köppen-Geiger climate zones, and across both rural and urban areas. Guidance on seasonally representative water quality monitoring by the World Health Organization and national water quality agencies could lead to improved assessments of access to safe drinking water.

  20. Behavioural change, indoor air pollution and child respiratory health in developing countries: a review.

    PubMed

    Barnes, Brendon R

    2014-05-01

    Indoor air pollution caused by the indoor burning of solid biomass fuels has been associated with Acute Respiratory Infections such as pneumonia amongst children of less than five years of age. Behavioural change interventions have been identified as a potential strategy to reduce child indoor air pollution exposure, yet very little is known about the impact of behavioural change interventions to reduce indoor air pollution. Even less is known about how behaviour change theory has been incorporated into indoor air pollution behaviour change interventions. A review of published studies spanning 1983-2013 suggests that behavioural change strategies have the potential to reduce indoor air pollution exposure by 20%-98% in laboratory settings and 31%-94% in field settings. However, the evidence is: (1) based on studies that are methodologically weak; and (2) have little or no underlying theory. The paper concludes with a call for more rigorous studies to evaluate the role of behavioural change strategies (with or without improved technologies) to reduce indoor air pollution exposure in developing countries as well as interventions that draw more strongly on existing behavioural change theory and practice. PMID:24776723

  1. Behavioural Change, Indoor Air Pollution and Child Respiratory Health in Developing Countries: A Review

    PubMed Central

    Barnes, Brendon R.

    2014-01-01

    Indoor air pollution caused by the indoor burning of solid biomass fuels has been associated with Acute Respiratory Infections such as pneumonia amongst children of less than five years of age. Behavioural change interventions have been identified as a potential strategy to reduce child indoor air pollution exposure, yet very little is known about the impact of behavioural change interventions to reduce indoor air pollution. Even less is known about how behaviour change theory has been incorporated into indoor air pollution behaviour change interventions. A review of published studies spanning 1983–2013 suggests that behavioural change strategies have the potential to reduce indoor air pollution exposure by 20%–98% in laboratory settings and 31%–94% in field settings. However, the evidence is: (1) based on studies that are methodologically weak; and (2) have little or no underlying theory. The paper concludes with a call for more rigorous studies to evaluate the role of behavioural change strategies (with or without improved technologies) to reduce indoor air pollution exposure in developing countries as well as interventions that draw more strongly on existing behavioural change theory and practice. PMID:24776723

  2. Health Informatics in Developing Countries: Going beyond Pilot Practices to Sustainable Implementations: A Review of the Current Challenges

    PubMed Central

    Almerares, Alfredo; Mayan, John Charles; González Bernaldo de Quirós, Fernán; Otero, Carlos

    2014-01-01

    Objectives Information technology is an essential tool to improve patient safety and the quality of care, and to reduce healthcare costs. There is a scarcity of large sustainable implementations in developing countries. The objective of this paper is to review the challenges faced by developing countries to achieve sustainable implementations in health informatics and possible ways to address them. Methods In this non-systematic review of the literature, articles were searched using the keywords medical informatics, developing countries, implementation, and challenges in PubMed, LILACS, CINAHL, Scopus, and EMBASE. The authors, after reading the literature, reached a consensus to classify the challenges into six broad categories. Results The authors describe the problems faced by developing countries arising from the lack of adequate infrastructure and the ways these can be bypassed; the fundamental need to develop nationwide e-Health agendas to achieve sustainable implementations; ways to overcome public uncertainty with respect to privacy and security; the difficulties shared with developed countries in achieving interoperability; the need for a trained workforce in health informatics and existing initiatives for its development; and strategies to achieve regional integration. Conclusions Central to the success of any implementation in health informatics is knowledge of the challenges to be faced. This is even more important in developing countries, where uncertainty and instability are common. The authors hope this article will assist policy makers, healthcare managers, and project leaders to successfully plan their implementations and make them sustainable, avoiding unexpected barriers and making better use of their resources. PMID:24627813

  3. The management of adult psychiatric emergencies in low-income and middle-income countries: a systematic review.

    PubMed

    Nadkarni, Abhijit; Hanlon, Charlotte; Bhatia, Urvita; Fuhr, Daniela; Ragoni, Celina; de Azevedo Perocco, Sérgio Luiz; Fortes, Sandra; Shidhaye, Rahul; Kinyanda, Eugene; Rangaswamy, Thara; Patel, Vikram

    2015-06-01

    The aim of this Review is to identify effective interventions and treatment guidelines to manage common types of psychiatric emergencies in non-specialist settings in low-income and middle-income countries. Mental health specialist services in low-income and middle-income countries are scarce. We did a systematic review of interventions for psychiatric emergencies and a literature search for low-income and middle-income-specific treatment guidelines for psychiatric emergencies. A dearth of high-quality guidelines and contextualised primary evidence for management of psychiatric emergencies in low-income and middle-income countries exists. Filling these gaps in present guidelines needs to be an urgent research priority in view of the adverse health and social consequences of such presentations and the present drive to scale up mental health care.

  4. National Information Policies: A Review of the Situation in Seventeen Industrialised Countries, with Particular Reference to Scientific and Technical Information.

    ERIC Educational Resources Information Center

    Hill, Michael W., Comp.

    This report reviews the information policies that are concerned with, or relevant to, the scientific and technical information of 17 industrialized countries: Australia, Austria, Canada, Czechoslovakia, Denmark, Finland, France, Germany (Federal Republic), Hungary, Japan, the Netherlands, Norway, Poland, Spain, the United Kingdom, the United…

  5. 75 FR 54939 - Generalized System of Preferences (GSP): Notice Changing the Date of the Country Practices Review...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-09

    ... From the Federal Register Online via the Government Publishing Office OFFICE OF THE UNITED STATES TRADE REPRESENTATIVE Generalized System of Preferences (GSP): Notice Changing the Date of the Country... the 2009 Annual Review under the Generalized System of Preferences (GSP) program. This...

  6. The Economics of Developing Countries Component of GCE "A" Level Economics--A Review of Examination Questions.

    ERIC Educational Resources Information Center

    Wood, Keith

    1984-01-01

    A review of the summer examination papers in 'A' level economics set by the eight boards of England and Wales during the period 1979-1983 show that, with two notable exceptions, the boards have not devoted much space to questions relating to the economics of developing countries. (Author/RM)

  7. Systematic Review of the Effectiveness of Mass Communication Programs to Change HIV/AIDS-Related Behaviors in Developing Countries

    ERIC Educational Resources Information Center

    Bertrand, Jane T.; O'Reilly, Kevin; Denison, Julie; Anhang, Rebecca; Sweat, Michael

    2006-01-01

    This review systematically examined the effectiveness of 24 mass media interventions on changing human immunodeficiency virus (HIV)-related knowledge, attitudes and behaviors. The intervention studies were published from 1990 through 2004, reported data from developing countries and compared outcomes using (i) pre- and post-intervention data, (ii)…

  8. Quality of Teaching in Four European Countries: A Review of the Literature and Application of an Assessment Instrument

    ERIC Educational Resources Information Center

    Van de Grift, Wim

    2007-01-01

    Background: From 2002 onwards, initiatives and first steps for the project International Comparative Analysis of Learning and Teaching (ICALT) have been taken by the inspectorates of education in England, Flanders (Belgium), Lower Saxony (Germany) and The Netherlands. The inspectorates of education in these European countries reviewed the results…

  9. A State of the Art Review on the Impact of Technology on Skill Demand in OECD Countries.

    ERIC Educational Resources Information Center

    Kim, Young-Hwa

    2002-01-01

    Review of research since the 1980s shows a consistent trend toward higher skill demands in Organisation for Economic Cooperation and Development countries. There is evidence both that higher skills are needed to implement technology and that implementing technology raises skill requirements. Automation is displacing low-skilled jobs and creating…

  10. The effects of global health initiatives on country health systems: a review of the evidence from HIV/AIDS control

    PubMed Central

    Biesma, Regien G; Brugha, Ruairí; Harmer, Andrew; Walsh, Aisling; Spicer, Neil; Walt, Gill

    2009-01-01

    This paper reviews country-level evidence about the impact of global health initiatives (GHIs), which have had profound effects on recipient country health systems in middle and low income countries. We have selected three initiatives that account for an estimated two-thirds of external funding earmarked for HIV/AIDS control in resource-poor countries: the Global Fund to Fight AIDS, TB and Malaria, the World Bank Multi-country AIDS Program (MAP) and the US President's Emergency Plan for AIDS Relief (PEPFAR). This paper draws on 31 original country-specific and cross-country articles and reports, based on country-level fieldwork conducted between 2002 and 2007. Positive effects have included a rapid scale-up in HIV/AIDS service delivery, greater stakeholder participation, and channelling of funds to non-governmental stakeholders, mainly NGOs and faith-based bodies. Negative effects include distortion of recipient countries’ national policies, notably through distracting governments from coordinated efforts to strengthen health systems and re-verticalization of planning, management and monitoring and evaluation systems. Sub-national and district studies are needed to assess the degree to which GHIs are learning to align with and build the capacities of countries to respond to HIV/AIDS; whether marginalized populations access and benefit from GHI-funded programmes; and about the cost-effectiveness and long-term sustainability of the HIV and AIDS programmes funded by the GHIs. Three multi-country sets of evaluations, which will be reporting in 2009, will answer some of these questions. PMID:19491291

  11. Solid waste management in Asian countries: a review of solid waste minimisation (3'r) towards low carbon

    NASA Astrophysics Data System (ADS)

    Ali, N. E.; Sion, H. C.

    2014-02-01

    The amount of solid-waste generated in Asian countries has increased tremendously, mainly due to the improvement in living standards, rapid developments in technology, growth in economy and population in the cities. Solid waste management is a global issue and major challenge facing Asian countries and neglecting its management may have negative consequences on the environment. Waste composition data proves the developed countries to have generated more recyclable materials while developing countries produce more organic and less recyclable waste such as paper, plastic and aluminium. In this regard, increase in number of landfills and disposal sites, will have an impact on GHG (greenhouse gas) emissions and pollutants to air and water. Alternative methods should therefore be taken to reduce the volume of waste. Most Asian countries have adopted the 3R (reduce, reuse, recycle) concept in order to reduce solid waste and their governments have implemented laws and regulations in order to support this. Implementation of 3R is the major contributor to the solid waste minimization and it can improve the quality of environmental sustainability and reduction of carbon dioxide emission in to the atmosphere. Based on our review, most of the countries practicing the 3R concept in tandem with laws and regulations perform better than those that just practice the 3R concept without any laws and regulations. The paper suggests that every country must focus on the laws and regulations relating to solid waste minimization so that it could be easily implemented as outlined.

  12. Cell block eleven (left) and cell block fifteen, looking from ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Cell block eleven (left) and cell block fifteen, looking from cell block two into the "Death Row" exercise yard - Eastern State Penitentiary, 2125 Fairmount Avenue, Philadelphia, Philadelphia County, PA

  13. Cell block eleven, looking from the "Death Row" exercise yard, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Cell block eleven, looking from the "Death Row" exercise yard, facing north (note cell block fifteen to the right and cell block fourteen in the distance_ - Eastern State Penitentiary, 2125 Fairmount Avenue, Philadelphia, Philadelphia County, PA

  14. HIV/AIDS health care challenges for cross-country migrants in low- and middle-income countries: a scoping review

    PubMed Central

    Suphanchaimat, Rapeepong; Sommanustweechai, Angkana; Khitdee, Chiraporn; Thaichinda, Chompoonut; Kantamaturapoj, Kanang; Leelahavarong, Pattara; Jumriangrit, Pensom; Topothai, Thitikorn; Wisaijohn, Thunthita; Putthasri, Weerasak

    2014-01-01

    Introduction HIV/AIDS has been one of the world’s most important health challenges in recent history. The global solidarity in responding to HIV/AIDS through the provision of antiretroviral therapy (ART) and encouraging early screening has been proved successful in saving lives of infected populations in past decades. However, there remain several challenges, one of which is how HIV/AIDS policies keep pace with the growing speed and diversity of migration flows. This study therefore aimed to examine the nature and the extent of HIV/AIDS health services, barriers to care, and epidemic burdens among cross-country migrants in low-and middle-income countries. Methods A scoping review was undertaken by gathering evidence from electronic databases and gray literature from the websites of relevant international initiatives. The articles were reviewed according to the defined themes: epidemic burdens of HIV/AIDS, barriers to health services and HIV/AIDS risks, and the operational management of the current health systems for HIV/AIDS. Results Of the 437 articles selected for an initial screening, 35 were read in full and mapped with the defined research questions. A high HIV/AIDS infection rate was a major concern among cross-country migrants in many regions, in particular sub-Saharan Africa. Despite a large number of studies reported in Africa, fewer studies were found in Asia and Latin America. Barriers of access to HIV/AIDS services comprised inadequate management of guidelines and referral systems, discriminatory attitudes, language differences, unstable legal status, and financial hardship. Though health systems management varied across countries, international partners consistently played a critical role in providing support for HIV/AIDS services to uninsured migrants and refugees. Conclusion It was evident that HIV/AIDS health care problems for migrants were a major concern in many developing nations. However, there was little evidence suggesting if the current

  15. Care Seeking for Neonatal Illness in Low- and Middle-Income Countries: A Systematic Review

    PubMed Central

    Herbert, Hadley K.; Lee, Anne CC; Chandran, Aruna; Rudan, Igor; Baqui, Abdullah H.

    2012-01-01

    Background Despite recent achievements to reduce child mortality, neonatal deaths continue to remain high, accounting for 41% of all deaths in children under five years of age worldwide, of which over 90% occur in low- and middle-income countries (LMICs). Infections are a leading cause of death and limitations in care seeking for ill neonates contribute to high mortality rates. As estimates for care-seeking behaviors in LMICs have not been studied, this review describes care seeking for neonatal illnesses in LMICs, with particular attention to type of care sought. Methods and Findings We conducted a systematic literature review of studies that reported the proportion of caregivers that sought care for ill or suspected ill neonates in LMICs. The initial search yielded 784 studies, of which 22 studies described relevant data from community household surveys, facility-based surveys, and intervention trials. The majority of studies were from South Asia (n = 17/22), set in rural areas (n = 17/22), and published within the last 4 years (n = 18/22). Of the 9,098 neonates who were ill or suspected to be ill, 4,320 caregivers sought some type of care, including care from a health facility (n = 370) or provider (n = 1,813). Care seeking ranged between 10% and 100% among caregivers with a median of 59%. Care seeking from a health care provider yielded a similar range and median, while care seeking at a health care facility ranged between 1% and 100%, with a median of 20%. Care-seeking estimates were limited by the few studies conducted in urban settings and regions other than South Asia. There was a lack of consistency regarding illness, care-seeking, and care provider definitions. Conclusions There is a paucity of data regarding newborn care-seeking behaviors; in South Asia, care seeking is low for newborn illness, especially in terms of care sought from health care facilities and medically trained providers. There is a need for representative data to

  16. Validated Screening Tools for Common Mental Disorders in Low and Middle Income Countries: A Systematic Review

    PubMed Central

    Ryan, Grace; De Silva, Mary J.

    2016-01-01

    Background A wide range of screening tools are available to detect common mental disorders (CMDs), but few have been specifically developed for populations in low and middle income countries (LMIC). Cross-cultural application of a screening tool requires that its validity be assessed against a gold standard diagnostic interview. Validation studies of brief CMD screening tools have been conducted in several LMIC, but until now there has been no review of screening tools for all CMDs across all LMIC populations. Methods A systematic review with broad inclusion criteria was conducted, producing a comprehensive summary of brief CMD screening tools validated for use in LMIC populations. For each validation, the diagnostic odds ratio (DOR) was calculated as an easily comparable measure of screening tool validity. Average DOR results weighted by sample size were calculated for each screening tool, enabling us to make broad recommendations about best performing screening tools. Results 153 studies fulfilled our inclusion criteria. Because many studies validated two or more screening tools, this corresponded to 273 separate validations against gold standard diagnostic criteria. We found that the validity of every screening tool tested in multiple settings and populations varied between studies, highlighting the importance of local validation. Many of the best performing tools were purposely developed for a specific population; however, as these tools have only been validated in one study, it is not possible to draw broader conclusions about their applicability in other contexts. Conclusions Of the tools that have been validated in multiple settings, the authors broadly recommend using the SRQ-20 to screen for general CMDs, the GHQ-12 for CMDs in populations with physical illness, the HADS-D for depressive disorders, the PHQ-9 for depressive disorders in populations with good literacy levels, the EPDS for perinatal depressive disorders, and the HADS-A for anxiety disorders

  17. Rotavirus vaccine RIX4414 (Rotarix™): a pharmacoeconomic review of its use in the prevention of rotavirus gastroenteritis in developing countries.

    PubMed

    Plosker, Greg L

    2011-11-01

    This article provides an overview of the clinical profile of rotavirus vaccine RIX4414 (Rotarix™) in the prevention of rotavirus gastroenteritis (RVGE) in developing countries, followed by a comprehensive review of pharmacoeconomic analyses with the vaccine in low- and middle-income countries. RVGE is associated with significant morbidity and mortality among children <5 years of age in developing countries. The protective efficacy of a two-dose oral series of rotavirus vaccine RIX4414 has been demonstrated in several well designed clinical trials conducted in developing countries, and the 'real-world' effectiveness of the vaccine has also been shown in naturalistic and case-control trials after the introduction of universal vaccination programmes with RIX4414 in Latin American countries. The WHO recommends universal rotavirus vaccination programmes for all countries. Numerous modelled cost-effectiveness analyses have been conducted with rotavirus vaccine RIX4414 across a wide range of low- and middle-income countries. Although data sources and assumptions varied across studies, results of the analyses consistently showed that the introduction of the vaccine as part of a national vaccination programme would be very (or highly) cost effective compared with no rotavirus vaccination programme, according to widely used cost-effectiveness thresholds for developing countries. Vaccine price was not known at the time the analyses were conducted and had to be estimated. In sensitivity analyses, rotavirus vaccine RIX4414 generally remained cost effective at the highest of a range of possible vaccine prices considered. Despite these favourable results, decisions regarding the implementation of universal vaccination programmes with RIX4414 may also be contingent on budgetary and other factors, underscoring the importance of subsidized vaccination programmes for poor countries through the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunization).

  18. The Social Determinants of Infant Mortality and Birth Outcomes in Western Developed Nations: A Cross-Country Systematic Review

    PubMed Central

    Kim, Daniel; Saada, Adrianna

    2013-01-01

    Infant mortality (IM) and birth outcomes, key population health indicators, have lifelong implications for individuals, and are unequally distributed globally. Even among western industrialized nations, striking cross-country and within-country patterns are evident. We sought to better understand these variations across and within the United States of America (USA) and Western Europe (WE), by conceptualizing a social determinants of IM/birth outcomes framework, and systematically reviewing the empirical literature on hypothesized social determinants (e.g., social policies, neighbourhood deprivation, individual socioeconomic status (SES)) and intermediary determinants (e.g., health behaviours). To date, the evidence suggests that income inequality and social policies (e.g., maternal leave policies) may help to explain cross-country variations in IM/birth outcomes. Within countries, the evidence also supports neighbourhood SES (USA, WE) and income inequality (USA) as social determinants. By contrast, within-country social cohesion/social capital has been underexplored. At the individual level, mixed associations have been found between individual SES, race/ethnicity, and selected intermediary factors (e.g., psychosocial factors) with IM/birth outcomes. Meanwhile, this review identifies several methodological gaps, including the underuse of prospective designs and the presence of residual confounding in a number of studies. Ultimately, addressing such gaps including through novel approaches to strengthen causal inference and implementing both health and non-health policies may reduce inequities in IM/birth outcomes across the western developed world. PMID:23739649

  19. The social determinants of infant mortality and birth outcomes in Western developed nations: a cross-country systematic review.

    PubMed

    Kim, Daniel; Saada, Adrianna

    2013-06-01

    Infant mortality (IM) and birth outcomes, key population health indicators, have lifelong implications for individuals, and are unequally distributed globally. Even among western industrialized nations, striking cross-country and within-country patterns are evident. We sought to better understand these variations across and within the United States of America (USA) and Western Europe (WE), by conceptualizing a social determinants of IM/birth outcomes framework, and systematically reviewing the empirical literature on hypothesized social determinants (e.g., social policies, neighbourhood deprivation, individual socioeconomic status (SES)) and intermediary determinants (e.g., health behaviours). To date, the evidence suggests that income inequality and social policies (e.g., maternal leave policies) may help to explain cross-country variations in IM/birth outcomes. Within countries, the evidence also supports neighbourhood SES (USA, WE) and income inequality (USA) as social determinants. By contrast, within-country social cohesion/social capital has been underexplored. At the individual level, mixed associations have been found between individual SES, race/ethnicity, and selected intermediary factors (e.g., psychosocial factors) with IM/birth outcomes. Meanwhile, this review identifies several methodological gaps, including the underuse of prospective designs and the presence of residual confounding in a number of studies. Ultimately, addressing such gaps including through novel approaches to strengthen causal inference and implementing both health and non-health policies may reduce inequities in IM/birth outcomes across the western developed world.

  20. What is known about the effects of medical tourism in destination and departure countries? A scoping review

    PubMed Central

    2010-01-01

    Background Medical tourism involves patients intentionally leaving their home country to access non-emergency health care services abroad. Growth in the popularity of this practice has resulted in a significant amount of attention being given to it from researchers, policy-makers, and the media. Yet, there has been little effort to systematically synthesize what is known about the effects of this phenomenon. This article presents the findings of a scoping review examining what is known about the effects of medical tourism in destination and departure countries. Methods Drawing on academic articles, grey literature, and media sources extracted from18 databases, we follow a widely used scoping review protocol to synthesize what is known about the effects of medical tourism in destination and departure countries. The review design has three main stages: (1) identifying the question and relevant literature; (2) selecting the literature; and (3) charting, collating, and summarizing the data. Results The large majority of the 203 sources accepted into the review offer a perspective of medical tourism from the Global North, focusing on the flow of patients from high income nations to lower and middle income countries. This greatly shapes any discussion of the effects of medical tourism on destination and departure countries. Five interrelated themes that characterize existing discussion of the effects of this practice were extracted from the reviewed sources. These themes frame medical tourism as a: (1) user of public resources; (2) solution to health system problems; (3) revenue generating industry; (4) standard of care; and (5) source of inequity. It is observed that what is currently known about the effects of medical tourism is minimal, unreliable, geographically restricted and mostly based on speculation. Conclusions Given its positive and negative effects on the health care systems of departure and destination countries, medical tourism is a highly significant and

  1. Review of household solid waste charges for developing countries--A focus on quantity-based charge methods.

    PubMed

    Welivita, Indunee; Wattage, Premachandra; Gunawardena, Prasanthi

    2015-12-01

    Solid waste management has become a major issue in almost all municipalities especially in developing countries across the world. As more waste needs to be collected and disposed of in urban areas, the increased cost cannot be covered by the available funds in developing countries. Managing the Household Solid Waste (HSW) sector is very important as it is the main contributor of the waste that needs to be collected in residential areas. The reduction of the amount of HSW to be disposed of can be achieved by households themselves practising the "4R" activities: reducing, reusing, recycling and recovering. As a policy instrument, the Waste Management Charge (WMC) for HSW has shown much success in encouraging such activities all over the world. Given the already difficult context in which developing countries operate, it is important to careful consider what kind of charging system is implemented. Using available literature, this paper reviews the applicability of available charging methods, from a flat rate method, through to volume-based (bags, cans or tag/sticker) and weight-based charging methods. These charging methods were evaluated on the basis of overall cost, technology need possible other issues. By considering the conditions in developing countries, a 'pre-paid bag based charging method' could be suggested as the most suitable charging method for a WMC in Sri Lanka or other developing countries. The potential applicability of this method was also examined in the context of social, economic and political characteristics. Whilst the use of economic instruments, including WMC, was widely discussed in the literature, the selection of a charging method in the context of developing countries is rarely discussed. Having said that, this paper gives an insight to the policy makers in developing countries upon using pre-paid bag based charging method for HSW sector. It also provides recommendations regarding possible issues in implementing for developing countries

  2. Digital technology for health sector governance in low and middle income countries: a scoping review

    PubMed Central

    Holeman, Isaac; Cookson, Tara Patricia; Pagliari, Claudia

    2016-01-01

    Background Poor governance impedes the provision of equitable and cost–effective health care in many low– and middle–income countries (LMICs). Although systemic problems such as corruption and inefficiency have been characterized as intractable, “good governance” interventions that promote transparency, accountability and public participation have yielded encouraging results. Mobile phones and other Information and Communication Technologies (ICTs) are beginning to play a role in these interventions, but little is known about their use and effects in the context of LMIC health care. Methods Multi–stage scoping review: Research questions and scope were refined through a landscape scan of relevant implementation activities and by analyzing related concepts in the literature. Relevant studies were identified through iterative Internet searches (Google, Google Scholar), a systematic search of academic databases (PubMed, Web of Science), social media crowdsourcing (targeted LinkedIn and Twitter appeals) and reading reference lists and websites of relevant organizations. Parallel expert interviews helped to verify concepts and emerging findings and identified additional studies for inclusion. Results were charted, analyzed thematically and summarized. Results We identified 34 articles from a wide range of disciplines and sectors, including 17 published research articles and 17 grey literature reports. Analysis of these articles revealed 15 distinct ways of using ICTs for good governance activities in LMIC health care. These use cases clustered into four conceptual categories: 1) gathering and verifying information on services to improve transparency and auditability 2) aggregating and visualizing data to aid communication and decision making 3) mobilizing citizens in reporting poor practices to improve accountability and quality and 4) automating and auditing processes to prevent fraud. Despite a considerable amount of implementation activity, we identified

  3. Digital technology for health sector governance in low and middle income countries: a scoping review

    PubMed Central

    Holeman, Isaac; Cookson, Tara Patricia; Pagliari, Claudia

    2016-01-01

    Background Poor governance impedes the provision of equitable and cost–effective health care in many low– and middle–income countries (LMICs). Although systemic problems such as corruption and inefficiency have been characterized as intractable, “good governance” interventions that promote transparency, accountability and public participation have yielded encouraging results. Mobile phones and other Information and Communication Technologies (ICTs) are beginning to play a role in these interventions, but little is known about their use and effects in the context of LMIC health care. Methods Multi–stage scoping review: Research questions and scope were refined through a landscape scan of relevant implementation activities and by analyzing related concepts in the literature. Relevant studies were identified through iterative Internet searches (Google, Google Scholar), a systematic search of academic databases (PubMed, Web of Science), social media crowdsourcing (targeted LinkedIn and Twitter appeals) and reading reference lists and websites of relevant organizations. Parallel expert interviews helped to verify concepts and emerging findings and identified additional studies for inclusion. Results were charted, analyzed thematically and summarized. Results We identified 34 articles from a wide range of disciplines and sectors, including 17 published research articles and 17 grey literature reports. Analysis of these articles revealed 15 distinct ways of using ICTs for good governance activities in LMIC health care. These use cases clustered into four conceptual categories: 1) gathering and verifying information on services to improve transparency and auditability 2) aggregating and visualizing data to aid communication and decision making 3) mobilizing citizens in reporting poor practices to improve accountability and quality and 4) automating and auditing processes to prevent fraud. Despite a considerable amount of implementation activity, we identified

  4. PEPFAR Transitions to Country Ownership: Review of Past Donor Transitions and Application of Lessons Learned to the Eastern Caribbean.

    PubMed

    Vogus, Abigail; Graff, Kylie

    2015-01-01

    The US President's Emergency Plan for AIDS Relief (PEPFAR) has shifted from an emergency response to a sustainable, country-owned response. The process of transition to country ownership is already underway in the Eastern Caribbean; the Office of the US Global AIDS Coordinator (OGAC) has advised the region that PEPFAR funding is being redirected away from the Eastern Caribbean toward Caribbean countries with high disease burden to strengthen services for key populations. This article seeks to highlight and apply lessons learned from other donor transitions to support a successful transition of HIV programs in the Eastern Caribbean. Based on a rapid review of both peer-reviewed and gray literature on donor transitions to country ownership in family planning, HIV, and other areas, we identified 48 resources that addressed key steps in the transition process and determinants of readiness for transition. Analysis of the existing literature revealed 6 steps that could help ensure successful transition, including developing a clear roadmap articulated through high-level diplomacy; investing in extensive stakeholder engagement; and supporting monitoring and evaluation during and after the transition to adjust course as needed. Nine specific areas to assess a country's readiness for transition include: leadership and management capacity, political and economic factors, the policy environment, identification of alternative funding sources, integration of HIV programs into the wider health system, the institutionalization of processes, the strength of procurement and supply chain management, identification of staffing and training needs, and engagement of civil society and the private sector. In the Caribbean, key areas requiring strengthening to ensure countries in the region can maintain the gains made under PEPFAR include further engaging civil society and the private sector, building the capacity of NGOs to take on essential program functions, and maintaining donor

  5. PEPFAR Transitions to Country Ownership: Review of Past Donor Transitions and Application of Lessons Learned to the Eastern Caribbean.

    PubMed

    Vogus, Abigail; Graff, Kylie

    2015-06-17

    The US President's Emergency Plan for AIDS Relief (PEPFAR) has shifted from an emergency response to a sustainable, country-owned response. The process of transition to country ownership is already underway in the Eastern Caribbean; the Office of the US Global AIDS Coordinator (OGAC) has advised the region that PEPFAR funding is being redirected away from the Eastern Caribbean toward Caribbean countries with high disease burden to strengthen services for key populations. This article seeks to highlight and apply lessons learned from other donor transitions to support a successful transition of HIV programs in the Eastern Caribbean. Based on a rapid review of both peer-reviewed and gray literature on donor transitions to country ownership in family planning, HIV, and other areas, we identified 48 resources that addressed key steps in the transition process and determinants of readiness for transition. Analysis of the existing literature revealed 6 steps that could help ensure successful transition, including developing a clear roadmap articulated through high-level diplomacy; investing in extensive stakeholder engagement; and supporting monitoring and evaluation during and after the transition to adjust course as needed. Nine specific areas to assess a country's readiness for transition include: leadership and management capacity, political and economic factors, the policy environment, identification of alternative funding sources, integration of HIV programs into the wider health system, the institutionalization of processes, the strength of procurement and supply chain management, identification of staffing and training needs, and engagement of civil society and the private sector. In the Caribbean, key areas requiring strengthening to ensure countries in the region can maintain the gains made under PEPFAR include further engaging civil society and the private sector, building the capacity of NGOs to take on essential program functions, and maintaining donor

  6. A review of the surveillance systems of influenza in selected countries in the tropical region

    PubMed Central

    Sanicas, Melvin; Forleo, Eduardo; Pozzi, Gianni; Diop, Doudou

    2014-01-01

    Influenza viruses cause annual epidemics of respiratory tract disease that affect all age groups. Many developing countries do not have an influenza surveillance system or adequate laboratory capacity for virus detection. The objective of this study was to describe the influenza surveillance systems in the different countries in the tropics and to identify outstanding research needs. A questionnaire was designed and sent to 52 NICs and MoHs in the different countries in tropical Asia and Africa to gather information on the surveillance systems, sentinel sites, specimen and data collection, and laboratory testing. Replies were received from 32 NICs and MoHs (61.5% response) – 17 were located in tropical Asia and 15 in Africa. There are 20 WHO recognized NICs in tropical Asia and 14 in tropical Africa, all with virus isolation and polymerase chain reaction (PCR) testing capacity. Of the Asian countries, only Hong Kong and Singapore reported that the patient population from the sites represents the broader community. In tropical Africa, only Senegal has sentinel sites distributed all over the country contributing to the geographic representativeness of the surveillance system. The rest of the countries in Africa have just established their influenza surveillance system in the past decade and are working toward geographic expansion of the ILI and SARI sites. Limited laboratory capacity or infrastructure to perform influenza surveillance makes difficult to justify the importance of influenza vaccine or other influenza control measures as a strategy for improving population health in the tropical region. PMID:25745529

  7. Barriers to access to opioid medicines: a review of national legislation and regulations of 11 central and eastern European countries.

    PubMed

    Vranken, Marjolein J M; Lisman, John A; Mantel-Teeuwisse, Aukje K; Jünger, Saskia; Scholten, Willem; Radbruch, Lukas; Payne, Sheila; Schutjens, Marie-Hélène D B

    2016-01-01

    Control measures designed to prevent the misuse of opioid medicines can often unintentionally restrict legitimate medical use, leaving patients with cancer in pain. This study aimed to develop and validate an assessment instrument based on WHO policy guidelines to systematically identify legal and regulatory barriers to opioid access in 11 European countries (Bulgaria, Cyprus, Estonia, Greece, Hungary, Latvia, Lithuania, Serbia, Slovakia, Slovenia, and Turkey) as part of the Access to Opioid Medication in Europe project. Relevant legislation and regulations were independently assessed by three reviewers and potential barriers were identified within nine categories including prescribing, penalties, and others. Potential barriers were identified in all countries, ranging from 22 potential barriers (Cyprus) to 128 potential barriers (Lithuania). The total number of barriers in a single category varied from one (Slovenia, usage category) to 49 (Greece, prescribing category). Differences, such as prescription validity, varied within one category, ranging from 5 days (Hungary) to 13 weeks (Cyprus). The results of this Review should give rise to a national review and revision of provisions that impede access to opioids, disproportionate to their (intended) benefit in preventing misuse, in these 11 European countries.

  8. Collaborative care for depression: a literature review and a model for implementation in developing countries.

    PubMed

    Farooq, Saeed

    2013-03-01

    Depression will soon be the leading cause of disability in developing countries but effective treatments are not widely available. There is compelling evidence for the effectiveness and cost-effectiveness of the multicondition collaborative care (MCC) model for depression in developing and developed countries. In the MCC model integrated care for depression is provided along with care for different non-communicable disorders. MCC has been shown to reduce hyperglycaemia and hyperlipidaemia and can lead to depression-free days when integrated care for depression and diabetes is provided. However, due to limited resources, it is not possible to make this effective model of care available at the population level. It is suggested that a public health intervention based on the MCC model can lead to better care for depression in developing countries. A public health programme of MCC which provides treatment for depression, diabetes and hypertension in a collaborative care programme will be a cost-effective way of providing treatment for depression in developing countries. This will cater for the leading cause of disability (unipolar depression) and the leading projected causes of mortality (ischaemic heart disease and cerebrovascular disease) in low-income and middle-income countries.

  9. Measurement of social capital in relation to health in low and middle income countries (LMIC): a systematic review.

    PubMed

    Agampodi, Thilini Chanchala; Agampodi, Suneth Buddhika; Glozier, Nicholas; Siribaddana, Sisira

    2015-03-01

    Social capital is a neglected determinant of health in low and middle income countries. To date, majority of evidence syntheses on social capital and health are based upon high income countries. We conducted this systematic review to identify the methods used to measure social capital in low and middle-income countries and to evaluate their relative strengths and weaknesses. An electronic search was conducted using Pubmed, Science citation index expanded, Social science citation index expanded, Web of knowledge, Cochrane, Trip, Google scholar and selected grey literature sources. We aimed to include all studies conducted in low and middle-income countries, published in English that have measured any aspect of social capital in relation to health in the study, from 1980 to January 2013. We extracted data using a data extraction form and performed narrative synthesis as the measures were heterogeneous. Of the 472 articles retrieved, 46 articles were selected for the review. The review included 32 studies from middle income countries and seven studies from low income countries. Seven were cross national studies. Most studies were descriptive cross sectional in design (n = 39). Only two randomized controlled trials were included. Among the studies conducted using primary data (n = 32), we identified18 purposely built tools that measured various dimensions of social capital. Validity (n = 11) and reliability (n = 8) of the tools were assessed only in very few studies. Cognitive constructs of social capital, namely trust, social cohesion and sense of belonging had a positive association towards measured health outcome in majority of the studies. While most studies measured social capital at individual/micro level (n = 32), group level measurements were obtained by aggregation of individual measures. As many tools originate in high income contexts, cultural adaptation, validation and reliability assessment is mandatory in adapting the tool to the study setting. Evidence

  10. Taxes on Sugar-Sweetened Beverages to Reduce Overweight and Obesity in Middle-Income Countries: A Systematic Review

    PubMed Central

    Nakhimovsky, Sharon S.; Feigl, Andrea B.

    2016-01-01

    Background The consumption of sugar-sweetened beverages (SSBs), which can lead to weight gain, is rising in middle-income countries (MICs). Taxing SSBs may help address this challenge. Systematic reviews focused on high-income countries indicate that taxing SSBs may reduce SSB consumption. Responsiveness to price changes may differ in MICs, where governments are considering the tax. To help inform their policy decisions, this review compiles evidence from MICs, assessing post-tax price increases (objective 1), changes in demand for SSBs and other products, overall and by socio-economic groups (objective 2), and effects on overweight and obesity prevalence (objective 3). Methods and Findings We conducted a systematic review on the effectiveness of SSB taxation in MICs (1990–2016) and identified nine studies from Brazil, Ecuador, India, Mexico, Peru, and South Africa. Estimates for own-price elasticity ranged from -0.6 to -1.2, and decreases in SSB consumption ranged from 5 to 39 kilojoules per person per day given a 10% increase in SSB prices. The review found that milk is a likely substitute, and foods prepared away from home, snacks, and candy are likely complements to SSBs. A quasi-experimental study and two modeling studies also found a negative relationship between SSB prices and obesity outcomes after accounting for substitution effects. Estimates are consistent despite variation in baseline obesity prevalence and per person per day consumption of SSBs across countries studied. Conclusions The review indicates that taxing SSBs will increase the prices of SSBs, especially sugary soda, in markets with few producers. Taxing SSBs will also reduce net energy intake by enough to prevent further growth in obesity prevalence, but not to reduce population weight permanently. Additional research using better survey data and stronger study designs is needed to ascertain the long-term effectiveness of an SSB tax on obesity prevalence in MICs. PMID:27669014

  11. Perceptions and impact of plain packaging of tobacco products in low and middle income countries, middle to upper income countries and low-income settings in high-income countries: a systematic review of the literature

    PubMed Central

    Hughes, Nicole; Arora, Monika; Grills, Nathan

    2016-01-01

    Objective To review the current literature around the potential impact, effectiveness and perceptions of plain packaging in low income settings. Method A systematic review of the literature. Data sources 9 databases (PubMed, Global Health, Social Policy and Practice, Applied Social Sciences Index and Abstracts (ASSIA), CINAHL, PsycINFO, British Library for Development Studies (BLDS), Global Health Library and Scopus) were searched. The terms used for searching combined terms for smoking and tobacco use with terms for plain packaging. Study selection Studies investigating the impact of plain packaging on the determinants of tobacco use, such as smoking behaviour, appeal, prominence, effectiveness of health warnings, response to plain packs, attitudes towards quitting or likelihood of smoking in low-income settings, were identified. Studies must have been published in English and be original research of any level of rigour. Data extraction Two independent reviewers assessed studies for inclusion and extracted data. Data synthesis The results were synthesised qualitatively, with themes grouped under four key headings: appeal and attractiveness; salience of health warnings and perceptions of harm; enjoyment and perceived taste ratings; and perceptions of the impact on tobacco usage behaviour. Results This review has identified four articles that met the inclusion criteria. Studies identified that tobacco products in plain packaging had less appeal than in branded packaging in low-income settings. Conclusions This review indicates that plain packaging appears to be successful in reducing appeal of smoking and packets, and supports the call for plain packaging to be widely implemented in conjunction with other tobacco control policies. However, there are considerable gaps in the amount of research conducted outside high-income countries. PMID:27000787

  12. A cross-country review of strategies of the German development cooperation to strengthen human resources

    PubMed Central

    Windisch, Ricarda; Wyss, Kaspar; Prytherch, Helen

    2009-01-01

    Background Recent years have seen growing awareness of the importance of human resources for health in health systems and with it an intensifying of the international and national policies in place to steer a response. This paper looks at how governments and donors in five countries – Cameroon, Indonesia, Malawi, Rwanda and Tanzania – have translated such policies into action. More detailed information with regard to initiatives of German development cooperation brings additional depth to the range and entry doors of human resources for health initiatives from the perspective of donor cooperation. Methods This qualitative study systematically presents different approaches and stages to human resources for health development in a cross-country comparison. An important reference to capture implementation at country level was grey literature such as policy documents and programme reports. In-depth interviews along a predefined grid with national and international stakeholders in the five countries provided information on issues related to human resources for health policy processes and implementation. Results All five countries have institutional entities in place and have drawn up national policies to address human resources for health. Only some of the countries have translated policies into strategies with defined targets and national programmes with budgets and operational plans. Traditional approaches of supporting training for individual health professionals continue to dominate. In some cases partners have played an advocacy and technical role to promote human resources for health development at the highest political levels, but usually they still focus on the provision of ad hoc training within their programmes, which may not be in line with national human resources for health development efforts or may even be counterproductive to them. Countries that face an emergency, such as Malawi, have intensified their efforts within a relatively short time and by

  13. PEPFAR Transitions to Country Ownership: Review of Past Donor Transitions and Application of Lessons Learned to the Eastern Caribbean

    PubMed Central

    Vogus, Abigail; Graff, Kylie

    2015-01-01

    The US President’s Emergency Plan for AIDS Relief (PEPFAR) has shifted from an emergency response to a sustainable, country-owned response. The process of transition to country ownership is already underway in the Eastern Caribbean; the Office of the US Global AIDS Coordinator (OGAC) has advised the region that PEPFAR funding is being redirected away from the Eastern Caribbean toward Caribbean countries with high disease burden to strengthen services for key populations. This article seeks to highlight and apply lessons learned from other donor transitions to support a successful transition of HIV programs in the Eastern Caribbean. Based on a rapid review of both peer-reviewed and gray literature on donor transitions to country ownership in family planning, HIV, and other areas, we identified 48 resources that addressed key steps in the transition process and determinants of readiness for transition. Analysis of the existing literature revealed 6 steps that could help ensure successful transition, including developing a clear roadmap articulated through high-level diplomacy; investing in extensive stakeholder engagement; and supporting monitoring and evaluation during and after the transition to adjust course as needed. Nine specific areas to assess a country’s readiness for transition include: leadership and management capacity, political and economic factors, the policy environment, identification of alternative funding sources, integration of HIV programs into the wider health system, the institutionalization of processes, the strength of procurement and supply chain management, identification of staffing and training needs, and engagement of civil society and the private sector. In the Caribbean, key areas requiring strengthening to ensure countries in the region can maintain the gains made under PEPFAR include further engaging civil society and the private sector, building the capacity of NGOs to take on essential program functions, and maintaining donor

  14. A review of acute and chronic peritoneal dialysis in developing countries

    PubMed Central

    Abraham, Georgi; Varughese, Santosh; Mathew, Milly; Vijayan, Madhusudan

    2015-01-01

    Various modalities of renal replacement therapy (RRT) are available for the management of acute kidney injury (AKI) and end-stage renal disease (ESRD). While developed countries mainly use hemodialysis as a form of RRT, peritoneal dialysis (PD) has been increasingly utilized in developing countries. Chronic PD offers various benefits including lower cost, home-based therapy, single access, less requirement of highly trained personnel and major infrastructure, higher number of patients under a single nephrologist with probably improved quality of life and freedom of activities. PD has been found to be lifesaving in the management of AKI in patients in developing countries where facilities for other forms of RRT are not readily available. The International Society of Peritoneal Dialysis has published guidelines regarding the use of PD in AKI, which has helped in ensuring uniformity. PD has also been successfully used in certain special situations of AKI due to snake bite, malaria, febrile illness, following cardiac surgery and in poisoning. Hemodialysis is the most common form of RRT used in ESRD worldwide, but some countries have begun to adopt a ‘PD first’ policy to reduce healthcare costs of RRT and ensure that it reaches the underserved population. PMID:26034593

  15. Strategy for Improved Nutrition of Children and Women in Developing Countries. A UNICEF Policy Review.

    ERIC Educational Resources Information Center

    United Nations Children's Fund, New York, NY.

    This United Nations Children's Fund (UNICEF) report proposes a strategy for reducing, and ultimately eliminating, malnutrition in developing countries. It proposes a methodology for the identification of appropriate actions in a given context through situation assessment and analysis, rather than through a predetermined set of technical…

  16. Schooling Options for Muslim Children Living in Muslim-Minority Countries--A Thematic Literature Review

    ERIC Educational Resources Information Center

    Musharraf, Muhammad Nabeel; Nabeel, Fatima Bushra

    2015-01-01

    Islamic education of children is a common problem faced by Muslims living in western, European and other developed countries as minority. It can be due to a number of factors such as unavailability of Islamic schools at a particular location, lack of enough number of students to warrant opening a full-fledged Islamic school, curriculum legislated…

  17. Student Assessment: A Review of Current Practices and Trends in the United States and Selected Countries.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany. Office for Planning, Research, and Support Services.

    A comprehensive overview of the current state of student assessment and a glimpse of the extent of student assessment in New York State (NYS), throughout the nation, and in foreign countries are provided. Background on existing testing programs in NYS and the assessment components of "A New Compact for Learning," a set of proposals from the NYS…

  18. The Financing and Provisioning of Education and Health Services in Developing Countries: Review Article.

    ERIC Educational Resources Information Center

    Heath, Julia A.

    1998-01-01

    The book "Marketizing Education and Health in Developing Countries," edited by Christopher Colclough, examines five salient aspects of education and health care (cost recovery, public versus private alternatives, cost shifting, improved efficiency, and fiscal reforms) useful for examining national privatization efforts. A marriage of market- and…

  19. Early Childhood, Major Challenges: Review of Early Childhood Education and Care Policies in OECD Countries

    ERIC Educational Resources Information Center

    Bennett, John; Neuman, Michelle J.

    2004-01-01

    This article presents the most recent results of a comparative review of early childhood education and care carried out by the Organization for Economic Co-operation and Development (OECD). Founded in 1961 and based in Paris, OECD is one of the world's most important sources of statistical, economic, and social data. Based on reviews in the…

  20. Topic 101: Eleven Campuses, One University, Many Strikes

    ERIC Educational Resources Information Center

    Navarro-Rivera, Pablo

    2010-01-01

    Students from the University of Puerto Rico (UPR) went on strike in April, and, soon after, 10 of the 11 campuses of a public system with more than 60,000 students were closed. "Once recintos, una universidad" (eleven campuses, one university) was the maxim students used to emphasize the concept of the UPR as a system unified by similar goals,…

  1. Access to HIV/AIDS care: a systematic review of socio-cultural determinants in low and high income countries

    PubMed Central

    2013-01-01

    Background The role of socio-cultural factors in influencing access to HIV/AIDS treatment, care and support is increasingly recognized by researchers, international donors and policy makers. Although many of them have been identified through qualitative studies, the evidence gathered by quantitative studies has not been systematically analysed. To fill this knowledge gap, we did a systematic review of quantitative studies comparing surveys done in high and low income countries to assess the extent to which socio-cultural determinants of access, identified through qualitative studies, have been addressed in epidemiological survey studies. Methods Ten electronic databases were searched (Cinahl, EMBASE, ISI Web of Science, IBSS, JSTOR, MedLine, Psyinfo, Psyindex and Cochrane). Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Meta-analysis was used to synthesize data comparing studies between low and high income countries. Results Thirty-four studies were included in the final review, 21 (62%) done in high income countries and 13 (38%) in low income countries. In low income settings, epidemiological research on access to HIV/AIDS services focused on socio-economic and health system factors while in high income countries the focus was on medical and psychosocial factors. These differences depict the perceived different barriers in the two regions. Common factors between the two regions were also found to affect HIV testing, including stigma, high risk sexual behaviours such as multiple sexual partners and not using condoms, and alcohol abuse. On the other hand, having experienced previous illness or other health conditions and good family communication was associated with adherence to ART uptake. Due to insufficient consistent data, a meta-analysis was only possible on adherence to treatment. Conclusions This review offers evidence of the current challenges for interdisciplinary work in epidemiology and public health

  2. Underutilization of cervical cancer prevention services in low and middle income countries: a review of contributing factors

    PubMed Central

    Chidyaonga-Maseko, Fresier; Chirwa, Maureen Leah; Muula, Adamson Sinjani

    2015-01-01

    This review aims at identifying barriers to utilization of cervical cancer prevention services in low- and middle-income countries. An electronic search was conducted using the following key words, HPV vaccination, screening, barriers, utilization and low and middle income/developed countries. Using the Garrard (1999) Matrix method approach, a modified matrix was designed and used as a data collection tool and data related to each category listed on the tool were entered into a matrix containing columns reflecting the categories. Constant comparative analysis was used to identify thematic categories. 31 articles published between 2001 and 2014 were yielded from the search. Analysis of the contents of the articles showed that the underutilization of cervical cancer screening services in low and middle-income countries is the result of barriers in accessing and utilizing of the prevention services. Though not mutually exclusive, the barriers were categorized in three categories; individual, community and health system related. Individual barriers include lack of awareness and knowledge about risk factors and prevention of cervical cancer. Age, marital status, diffidence, social economic status, cultural and religious belief of the women also determine the women's' willingness to utilize the services. In some communities there is stigma attached to discussing reproductive health issues and this limits the young women's awareness of cervical cancer and its prevention. Understanding individual, community and health system barriers that hinder women's utilization of cervical cancer prevention services is very crucial in designing effective cervical cancer control programs in low- and middle-income countries. PMID:26523173

  3. Female Genital Mutilation: A Literature Review of the Current Status of Legislation and Policies in 27 African Countries and Yemen.

    PubMed

    Muthumbi, Jane; Svanemyr, Joar; Scolaro, Elisa; Temmerman, Marleen; Say, Lale

    2015-09-01

    This article discusses the results of a literature review that has assessed the impact of Female Genital Mutilation (FGM) legislation in 28 countries (27 in Africa and Yemen) where FGM is concentrated. Evidence on the impact of FGM legislation was available on prevalence of FGM; changes in societal attitudes and perceptions of FGM; knowledge and awareness of FGM legislation and consequences, and the impact on medicalization. While the majority of countries have adopted legal frameworks prohibiting FGM, these measures have been ineffective in preventing and/or in accelerating the abandonment of the practice. Anti-FGM laws have had an impact on prevalence in only two countries where strict enforcement of legal measures has been complemented by robust monitoring, coupled with robust advocacy efforts in communities. Owing to poor enforcement and lax penalties, legal measures have had a limited impact on medicalization. Similarly, legal frameworks have had a limited impact on societal attitudes and perceptions of FGM, with evidence suggesting rigid enforcement of FGM laws has in some instances been counterproductive. Although evidence suggests legislation has not influenced the decline in FGM in the majority of countries, legal frameworks are nevertheless key components of a comprehensive response to the elimination and abandonment of the practice, and need to be complemented by measures that address the underlying socio-cultural norms that are the root of this practice.

  4. Hospitals in rural or remote areas: An exploratory review of policies in 8 high-income countries.

    PubMed

    Rechel, Bernd; Džakula, Aleksandar; Duran, Antonio; Fattore, Giovanni; Edwards, Nigel; Grignon, Michel; Haas, Marion; Habicht, Triin; Marchildon, Gregory P; Moreno, Antonio; Ricciardi, Walter; Vaughan, Louella; Smith, Tina Anderson

    2016-07-01

    Our study reviewed policies in 8 high-income countries (Australia, Canada, United States, Italy, Spain, United Kingdom, Croatia and Estonia) in Europe, Australasia and North America with regard to hospitals in rural or remote areas. We explored whether any specific policies on hospitals in rural or remote areas are in place, and, if not, how countries made sure that the population in remote or rural areas has access to acute inpatient services. We found that only one of the eight countries (Italy) had drawn up a national policy on hospitals in rural or remote areas. In the United States, although there is no singular comprehensive national plan or vision, federal levers have been used to promote access in rural or remote areas and provide context for state and local policy decisions. In Australia and Canada, intermittent policies have been developed at the sub-national level of states and provinces respectively. In those countries where access to hospital services in rural or remote areas is a concern, common challenges can be identified, including the financial sustainability of services, the importance of medical education and telemedicine and the provision of quick transport to more specialized services. PMID:27312144

  5. Quality of Reporting of Randomised Controlled Trials of Herbal Interventions in ASEAN Plus Six Countries: A Systematic Review

    PubMed Central

    Pratoomsoot, Chayanin; Sruamsiri, Rosarin; Dilokthornsakul, Piyameth; Chaiyakunapruk, Nathorn

    2015-01-01

    Background Many randomised controlled trials (RCTs) of herbal interventions have been conducted in the ASEAN Communities. Good quality reporting of RCTs is essential for assessing clinical significance. Given the importance ASEAN placed on herbal medicines, the reporting quality of RCTs of herbal interventions among the ASEAN Communities deserved a special attention. Objectives To systematically review the quality of reporting of RCTs of herbal interventions conducted in the ASEAN Plus Six Countries. Methods Searches were performed using PubMed, EMBASE, The Cochrane Library, and Allied and Complementary Medicine (AMED), from inception through October 2013. These were limited to studies specific to humans and RCTs. Herbal species search terms were based on those listed in the National List of Essential Medicines [NLEM (Thailand, 2011)]. Studies conducted in the ASEAN Plus Six Countries, published in English were included. Results Seventy-one articles were identified. Thirty (42.25%) RCTs were from ASEAN Countries, whereas 41 RCTs (57.75%) were from Plus Six Group. Adherence to the recommended CONSORT checklist items for reporting of RCTs of herbal interventions among ASEAN Plus Six Countries ranged from 0% to 97.18%. Less than a quarter of the RCTs (18.31%) reported information on standardisation of the herbal products. However, the scope of our interventions of interest was limited to those developed from 20 herbal species listed in the NLEM of Thailand. Conclusions The present study highlights the need to improve reporting quality of RCTs of herbal interventions across ASEAN Plus Six Communities. PMID:25633206

  6. Underutilization of cervical cancer prevention services in low and middle income countries: a review of contributing factors.

    PubMed

    Chidyaonga-Maseko, Fresier; Chirwa, Maureen Leah; Muula, Adamson Sinjani

    2015-01-01

    This review aims at identifying barriers to utilization of cervical cancer prevention services in low- and middle-income countries. An electronic search was conducted using the following key words, HPV vaccination, screening, barriers, utilization and low and middle income/developed countries. Using the Garrard (1999) Matrix method approach, a modified matrix was designed and used as a data collection tool and data related to each category listed on the tool were entered into a matrix containing columns reflecting the categories. Constant comparative analysis was used to identify thematic categories. 31 articles published between 2001 and 2014 were yielded from the search. Analysis of the contents of the articles showed that the underutilization of cervical cancer screening services in low and middle-income countries is the result of barriers in accessing and utilizing of the prevention services. Though not mutually exclusive, the barriers were categorized in three categories; individual, community and health system related. Individual barriers include lack of awareness and knowledge about risk factors and prevention of cervical cancer. Age, marital status, diffidence, social economic status, cultural and religious belief of the women also determine the women's' willingness to utilize the services. In some communities there is stigma attached to discussing reproductive health issues and this limits the young women's awareness of cervical cancer and its prevention. Understanding individual, community and health system barriers that hinder women's utilization of cervical cancer prevention services is very crucial in designing effective cervical cancer control programs in low- and middle-income countries. PMID:26523173

  7. User charges for health services in developing countries: a review of the economic literature.

    PubMed

    McPake, B

    1993-06-01

    Literature suggests that in theory, the efficiency of user charges for health services is related to the level of externality, the price elasticity of demand, the proportion of total costs which are private access costs, and the level of the government budget constraint. Theoretical models predict that price elasticity of demand for health services is likely to be higher for lower income groups and that user charges are therefore unlikely to promote equity, or reduce the discrepancies between the utilisation rates of the rich and poor, 'ceteris paribus'. Empirical evidence tends to confirm the latter prediction but to suggest that user charges in many countries provide the scope for welfare gains for the majority. Unfortunately, this scope is seldom exploited in practice. It is argued that many countries have little choice but to try to exploit the potential for majority gains, but that more emphasis should be placed on ensuring quality improvements than on superficial financial measures of success.

  8. Health information technology in primary health care in developing countries: a literature review.

    PubMed Central

    Tomasi, Elaine; Facchini, Luiz Augusto; Maia, Maria de Fatima Santos

    2004-01-01

    This paper explores the debate and initiatives concerning the use of information technology (IT) in primary health care in developing countries. The literature from 1992-2002 was identified from searches of the MEDLINE, Latin American and Caribbean Health Science Literature Database (LILACS), Cochrane Library and Web of Science databases. The search identified 884 references, 350 of which were classified according to the scheme described by the Pan American Health Organization (PAHO). For the analysis of advantages, problems and perspectives of IT applications and systems, 52 articles were selected according to their potential contribution to the primary health-care processes in non-developed countries. These included: 10 on electronic patient registries (EPR), 22 on process and programmatic action evaluation and management systems (PPAEM) and 20 on clinical decision-support systems (CDS). The main advantages, limitations and perspectives are discussed. PMID:15640923

  9. Review of household solid waste charges for developing countries--A focus on quantity-based charge methods.

    PubMed

    Welivita, Indunee; Wattage, Premachandra; Gunawardena, Prasanthi

    2015-12-01

    Solid waste management has become a major issue in almost all municipalities especially in developing countries across the world. As more waste needs to be collected and disposed of in urban areas, the increased cost cannot be covered by the available funds in developing countries. Managing the Household Solid Waste (HSW) sector is very important as it is the main contributor of the waste that needs to be collected in residential areas. The reduction of the amount of HSW to be disposed of can be achieved by households themselves practising the "4R" activities: reducing, reusing, recycling and recovering. As a policy instrument, the Waste Management Charge (WMC) for HSW has shown much success in encouraging such activities all over the world. Given the already difficult context in which developing countries operate, it is important to careful consider what kind of charging system is implemented. Using available literature, this paper reviews the applicability of available charging methods, from a flat rate method, through to volume-based (bags, cans or tag/sticker) and weight-based charging methods. These charging methods were evaluated on the basis of overall cost, technology need possible other issues. By considering the conditions in developing countries, a 'pre-paid bag based charging method' could be suggested as the most suitable charging method for a WMC in Sri Lanka or other developing countries. The potential applicability of this method was also examined in the context of social, economic and political characteristics. Whilst the use of economic instruments, including WMC, was widely discussed in the literature, the selection of a charging method in the context of developing countries is rarely discussed. Having said that, this paper gives an insight to the policy makers in developing countries upon using pre-paid bag based charging method for HSW sector. It also provides recommendations regarding possible issues in implementing for developing countries

  10. Adherence to Antiretroviral Medications among Persons who Inject Drugs in Transitional, Low and Middle Income Countries: An International Systematic Review

    PubMed Central

    Feelemyer, Jonathan; Jarlais, Don Des; Arasteh, Kamyar; Uuskula, Anneli

    2014-01-01

    Adherence to antiretroviral (ART) medication is vital to reducing morbidity and mortality among HIV positive persons. People who inject drugs (PWID) are at high risk for HIV infection in transitional/low/middle income countries (TLMIC). We conducted a systematic review of studies reporting adherence to ARTs among persons with active injection drug use and/or histories of injection drug use in TLMIC. Meta-regression was performed to examine relationships between location, adherence measurements, and follow-up period. Fifteen studies were included from seven countries. Adherence levels ranged from 33% to 97%; mean weighted adherence was 72%. ART adherence was associated with different methods of measuring adherence and studies conducted in Eastern Europe and East Asia. The great heterogeneity observed precludes generalization to TLMIC as a whole. Given the critical importance of ART adherence more research is needed on ART adherence among PWID in TLMIC, including the use of standardized methods for reporting adherence to ARTs. PMID:25331268

  11. A review of international and UK-based ethical guidelines for researchers conducting nontherapeutic genetic studies in developing countries.

    PubMed

    Roy Choudhury, Shormila; Knapp, Leslie A

    2006-01-01

    Initiation and implementation of nontherapeutic genetic research projects, sponsored by developed countries and conducted in developing countries, requires careful consideration and awareness of procedures that ensure ethical research. This article reviews, and discusses controversies surrounding, the ethical principles established internationally and recommended by institutions in the UK for designing and implementing nontherapeutic genetic research studies. Before project commencement, the researcher should submit proposals to appropriate ethics committees and, wherever possible, seek guidance from experienced researchers. The researcher must also be aware of his/her responsibilities when conducting research with human participants. Responsibilities include respecting autonomy, privacy and confidentiality of participants, respecting social and cultural differences, providing appropriate information to participants, obtaining informed consent and offering appropriate compensation for participation. Finally, researchers involved in human genetics studies must also consider specific issues and public concerns when collecting biological samples. This includes using anonymised samples, considering future use of samples and ensuring confidentiality of results.

  12. Community Engagement to Enhance Child Survival and Early Development in Low- and Middle-Income Countries: An Evidence Review

    PubMed Central

    Farnsworth, S. Katherine; Böse, Kirsten; Fajobi, Olaoluwa; Souza, Patricia Portela; Peniston, Anne; Davidson, Leslie L.; Griffiths, Marcia; Hodgins, Stephen

    2014-01-01

    As part of a broader evidence summit, USAID and UNICEF convened a literature review of effective means to empower communities to achieve behavioral and social changes to accelerate reductions in under-5 mortality and optimize early child development. The authors conducted a systematic review of the effectiveness of community mobilization and participation that led to behavioral change and one or more of the following: child health, survival, and development. The level and nature of community engagement was categorized using two internationally recognized models and only studies where the methods of community participation could be categorized as collaborative or shared leadership were eligible for analysis. The authors identified 34 documents from 18 countries that met the eligibility criteria. Studies with shared leadership typically used a comprehensive community action cycle, whereas studies characterized as collaborative showed clear emphasis on collective action but did not undergo an initial process of community dialogue. The review concluded that programs working collaboratively or achieving shared leadership with a community can lead to behavior change and cost-effective sustained transformation to improve critical health behaviors and reduce poor health outcomes in low- and middle-income countries. Overall, community engagement is an understudied component of improving child outcomes. PMID:25207448

  13. Tobacco Use and Smoking Cessation Practices among Physicians in Developing Countries: A Literature Review (1987–2010)

    PubMed Central

    Abdullah, Abu S.; Stillman, Frances A.; Yang, Li; Luo, Hongye; Zhang, Zhiyong; Samet, Jonathan M.

    2013-01-01

    Physicians have a key role to play in combating tobacco use and reducing the tobacco induced harm to health. However, there is a paucity of information about tobacco-use and cessation among physicians in developing countries. To assess the need for and nature of smoking cessation services among physicians in developing countries, a detailed literature review of studies published in English, between 1987 and 2010 was carried out. The electronic databases Medline and Pub Med were searched for published studies. The findings show that there are regional variations in the current smoking prevalence, quitting intentions, and cessation services among physicians. Smoking prevalence (median) was highest in Central/Eastern Europe (37%), followed by Africa (29%), Central and South America (25%) and Asia (17.5%). There were significant gender differences in smoking prevalence across studies, with higher prevalence among males than females. Smoking at work or in front of patients was commonly practiced by physicians in some countries. Asking about smoking status or advising patients to quit smoking was not common practice among the physicians, especially among smoker physicians. Organized smoking cessation programs for physicians did not exist in all of these regions. This review suggests that while smoking of physicians varies across different developing regions; prevalence rates tend to be higher than among physicians in developed countries. Quitting rates were low among the physicians, and the delivery of advice on quitting smoking was not common across the studies. To promote tobacco control and increase cessation in populations, there is a need to build physicians’ capacity so that they can engage in tobacco use prevention and cessation activities. PMID:24380976

  14. Narrative Review Comparing the Benefits of and Participation in Cardiac Rehabilitation in High-, Middle- and Low-Income Countries

    PubMed Central

    Grace, Sherry L.

    2015-01-01

    Background Cardiovascular disease is a leading cause of morbidity worldwide. Cardiac rehabilitation (CR) is a comprehensive secondary prevention approach, with established benefits in reducing morbidity in high-income countries (HICs). The objectives of this review were to summarize what is known about the benefits of CR, including consideration of cost-effectiveness, in addition to rates of CR participation and adherence in high-, as well as low- and middle-income countries (LMICs). Methods A literature search of Medline, Excerpta Medica Database (EMBASE), and Google Scholar was conducted for published articles from database inception to October 2013. The search was first directed to identify meta-analyses and reviews reporting on the benefits of CR. Then, the search was focused to identify articles reporting CR participation and dropout rates. Full-text versions of relevant abstracts were summarized qualitatively. Results Based on meta-analysis, CR significantly reduced all-cause mortality by 13%–26%, cardiac mortality by 20%–36%, myocardial re-infarction by 25%–47%, and risk factors. CR is cost-effective in HICs. In LMICs, CR is demonstrated to reduce risk factors, with no studies on mortality or cost-effectiveness. Based on available data, CR participation rates are <50% in the majority of countries, with documented dropout rates up to 56% and 82% in high- and middle-income countries, respectively. Conclusions CR is a beneficial intervention for heart patients in high and LMICs, but is underutilized with low participation and adherence rates worldwide. While more research is needed in LMICs, strategies shown to increase participation and program adherence should be implemented. PMID:25534902

  15. What makes Health Demand-Side Financing Schemes Work in Low-and Middle-Income Countries? A Realist Review.

    PubMed

    Gopalan, Saji S; Das, Ashis; Mutasa, Ronald

    2014-12-01

    This realist review explored causal pathways of the possible consumer effects of health sector demand-side financial (DSF) incentives, their contextual factors and mechanisms in low-and-middle-income countries. We searched six electronic data bases and identified 659 abstracts with different evaluation designs. Based on methodological rigor and content relevance, only 24 studies published up to April 2013 were selected for the final review. A conceptual framework consisting of various program theories on potential context-mechanism-outcome (C-M-O) configuration of DSF initiative was designed, tested and adapted during the review. Synthesized results were presented as a C-M-O configuration for each of the consumer -side effect. DSF was effective to improve health seeking behaviour considerably and health status to some extent. The causal pathway of DSF's functioning and effectiveness was not linear. Key demand-side contextual factors which affected DSF's consumer-side effects were background characteristics of the beneficiaries including their socio-cultural beliefs, motivations, and level of health awareness. At the supply-side, service availability status and provider incentives were contextual determinants. The mechanisms which enabled the interaction of contextual influence were consumer and provider accountability and consumer trust on providers. In order to enhance DSF programs' effectiveness, their design and implementation should carefully consider the potential contextual elements that may influence the causal pathways. Significance for public healthThis article focuses on a rare topic i.e. Realist Review, which is an emerging concept to explore causal factors behind every intervention that make it effective or ineffective. This manuscript is a first attempt on a Realist Review of health sector demand-side financing (DSF) in a number of low-and middle-income countries. DSF is a widely employed health promotion strategy in many countries to improve health

  16. What makes Health Demand-Side Financing Schemes Work in Low-and Middle-Income Countries? A Realist Review

    PubMed Central

    Gopalan, Saji S.; Das, Ashis; Mutasa, Ronald

    2014-01-01

    This realist review explored causal pathways of the possible consumer effects of health sector demand-side financial (DSF) incentives, their contextual factors and mechanisms in low-and-middle-income countries. We searched six electronic data bases and identified 659 abstracts with different evaluation designs. Based on methodological rigor and content relevance, only 24 studies published up to April 2013 were selected for the final review. A conceptual framework consisting of various program theories on potential context-mechanism-outcome (C-M-O) configuration of DSF initiative was designed, tested and adapted during the review. Synthesized results were presented as a C-M-O configuration for each of the consumer –side effect. DSF was effective to improve health seeking behaviour considerably and health status to some extent. The causal pathway of DSF’s functioning and effectiveness was not linear. Key demand-side contextual factors which affected DSF’s consumer-side effects were background characteristics of the beneficiaries including their socio-cultural beliefs, motivations, and level of health awareness. At the supply-side, service availability status and provider incentives were contextual determinants. The mechanisms which enabled the interaction of contextual influence were consumer and provider accountability and consumer trust on providers. In order to enhance DSF programs’ effectiveness, their design and implementation should carefully consider the potential contextual elements that may influence the causal pathways. Significance for public health This article focuses on a rare topic i.e. Realist Review, which is an emerging concept to explore causal factors behind every intervention that make it effective or ineffective. This manuscript is a first attempt on a Realist Review of health sector demand-side financing (DSF) in a number of low-and middle-income countries. DSF is a widely employed health promotion strategy in many countries to improve

  17. High coverage needle/syringe programs for people who inject drugs in low and middle income countries: a systematic review

    PubMed Central

    2013-01-01

    Background Persons who inject drugs (PWID) are at an elevated risk for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection. In many high-income countries, needle and syringe exchange programs (NSP) have been associated with reductions in blood-borne infections. However, we do not have a good understanding of the effectiveness of NSP in low/middle-income and transitional-economy countries. Methods A systematic literature review based on PRISMA guidelines was utilized to collect primary study data on coverage of NSP programs and changes in HIV and HCV infection over time among PWID in low-and middle-income and transitional countries (LMICs). Included studies reported laboratory measures of either HIV or HCV and at least 50% coverage of the local injecting population (through direct use or through secondary exchange). We also included national reports on newly reported HIV cases for countries that had national level data for PWID in conjunction with NSP scale-up and implementation. Results Studies of 11 NSPs with high-coverage from Bangladesh, Brazil, China, Estonia, Iran, Lithuania, Taiwan, Thailand and Vietnam were included in the review. In five studies HIV prevalence decreased (range −3% to −15%) and in three studies HCV prevalence decreased (range −4.2% to −10.2%). In two studies HIV prevalence increased (range +5.6% to +14.8%). HCV incidence remained stable in one study. Of the four national reports of newly reported HIV cases, three reported decreases during NSP expansion, ranging from −30% to −93.3%, while one national report documented an increase in cases (+37.6%). Estimated incidence among new injectors decreased in three studies, with reductions ranging from −11/100 person years at risk to −16/100 person years at risk. Conclusions While not fully consistent, the data generally support the effectiveness of NSP in reducing HIV and HCV infection in low/middle-income and transitional-economy countries. If high coverage is

  18. Prevalence of Latent Tuberculosis among Health Care Workers in High Burden Countries: A Systematic Review and Meta-Analysis

    PubMed Central

    Nasreen, Sharifa; Shokoohi, Mostafa; Malvankar-Mehta, Monali S.

    2016-01-01

    Background Tuberculosis is one of the leading causes of death worldwide. Twenty-two high burden countries contributed to the majority of worldwide tuberculosis cases in 2015. Health care workers are at high risk of acquiring tuberculosis through occupational exposure. Objective To estimate the prevalence of latent tuberculosis infection (LTBI) among health care workers in high burden countries. Methods Databases including MEDLINE (Ovid), EMBASE (Ovid), CINAHL (Ovid) and ISI Web of Science (Thompson-Reuters), and grey literature were searched for English language records on relevant medical subject headings (MeSH) terms of LTBI and health care providers. Literature was systematically reviewed using EPPI-Reviewer4 software. Prevalence and incidence of LTBI and 95% confidence intervals (CI) were reported. Pooled prevalence of LTBI and 95% CI were calculated using random-effects meta-analysis models and heterogeneity was assessed using I2 statistics. Sub-group analysis was conducted to assess the cause of heterogeneity. Results A total of 990 records were identified. Of those, 18 studies from only 7 high burden countries representing 10,078 subjects were included. Tuberculin skin test results were available for 9,545 participants. The pooled prevalence of LTBI was 47% (95% CI 34% to 60%, I2 = 99.6%). In subgroup analyses according to the country of the study, the pooled prevalence of LTBI was lowest in Brazil (37%) and highest in South Africa (64%). The pooled prevalence of LTBI among medical and nursing students was 26% (95% CI 6% to 46%, I2 = 99.3%) while the prevalence among all types of health care workers was 57% (95% CI 44% to 70%, I2 = 99.1%). Incidence of LTBI was available for health care workers in four countries. The cumulative incidence ranged from 2.8% in Brazilian medical students to 38% among all types of health care workers in South Africa. Conclusion The findings of this study suggest that there is a high burden of LTBI among health care workers in

  19. The Impact of Clinical Social Franchising on Health Services in Low- and Middle-Income Countries: A Systematic Review

    PubMed Central

    Beyeler, Naomi; York De La Cruz, Anna; Montagu, Dominic

    2013-01-01

    Background The private sector plays a large role in health services delivery in low- and middle-income countries; yet significant gaps remain in the quality and accessibility of private sector services. Clinical social franchising, which applies the commercial franchising model to achieve social goals and improve health care, is increasingly used in developing countries to respond to these limitations. Despite the growth of this approach, limited evidence documents the effect of social franchising on improving health care quality and access. Objectives and Methods We examined peer-reviewed and grey literature to evaluate the effect of social franchising on health care quality, equity, cost-effectiveness, and health outcomes. We included all studies of clinical social franchise programs located in low- and middle-income countries. We assessed study bias using the WHO-Johns Hopkins Rigour Scale and used narrative synthesis to evaluate the findings. Results Of 113 identified articles, 23 were included in this review; these evaluated a small sample of franchises globally and focused on reproductive health franchises. Results varied widely across outcomes and programs. Social franchising was positively associated with increased client volume and client satisfaction. The findings on health care utilization and health impact were mixed; some studies find that franchises significantly outperform other models of health care, while others show franchises are equivalent to or worse than other private or public clinics. In two areas, cost-effectiveness and equity, social franchises were generally found to have poorer outcomes. Conclusions Our review indicates that social franchising may strengthen some elements of private sector health care. However, gaps in the evidence remain. Additional research should include: further documentation of the effect of social franchising, evaluating the equity and cost-effectiveness of this intervention, and assessing the role of franchising

  20. mHealth adoption in low-resource environments: a review of the use of mobile healthcare in developing countries.

    PubMed

    Chib, Arul; van Velthoven, Michelle Helena; Car, Josip

    2015-01-01

    The acknowledged potential of using mobile phones for improving healthcare in low-resource environments of developing countries has yet to translate into significant mHealth policy investment. The low uptake of mHealth in policy agendas may stem from a lack of evidence of the scalable, sustainable impact on health indicators. The mHealth literature in low- and middle-income countries reveals a burgeoning body of knowledge; yet, existing reviews suggest that the projects yield mixed results. This article adopts a stage-based approach to understand the varied contributions to mHealth research. The heuristic of inputs-mechanism-outputs is proposed as a tool to categorize mHealth studies. This review (63 articles comprising 53 studies) reveals that mHealth studies in developing countries tend to concentrate on specific stages, principally on pilot projects that adopt a deterministic approach to technological inputs (n = 32), namely introduction and implementation. Somewhat less studied were research designs that demonstrate evidence of outputs (n = 15), such as improvements in healthcare processes and public health indicators. The review finds a lack of emphasis on studies that provide theoretical understanding (n = 6) of adoption and appropriation of technological introduction that produces measurable health outcomes. As a result, there is a lack of dominant theory, or measures of outputs relevant to making policy decisions. Future work needs to aim for establishing theoretical and measurement standards, particularly from social scientific perspectives, in collaboration with researchers from the domains of information technology and public health. Priorities should be set for investments and guidance in evaluation disseminated by the scientific community to practitioners and policymakers. PMID:24673171

  1. Supervising community health workers in low-income countries – a review of impact and implementation issues

    PubMed Central

    Hill, Zelee; Dumbaugh, Mari; Benton, Lorna; Källander, Karin; Strachan, Daniel; Asbroek, Augustinus ten; Tibenderana, James; Kirkwood, Betty; Meek, Sylvia

    2014-01-01

    Background Community health workers (CHWs) are an increasingly important component of health systems and programs. Despite the recognized role of supervision in ensuring CHWs are effective, supervision is often weak and under-supported. Little is known about what constitutes adequate supervision and how different supervision strategies influence performance, motivation, and retention. Objective To determine the impact of supervision strategies used in low- and middle-income countries and discuss implementation and feasibility issues with a focus on CHWs. Design A search of peer-reviewed, English language articles evaluating health provider supervision strategies was conducted through November 2013. Included articles evaluated the impact of supervision in low- or middle-income countries using a controlled, pre-/post- or observational design. Implementation and feasibility literature included both peer-reviewed and gray literature. Results A total of 22 impact papers were identified. Papers were from a range of low- and middle-income countries addressing the supervision of a variety of health care providers. We classified interventions as testing supervision frequency, the supportive/facilitative supervision package, supervision mode (peer, group, and community), tools (self-assessment and checklists), focus (quality assurance/problem solving), and training. Outcomes included coverage, performance, and perception of quality but were not uniform across studies. Evidence suggests that improving supervision quality has a greater impact than increasing frequency of supervision alone. Supportive supervision packages, community monitoring, and quality improvement/problem-solving approaches show the most promise; however, evaluation of all strategies was weak. Conclusion Few supervision strategies have been rigorously tested and data on CHW supervision is particularly sparse. This review highlights the diversity of supervision approaches that policy makers have to choose

  2. The terrain of health policy analysis in low and middle income countries: a review of published literature 1994–2007

    PubMed Central

    Gilson, Lucy; Raphaely, Nika

    2008-01-01

    This article provides the first ever review of literature analysing the health policy processes of low and middle income countries (LMICs). Based on a systematic search of published literature using two leading international databases, the article maps the terrain of work published between 1994 and 2007, in terms of policy topics, lines of inquiry and geographical base, as well as critically evaluating its strengths and weaknesses. The overall objective of the review is to provide a platform for the further development of this field of work. From an initial set of several thousand articles, only 391 were identified as relevant to the focus of inquiry. Of these, 164 were selected for detailed review because they present empirical analyses of health policy change processes within LMIC settings. Examination of these articles clearly shows that LMIC health policy analysis is still in its infancy. There are only small numbers of such analyses, whilst the diversity of policy areas, topics and analytical issues that have been addressed across a large number of country settings results in a limited depth of coverage within this body of work. In addition, the majority of articles are largely descriptive in nature, limiting understanding of policy change processes within or across countries. Nonetheless, the broad features of experience that can be identified from these articles clearly confirm the importance of integrating concern for politics, process and power into the study of health policy. By generating understanding of the factors influencing the experience and results of policy change, such analysis can inform action to strengthen future policy development and implementation. This article, finally, outlines five key actions needed to strengthen the field of health policy analysis within LMICs, including capacity development and efforts to generate systematic and coherent bodies of work underpinned by both the intent to undertake rigorous analytical work and concern

  3. Assistive technologies for ageing populations in six low-income and middle-income countries: a systematic review

    PubMed Central

    Marasinghe, Keshini Madara; Lapitan, Jostacio Moreno; Ross, Alex

    2015-01-01

    Despite the benefits derived from the use of assistive technologies (AT), some parts of the world have minimal or no access to AT. In many low-income and middle-income countries (LMIC), only 5–15% of people who require AT have access to them. Rapid demographic changes will exacerbate this situation as populations over 60 years of age, as well as functional limitations among older populations, in LMIC are expected to be higher than in high-income countries in the coming years. Given both these trends, AT are likely to be in high demand and provide many benefits to respond to challenges related to healthy and productive ageing. Multiple databases were searched for English literature. Three groups of keywords were combined: those relating to AT, ageing population and LMIC selected for this study, namely Brazil, Cambodia, Egypt, India, Turkey and Zimbabwe. These countries are expected to see the most rapid growth in the 65 and above population in the coming years. Results indicate that all countries had AT designed for older adults with existing impairment and disability, but had limited AT that are designed to prevent impairment and disability among older adults who do not currently have any disabilities. All countries have ratified the UN Convention on the Rights of Persons with Disabilities. The findings conclude that AT for ageing populations have received some attention in LMIC as attested by the limited literature results. Analysis of review findings indicate the need for a comprehensive, integrated health and social system approach to increase the current availability of AT for ageing populations in LMIC. These would entail, yet not be limited to, work on: (1) promoting initiatives for low-cost AT; (2) awareness raising and capacity building on AT; (3) bridging the gap between AT policy and practice; and (4) fostering targeted research on AT. PMID:26688747

  4. Equity in the allocation of public sector financial resources in low- and middle-income countries: a systematic literature review.

    PubMed

    Anselmi, Laura; Lagarde, Mylene; Hanson, Kara

    2015-05-01

    This review aims to identify, assess and analyse the evidence on equity in the distribution of public health sector expenditure in low- and middle-income countries. Four bibliographic databases and five websites were searched to identify quantitative studies examining equity in the distribution of public health funding in individual countries or groups of countries. Two different types of studies were identified: benefit incidence analysis (BIA) and resource allocation comparison (RAC) studies. Quality appraisal and data synthesis were tailored to each study type to reflect differences in the methods used and in the information provided. We identified 39 studies focusing on African, Asian and Latin American countries. Of these, 31 were BIA studies that described the distribution, typically across socio-economic status, of individual monetary benefit derived from service utilization. The remaining eight were RAC studies that compared the actual expenditure across geographic areas to an ideal need-based distribution. Overall, the quality of the evidence from both types of study was relatively weak. Looking across studies, the evidence confirms that resource allocation formulae can enhance equity in resource allocation across geographic areas and that the poor benefits proportionally more from primary health care than from hospital expenditure. The lack of information on the distribution of benefit from utilization in RAC studies and on the countries' approaches to resource allocation in BIA studies prevents further policy analysis. Additional research that relates the type of resource allocation mechanism to service provision and to the benefit distribution is required for a better understanding of equity-enhancing resource allocation policies.

  5. Genital Chlamydia Prevalence in Europe and Non-European High Income Countries: Systematic Review and Meta-Analysis

    PubMed Central

    Redmond, Shelagh M.; Alexander-Kisslig, Karin; Woodhall, Sarah C.; van den Broek, Ingrid V. F.; van Bergen, Jan; Ward, Helen; Uusküla, Anneli; Herrmann, Björn; Andersen, Berit; Götz, Hannelore M.; Sfetcu, Otilia; Low, Nicola

    2015-01-01

    Background Accurate information about the prevalence of Chlamydia trachomatis is needed to assess national prevention and control measures. Methods We systematically reviewed population-based cross-sectional studies that estimated chlamydia prevalence in European Union/European Economic Area (EU/EEA) Member States and non-European high income countries from January 1990 to August 2012. We examined results in forest plots, explored heterogeneity using the I2 statistic, and conducted random effects meta-analysis if appropriate. Meta-regression was used to examine the relationship between study characteristics and chlamydia prevalence estimates. Results We included 25 population-based studies from 11 EU/EEA countries and 14 studies from five other high income countries. Four EU/EEA Member States reported on nationally representative surveys of sexually experienced adults aged 18–26 years (response rates 52–71%). In women, chlamydia point prevalence estimates ranged from 3.0–5.3%; the pooled average of these estimates was 3.6% (95% CI 2.4, 4.8, I2 0%). In men, estimates ranged from 2.4–7.3% (pooled average 3.5%; 95% CI 1.9, 5.2, I2 27%). Estimates in EU/EEA Member States were statistically consistent with those in other high income countries (I2 0% for women, 6% for men). There was statistical evidence of an association between survey response rate and estimated chlamydia prevalence; estimates were higher in surveys with lower response rates, (p = 0.003 in women, 0.018 in men). Conclusions Population-based surveys that estimate chlamydia prevalence are at risk of participation bias owing to low response rates. Estimates obtained in nationally representative samples of the general population of EU/EEA Member States are similar to estimates from other high income countries. PMID:25615574

  6. Income and child mortality in developing countries: a systematic review and meta-analysis

    PubMed Central

    O'Hare, Bernadette; Makuta, Innocent; Chiwaula, Levison; Bar-Zeev, Naor

    2013-01-01

    Objective We aimed to quantify the relationship between national income and infant and under-five mortality in developing countries. Design We conducted a systematic literature search of studies that examined the relationship between income and child mortality (infant and/or under-five mortality) and meta-analysed their results. Setting Developing countries. Main outcome measures Child mortality (infant and /or under-five mortality). Results The systematic literature search identified 24 studies, which produced 38 estimates that examined the impact of income on the mortality rates. Using meta-analysis, we produced pooled estimates of the relationship between income and mortality. The pooled estimate of the relationship between income and infant mortality before adjusting for covariates is −0.95 (95% CI −1.34 to −0.57) and that for under-five mortality is −0.45 (95% CI −0.79 to −0.11). After adjusting for covariates, pooled estimate of the relationship between income and infant mortality is −0.33 (−0.39 to −0.26) while the estimate for under-five mortality is −0.28 (−0.37 to −0.19). If a country has an infant mortality of 50 per 1000 live births and the gross domestic product per capita purchasing power parity increases by 10%, the infant mortality will decrease to 45 per 1000 live births. Conclusion Income is an important determinant of child survival and this work provides a pooled estimate for the relationship. PMID:23824332

  7. Narrative review: tetanus-a health threat after natural disasters in developing countries.

    PubMed

    Afshar, Majid; Raju, Mahesh; Ansell, David; Bleck, Thomas P

    2011-03-01

    Tetanus is an expected complication when disasters strike in developing countries, where tetanus immunization coverage is often low or nonexistent. Collapsing structures and swirling debris inflict numerous crush injuries, fractures, and serious wounds. Clostridium tetani infects wounds contaminated with dirt, feces, or saliva and releases neurotoxins that may cause fatal disease. Clusters of infections have recently occurred after tsunamis and earthquakes in Indonesia, Kashmir, and Haiti. The emergency response to clusters of tetanus infections in developing countries after a natural disaster requires a multidisciplinary approach in the absence of an intensive care unit, readily available resources, and a functioning cold-chain system. It is essential that injured people receive immediate surgical and medical care of contaminated, open wounds with immunization and immunoglobulin therapy. Successful treatment of tetanus depends on prompt diagnosis of clinical tetanus, treatment to ensure neutralization of circulating toxin and elimination of C. tetani infection, control of spasms and convulsions, maintenance of the airway, and management of respiratory failure and autonomic dysfunction.

  8. Are countries using global fund support to implement HIV drug resistance surveillance? A review of funded HIV grants.

    PubMed

    Kelley, Karen F; Caudwell, Emily; Xueref, Serge; Ha, Thuy Huong; Bertagnolio, Silvia

    2012-05-01

    The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is the largest funder of human immunodeficiency virus (HIV) prevention and treatment programs worldwide. Since 2002, the Global Fund has encouraged grant recipients to implement drug resistance surveillance (DRS) as part of treatment programs. We reviewed documentation of 147 grants funded in 2004-2008 (funding rounds 4-8) to assess grantees' use of funds to support HIV DRS. Overall, 94 grants (64%) described HIV DRS as part of the national treatment program. However, only 32 grants (22%) specifically documented DRS as a grant-funded activity. This review provides baseline information suggesting limited use by countries of Global Fund financing to support HIV DRS. Additional assessment is required to evaluate barriers to using Global Fund grants to support DRS.

  9. Postpartum Depression among Rural Women from Developed and Developing Countries: A Systematic Review

    ERIC Educational Resources Information Center

    Villegas, Laura; McKay, Katherine; Dennis, Cindy-Lee; Ross, Lori E.

    2011-01-01

    Purpose: Postpartum depression (PPD) is a significant public health problem, with significant consequences for the mother, infant, and family. Available research has not adequately examined the potential impact of sociodemographic characteristics, such as place of residence, on risk for PPD. Therefore, this systematic review and meta-analysis…

  10. 76 FR 38747 - Review of New Sources and Modifications in Indian Country

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-01

    .... 32191 Millwork (wood products mfg). 323110 Printing operations (lithographic). 324121 Asphalt hot mix... provisions and consideration of the public comments. On August 21, 2006 (71 FR 48696), EPA proposed the... New Source Review (NSR): Aggregation and Project Netting; 74 FR 2376.) Regarding the proposed list...

  11. Who uses sunbeds? A systematic literature review of risk groups in developed countries.

    PubMed

    Schneider, S; Krämer, H

    2010-06-01

    Skin cancer is caused by ultraviolet radiation (UVR). Indoor tanning is a totally avoidable risk behaviour. This review addresses the specific characteristics of sunbed users and the differences in motivation and risk perception compared with non-users. This review is based solely on empirical original articles. Based on literature searches with widely used reference databases ('PubMed', 'OVID', 'Social Citation Index', 'ERIC--Educational Resources Information Center', 'Web of Science' and the 'International Bibliography of the Social Sciences'), we included studies from developed nations with a publication date between 1 January 2000 and 12 August 2008. All studies were selected, classified and coded simultaneously by both authors on a blinded basis. All searches were performed on 13 and 14 August 2008. In accordance with the QUOROM and the MOOSE Statements, we identified 16 original studies. The typical sunbed user is female, between 17 and 30 years old, and tends to live a comparatively unhealthy lifestyle: Users smoke cigarettes and drink alcohol more frequently and eat less healthy food than non-users. Users are characterized by a lack of knowledge about health risks of UVR, and prompted by the frequent use of sunbeds by friends or family members and the experience of positive emotions and relaxation by indoor tanning. This review is the first systematic review on risk groups among sunbed users that has been published in a scientific journal. There is still a lack of information among users, particularly among young people regarding the safety of solariums. PMID:20015180

  12. Multinational Corporations in Developed Countries: A Review of Recent Research and Policy Thinking.

    ERIC Educational Resources Information Center

    Lea, Sperry; Webley, Simon

    The present state of multinational corporations (MNC) in North America and Europe is described and commented upon in this study. Specifically, it reviews serious research and policy thinking by private and official bodies in the United States, Canada, the United Kingdom, and on the continent of Europe. It concentrates on the major issues arising…

  13. Country tobacco laws and article 11 of the WHO Framework Convention on Tobacco Control: a review of tobacco packaging and labeling regulations of 25 countries

    PubMed Central

    2013-01-01

    Background Urgent, evidence-based tobacco control efforts have been advocated by the WHO through the Framework Convention on Tobacco Control (FCTC) articles and guidelines. The level of implementation of these guidelines varies by country and region. This paper identifies areas of alignment and non-alignment of country tobacco laws with respect to the FCTC’s article 11 requirements, which lists guidelines for regulating tobacco packaging and labeling. Methods Countries from each of the six WHO regions were ranked by number of smokers and 25 countries were selected, representing countries from all WHO regions with the highest number of smokers. A scoring guide based on the FCTC article 11 requirements was created and used to rank country tobacco laws and assess levels of alignment as well as identify common areas of weakness and strength. Results Across the countries examined, laws were generally strong in mandating the display of health warning messages on the front and back of cigarette packs and cartons. However, they were deficient in prohibiting the display of emission yields, and placing warnings at the top of the principal display area, as well as requiring health messages on tobacco’s negative social and economic outcomes. Conclusion Country tobacco packaging and labeling laws can be strengthened by greater compliance with the FCTC article 11 guidelines. PMID:24195752

  14. The Identification of Children with, or at Significant Risk of, Intellectual Disabilities in Low- and Middle-Income Countries: A Review

    ERIC Educational Resources Information Center

    Robertson, Janet; Hatton, Chris; Emerson, Eric; Yasamy, M. Taghi

    2012-01-01

    Background: Developmental monitoring of children is an important strategy for the early detection and management of intellectual disabilities (ID) in high-income countries. This review summarizes the literature on identifying children with ID in low- and middle-income (LAMI) countries. Materials and methods: Electronic literature database searches…

  15. Mobile health use in low- and high-income countries: an overview of the peer-reviewed literature.

    PubMed

    Bastawrous, Andrew; Armstrong, Matthew J

    2013-04-01

    The evolution of mobile phone technology has introduced new possibilities to the field of medicine. Combining technological advances with medical expertise has led to the use of mobile phones in all healthcare areas including diagnostics, telemedicine, research, reference libraries and interventions. This article provides an overview of the peer-reviewed literature, published between 1 August 2006 and 1 August 2011, for the application of mobile/cell phones (from basic text-messaging systems to smartphones) in healthcare in both resource-poor and high-income countries. Smartphone use is paving the way in high-income countries, while basic text-messaging systems of standard mobile phones are proving to be of value in low- and middle-income countries. Ranging from infection outbreak reporting, anti-HIV therapy adherence to gait analysis, resuscitation training and radiological imaging, the current uses and future possibilities of mobile phone technology in healthcare are endless. Multiple mobile phone based applications are available for healthcare workers and healthcare consumers; however, the absolute majority lack an evidence base. Therefore, more rigorous research is required to ensure that healthcare is not flooded with non-evidence based applications and is maximized for patient benefit.

  16. Mobile health use in low- and high-income countries: an overview of the peer-reviewed literature

    PubMed Central

    Bastawrous, Andrew; Armstrong, Matthew J

    2013-01-01

    The evolution of mobile phone technology has introduced new possibilities to the field of medicine. Combining technological advances with medical expertise has led to the use of mobile phones in all healthcare areas including diagnostics, telemedicine, research, reference libraries and interventions. This article provides an overview of the peer-reviewed literature, published between 1 August 2006 and 1 August 2011, for the application of mobile/cell phones (from basic text-messaging systems to smartphones) in healthcare in both resource-poor and high-income countries. Smartphone use is paving the way in high-income countries, while basic text-messaging systems of standard mobile phones are proving to be of value in low- and middle-income countries. Ranging from infection outbreak reporting, anti-HIV therapy adherence to gait analysis, resuscitation training and radiological imaging, the current uses and future possibilities of mobile phone technology in healthcare are endless. Multiple mobile phone based applications are available for healthcare workers and healthcare consumers; however, the absolute majority lack an evidence base. Therefore, more rigorous research is required to ensure that healthcare is not flooded with non-evidence based applications and is maximized for patient benefit. PMID:23564897

  17. Prevalence of rheumatoid arthritis in low– and middle–income countries: A systematic review and analysis

    PubMed Central

    Rudan, Igor; Sidhu, Simrita; Papana, Angeliki; Meng, Shi–Jiao; Xin–Wei, Yu; Wang, Wei; Campbell–Page, Ruth M.; Demaio, Alessandro Rhyll; Nair, Harish; Sridhar, Devi; Theodoratou, Evropi; Dowman, Ben; Adeloye, Davies; Majeed, Azeem; Car, Josip; Campbell, Harry; Wang, Wei; Chan, Kit Yee

    2015-01-01

    Background Rheumatoid arthritis (RA) is an autoimmune disorder that affects the small joints of the body. It is one of the leading causes of chronic morbidity in high–income countries, but little is known about the burden of this disease in low– and middle–income countries (LMIC). Methods The aim of this study was to estimate the prevalence of RA in six of the World Health Organization's (WHO) regions that harbour LMIC by identifying all relevant studies in those regions. To accomplish this aim various bibliographic databases were searched: PubMed, EMBASE, Global Health, LILACS and the Chinese databases CNKI and WanFang. Studies were selected based on pre–defined inclusion criteria, including a definition of RA based on the 1987 revision of the American College of Rheumatology (ACR) definition. Results Meta–estimates of regional RA prevalence rates for countries of low or middle income were 0.40% (95% CI: 0.23–0.57%) for Southeast Asian, 0.37% (95% CI: 0.23–0.51%) for Eastern Mediterranean, 0.62% (95% CI: 0.47–0.77%) for European, 1.25% (95% CI: 0.64–1.86%) for American and 0.42% (95% CI: 0.30–0.53%) for Western Pacific regions. A formal meta–analysis could not be performed for the sub–Saharan African region due to limited data. Male prevalence of RA in LMIC was 0.16% (95% CI: 0.11–0.20%) while the prevalence in women reached 0.75% (95% CI: 0.60–0.90%). This difference between males and females was statistically significant (P < 0.0001). The prevalence of RA did not differ significantly between urban and rural settings (P = 0.353). These prevalence estimates represent 2.60 (95% CI: 1.85–3.34%) million male sufferers and 12.21 (95% CI: 9.78–14.67%) million female sufferers in LMIC in the year 2000, and 3.16 (95% CI: 2.25–4.05%) million affected males and 14.87 (95% CI: 11.91–17.86%) million affected females in LMIC in the year 2010. Conclusion Given that majority of the world’s population resides in LMIC, the number of

  18. Comparison of Eleven Heavy Metals in Moringa Oleifera Lam. Products.

    PubMed

    Limmatvapirat, C; Limmatvapirat, S; Charoenteeraboon, J; Wessapan, C; Kumsum, A; Jenwithayaamornwech, S; Luangthuwapranit, P

    2015-01-01

    Eleven heavy metals in various products of Moringa oleifera were analyzed to determine eleven heavy metals (Al, As, Cd, Cr, Cu, Fe, Pb, Mn, Hg, Ni, and Zn) using Inductively Coupled Plasma-Mass Spectrometry. The products of M. oleifera were purchased in Nakhon Pathom, Thailand. All products were digested with nitric acid solution before determining the concentrations of heavy metals. The recoveries of all heavy metals were found to be in the range of 99.89-103.05%. Several criteria such as linearity, limits of detection, limits of quantification, specificity, precision under repeatability conditions and intermediate precision reproducibility were evaluated. Results indicate that this method could be used in the laboratory for determination of eleven heavy metals in M. oleifera products with acceptable analytical performance. The results of analysis showed that the highest concentrations of As, Cr, Hg, and Mn were found in tea leaves while the highest concentrations of Al, Cd, Cu, Fe, Ni, Pb, and Zn were found in leaf capsules. Continuous monitoring of heavy metals in M. oleifera products is crucial for consumer health. PMID:26664066

  19. Comparison of Eleven Heavy Metals in Moringa Oleifera Lam. Products

    PubMed Central

    Limmatvapirat, C.; Limmatvapirat, S.; Charoenteeraboon, J.; Wessapan, C.; Kumsum, A.; Jenwithayaamornwech, S.; Luangthuwapranit, P.

    2015-01-01

    Eleven heavy metals in various products of Moringa oleifera were analyzed to determine eleven heavy metals (Al, As, Cd, Cr, Cu, Fe, Pb, Mn, Hg, Ni, and Zn) using Inductively Coupled Plasma-Mass Spectrometry. The products of M. oleifera were purchased in Nakhon Pathom, Thailand. All products were digested with nitric acid solution before determining the concentrations of heavy metals. The recoveries of all heavy metals were found to be in the range of 99.89-103.05%. Several criteria such as linearity, limits of detection, limits of quantification, specificity, precision under repeatability conditions and intermediate precision reproducibility were evaluated. Results indicate that this method could be used in the laboratory for determination of eleven heavy metals in M. oleifera products with acceptable analytical performance. The results of analysis showed that the highest concentrations of As, Cr, Hg, and Mn were found in tea leaves while the highest concentrations of Al, Cd, Cu, Fe, Ni, Pb, and Zn were found in leaf capsules. Continuous monitoring of heavy metals in M. oleifera products is crucial for consumer health. PMID:26664066

  20. Comparison of Eleven Heavy Metals in Moringa Oleifera Lam. Products.

    PubMed

    Limmatvapirat, C; Limmatvapirat, S; Charoenteeraboon, J; Wessapan, C; Kumsum, A; Jenwithayaamornwech, S; Luangthuwapranit, P

    2015-01-01

    Eleven heavy metals in various products of Moringa oleifera were analyzed to determine eleven heavy metals (Al, As, Cd, Cr, Cu, Fe, Pb, Mn, Hg, Ni, and Zn) using Inductively Coupled Plasma-Mass Spectrometry. The products of M. oleifera were purchased in Nakhon Pathom, Thailand. All products were digested with nitric acid solution before determining the concentrations of heavy metals. The recoveries of all heavy metals were found to be in the range of 99.89-103.05%. Several criteria such as linearity, limits of detection, limits of quantification, specificity, precision under repeatability conditions and intermediate precision reproducibility were evaluated. Results indicate that this method could be used in the laboratory for determination of eleven heavy metals in M. oleifera products with acceptable analytical performance. The results of analysis showed that the highest concentrations of As, Cr, Hg, and Mn were found in tea leaves while the highest concentrations of Al, Cd, Cu, Fe, Ni, Pb, and Zn were found in leaf capsules. Continuous monitoring of heavy metals in M. oleifera products is crucial for consumer health.

  1. Staffing remote rural areas in middle- and low-income countries: A literature review of attraction and retention

    PubMed Central

    Lehmann, Uta; Dieleman, Marjolein; Martineau, Tim

    2008-01-01

    Background Many countries in middle- and low-income countries today suffer from severe staff shortages and/or maldistribution of health personnel which has been aggravated more recently by the disintegration of health systems in low-income countries and by the global policy environment. One of the most damaging effects of severely weakened and under-resourced health systems is the difficulty they face in producing, recruiting, and retaining health professionals, particularly in remote areas. Low wages, poor working conditions, lack of supervision, lack of equipment and infrastructure as well as HIV and AIDS, all contribute to the flight of health care personnel from remote areas. In this global context of accelerating inequities health service policy makers and managers are searching for ways to improve the attraction and retention of staff in remote areas. But the development of appropriate strategies first requires an understanding of the factors which influence decisions to accept and/or stay in a remote post, particularly in the context of mid and low income countries (MLICS), and which strategies to improve attraction and retention are therefore likely to be successful. It is the aim of this review article to explore the links between attraction and retention factors and strategies, with a particular focus on the organisational diversity and location of decision-making. Methods This is a narrative literature review which took an iterative approach to finding relevant literature. It focused on English-language material published between 1997 and 2007. The authors conducted Pubmed searches using a range of different search terms relating to attraction and retention of staff in remote areas. Furthermore, a number of relevant journals as well as unpublished literature were systematically searched. While the initial search included articles from high- middle- and low-income countries, the review focuses on middle- and low-income countries. About 600 papers were

  2. Information needs of health care workers in developing countries: a literature review with a focus on Africa

    PubMed Central

    Pakenham-Walsh, Neil; Bukachi, Frederick

    2009-01-01

    Health care workers in developing countries continue to lack access to basic, practical information to enable them to deliver safe, effective care. This paper provides the first phase of a broader literature review of the information and learning needs of health care providers in developing countries. A Medline search revealed 1762 papers, of which 149 were identified as potentially relevant to the review. Thirty-five of these were found to be highly relevant. Eight of the 35 studies looked at information needs as perceived by health workers, patients and family/community members; 14 studies assessed the knowledge of health workers; and 8 looked at health care practice. The studies suggest a gross lack of knowledge about the basics on how to diagnose and manage common diseases, going right across the health workforce and often associated with suboptimal, ineffective and dangerous health care practices. If this level of knowledge and practice is representative, as it appears to be, it indicates that modern medicine, even at a basic level, has largely failed the majority of the world's population. The information and learning needs of family caregivers and primary and district health workers have been ignored for too long. Improving the availability and use of relevant, reliable health care information has enormous potential to radically improve health care worldwide. PMID:19356239

  3. Policies for the Sustainable Development of Biofuels in the Pan American Region: A Review and Synthesis of Five Countries

    NASA Astrophysics Data System (ADS)

    Solomon, Barry D.; Banerjee, Aparajita; Acevedo, Alberto; Halvorsen, Kathleen E.; Eastmond, Amarella

    2015-12-01

    Rapid growth of biofuel production in the United States and Brazil over the past decade has increased interest in replicating this success in other nations of the Pan American region. However, the continued use of food-based feedstock such as maize is widely seen as unsustainable and is in some cases linked to deforestation and increased greenhouse gas emissions, raising further doubts about long-term sustainability. As a result, many nations are exploring the production and use of cellulosic feedstock, though progress has been extremely slow. In this paper, we will review the North-South axis of biofuel production in the Pan American region and its linkage with the agricultural sectors in five countries. Focus will be given to biofuel policy goals, their results to date, and consideration of sustainability criteria and certification of producers. Policy goals, results, and sustainability will be highlighted for the main biofuel policies that have been enacted at the national level. Geographic focus will be given to the two largest producers—the United States and Brazil; two smaller emerging producers—Argentina and Canada; and one stalled program—Mexico. However, several additional countries in the region are either producing or planning to produce biofuels. We will also review alternative international governance schemes for biofuel sustainability that have been recently developed, and whether the biofuel programs are being managed to achieve improved environmental quality and sustainable development.

  4. Application of constructed wetlands for wastewater treatment in developing countries--a review of recent developments (2000-2013).

    PubMed

    Zhang, Dong Qing; Jinadasa, K B S N; Gersberg, Richard M; Liu, Yu; Ng, Wun Jern; Tan, Soon Keat

    2014-08-01

    Inadequate access to clean water and sanitation has become one of the most pervasive problems afflicting people throughout the developing world. Replication of centralized water-, energy- and cost-intensive technologies has proved ineffective in resolving the complex water-related problems resulting from rapid urbanization in the developing countries. Instead constructed wetlands (CWs) have emerged and become a viable option for wastewater treatment, and are currently being recognized as attractive alternatives to conventional wastewater treatment methods. The primary objective of this review is to present a comprehensive overview of the diverse range of practice, applications and researches of CW systems for removing various contaminants from wastewater in developing countries, placing them in the overall context of the need for low-cost and sustainable wastewater treatment systems. Emphasis of this review is placed on the treatment performance of various types of CWs including: (i) free water surface flow CW; (ii) subsurface flow CW; (iii) hybrid systems; and, (iv) floating treatment wetland. The impacts of different wetland design and pertinent operational variables (e.g., hydraulic loading rate, vegetation species, physical configurations, and seasonal variation) on contaminant removal in CW systems are also summarized and highlighted. Finally, the cost and land requirements for CW systems are critically evaluated.

  5. Policies for the Sustainable Development of Biofuels in the Pan American Region: A Review and Synthesis of Five Countries.

    PubMed

    Solomon, Barry D; Banerjee, Aparajita; Acevedo, Alberto; Halvorsen, Kathleen E; Eastmond, Amarella

    2015-12-01

    Rapid growth of biofuel production in the United States and Brazil over the past decade has increased interest in replicating this success in other nations of the Pan American region. However, the continued use of food-based feedstock such as maize is widely seen as unsustainable and is in some cases linked to deforestation and increased greenhouse gas emissions, raising further doubts about long-term sustainability. As a result, many nations are exploring the production and use of cellulosic feedstock, though progress has been extremely slow. In this paper, we will review the North-South axis of biofuel production in the Pan American region and its linkage with the agricultural sectors in five countries. Focus will be given to biofuel policy goals, their results to date, and consideration of sustainability criteria and certification of producers. Policy goals, results, and sustainability will be highlighted for the main biofuel policies that have been enacted at the national level. Geographic focus will be given to the two largest producers-the United States and Brazil; two smaller emerging producers-Argentina and Canada; and one stalled program-Mexico. However, several additional countries in the region are either producing or planning to produce biofuels. We will also review alternative international governance schemes for biofuel sustainability that have been recently developed, and whether the biofuel programs are being managed to achieve improved environmental quality and sustainable development.

  6. When do newborns die? A systematic review of timing of overall and cause-specific neonatal deaths in developing countries

    PubMed Central

    Sankar, M J; Natarajan, C K; Das, R R; Agarwal, R; Chandrasekaran, A; Paul, V K

    2016-01-01

    About 99% of neonatal deaths occur in low- and middle-income countries. There is a paucity of information on the exact timing of neonatal deaths in these settings. The objective of this review was to determine the timing of overall and cause-specific neonatal deaths in developing country settings. We searched MEDLINE via PubMed, Cochrane CENTRAL, WHOLIS and CABI using sensitive search strategies. Searches were limited to studies involving humans published in the last 10 years. A total of 22 studies were included in the review. Pooled results indicate that about 62% of the total neonatal deaths occurred during the first 3 days of life; the first day alone accounted for two-thirds. Almost all asphyxia-related and the majority of prematurity- and malformation-related deaths occurred in the first week of life (98%, 83% and 78%, respectively). Only one-half of sepsis-related deaths occurred in the first week while one-quarter occurred in each of the second and third to fourth weeks of life. The distribution of both overall and cause-specific mortality did not differ greatly between Asia and Africa. The first 3 days after birth account for about 30% of under-five child deaths. The first week of life accounts for most of asphyxia-, prematurity- and malformation-related mortality and one-half of sepsis-related deaths. PMID:27109087

  7. Mental health issues among migrant workers in Gulf Cooperation Council countries: literature review and case illustrations.

    PubMed

    Kronfol, Ziad; Saleh, Marwa; Al-Ghafry, Maha

    2014-08-01

    More than 15 million non-nationals are currently living and working in Gulf Cooperation Council (GCC) states. The majority are blue-collar or domestic workers coming from the Indian Subcontinent or South East Asia. They often work under very harsh conditions. There are reports of a high rate of psychosis and suicide among these people but no reliable data are available. To address this issue we conducted a literature search both in English and in Arabic to review the available articles on the psychological well-being of this population. Very few articles were found. We hereby review the available literature and contribute by presenting several brief vignettes to illustrate the various clinical aspects of this at risk population. We also discuss possible reasons for underreporting and underscore the need for more research in this area.

  8. Dynamic Transmission Economic Evaluation of Infectious Disease Interventions in Low- and Middle-Income Countries: A Systematic Literature Review.

    PubMed

    Drake, Tom L; Devine, Angela; Yeung, Shunmay; Day, Nicholas P J; White, Lisa J; Lubell, Yoel

    2016-02-01

    Economic evaluation using dynamic transmission models is important for capturing the indirect effects of infectious disease interventions. We examine the use of these methods in low- and middle-income countries, where infectious diseases constitute a major burden. This review is comprised of two parts: (1) a summary of dynamic transmission economic evaluations across all disease areas published between 2011 and mid-2014 and (2) an in-depth review of mosquito-borne disease studies focusing on health economic methods and reporting. Studies were identified through a systematic search of the MEDLINE database and supplemented by reference list screening. Fifty-seven studies were eligible for inclusion in the all-disease review. The most common subject disease was HIV/AIDS, followed by malaria. A diverse range of modelling methods, outcome metrics and sensitivity analyses were used, indicating little standardisation. Seventeen studies were included in the mosquito-borne disease review. With notable exceptions, most studies did not employ economic evaluation methods beyond calculating a cost-effectiveness ratio or net benefit. Many did not adhere to health care economic evaluations reporting guidelines, particularly with respect to full model reporting and uncertainty analysis. We present a summary of the state-of-the-art and offer recommendations for improved implementation and reporting of health economic methods in this crossover discipline.

  9. Economic impacts of health shocks on households in low and middle income countries: a review of the literature

    PubMed Central

    2014-01-01

    Poor health is a source of impoverishment among households in low -and middle- income countries (LMICs) and a subject of voluminous literature in recent years. This paper reviews recent empirical literature on measuring the economic impacts of health shocks on households. Key inclusion criteria were studies that explored household level economic outcomes (burden of out-of-pocket (OOP) health spending, labour supply responses and non-medical consumption) of health shocks and sought to correct for the likely endogeneity of health shocks, in addition to studies that measured catastrophic and impoverishment effects of ill health. The review only considered literature in the English language and excluded studies published before 2000 since these have been included in previous reviews. We identified 105 relevant articles, reports, and books. Our review confirmed the major conclusion of earlier reviews based on the pre-2000 literature - that households in LMICs bear a high but variable burden of OOP health expenditure. Households use a range of sources such as income, savings, borrowing, using loans or mortgages, and selling assets and livestock to meet OOP health spending. Health shocks also cause significant reductions in labour supply among households in LMICs, and households (particularly low-income ones) are unable to fully smooth income losses from moderate and severe health shocks. Available evidence rejects the hypothesis of full consumption insurance in the face of major health shocks. Our review suggests additional research on measuring and harmonizing indicators of health shocks and economic outcomes, measuring economic implications of non-communicable diseases for households and analyses based on longitudinal data. Policymakers need to include non-health system interventions, including access to credit and disability insurance in addition to support formal insurance programs to ameliorate the economic impacts of health shocks. PMID:24708831

  10. Economic impacts of health shocks on households in low and middle income countries: a review of the literature.

    PubMed

    Alam, Khurshid; Mahal, Ajay

    2014-01-01

    Poor health is a source of impoverishment among households in low -and middle- income countries (LMICs) and a subject of voluminous literature in recent years. This paper reviews recent empirical literature on measuring the economic impacts of health shocks on households. Key inclusion criteria were studies that explored household level economic outcomes (burden of out-of-pocket (OOP) health spending, labour supply responses and non-medical consumption) of health shocks and sought to correct for the likely endogeneity of health shocks, in addition to studies that measured catastrophic and impoverishment effects of ill health. The review only considered literature in the English language and excluded studies published before 2000 since these have been included in previous reviews. We identified 105 relevant articles, reports, and books. Our review confirmed the major conclusion of earlier reviews based on the pre-2000 literature--that households in LMICs bear a high but variable burden of OOP health expenditure. Households use a range of sources such as income, savings, borrowing, using loans or mortgages, and selling assets and livestock to meet OOP health spending. Health shocks also cause significant reductions in labour supply among households in LMICs, and households (particularly low-income ones) are unable to fully smooth income losses from moderate and severe health shocks. Available evidence rejects the hypothesis of full consumption insurance in the face of major health shocks. Our review suggests additional research on measuring and harmonizing indicators of health shocks and economic outcomes, measuring economic implications of non-communicable diseases for households and analyses based on longitudinal data. Policymakers need to include non-health system interventions, including access to credit and disability insurance in addition to support formal insurance programs to ameliorate the economic impacts of health shocks. PMID:24708831

  11. Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review

    PubMed Central

    Basu, Sanjay; Andrews, Jason; Kishore, Sandeep; Panjabi, Rajesh; Stuckler, David

    2012-01-01

    Introduction Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. Methods and Findings Peer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of “private sector” included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. “Competitive dynamics” for

  12. Review of Electronic Decision-Support Tools for Diabetes Care: A Viable Option for Low- and Middle-Income Countries?

    PubMed Central

    Ali, Mohammed K; Shah, Seema; Tandon, Nikhil

    2011-01-01

    Context: Diabetes care is complex, requiring motivated patients, providers, and systems that enable guideline-based preventative care processes, intensive risk-factor control, and positive lifestyle choices. However, care delivery in low- and middle-income countries (LMIC) is hindered by a compendium of systemic and personal factors. While electronic medical records (EMR) and computerized clinical decision-support systems (CDSS) have held great promise as interventions that will overcome system-level challenges to improving evidence-based health care delivery, evaluation of these quality improvement interventions for diabetes care in LMICs is lacking. Objective and Data Sources: We reviewed the published medical literature (systematic search of MEDLINE database supplemented by manual searches) to assess the quantifiable and qualitative impacts of combined EMR–CDSS tools on physician performance and patient outcomes and their applicability in LMICs. Study Selection and Data Extraction: Inclusion criteria prespecified the population (type 1 or 2 diabetes patients), intervention (clinical EMR–CDSS tools with enhanced functionalities), and outcomes (any process, self-care, or patient-level data) of interest. Case, review, or methods reports and studies focused on nondiabetes, nonclinical, or in-patient uses of EMR–CDSS were excluded. Quantitative and qualitative data were extracted from studies by separate single reviewers, respectively, and relevant data were synthesized. Results: Thirty-three studies met inclusion criteria, originating exclusively from high-income country settings. Among predominantly experimental study designs, process improvements were consistently observed along with small, variable improvements in risk-factor control, compared with baseline and/or control groups (where applicable). Intervention benefits varied by baseline patient characteristics, features of the EMR–CDSS interventions, motivation and access to technology among patients

  13. Dietary management of childhood diarrhea in low- and middle-income countries: a systematic review

    PubMed Central

    2013-01-01

    Background Current WHO guidelines on the management and treatment of diarrhea in children strongly recommend continued feeding alongside the administration of oral rehydration solution and zinc therapy, but there remains some debate regarding the optimal diet or dietary ingredients for feeding children with diarrhea. Methods We conducted a systematic search for all published randomized controlled trials evaluating food-based interventions among children under five years old with diarrhea in low- and middle-income countries. We classified 29 eligible studies into one or more comparisons: reduced versus regular lactose liquid feeds, lactose-free versus lactose-containing liquid feeds, lactose-free liquid feeds versus lactose-containing mixed diets, and commercial/specialized ingredients versus home-available ingredients. We used all available outcome data to conduct random-effects meta-analyses to estimate the average effect of each intervention on diarrhea duration, stool output, weight gain and treatment failure risk for studies on acute and persistent diarrhea separately. Results Evidence of low-to-moderate quality suggests that among children with acute diarrhea, diluting or fermenting lactose-containing liquid feeds does not affect any outcome when compared with an ordinary lactose-containing liquid feeds. In contrast, moderate quality evidence suggests that lactose-free liquid feeds reduce duration and the risk of treatment failure compared to lactose-containing liquid feeds in acute diarrhea. Only limited evidence of low quality was available to assess either of these two approaches in persistent diarrhea, or to assess lactose-free liquid feeds compared to lactose-containing mixed diets in either acute or persistent diarrhea. For commercially prepared or specialized ingredients compared to home-available ingredients, we found low-to-moderate quality evidence of no effect on any outcome in either acute or persistent diarrhea, though when we restricted these

  14. Impact of high ambient temperature on unintentional injuries in high-income countries: a narrative systematic literature review

    PubMed Central

    Otte im Kampe, Eveline; Kovats, Sari; Hajat, Shakoor

    2016-01-01

    Objectives Given the likelihood of increased hot weather due to climate change, it is crucial to have prevention measures in place to reduce the health burden of high temperatures and heat waves. The aim of this review is to summarise and evaluate the evidence on the effects of summertime weather on unintentional injuries in high-income countries. Design 3 databases (Global Public Health, EMBASE and MEDLINE) were searched by using related keywords and their truncations in the title and abstract, and reference lists of key studies were scanned. Studies reporting heatstroke and intentional injuries were excluded. Results 13 studies met our inclusion criteria. 11 out of 13 studies showed that the risk of unintentional injuries increases with increasing ambient temperatures. On days with moderate temperatures, the increased risk varied between 0.4% and 5.3% for each 1°C increase in ambient temperature. On extreme temperature days, the risk of injuries decreased. 2 out of 3 studies on occupational accidents found an increase in work-related accidents during high temperatures. For trauma hospital admissions, 6 studies reported an increase during hot weather, whereas 1 study found no association. The evidence for impacts on injuries by subgroups such as children, the elderly and drug users was limited and inconsistent. Conclusions The present review describes a broader range of types of unintentional fatal and non-fatal injuries (occupational, trauma hospital admissions, traffic, fire entrapments, poisoning and drug overdose) than has previously been reported. Our review confirms that hot weather can increase the risk of unintentional injuries and accidents in high-income countries. The results are useful for injury prevention strategies. PMID:26868947

  15. A Political Review of International Literacy Meetings in Industrialized Countries, 1981-1994

    NASA Astrophysics Data System (ADS)

    Hautecoeur, Jean-Paul

    1997-03-01

    The author presents a historical survey of the official discourse on functional literacy in the industrialized countries on the basis of the reports of 20 seminars and international conferences linked to UNESCO. The article has two objectives: (1) to document and interpret globally the political evolution of the literacy movement in the north - in fact limited to western Europe and north America; (2) within the context of the Fifth International Conference on Adult Education, to pose the question: to what extent are the same issues involved throughout the world under the rubric of literacy? The author goes on to underline the broad geopolitical tendencies of the literacy movement, sketching its symbolic features and the tensions and areas of consensus within it. He traces the evolution of its dominant symbology and the ideological positions of its key figures. He concludes with a typology of the principal political tendencies of this movement, while making it clear that the real objectives of fighting poverty and exclusion are pursued outside the literacy movement and within the "minor literacies" of everyday life.

  16. A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries

    PubMed Central

    2013-01-01

    Background This systematic review provides a narrative synthesis of the evidence on the effectiveness of mental health promotion interventions for young people in low and middle-income countries (LMICs). Commissioned by the WHO, a review of the evidence for mental health promotion interventions across the lifespan from early years to adulthood was conducted. This paper reports on the findings for interventions promoting the positive mental health of young people (aged 6–18 years) in school and community-based settings. Methods Searching a range of electronic databases, 22 studies employing RCTs (N = 11) and quasi-experimental designs conducted in LMICs since 2000 were identified. Fourteen studies of school-based interventions implemented in eight LMICs were reviewed; seven of which included interventions for children living in areas of armed conflict and six interventions of multicomponent lifeskills and resilience training. Eight studies evaluating out-of-school community interventions for adolescents were identified in five countries. Using the Effective Public Health Practice Project (EPHPP) criteria, two reviewers independently assessed the quality of the evidence. Results The findings from the majority of the school-based interventions are strong. Structured universal interventions for children living in conflict areas indicate generally significant positive effects on students’ emotional and behavioural wellbeing, including improved self-esteem and coping skills. However, mixed results were also reported, including differential effects for gender and age groups, and two studies reported nonsignficant findings. The majority of the school-based lifeskills and resilience programmes received a moderate quality rating, with findings indicating positive effects on students’ self-esteem, motivation and self-efficacy. The quality of evidence from the community-based interventions for adolescents was moderate to strong with promising findings concerning the

  17. Emotional and Behavioral Problems in Migrant Children and Adolescents in American Countries: A Systematic Review.

    PubMed

    Belhadj Kouider, Esmahan; Koglin, Ute; Petermann, Franz

    2015-08-01

    The present review postulates the current mental health status in migrant children and adolescents in the North American continent. 35 studies published from 2009 to 2013 chosen from a systematic literature research were included. Almost all studies were conducted in the United States and Canada. From the perspective of selection effect, migration as a risk factor was not proven. The migration process perspective could have underestimated a higher danger of problem behavior in second-generation migrant children. Comparing native and migrant children, balanced results in problem behavior were reported, but the Asian migrant group was at higher risk of developing mental disorders. Family-based risk factors were offered: high acculturation stress, low English language competence, language brokering, discrepancies in children's and parent's cultural orientation, the non-Western cultural orientation, e.g., collectivistic, acceptance feelings of parents, or harsh parenting. However, the importance to support migrant families in the acculturation process becomes apparent. PMID:24851820

  18. Groundwater socio-ecology and governance: a review of institutions and policies in selected countries

    NASA Astrophysics Data System (ADS)

    Mukherji, Aditi; Shah, Tushaar

    2005-03-01

    Groundwater is crucial for the livelihoods and food security of millions of people, and yet, knowledge formation in the field of groundwater has remained asymmetrical. While, scientific knowledge in the discipline (hydrology and hydrogeology) has advanced remarkably, relatively little is known about the socio-economic impacts and institutions that govern groundwater use. This paper therefore has two objectives. The first is to provide a balanced view of the plus and the down side of groundwater use, especially in agriculture. In doing so, examples are drawn from countries such as India, Pakistan, Bangladesh, China, Spain and Mexico—all of which make very intensive use of groundwater. Second, institutions and policies that influence groundwater use are analyzed in order to understand how groundwater is governed in these countries and whether successful models of governance could be replicated elsewhere. Finally, the authors argue that there is a need for a paradigm shift in the way groundwater is presently perceived and managed—from management to governance mode. In this attempt, a number of instruments such as direct regulation, indirect policy levers, livelihood adaptation and people's participation will have to be deployed simultaneously in a quest for better governance. L'eau souterraine est cruciale pour la survie et la sécurité alimentaire de plusieurs millions de personnes mais cependant la foramtion en matière d'eaux souterraines reste asymmétrique. Alors que la connaissance scientifique dans la discipline (hydrologie et hydrogéologie) a avancée de manière remarquable, on connaît peu de choses sur les impacts socio-économiques et les institutions qui gouvernent l'utilisation des eaux souterraines. Cet article a par conséquent deux objectifs. Le premier est d'assurer un point de vue balancé entre le côté positif et le côté négatif de l'utilisation de l'eau souterraine, spécialement en agriculture. De cette manière, des exemples d

  19. Groundwater socio-ecology and governance: a review of institutions and policies in selected countries

    NASA Astrophysics Data System (ADS)

    Mukherji, Aditi; Shah, Tushaar

    2005-03-01

    Groundwater is crucial for the livelihoods and food security of millions of people, and yet, knowledge formation in the field of groundwater has remained asymmetrical. While, scientific knowledge in the discipline (hydrology and hydrogeology) has advanced remarkably, relatively little is known about the socio-economic impacts and institutions that govern groundwater use. This paper therefore has two objectives. The first is to provide a balanced view of the plus and the down side of groundwater use, especially in agriculture. In doing so, examples are drawn from countries such as India, Pakistan, Bangladesh, China, Spain and Mexico—all of which make very intensive use of groundwater. Second, institutions and policies that influence groundwater use are analyzed in order to understand how groundwater is governed in these countries and whether successful models of governance could be replicated elsewhere. Finally, the authors argue that there is a need for a paradigm shift in the way groundwater is presently perceived and managed—from management to governance mode. In this attempt, a number of instruments such as direct regulation, indirect policy levers, livelihood adaptation and people's participation will have to be deployed simultaneously in a quest for better governance. L'eau souterraine est cruciale pour la survie et la sécurité alimentaire de plusieurs millions de personnes mais cependant la foramtion en matière d'eaux souterraines reste asymmétrique. Alors que la connaissance scientifique dans la discipline (hydrologie et hydrogéologie) a avancée de manière remarquable, on connaît peu de choses sur les impacts socio-économiques et les institutions qui gouvernent l'utilisation des eaux souterraines. Cet article a par conséquent deux objectifs. Le premier est d'assurer un point de vue balancé entre le côté positif et le côté négatif de l'utilisation de l'eau souterraine, spécialement en agriculture. De cette manière, des exemples d

  20. Financial burden for tuberculosis patients in low- and middle-income countries: a systematic review.

    PubMed

    Tanimura, Tadayuki; Jaramillo, Ernesto; Weil, Diana; Raviglione, Mario; Lönnroth, Knut

    2014-06-01

    In order to inform the development of appropriate strategies to improve financial risk protection, we conducted a systematic literature review of the financial burden of tuberculosis (TB) faced by patients and affected families. The mean total costs ranged from $55 to $8198, with an unweighted average of $847. On average, 20% (range 0-62%) of the total cost was due to direct medical costs, 20% (0-84%) to direct non-medical costs, and 60% (16-94%) to income loss. Half of the total cost was incurred before TB treatment. On average, the total cost was equivalent to 58% (range 5-306%) of reported annual individual and 39% (4-148%) of reported household income. Cost as percentage of income was particularly high among poor people and those with multidrug-resistant TB. Commonly reported coping mechanisms included taking a loan and selling household items. The total cost of TB for patients can be catastrophic. Income loss often constitutes the largest financial risk for patients. Apart from ensuring that healthcare services are fairly financed and delivered in a way that minimises direct and indirect costs, there is a need to ensure that TB patients and affected families receive appropriate income replacement and other social protection interventions. PMID:24525439

  1. Financial burden for tuberculosis patients in low- and middle-income countries: a systematic review

    PubMed Central

    Tanimura, Tadayuki; Jaramillo, Ernesto; Weil, Diana; Raviglione, Mario; Lönnroth, Knut

    2014-01-01

    In order to inform the development of appropriate strategies to improve financial risk protection, we conducted a systematic literature review of the financial burden of tuberculosis (TB) faced by patients and affected families. The mean total costs ranged from $55 to $8198, with an unweighted average of $847. On average, 20% (range 0–62%) of the total cost was due to direct medical costs, 20% (0–84%) to direct non-medical costs, and 60% (16–94%) to income loss. Half of the total cost was incurred before TB treatment. On average, the total cost was equivalent to 58% (range 5–306%) of reported annual individual and 39% (4–148%) of reported household income. Cost as percentage of income was particularly high among poor people and those with multidrug-resistant TB. Commonly reported coping mechanisms included taking a loan and selling household items. The total cost of TB for patients can be catastrophic. Income loss often constitutes the largest financial risk for patients. Apart from ensuring that healthcare services are fairly financed and delivered in a way that minimises direct and indirect costs, there is a need to ensure that TB patients and affected families receive appropriate income replacement and other social protection interventions. PMID:24525439

  2. Behavior change interventions to prevent HIV infection among women living in low and middle income countries: a systematic review.

    PubMed

    McCoy, Sandra I; Kangwende, Rugare A; Padian, Nancy S

    2010-06-01

    We conducted a systematic review of behavioral change interventions to prevent the sexual transmission of HIV among women and girls living in low- and middle-income countries. PubMed/MEDLINE, Web of Science, the Cochrane Library, and other databases and bibliographies were systematically searched for trials using randomized or quasi-experimental designs to evaluate behavioral interventions with HIV infection as an outcome. We identified 11 analyses for inclusion reporting on eight unique interventions. Interventions varied widely in intensity, duration, and delivery as well as by target population. Only two analyses showed a significant protective effect on HIV incidence among women and only three of ten analyses that measured behavioral outcomes reduced any measure of HIV-related risk behavior. Ongoing research is needed to determine whether behavior change interventions can be incorporated as independent efficacious components in HIV prevention packages for women or simply as complements to biomedical prevention strategies. PMID:19949847

  3. Government regulation of pricing and reimbursement of prescription medicines: results of a recent multi-country review.

    PubMed

    Kingham, Richard; Wheeler, Joanna

    2009-01-01

    Access to prescription medicines is an essential component of publicly funded or publicly assisted healthcare programs. Thus, important policy questions are presented when government agencies that administer those programs establish procedures for making decisions about the appropriate use of medicines, including determinations as to which medicines will be reimbursed, at what prices, and for which patients. The authors reviewed systems for making determinations on pricing and reimbursement of prescription medicines under public healthcare systems in 10 countries, including four member states of the European Union (EU) (France, Germany, Italy and the United Kingdom), plus Australia, Brazil, China, India, Japan and Korea. In addition to national regulatory requirements, the authors considered international agreements that may impose obligations with respect to procedures for pricing and reimbursement of prescription medicines, including the EU's Transparency Directive, agreements administered by the World Trade Organization (WTO), and bilateral free trade agreements negotiated by the United States in recent years. Drawing on this experience, the authors sought to identify common themes, pitfalls and best practices in national systems for regulating pricing and reimbursement of prescription medicines. The authors have focused primarily on procedures, rather than the underlying political assumptions or substantive economic objectives. They have assumed that all countries have--or should have--a common interest in assuring that decision-making procedures afford interested persons who have relevant information a meaningful opportunity to participate

  4. The epilepsy treatment gap in developing countries: a systematic review of the magnitude, causes and intervention strategies

    PubMed Central

    Mbuba, Caroline K.; Ngugi, Anthony K.; Newton, Charles R.; Carter, Julie A.

    2013-01-01

    In many developing countries, people with epilepsy do not receive appropriate treatment for their condition, a phenomenon called the treatment gap (TG). We carried out a systematic review to investigate the magnitude, causes and intervention strategies to improve outcomes in developing countries. We systematically searched MEDLINE, EMBASE and PsycINFO databases, supplemented by a hand search of references in the key papers. The degree of heterogeneity and a pooled TG estimate were determined using meta-analysis techniques. The estimates were further stratified by continent and location of study (urban, rural). Twenty-seven studies met the inclusion criteria: twelve from Africa, nine from Asia and six from Latin America. We observed a high degree of heterogeneity and inconsistency between studies. The overall estimate of the TG was 56/100 (95% CI: 31.1-100.0). The variation in estimates could possibly be explained by non-uniform TG estimation methods and the diverse study populations, among other factors. The TG was mainly attributed to inadequate skilled manpower, cost of treatment, cultural beliefs and unavailability of anti-epileptic drugs (AEDs). These factors have been addressed using different intervention strategies for instance education and supply of AEDs. Future research should estimate the TG coherently and develop sustainable interventions that will address the causes. PMID:18557778

  5. Systematic Literature Review on ICF From 2001 to 2013 in the Nordic Countries Focusing on Clinical and Rehabilitation Context.

    PubMed

    Maribo, Thomas; Petersen, Kirsten S; Handberg, Charlotte; Melchiorsen, Hanne; Momsen, Anne-Mette H; Nielsen, Claus V; Leonardi, Matilde; Labriola, Merete

    2016-01-01

    We present a systematic review on International Classification of Functioning, Disability and Health (ICF) used in the Nordic countries from 2001 through 2013, describing and quantifying the development in utilization of ICF, and describe the extent to which the different components of the ICF have been used. A search was conducted in EMBASE, MEDLINE and PsycInfo. Papers from Nordic countries were included if ICF was mentioned in title or abstract. Papers were assigned to one of eight categories covering the wide rehabilitation area; furthermore, area of focus was assigned. Use of ICF components and intervention were coded in papers categorized as "clinical and/or rehabilitation contexts" or "non-clinical contexts". One hundred seventy papers were included, of these 99 papers were from the categories "clinical and/or rehabilitation contexts" or "non-clinical contexts". Forty-two percent of the 170 included papers were published in the period 2011 - 2013. There was an increase in ICF-relevant papers from 2001 to 2013, especially in the categories "clinical and/or rehabilitation contexts" and "non-clinical contexts". The most represented focus areas were neurology, musculoskeletal, and work-related areas. All five or at least four ICF components were mentioned in the results or discussions in most papers, and activity was most frequently mentioned.

  6. Ecology of West Nile virus across four European countries: review of weather profiles, vector population dynamics and vector control response.

    PubMed

    Chaskopoulou, Alexandra; L'Ambert, Gregory; Petric, Dusan; Bellini, Romeo; Zgomba, Marija; Groen, Thomas A; Marrama, Laurence; Bicout, Dominique J

    2016-01-01

    West Nile virus (WNV) represents a serious burden to human and animal health because of its capacity to cause unforeseen and large epidemics. Until 2004, only lineage 1 and 3 WNV strains had been found in Europe. Lineage 2 strains were initially isolated in 2004 (Hungary) and in 2008 (Austria) and for the first time caused a major WNV epidemic in 2010 in Greece with 262 clinical human cases and 35 fatalities. Since then, WNV lineage 2 outbreaks have been reported in several European countries including Italy, Serbia and Greece. Understanding the interaction of ecological factors that affect WNV transmission is crucial for preventing or decreasing the impact of future epidemics. The synchronous co-occurrence of competent mosquito vectors, virus, bird reservoir hosts, and susceptible humans is necessary for the initiation and propagation of an epidemic. Weather is the key abiotic factor influencing the life-cycles of the mosquito vector, the virus, the reservoir hosts and the interactions between them. The purpose of this paper is to review and compare mosquito population dynamics, and weather conditions, in three ecologically different contexts (urban/semi-urban, rural/agricultural, natural) across four European countries (Italy, France, Serbia, Greece) with a history of WNV outbreaks. Local control strategies will be described as well. Improving our understanding of WNV ecology is a prerequisite step for appraising and optimizing vector control strategies in Europe with the ultimate goal to minimize the probability of WNV infection. PMID:27590848

  7. Reforms from the Ground Up: A Review of Community-Based Forest Management in Tropical Developing Countries

    NASA Astrophysics Data System (ADS)

    Tole, Lise

    2010-06-01

    After an initial burst of enthusiasm in the 1990s, community-based forest management (CBFM) is increasingly being viewed with a critical eye. Evidence suggests that many programs have failed to promote their stated objectives of sustainability, efficiency, equity, democratic participation and poverty reduction. A large volume of academic literature now exists on CBFM, examining both the success and failure of such initiatives in a wide variety of countries. Through analysis of key themes, concepts and issues in CBFM, this article provides a review of CBFM initiatives in tropical developing countries for policymakers, practitioners and planners wishing to gain an understanding of this wide-ranging, interdisciplinary academic literature. The article identifies key institutions and incentives that appear to significantly affect the success or failure of CBFM initiatives. In particular, it reports that consideration of institutional and socioeconomic factors along with personal characteristics of key stakeholders such as beliefs, attitudes, financial resources and skills are important determinants of CBFM outcomes. However, local incentive structures also appear to be important. There is increasing recognition in the literature of the need to consider the conditions under which local politicians entrusted with carrying out CBFM initiatives will deem it worthwhile to invest their scarce time and resources on environmental governance.

  8. Ecology of West Nile virus across four European countries: review of weather profiles, vector population dynamics and vector control response.

    PubMed

    Chaskopoulou, Alexandra; L'Ambert, Gregory; Petric, Dusan; Bellini, Romeo; Zgomba, Marija; Groen, Thomas A; Marrama, Laurence; Bicout, Dominique J

    2016-01-01

    West Nile virus (WNV) represents a serious burden to human and animal health because of its capacity to cause unforeseen and large epidemics. Until 2004, only lineage 1 and 3 WNV strains had been found in Europe. Lineage 2 strains were initially isolated in 2004 (Hungary) and in 2008 (Austria) and for the first time caused a major WNV epidemic in 2010 in Greece with 262 clinical human cases and 35 fatalities. Since then, WNV lineage 2 outbreaks have been reported in several European countries including Italy, Serbia and Greece. Understanding the interaction of ecological factors that affect WNV transmission is crucial for preventing or decreasing the impact of future epidemics. The synchronous co-occurrence of competent mosquito vectors, virus, bird reservoir hosts, and susceptible humans is necessary for the initiation and propagation of an epidemic. Weather is the key abiotic factor influencing the life-cycles of the mosquito vector, the virus, the reservoir hosts and the interactions between them. The purpose of this paper is to review and compare mosquito population dynamics, and weather conditions, in three ecologically different contexts (urban/semi-urban, rural/agricultural, natural) across four European countries (Italy, France, Serbia, Greece) with a history of WNV outbreaks. Local control strategies will be described as well. Improving our understanding of WNV ecology is a prerequisite step for appraising and optimizing vector control strategies in Europe with the ultimate goal to minimize the probability of WNV infection.

  9. Systematic Literature Review on ICF From 2001 to 2013 in the Nordic Countries Focusing on Clinical and Rehabilitation Context

    PubMed Central

    Maribo, Thomas; Petersen, Kirsten S.; Handberg, Charlotte; Melchiorsen, Hanne; Momsen, Anne-Mette H.; Nielsen, Claus V.; Leonardi, Matilde; Labriola, Merete

    2016-01-01

    We present a systematic review on International Classification of Functioning, Disability and Health (ICF) used in the Nordic countries from 2001 through 2013, describing and quantifying the development in utilization of ICF, and describe the extent to which the different components of the ICF have been used. A search was conducted in EMBASE, MEDLINE and PsycInfo. Papers from Nordic countries were included if ICF was mentioned in title or abstract. Papers were assigned to one of eight categories covering the wide rehabilitation area; furthermore, area of focus was assigned. Use of ICF components and intervention were coded in papers categorized as “clinical and/or rehabilitation contexts” or “non-clinical contexts”. One hundred seventy papers were included, of these 99 papers were from the categories “clinical and/or rehabilitation contexts” or “non-clinical contexts”. Forty-two percent of the 170 included papers were published in the period 2011 - 2013. There was an increase in ICF-relevant papers from 2001 to 2013, especially in the categories “clinical and/or rehabilitation contexts” and “non-clinical contexts”. The most represented focus areas were neurology, musculoskeletal, and work-related areas. All five or at least four ICF components were mentioned in the results or discussions in most papers, and activity was most frequently mentioned. PMID:26668676

  10. A review of literature on drug use in Sub-Saharan Africa countries and its economic and social implications.

    PubMed

    Affinnih, Y H

    1999-02-01

    The drug problem in Africa cannot be seen as an isolated phenomenon but rather as part of the larger narcoscape which partakes of the fluid yet disjunctive qualities of Appadurai's landscapes. In this volatile environment, the transformation of Sub-Saharan Africa (SSA) nations from transit points in an international drug network to consumer countries seems inevitable. At the same time, Africa has undergone rapid economic and social changes that have facilitate this shift. A review of the literature reveals that there is a pressing need to investigate current trends and patterns of drug use in the countries of SSA. These nations, struggling with the consequences of AIDS, famine, refugees, and political unrest, could ill afford to address the consequences of widespread drug use. It is critical, therefore, that they address the drug problem before it reaches crisis proportions. To do so, they need information describing the magnitude of the problem as well as a firm understanding of the relationships between drug use and crime, unemployment, violence, and the breakdown of family life. The more that is known about the nature and complexity of drug use in Africa, the better policymakers can formulate a sound and effective strategy to curtail the drug "epidemic."

  11. Dietary Determinants of and Possible Solutions to Iron Deficiency for Young Women Living in Industrialized Countries: A Review

    PubMed Central

    Beck, Kathryn L.; Conlon, Cathryn A.; Kruger, Rozanne; Coad, Jane

    2014-01-01

    Iron deficiency is a concern in both developing and developed (industrialized) countries; and young women are particularly vulnerable. This review investigates dietary determinants of and possible solutions to iron deficiency in young women living in industrialized countries. Dietary factors including ascorbic acid and an elusive factor in animal protein foods (meat; fish and poultry) enhance iron absorption; while phytic acid; soy protein; calcium and polyphenols inhibit iron absorption. However; the effects of these dietary factors on iron absorption do not necessarily translate into an association with iron status and iron stores (serum ferritin concentration). In cross-sectional studies; only meat intake has consistently (positively) been associated with higher serum ferritin concentrations. The enhancing effects of ascorbic acid and meat on iron absorption may be negated by the simultaneous consumption of foods and nutrients which are inhibitory. Recent cross-sectional studies have considered the combination and timing of foods consumed; with mixed results. Dietary interventions using a range of focused dietary measures to improve iron status appear to be more effective than dietary approaches that focus on single nutrients or foods. Further research is needed to determine optimal dietary recommendations for both the prevention and treatment of iron deficiency. PMID:25244367

  12. Early-life conditions and older adult health in low- and middle-income countries: a review.

    PubMed

    McEniry, M

    2013-02-01

    Population aging and subsequent projected large increases in chronic conditions will be important health concerns in low- and middle-income countries. Although evidence is accumulating, little is known regarding the impact of poor early-life conditions on older adult (50 years and older) health in these settings. A systematic review of 1141 empirical studies was conducted to identify population-based and community studies in low- and middle-income countries, which examined associations between early-life conditions and older adult health. The resulting review of 20 studies revealed strong associations between (1) in utero/early infancy exposures (independent of other early life and adult conditions) and adult heart disease and diabetes; (2) poor nutrition during childhood and difficulties in adult cognition and diabetes; (3) specific childhood illnesses such as rheumatic fever and malaria and adult heart disease and mortality; (4) poor childhood health and adult functionality/disability and chronic diseases; (5) poor childhood socioeconomic status (SES) and adult mortality, functionality/disability and cognition; and (6) parental survival during childhood and adult functionality/disability and cognition. In several instances, associations remained strong even after controlling for adult SES and lifestyle. Although exact mechanisms cannot be identified, these studies reinforce to some extent the importance of early-life environment on health at older ages. Given the paucity of cohort data from the developing world to examine hypotheses of early-life conditions and older adult health, population-based studies are relevant in providing a broad perspective on the origins of adult health.

  13. Childhood dual burden of under- and over-nutrition in low- and middle-income countries: a critical review

    PubMed Central

    Tzioumis, Emma; Adair, Linda S.

    2015-01-01

    Background In low- and middle income countries, the distribution of childhood nutritional diseases is shifting from a predominance of undernutrition to a dual burden of under- and overnutrition. This novel and complex problem challenges governments and health organizations to tackle opposite ends of the malnutrition spectrum. The dual burden may manifest within a community, household, or individual, but these different levels have not been addressed collectively. Objective To critically review literature on the prevalence, trends, and predictors of the dual burden, with a focus on children from birth to 18 years. Methods We reviewed literature since January 1, 1990, published in English, using the PubMed search terms: nutrition transition, double burden, dual burden, nutrition status, obesity, overweight, underweight, stunting, body composition, and micronutrient deficiencies. Findings were classified and described according to dual burden level (community, household, individual). Results Global trends indicate decreases in diseases of undernutrition, while overnutrition is increasing. On the community level, economic status may influence the dual burden’s extent, with obesity increasingly affecting the already undernourished poor. In a household, shared determinants of poor nutritional status among members can result in disparate nutritional status across generations. Within an individual, obesity may co-occur with stunting or anemia, due to shared underlying determinants or physiologic links. Conclusions The dual burden of malnutrition poses a threat to children’s health in low- and middle-income countries. We must remain committed to reducing undernutrition while simultaneously preventing overnutrition, through integrated child health programs that incorporate prevention of infection, diet quality, and physical activity. PMID:25076771

  14. A review of potable water accessibility and sustainability issues in developing countries - case study of Uganda.

    PubMed

    Nayebare, Shedrack R; Wilson, Lloyd R; Carpenter, David O; Dziewulski, David M; Kannan, Kurunthachalam

    2014-01-01

    Providing sources of sustainable and quality potable water in Uganda is a significant public health issue. This project aimed at identifying and prioritizing possible actions on how sustainable high quality potable water in Uganda's water supply systems could be achieved. In that respect, a review of both the current water supply systems and government programs on drinking water in Uganda was completed. Aspects of quantity, quality, treatment methods, infrastructure, storage and distribution of water for different water systems were evaluated and compared with the existing water supply systems in the U.S., Latin America and the Caribbean, for purposes of generating feasible recommendations and opportunities for improvement. Uganda utilizes surface water, groundwater, and rainwater sources for consumption. Surface water covers 15.4% of the land area and serves both urban and rural populations. Lake Victoria contributes about 85% of the total fresh surface water. Potable water quality is negatively affected by the following factors: disposal of sewage and industrial effluents, agricultural pesticides and fertilizers, and surface run-offs during heavy rains. The total renewable groundwater resources in Uganda are estimated to be 29 million m3/year with about 20,000 boreholes, 3000 shallow-wells and 200,000 springs, serving more than 80% of the rural and slum communities. Mean annual rainfall in Uganda ranges from 500 mm to 2500 mm. Groundwater and rainwater quality is mainly affected by poor sanitation and unhygienic practices. There are significant regional variations in the accessibility of potable water, with the Northeastern region having the least amount of potable water from all sources. Uganda still lags behind in potable water resource development. Priorities should be placed mainly on measures available for improvement of groundwater and rainwater resource utilization, protection of watersheds, health education, improved water treatment methods and

  15. The financial burden from non-communicable diseases in low- and middle-income countries: a literature review

    PubMed Central

    2013-01-01

    Non-communicable diseases (NCDs) were previously considered to only affect high-income countries. However, they now account for a very large burden in terms of both mortality and morbidity in low- and middle-income countries (LMICs), although little is known about the impact these diseases have on households in these countries. In this paper, we present a literature review on the costs imposed by NCDs on households in LMICs. We examine both the costs of obtaining medical care and the costs associated with being unable to work, while discussing the methodological issues of particular studies. The results suggest that NCDs pose a heavy financial burden on many affected households; poor households are the most financially affected when they seek care. Medicines are usually the largest component of costs and the use of originator brand medicines leads to higher than necessary expenses. In particular, in the treatment of diabetes, insulin – when required – represents an important source of spending for patients and their families. These financial costs deter many people suffering from NCDs from seeking the care they need. The limited health insurance coverage for NCDs is reflected in the low proportions of patients claiming reimbursement and the low reimbursement rates in existing insurance schemes. The costs associated with lost income-earning opportunities are also significant for many households. Therefore, NCDs impose a substantial financial burden on many households, including the poor in low-income countries. The financial costs of obtaining care also impose insurmountable barriers to access for some people, which illustrates the urgency of improving financial risk protection in health in LMIC settings and ensuring that NCDs are taken into account in these systems. In this paper, we identify areas where further research is needed to have a better view of the costs incurred by households because of NCDs; namely, the extension of the geographical scope, the

  16. The efficacy of interventions to reduce adolescent childbearing in low- and middle-income countries: a systematic review.

    PubMed

    McQueston, Kate; Silverman, Rachel; Glassman, Amanda

    2013-12-01

    This study reviews the scope and quality of existing literature regarding the interventions to reduce adolescent childbearing in low- and middle-income countries and compiles findings concerning their effectiveness. A total of 737 studies published between 2000 and 2011 were reviewed; 19 were identified as meeting eligibility criteria. Studies were included that: evaluated program effects on adolescents and young people, either as the primary target population or as a subset of a broader target group; evaluated an intervention intended to reduce adolescent fertility or generate improvements on a related outcome; and reported childbearing-related outcomes. Evidence indicates that a variety of interventions may be successful at reducing fertility, including school-based programs, health counseling, and cash transfers. An overview of evaluation efforts to date is provided, and potential best practices are highlighted. Conclusions are that funding for adolescent fertility initiatives should be directed toward programs for which a sound evidence base exists, such as cash transfers or other interventions that encourage school enrollment, and that programs of unknown effectiveness should be conducted in tandem with rigorous evaluation. PMID:24323658

  17. Factors Influencing Household Uptake of Improved Solid Fuel Stoves in Low- and Middle-Income Countries: A Qualitative Systematic Review

    PubMed Central

    Debbi, Stanistreet; Elisa, Puzzolo; Nigel, Bruce; Dan, Pope; Eva, Rehfuess

    2014-01-01

    Household burning of solid fuels in traditional stoves is detrimental to health, the environment and development. A range of improved solid fuel stoves (IS) are available but little is known about successful approaches to dissemination. This qualitative systematic review aimed to identify factors that influence household uptake of IS in low- and middle-income countries. Extensive searches were carried out and studies were screened and extracted using established systematic review methods. Fourteen qualitative studies from Asia, Africa and Latin-America met the inclusion criteria. Thematic synthesis was used to synthesise data and findings are presented under seven framework domains. Findings relate to user and stakeholder perceptions and highlight the importance of cost, good stove design, fuel and time savings, health benefits, being able to cook traditional dishes and cleanliness in relation to uptake. Creating demand, appropriate approaches to business, and community involvement, are also discussed. Achieving and sustaining uptake is complex and requires consideration of a broad range of factors, which operate at household, community, regional and national levels. Initiatives aimed at IS scale up should include quantitative evaluations of effectiveness, supplemented with qualitative studies to assess factors affecting uptake, with an equity focus. PMID:25123070

  18. The efficacy of interventions to reduce adolescent childbearing in low- and middle-income countries: a systematic review.

    PubMed

    McQueston, Kate; Silverman, Rachel; Glassman, Amanda

    2013-12-01

    This study reviews the scope and quality of existing literature regarding the interventions to reduce adolescent childbearing in low- and middle-income countries and compiles findings concerning their effectiveness. A total of 737 studies published between 2000 and 2011 were reviewed; 19 were identified as meeting eligibility criteria. Studies were included that: evaluated program effects on adolescents and young people, either as the primary target population or as a subset of a broader target group; evaluated an intervention intended to reduce adolescent fertility or generate improvements on a related outcome; and reported childbearing-related outcomes. Evidence indicates that a variety of interventions may be successful at reducing fertility, including school-based programs, health counseling, and cash transfers. An overview of evaluation efforts to date is provided, and potential best practices are highlighted. Conclusions are that funding for adolescent fertility initiatives should be directed toward programs for which a sound evidence base exists, such as cash transfers or other interventions that encourage school enrollment, and that programs of unknown effectiveness should be conducted in tandem with rigorous evaluation.

  19. Systematic Review of Breast Cancer Biology in Developing Countries (Part 2): Asian Subcontinent and South East Asia

    PubMed Central

    Bhikoo, Riyaz; Srinivasa, Sanket; Yu, Tzu-Chieh; Moss, David; Hill, Andrew G

    2011-01-01

    There has been no systematic appraisal of ethnicity-based variations in breast cancer (BC) biology amongst women from developing countries. A qualitative systematic review was conducted of breast cancer size, stage, grade, histological type, extra-mammary involvement, hormone receptor status as well as patient demographics. This review includes patients from Africa, the Middle East, Eastern Europe, Mexico, the Caribbean and South America. BC in these regions present at an earlier age with large aggressive tumours. Distant metastases are frequently present at the time of diagnosis. African women have a higher frequency of triple negative tumours. Over half of Middle Eastern women have lymph node involvement at the time of diagnosis. Despite experiencing a lower incidence compared to the Ashkenazi Jewish population, Palestinian women have poorer five-year survival outcomes. The majority of women from Mexico and South America have stage two or three disease whilst over sixty percent of women from Eastern Europe have either stage one or stage two disease. The biological characteristics of BC in the Caribbean cannot be fully assessed due to a paucity of data from the region. BC amongst the developing world is characterised by an early peak age of onset with aggressive biological characteristics. Strategies that improve breast cancer awareness, address amenable risk factors and improve early detection are essential. PMID:24212815

  20. Linking governance mechanisms to health outcomes: a review of the literature in low- and middle-income countries.

    PubMed

    Ciccone, Dana Karen; Vian, Taryn; Maurer, Lydia; Bradley, Elizabeth H

    2014-09-01

    We conducted a synthesis of peer-reviewed literature to shed light on links between governance mechanisms and health outcomes in low- and middle-income countries. Our review yielded 30 studies, highlighting four key governance mechanisms by which governance may influence health outcomes in these settings: Health system decentralization that enables responsiveness to local needs and values; health policymaking that aligns and empowers diverse stakeholders; enhanced community engagement; and strengthened social capital. Most, but not all, studies found a positive association between governance and health. Additionally, the nature of the association between governance mechanisms and health differed across studies. In some studies (N = 9), the governance effect was direct and positive, while in others (N = 5), the effect was indirect or modified by contextual factors. In still other studies (N = 4), governance was found to have a moderating effect, indicating that governance mechanisms influenced other system processes or structures that improved health. The remaining studies reported mixed findings about the association between governance and health (N = 6), no association between governance and health (N = 4), or had inconclusive results (N = 2). Further exploration is needed to fully understand the relationship between governance and health and to inform the design and delivery of evidence-based, effective governance interventions around the world.

  1. Does performance-based financing increase value for money in low- and middle- income countries? A systematic review.

    PubMed

    Turcotte-Tremblay, Anne-Marie; Spagnolo, Jessica; De Allegri, Manuela; Ridde, Valéry

    2016-12-01

    Governments of low- and middle-income countries (LMICs) are widely implementing performance-based financing (PBF) to improve healthcare services. However, it is unclear whether PBF provides good value for money compared to status quo or other interventions aimed at strengthening the healthcare system in LMICs. The objective of this systematic review is to identify and synthesize the existing literature that examines whether PBF represents an efficient manner of investing resources. We considered PBF to be efficient when improved care quality or quantity was achieved with equal or lower costs, or alternatively, when the same quality of care was achieved using less financial resources. A manual search of the reference lists of two recent systematic reviews on economic evaluations of PBF was conducted to identify articles that met our inclusion and exclusion criteria. Subsequently, a search strategy was developed with the help of a librarian. The following databases and search engines were used: PubMed, EconLit, Google Scholar and Google. Experts on economic evaluations were consulted for validation of the selected studies. A total of seven articles from five LMICs were selected for this review. We found the overall strength of the evidence to be weak. None of the articles were full economic evaluations; they did not make clear connections between the costs and effects of PBF. Only one study reported using a randomized controlled trial, but issues with the randomization procedure were reported. Important alternative interventions to strengthen the capacities of the healthcare system have not been considered. Few studies examined the costs and consequences of PBF in the long term. Important costs and consequences were omitted from the evaluations. Few LMICs are represented in the literature, despite wide implementation. Lastly, most articles had at least one author employed by an organization involved in the implementation of PBF, thereby resulting in potential

  2. Does performance-based financing increase value for money in low- and middle- income countries? A systematic review.

    PubMed

    Turcotte-Tremblay, Anne-Marie; Spagnolo, Jessica; De Allegri, Manuela; Ridde, Valéry

    2016-12-01

    Governments of low- and middle-income countries (LMICs) are widely implementing performance-based financing (PBF) to improve healthcare services. However, it is unclear whether PBF provides good value for money compared to status quo or other interventions aimed at strengthening the healthcare system in LMICs. The objective of this systematic review is to identify and synthesize the existing literature that examines whether PBF represents an efficient manner of investing resources. We considered PBF to be efficient when improved care quality or quantity was achieved with equal or lower costs, or alternatively, when the same quality of care was achieved using less financial resources. A manual search of the reference lists of two recent systematic reviews on economic evaluations of PBF was conducted to identify articles that met our inclusion and exclusion criteria. Subsequently, a search strategy was developed with the help of a librarian. The following databases and search engines were used: PubMed, EconLit, Google Scholar and Google. Experts on economic evaluations were consulted for validation of the selected studies. A total of seven articles from five LMICs were selected for this review. We found the overall strength of the evidence to be weak. None of the articles were full economic evaluations; they did not make clear connections between the costs and effects of PBF. Only one study reported using a randomized controlled trial, but issues with the randomization procedure were reported. Important alternative interventions to strengthen the capacities of the healthcare system have not been considered. Few studies examined the costs and consequences of PBF in the long term. Important costs and consequences were omitted from the evaluations. Few LMICs are represented in the literature, despite wide implementation. Lastly, most articles had at least one author employed by an organization involved in the implementation of PBF, thereby resulting in potential

  3. Social networks and health: a systematic review of sociocentric network studies in low- and middle-income countries.

    PubMed

    Perkins, Jessica M; Subramanian, S V; Christakis, Nicholas A

    2015-01-01

    In low- and middle-income countries (LMICs), naturally occurring social networks may be particularly vital to health outcomes as extended webs of social ties often are the principal source of various resources. Understanding how social network structure, and influential individuals within the network, may amplify the effects of interventions in LMICs, by creating, for example, cascade effects to non-targeted participants, presents an opportunity to improve the efficiency and effectiveness of public health interventions in such settings. We conducted a systematic review of PubMed, Econlit, Sociological Abstracts, and PsycINFO to identify a sample of 17 sociocentric network papers (arising from 10 studies) that specifically examined health issues in LMICs. We also separately selected to review 19 sociocentric network papers (arising from 10 other studies) on development topics related to wellbeing in LMICs. First, to provide a methodological resource, we discuss the sociocentric network study designs employed in the selected papers, and then provide a catalog of 105 name generator questions used to measure social ties across all the LMIC network papers (including both ego- and sociocentric network papers) cited in this review. Second, we show that network composition, individual network centrality, and network structure are associated with important health behaviors and health and development outcomes in different contexts across multiple levels of analysis and across distinct network types. Lastly, we highlight the opportunities for health researchers and practitioners in LMICs to 1) design effective studies and interventions in LMICs that account for the sociocentric network positions of certain individuals and overall network structure, 2) measure the spread of outcomes or intervention externalities, and 3) enhance the effectiveness and efficiency of aid based on knowledge of social structure. In summary, human health and wellbeing are connected through complex

  4. Investigating the orientation of eleven mosques in Greece

    NASA Astrophysics Data System (ADS)

    Pantazis, George; Lambrou, Evangelia

    2009-07-01

    This paper investigates the orientation of eleven mosques situated in several regions of Greece. The aim of this work is to verify whether and how accurately the monuments have been constructed according to the Muslim tradition. As geodetic and astrogeodetic methods are used, the geometric documentation of each monument is carried out and its astronomical orientation is determined. The qibla for each monument is calculated by using geodetic equations. The mosques' main axis azimuths are determined by a precision of some arc minutes. Also, their orientation, relative to the Canopus star (Alpha Carinae) - which the tradition has closely related to Kaabah in Mecca - is examined. All the mosques seem to follow the religious rule.

  5. Tuberculosis Treatment Non-Adherence and Lost to Follow Up among TB Patients with or without HIV in Developing Countries: A Systematic Review.

    PubMed

    Tola, Habteyes Hailu; Tol, Azar; Shojaeizadeh, Davoud; Garmaroudi, Gholamreza

    2015-01-01

    This systematic review intended to combine factors associated with tuberculosis treatment non-adherence and lost to follow up among TB patients with/without HIV in developing countries. Comprehensive remote electronic databases (MEDLINE, (PMC, Pub Med Central), Google scholar and Web of science) search was conducted using the following keywords: Tuberculosis, treatment, compliance, adherence, default, behavioural factors and socioeconomic factors. All types of studies intended to assess TB treatment non-adherence and lost to follow up in developing countries among adult TB patient from 2008 to data extraction date were included. Twenty-six original and one-reviewed articles, which meet inclusion criteria, were reviewed. TB treatment non-adherence and lost to follow up were continued across developing countries. The main factors associated with TB treatment non-adherence and lost to follow up were socioeconomic factors: lack of transportation cost, lack of social support, and patients-health care worker poor communication. Behavioural factors were Feeling better after few weeks of treatments, tobacco and alcohol use, knowledge deficit about duration of treatment and consequences of non-adherence and lost to follow up. TB treatment non-adherence and lost to follow up were continued across developing countries throughout the publication years of reviewed articles. Numerous, socioeconomic and behavioural factors were influencing TB treatment adherence and lost to follow up. Therefore, well understanding and minimizing of the effect of these associated factors is very important to enhance treatment adherence and follow up completion in developing countries.

  6. School-based interventions for minors in war-exposed countries: a review of targeted and general programmes.

    PubMed

    Persson, T J; Rousseau, C

    2009-01-01

    Lately, there has been a call to develop and assess efficacious mental health interventions for minors who have witnessed organized violence. This review outlines what is currently known about targeted and general school-based interventions for children and adolescents in war exposed countries. Seven empirical outcome studies were identified from a PubMed and PsychINFO search; four targeted and three general programmes. Despite the paucity of published evidence, some promising findings were noted. School-based interventions implemented by locally trained paraprofessionals in organized violence settings appear to be a feasible and low cost sustainable alternative to individualized therapy for distressed children in low and middle income countries. However, the reported outcomes for treatment effectiveness were mixed and suggest that school-based group crisis interventions for traumatized war exposed minors may not be sufficient to reduce mental distress and may sometimes even increase it. Several limitations in the published literature were observed. Although studies reported changes in symptoms associated with interventions, most did not report on the degree of functional impairment. Further, there may be a need to develop interventions targeting other dimensions of organized violence than post-traumatic distress, for example, depression and maladaptive grief. At this point in time it is difficult to compare targeted versus general interventions. There may be risks associated with screening minors, and studies should weigh the cost benefit of targeted versus broader treatment approaches. Future research should aim to determine which therapeutic ingredients, which could be professional-specific, such as manualized cognitive-behavioural therapy, culture-specific, or a combination, significantly contribute to positive outcomes. PMID:19920327

  7. Economic Analysis of Children’s Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis

    PubMed Central

    Poenaru, Dan; Ozgediz, Doruk; Ameh, Emmanuel A.; Farmer, Diana; Smith, Emily R.; Rice, Henry E.

    2016-01-01

    Background Understanding the economic value of health interventions is essential for policy makers to make informed resource allocation decisions. The objective of this systematic review was to summarize available information on the economic impact of children’s surgical care in low- and middle-income countries (LMICs). Methods We searched MEDLINE (Pubmed), Embase, and Web of Science for relevant articles published between Jan. 1996 and Jan. 2015. We summarized reported cost information for individual interventions by country, including all costs, disability weights, health outcome measurements (most commonly disability-adjusted life years [DALYs] averted) and cost-effectiveness ratios (CERs). We calculated median CER as well as societal economic benefits (using a human capital approach) by procedure group across all studies. The methodological quality of each article was assessed using the Drummond checklist and the overall quality of evidence was summarized using a scale adapted from the Agency for Healthcare Research and Quality. Findings We identified 86 articles that met inclusion criteria, spanning 36 groups of surgical interventions. The procedure group with the lowest median CER was inguinal hernia repair ($15/DALY). The procedure group with the highest median societal economic benefit was neurosurgical procedures ($58,977). We found a wide range of study quality, with only 35% of studies having a Drummond score ≥ 7. Interpretation Our findings show that many areas of children’s surgical care are extremely cost-effective in LMICs, provide substantial societal benefits, and are an appropriate target for enhanced investment. Several areas, including inguinal hernia repair, trichiasis surgery, cleft lip and palate repair, circumcision, congenital heart surgery and orthopedic procedures, should be considered “Essential Pediatric Surgical Procedures” as they offer considerable economic value. However, there are major gaps in existing research quality

  8. Heart Failure Care in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

    PubMed Central

    Callender, Thomas; Woodward, Mark; Roth, Gregory; Farzadfar, Farshad; Lemarie, Jean-Christophe; Gicquel, Stéphanie; Atherton, John; Rahimzadeh, Shadi; Ghaziani, Mehdi; Shaikh, Maaz; Bennett, Derrick; Patel, Anushka; Lam, Carolyn S. P.; Sliwa, Karen; Barretto, Antonio; Siswanto, Bambang Budi; Diaz, Alejandro; Herpin, Daniel; Krum, Henry; Eliasz, Thomas; Forbes, Anna; Kiszely, Alastair; Khosla, Rajit; Petrinic, Tatjana; Praveen, Devarsetty; Shrivastava, Roohi; Xin, Du; MacMahon, Stephen; McMurray, John; Rahimi, Kazem

    2014-01-01

    Background Heart failure places a significant burden on patients and health systems in high-income countries. However, information about its burden in low- and middle-income countries (LMICs) is scant. We thus set out to review both published and unpublished information on the presentation, causes, management, and outcomes of heart failure in LMICs. Methods and Findings Medline, Embase, Global Health Database, and World Health Organization regional databases were searched for studies from LMICs published between 1 January 1995 and 30 March 2014. Additional unpublished data were requested from investigators and international heart failure experts. We identified 42 studies that provided relevant information on acute hospital care (25 LMICs; 232,550 patients) and 11 studies on the management of chronic heart failure in primary care or outpatient settings (14 LMICs; 5,358 patients). The mean age of patients studied ranged from 42 y in Cameroon and Ghana to 75 y in Argentina, and mean age in studies largely correlated with the human development index of the country in which they were conducted (r = 0.71, p<0.001). Overall, ischaemic heart disease was the main reported cause of heart failure in all regions except Africa and the Americas, where hypertension was predominant. Taking both those managed acutely in hospital and those in non-acute outpatient or community settings together, 57% (95% confidence interval [CI]: 49%–64%) of patients were treated with angiotensin-converting enzyme inhibitors, 34% (95% CI: 28%–41%) with beta-blockers, and 32% (95% CI: 25%–39%) with mineralocorticoid receptor antagonists. Mean inpatient stay was 10 d, ranging from 3 d in India to 23 d in China. Acute heart failure accounted for 2.2% (range: 0.3%–7.7%) of total hospital admissions, and mean in-hospital mortality was 8% (95% CI: 6%–10%). There was substantial variation between studies (p<0.001 across all variables), and most data were from urban tertiary referral centres

  9. Integration of antenatal care services with health programmes in low– and middle–income countries: systematic review

    PubMed Central

    de Jongh, Thyra E; Gurol–Urganci, Ipek; Allen, Elizabeth; Zhu, Nina Jiayue; Atun, Rifat

    2016-01-01

    Background Antenatal care (ANC) presents a potentially valuable platform for integrated delivery of additional health services for pregnant women–services that are vital to reduce the persistently high rates of maternal and neonatal mortality in low– and middle–income countries (LMICs). However, there is limited evidence on the impact of integrating health services with ANC to guide policy. This review assesses the impact of integration of postnatal and other health services with ANC on health services uptake and utilisation, health outcomes and user experience of care in LMICs. Methods Cochrane Library, MEDLINE, Embase, CINAHL Plus, POPLINE and Global Health were searched for studies that compared integrated models for delivery of postnatal and other health services with ANC to non–integrated models. Risk of bias of included studies was assessed using the Cochrane Effective Practice and Organisation of Care (EPOC) criteria and the Newcastle–Ottawa Scale, depending on the study design. Due to high heterogeneity no meta–analysis could be conducted. Results are presented narratively. Findings 12 studies were included in the review. Limited evidence, with moderate– to high–risk of bias, suggests that integrated service delivery results in improved uptake of essential health services for women, earlier initiation of treatment, and better health outcomes. Women also reported improved satisfaction with integrated services. Conclusions The reported evidence is largely based on non–randomised studies with poor generalizability, and therefore offers very limited policy guidance. More rigorously conducted and geographically diverse studies are needed to better ascertain and quantify the health and economic benefits of integrating health services with ANC. PMID:27231539

  10. The cost of injury and trauma care in low- and middle-income countries: a review of economic evidence

    PubMed Central

    Wesson, Hadley K H; Boikhutso, Nonkululeko; Bachani, Abdulgafoor M; Hofman, Karen J; Hyder, Adnan A

    2014-01-01

    Introduction Injuries are a significant cause of mortality and morbidity, of which more than 90% occur in low- and middle-income countries (LMICs). Given the extent of this burden being confronted by LMICs, there is need to place injury prevention at the forefront of public health initiatives and to understand the costs associated with injury. The aim of this article is to describe the extent to which injury-related costing studies have been conducted in LMICs. Methods A review of literature was performed to explore costing data available for injury and/or trauma care in LMICs. Study quality was described using recommendations from the Community Guide’s quality assessment tool for economic evaluations. Results The review identified 68 studies, of which 13 were full economic evaluations. Cost of injury varied widely with mean costs ranging from US$14 to US$17 400. In terms of injury-prevention interventions, cost per disability adjusted life year averted for injury-prevention interventions ranged from US$10.90 for speed bump installation to US$17 000 for drunk driving and breath testing campaigns in Africa. The studies varied in quality, ranging from very good to unsatisfactory. Discussion There is a lack of injury-related economic evidence from LMICs. Current costing research has considerable variability in the costs and cost descriptions of injury and associated prevention interventions. The generalizability of these studies is limited. Yet the economic burden of injury is high, suggesting significant potential for cost savings through injury prevention. A standardized approach to economic evaluation of injury in LMICs is needed to further prioritize investing in injury prevention. PMID:24097794

  11. Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review.

    PubMed

    Kok, Maryse C; Dieleman, Marjolein; Taegtmeyer, Miriam; Broerse, Jacqueline E W; Kane, Sumit S; Ormel, Hermen; Tijm, Mandy M; de Koning, Korrie A M

    2015-11-01

    Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors influence CHW performance. A systematic review was conducted to identify intervention design related factors influencing performance of CHWs. We systematically searched six databases for quantitative and qualitative studies that included CHWs working in promotional, preventive or curative primary health services in LMICs. One hundred and forty studies met the inclusion criteria, were quality assessed and double read to extract data relevant to the design of CHW programmes. A preliminary framework containing factors influencing CHW performance and characteristics of CHW performance (such as motivation and competencies) guided the literature search and review.A mix of financial and non-financial incentives, predictable for the CHWs, was found to be an effective strategy to enhance performance, especially of those CHWs with multiple tasks. Performance-based financial incentives sometimes resulted in neglect of unpaid tasks. Intervention designs which involved frequent supervision and continuous training led to better CHW performance in certain settings. Supervision and training were often mentioned as facilitating factors, but few studies tested which approach worked best or how these were best implemented. Embedment of CHWs in community and health systems was found to diminish workload and increase CHW credibility. Clearly defined CHW roles and introduction of clear processes for communication among different levels of the health system could strengthen CHW performance.When designing community-based health programmes, factors that increased CHW performance in comparable settings should be taken into account. Additional intervention research to develop a better evidence base for the most effective training and supervision mechanisms and qualitative research to inform

  12. Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review

    PubMed Central

    Kok, Maryse C; Dieleman, Marjolein; Taegtmeyer, Miriam; Broerse, Jacqueline EW; Kane, Sumit S; Ormel, Hermen; Tijm, Mandy M; de Koning, Korrie AM

    2015-01-01

    Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors influence CHW performance. A systematic review was conducted to identify intervention design related factors influencing performance of CHWs. We systematically searched six databases for quantitative and qualitative studies that included CHWs working in promotional, preventive or curative primary health services in LMICs. One hundred and forty studies met the inclusion criteria, were quality assessed and double read to extract data relevant to the design of CHW programmes. A preliminary framework containing factors influencing CHW performance and characteristics of CHW performance (such as motivation and competencies) guided the literature search and review. A mix of financial and non-financial incentives, predictable for the CHWs, was found to be an effective strategy to enhance performance, especially of those CHWs with multiple tasks. Performance-based financial incentives sometimes resulted in neglect of unpaid tasks. Intervention designs which involved frequent supervision and continuous training led to better CHW performance in certain settings. Supervision and training were often mentioned as facilitating factors, but few studies tested which approach worked best or how these were best implemented. Embedment of CHWs in community and health systems was found to diminish workload and increase CHW credibility. Clearly defined CHW roles and introduction of clear processes for communication among different levels of the health system could strengthen CHW performance. When designing community-based health programmes, factors that increased CHW performance in comparable settings should be taken into account. Additional intervention research to develop a better evidence base for the most effective training and supervision mechanisms and qualitative research to

  13. A Review of Parenting Programs in Developing Countries: Opportunities and Challenges for Preventing Emotional and Behavioral Difficulties in Children

    ERIC Educational Resources Information Center

    Mejia, Anilena; Calam, Rachel; Sanders, Matthew R.

    2012-01-01

    Many children in developing countries are at risk of emotional and behavioral difficulties, which are likely to be elevated due to the effects of poverty. Parenting programs have shown to be effective preventative strategies in high-income countries, but to date the research on their effectiveness in lower-income countries is limited.…

  14. Developing the Evidence Base to Inform Best Practice: A Scoping Study of Breast and Cervical Cancer Reviews in Low- and Middle-Income Countries

    PubMed Central

    Demment, Margaret M.; Peters, Karen; Dykens, J. Andrew; Dozier, Ann; Nawaz, Haq; McIntosh, Scott; Smith, Jennifer S.; Sy, Angela; Irwin, Tracy; Fogg, Thomas T.; Khaliq, Mahmooda; Blumenfeld, Rachel; Massoudi, Mehran; De Ver Dye, Timothy

    2015-01-01

    Background Breast and cervical cancers have emerged as major global health challenges and disproportionately lead to excess morbidity and mortality in low- and middle-income countries (LMICs) when compared to high-income countries. The objective of this paper was to highlight key findings, recommendations, and gaps in research and practice identified through a scoping study of recent reviews in breast and cervical cancer in LMICs. Methods We conducted a scoping study based on the six-stage framework of Arskey and O’Malley. We searched PubMed, Cochrane Reviews, and CINAHL with the following inclusion criteria: 1) published between 2005-February 2015, 2) focused on breast or cervical cancer 3) focused on LMIC, 4) review article, and 5) published in English. Results Through our systematic search, 63 out of the 94 identified cervical cancer reviews met our selection criteria and 36 of the 54 in breast cancer. Cervical cancer reviews were more likely to focus upon prevention and screening, while breast cancer reviews were more likely to focus upon treatment and survivorship. Few of the breast cancer reviews referenced research and data from LMICs themselves; cervical cancer reviews were more likely to do so. Most reviews did not include elements of the PRISMA checklist. Conclusion Overall, a limited evidence base supports breast and cervical cancer control in LMICs. Further breast and cervical cancer prevention and control studies are necessary in LMICs. PMID:26325181

  15. Systematic Review of the Effectiveness of Mass Media Interventions for Child Survival in Low- and Middle-Income Countries

    PubMed Central

    Naugle, Danielle A.; Hornik, Robert C.

    2014-01-01

    Through a systematic review of the literature, this article summarizes and evaluates evidence for the effectiveness of mass media interventions for child survival. To be included, studies had to describe a mass media intervention; address a child survival health topic; present quantitative data from a low- or middle-income country; use an evaluation design that compared outcomes using pre- and postintervention data, treatment versus comparison groups, or postintervention data across levels of exposure; and report a behavioral or health outcome. The 111 campaign evaluations that met the inclusion criteria included 15 diarrheal disease, 8 immunization, 2 malaria, 14 nutrition, 1 preventing mother-to-child transmission of HIV, 4 respiratory disease, and 67 reproductive health interventions. These evaluations were then sorted into weak (n = 33), moderate (n = 32), and stronger evaluations (n = 46) on the basis of the sampling method, the evaluation design, and efforts to address threats to inference of mass media effects. The moderate and stronger evaluations provide evidence that mass media-centric campaigns can positively impact a wide range of child survival health behaviors. PMID:25207453

  16. The impact of vouchers on the use and quality of health care in developing countries: a systematic review.

    PubMed

    Brody, Carinne Meyer; Bellows, Nicole; Campbell, Martha; Potts, Malcom

    2013-01-01

    One approach to delivering healthcare in developing countries is through voucher programmes, where vouchers are distributed to a targeted population for free or subsidised health care. Using inclusion/exclusion criteria, a search of databases, key journals and websites review was conducted in October 2010. A narrative synthesis approach was taken to summarise and analyse five outcome categories: targeting, utilisation, cost efficiency, quality and health outcomes. Sub-group and sensitivity analyses were also performed. A total of 24 studies evaluating 16 health voucher programmes were identified. The findings from 64 outcome variables indicates: modest evidence that vouchers effectively target specific populations; insufficient evidence to determine whether vouchers deliver healthcare efficiently; robust evidence that vouchers increase utilisation; modest evidence that vouchers improve quality; no evidence that vouchers have an impact on health outcomes; however, this last conclusion was found to be unstable in a sensitivity analysis. The results in the areas of targeting, utilisation and quality indicate that vouchers have a positive effect on health service delivery. The subsequent link that they improve health was found to be unstable from the data analysed; another finding of a positive effect would result in robust evidence. Vouchers are still new and the number of published studies is limiting. PMID:23336251

  17. Methods for studying private sector supply of public health products in developing countries: a conceptual framework and review.

    PubMed

    Conteh, Lesong; Hanson, Kara

    2003-10-01

    The private sector is an important supplier of public health products (PHPs) in developing countries. Although there are concerns about the quality and affordability of these products, private providers also offer possibilities for expanding access to key commodities. This paper proposes a conceptual framework for understanding the public health implications of private sales of PHPs. It reviews methods for studying these sales, together with their advantages and shortcomings. Ten methods are identified which can be used for studying the behaviour of providers and consumers. The effects of seasonal variation are discussed, together with the challenges of creating a sampling frame and studying illicit behaviour. We conclude that relatively little is known about the sales of PHPs, that more is known about contraceptives and drugs than about the newer products, and that the demand side of the market has been studied in greater depth than the behaviour of suppliers. The existing toolbox is biased towards formal providers, and thus, probably towards understanding the provision of PHPs to those who are better off. Methods for studying the supply of PHPs in outlets used by poor people is a priority area for further methodological development.

  18. Is Higher Consumption of Animal Flesh Foods Associated with Better Iron Status among Adults in Developed Countries? A Systematic Review

    PubMed Central

    Jackson, Jacklyn; Williams, Rebecca; McEvoy, Mark; MacDonald-Wicks, Lesley; Patterson, Amanda

    2016-01-01

    Iron deficiency (ID) is the most prevalent nutrient deficiency within the developed world. This is of concern as ID has been shown to affect immunity, thermoregulation, work performance and cognition. Animal flesh foods provide the richest and most bioavailable source of dietary (haem) iron, however, it is unclear whether low animal flesh diets contribute to ID. This systematic review aimed to investigate whether a higher consumption of animal flesh foods is associated with better iron status in adults. CINAHL, Cochrane, EMBASE and MEDLINE were searched for published studies that included adults (≥18 years) from developed countries and measured flesh intakes in relation to iron status indices. Eight experimental and 41 observational studies met the inclusion criteria. Generally, studies varied in population and study designs and results were conflicting. Of the seven high quality studies, five showed a positive association between animal flesh intake (85–300 g/day) and iron status. However, the optimum quantity or frequency of flesh intake required to maintain or achieve a healthy iron status remains unclear. Results show a promising relationship between animal flesh intake and iron status, however, additional longitudinal and experimental studies are required to confirm this relationship and determine optimal intakes to reduce ID development. PMID:26891320

  19. Violent video game effects on aggression, empathy, and prosocial behavior in eastern and western countries: a meta-analytic review.

    PubMed

    Anderson, Craig A; Shibuya, Akiko; Ihori, Nobuko; Swing, Edward L; Bushman, Brad J; Sakamoto, Akira; Rothstein, Hannah R; Saleem, Muniba

    2010-03-01

    Meta-analytic procedures were used to test the effects of violent video games on aggressive behavior, aggressive cognition, aggressive affect, physiological arousal, empathy/desensitization, and prosocial behavior. Unique features of this meta-analytic review include (a) more restrictive methodological quality inclusion criteria than in past meta-analyses; (b) cross-cultural comparisons; (c) longitudinal studies for all outcomes except physiological arousal; (d) conservative statistical controls; (e) multiple moderator analyses; and (f) sensitivity analyses. Social-cognitive models and cultural differences between Japan and Western countries were used to generate theory-based predictions. Meta-analyses yielded significant effects for all 6 outcome variables. The pattern of results for different outcomes and research designs (experimental, cross-sectional, longitudinal) fit theoretical predictions well. The evidence strongly suggests that exposure to violent video games is a causal risk factor for increased aggressive behavior, aggressive cognition, and aggressive affect and for decreased empathy and prosocial behavior. Moderator analyses revealed significant research design effects, weak evidence of cultural differences in susceptibility and type of measurement effects, and no evidence of sex differences in susceptibility. Results of various sensitivity analyses revealed these effects to be robust, with little evidence of selection (publication) bias. PMID:20192553

  20. Impact of Male Partner Antenatal Accompaniment on Perinatal Health Outcomes in Developing Countries: A Systematic Literature Review.

    PubMed

    Aguiar, Carolina; Jennings, Larissa

    2015-09-01

    Encouraging male partners to accompany women to antenatal care (ANC) is an important first step in engaging men on maternal and newborn health. However, little is known regarding the impact of male partner antenatal accompaniment beyond HIV-related perinatal outcomes. A systematic review was conducted to synthesize the evidence on the influence of male accompaniment on non-HIV outcomes during pregnancy and into the postpartum period. Eligible studies were published in English from 2003 to 2013 and evaluated the effect of male antenatal accompaniment on perinatal health in a developing country. Four electronic databases and selected reference lists were searched. Out of 84 potential citations retrieved, seven publications were retained for the assessment of male antenatal accompaniment's influence using iterative thematic analysis. During pregnancy, male antenatal accompaniment positively impacted women's knowledge of danger signs, but did not affect birth preparedness, ANC utilization, or miscarriages. During labor and delivery, men's ANC presence was associated with increases in institutional delivery and skilled birth attendance, but with no effect for birth-related outcomes. During the early postnatal period, male antenatal accompaniment was associated with higher uptake of postnatal services, but with mixed effects on breastfeeding and newborn survival. Couples' increased communication on pregnancy care and men's subsequent motivation to ensure safe delivery may explain these observed benefits. Inadequate communication, late accompaniment, or partner type may explain the lack of influence on some outcomes. More efforts are needed to expand the implementation and evaluation of male involvement strategies to improve perinatal health. PMID:25656727

  1. A Systematic Review and Meta-analysis of the Association Between Giardia lamblia and Endemic Pediatric Diarrhea in Developing Countries

    PubMed Central

    Muhsen, Khitam; Levine, Myron M.

    2012-01-01

    We performed a systematic literature review and meta-analysis examining the association between diarrhea in young children in nonindustrialized settings and Giardia lamblia infection. Eligible were case/control and longitudinal studies that defined the outcome as acute or persistent (>14 days) diarrhea, adjusted for confounders and lasting for at least 1 year. Data on G. lamblia detection (mainly in stools) from diarrhea patients and controls without diarrhea were abstracted. Random effects model meta-analysis obtained pooled odds ratios (ORs) and 95% confidence intervals (CIs). Twelve nonindustrialized-setting acute pediatric diarrhea studies met the meta-analysis inclusion criteria. Random-effects model meta-analysis of combined results (9774 acute diarrhea cases and 8766 controls) yielded a pooled OR of 0.60 (95% CI, .38–.94; P = .03), indicating that G. lamblia was not associated with acute diarrhea. However, limited data suggest that initial Giardia infections in early infancy may be positively associated with diarrhea. Meta-analysis of 5 persistent diarrhea studies showed a pooled OR of 3.18 (95% CI, 1.50–6.76; P < .001), positively linking Giardia with that syndrome. The well-powered Global Enteric Multicenter Study (GEMS) is prospectively addressing the association between G. lamblia infection and diarrhea in children in developing countries. PMID:23169940

  2. Violent video game effects on aggression, empathy, and prosocial behavior in eastern and western countries: a meta-analytic review.

    PubMed

    Anderson, Craig A; Shibuya, Akiko; Ihori, Nobuko; Swing, Edward L; Bushman, Brad J; Sakamoto, Akira; Rothstein, Hannah R; Saleem, Muniba

    2010-03-01

    Meta-analytic procedures were used to test the effects of violent video games on aggressive behavior, aggressive cognition, aggressive affect, physiological arousal, empathy/desensitization, and prosocial behavior. Unique features of this meta-analytic review include (a) more restrictive methodological quality inclusion criteria than in past meta-analyses; (b) cross-cultural comparisons; (c) longitudinal studies for all outcomes except physiological arousal; (d) conservative statistical controls; (e) multiple moderator analyses; and (f) sensitivity analyses. Social-cognitive models and cultural differences between Japan and Western countries were used to generate theory-based predictions. Meta-analyses yielded significant effects for all 6 outcome variables. The pattern of results for different outcomes and research designs (experimental, cross-sectional, longitudinal) fit theoretical predictions well. The evidence strongly suggests that exposure to violent video games is a causal risk factor for increased aggressive behavior, aggressive cognition, and aggressive affect and for decreased empathy and prosocial behavior. Moderator analyses revealed significant research design effects, weak evidence of cultural differences in susceptibility and type of measurement effects, and no evidence of sex differences in susceptibility. Results of various sensitivity analyses revealed these effects to be robust, with little evidence of selection (publication) bias.

  3. Efficacy of Community-Based Rehabilitation for Children with or at Significant Risk of Intellectual Disabilities in Low- and Middle-Income Countries: A Review

    ERIC Educational Resources Information Center

    Robertson, Janet; Emerson, Eric; Hatton, Chris; Yasamy, M. T.

    2012-01-01

    Background: Community-based rehabilitation (CBR) is being implemented in more than 90 countries. Concerns have been voiced about the adequacy of the evidence base regarding the efficacy, effectiveness and efficiency of CBR. This review summarizes evidence on the efficacy of CBR for children with intellectual disabilities. Materials and method:…

  4. Basic Education for Girls in Yemen: Country Case Study and Analysis. Mid-Decade Review of Progress towards Education for All.

    ERIC Educational Resources Information Center

    Beatty, Sharon

    In 1995, the International Consultative Forum on Education for All (EFA) commissioned case studies in developing countries as part of a mid-decade review of progress in expanding access to basic education. This paper examines provision of basic education (grades 1-9) in Yemen, focusing on obstacles to girls' education in rural areas. The report…

  5. Thrombosis of the portal vein in eleven dogs.

    PubMed

    Van Winkle, T J; Bruce, E

    1993-01-01

    Case records from the small animal necropsy service of the University of Pennsylvania (Philadelphia, PA) from January 1981 through August 1990 were searched for reports of animals with grossly visible portal vein thrombi. Eleven dogs identified from their case materials as having portal vein thrombosis were used for this study. The age of the dogs ranged from 2 to 13 years, and there were five spayed females and six males--four intact and two castrated. Seven breeds were represented (Lhasa Apso, German Wire haired Pointer, Shetland Sheepdog, Dalmatian, Irish Wolfhound, Old English Sheepdog, and Siberian Husky), and the remaining four cases were identified as mixed breeds. The weight of the dogs ranged from 7.7 to 50 kg, and most of them were considered overweight. Dogs with microthrombi and tumor emboli in the portal vein were excluded. No age, sex, or breed predisposition was found. Thrombi were also detected in the pulmonary arteries in five of the dogs and both the pulmonary arteries and aorta in one dog. The portal thrombi extended into the mesenteric veins in three dogs, resulting in infarction of the jejunum. One of these dogs and two other dogs had chronic occlusion of the portal vein, with the formation of secondary portosystemic shunts. Conditions also present in dogs with portal vein thrombi included pancreatic necrosis (four dogs), peritonitis (two dogs), distant neoplasia (three dogs), and therapy with steroids (ten dogs).

  6. Reported Availability and Gaps of Pediatric Palliative Care in Low- and Middle-Income Countries: A Systematic Review of Published Data

    PubMed Central

    Howard, Scott C.; Baker, Justin N.; Ribeiro, Raul C.; Lam, Catherine G.

    2014-01-01

    Abstract Background: The majority of young people in need of palliative care live in low- and middle-income countries, where curative treatment is less available. Objective: We systematically reviewed published data describing palliative care services available to young people with life-limiting conditions in low- and middle-income countries and assessed core elements with respect to availability, gaps, and under-reported aspects. Methods: PubMed, CINAHL, EMBASE (1980–2013), and secondary bibliographies were searched for publications that included patients younger than 25 years with life-limiting conditions and described palliative care programs in low- and middle-income countries. A data extraction checklist considered 15 items across seven domains: access, education/capacity building, health system support, pain management, symptom management, end-of-life care, and bereavement. Data were aggregated by program and country. Results: Of 1572 records, 238 met criteria for full-text review; 34 qualified for inclusion, representing 30 programs in 21 countries. The median checklist score was 7 (range, 1–14) of 10 reported (range, 3–14). The most pervasive gaps were in national health system support (unavailable in 7 of 17 countries with programs reporting), specialized education (unavailable in 7 of 19 countries with programs reporting), and comprehensive opioid access (unavailable in 14 of 21 countries with programs reporting). Underreported elements included specified practices for pain management and end-of-life support. Conclusion: Comprehensive pediatric palliative care provision is possible even in markedly impoverished settings. Improved national health system support, specialized training and opioid access are key targets for research and advocacy. Application of a checklist methodology can promote awareness of gaps to guide program evaluation, reporting, and strengthening. PMID:25225748

  7. Epidemiology of oral cancer in Arab countries

    PubMed Central

    Al-Jaber, Abeer; Al-Nasser, Lubna; El-Metwally, Ashraf

    2016-01-01

    Objectives: To review the oral cancer (OC) studies that were conducted in Arab countries with regard to epidemiology, risk factors, and prognosis. Methods: A computer-based PubMed literature search was performed to retrieve studies conducted in the Arab world on epidemiology of OC. After screening for exclusion criteria, cross-referencing, and searching local journals, a total of 19 articles were included. Results: Eight prevalence studies found an OC prevalence ranging from 1.8 to 2.13 per 100,000 persons. Oral cancer patients were mostly in their fifth to sixth decade of life, and the incidence in younger age was reported in some Arab countries. Yemenis have an alarming high prevalence of OC among people younger than 45 years. Eleven studies explored determinants or prognosis of OC. Behavioral determinants such as smokeless tobacco (Shamma and Qat), and cigarette smoking were strongly associated with OC. Alcohol drinking and solar radiation exposures were cited as possible risk factors. The most affected sites were tongue, floor of the mouth, and lower lip variations in the affected site were attributed to the socio-cultural behavior of the populations under study. Squamous cell carcinoma was the most frequently detected cancer, and usually patients were in late stages (III and IV) at the time of diagnosis. Conclusion: No solid evidence exists regarding the true OC prevalence/incidence in most Arab countries due to the lack of national cancer registries and population-based studies. PMID:26905345

  8. Barriers and facilitators to health information exchange in low- and middle-income country settings: a systematic review.

    PubMed

    Akhlaq, Ather; McKinstry, Brian; Muhammad, Khalid Bin; Sheikh, Aziz

    2016-11-01

    The exchange and use of health information can help healthcare professionals and policymakers make informed decisions on ways of improving patient and population health. Many low- and middle-income countries (LMICs) have however failed to embrace the approaches and technologies to facilitate health information exchange (HIE). We sought to understand the barriers and facilitators to the implementation and adoption of HIE in LMICs. Two reviewers independently searched 11 academic databases for published and on-going qualitative, quantitative and mixed-method studies and searched for unpublished work through the Google search engine. The searches covered the period from January 1990 to July 2014 and were not restricted by language. Eligible studies were independently, critically appraised and then thematically analysed. The searches yielded 5461 citations after de-duplication of results. Of these, 56 articles, three conference abstracts and four technical reports met the inclusion criteria. The lack of importance given to data in decision making, corruption and insecurity, lack of training and poor infrastructure were considered to be major challenges to implementing HIE, but strong leadership and clear policy direction coupled with the financial support to acquire essential technology, improve the communication network, and provide training for staff all helped to promote implementation. The body of work also highlighted how implementers of HIE needed to take into account local needs to ensure that stakeholders saw HIE as relevant and advantageous. HIE interventions implemented through leapfrog technologies such as telehealth/telemedicine and mHealth in Brazil, Kenya, and South Africa, provided successful examples of exchanging health information in LMICs despite limited resources and capability. It is important that implementation of HIE is aligned with national priorities and local needs. PMID:27185528

  9. Road Traffic Injury Prevention Initiatives: A Systematic Review and Metasummary of Effectiveness in Low and Middle Income Countries

    PubMed Central

    Staton, Catherine; Vissoci, Joao; Gong, Enying; Toomey, Nicole; Wafula, Rebeccah; Abdelgadir, Jihad; Zhou, Yi; Liu, Chen; Pei, Fengdi; Zick, Brittany; Ratliff, Camille D.; Rotich, Claire; Jadue, Nicole; de Andrade, Luciano; von Isenburg, Megan; Hocker, Michael

    2016-01-01

    Background Road traffic injuries (RTIs) are a growing but neglected global health crisis, requiring effective prevention to promote sustainable safety. Low- and middle-income countries (LMICs) share a disproportionately high burden with 90% of the world’s road traffic deaths, and where RTIs are escalating due to rapid urbanization and motorization. Although several studies have assessed the effectiveness of a specific intervention, no systematic reviews have been conducted summarizing the effectiveness of RTI prevention initiatives specifically performed in LMIC settings; this study will help fill this gap. Methods In accordance with PRISMA guidelines we searched the electronic databases MEDLINE, EMBASE, Scopus, Web of Science, TRID, Lilacs, Scielo and Global Health. Articles were eligible if they considered RTI prevention in LMICs by evaluating a prevention-related intervention with outcome measures of crash, RTI, or death. In addition, a reference and citation analysis was conducted as well as a data quality assessment. A qualitative metasummary approach was used for data analysis and effect sizes were calculated to quantify the magnitude of emerging themes. Results Of the 8560 articles from the literature search, 18 articles from 11 LMICs fit the eligibility and inclusion criteria. Of these studies, four were from Sub-Saharan Africa, ten from Latin America and the Caribbean, one from the Middle East, and three from Asia. Half of the studies focused specifically on legislation, while the others focused on speed control measures, educational interventions, enforcement, road improvement, community programs, or a multifaceted intervention. Conclusion Legislation was the most common intervention evaluated with the best outcomes when combined with strong enforcement initiatives or as part of a multifaceted approach. Because speed control is crucial to crash and injury prevention, road improvement interventions in LMIC settings should carefully consider how the

  10. Barriers and facilitators to health information exchange in low- and middle-income country settings: a systematic review.

    PubMed

    Akhlaq, Ather; McKinstry, Brian; Muhammad, Khalid Bin; Sheikh, Aziz

    2016-11-01

    The exchange and use of health information can help healthcare professionals and policymakers make informed decisions on ways of improving patient and population health. Many low- and middle-income countries (LMICs) have however failed to embrace the approaches and technologies to facilitate health information exchange (HIE). We sought to understand the barriers and facilitators to the implementation and adoption of HIE in LMICs. Two reviewers independently searched 11 academic databases for published and on-going qualitative, quantitative and mixed-method studies and searched for unpublished work through the Google search engine. The searches covered the period from January 1990 to July 2014 and were not restricted by language. Eligible studies were independently, critically appraised and then thematically analysed. The searches yielded 5461 citations after de-duplication of results. Of these, 56 articles, three conference abstracts and four technical reports met the inclusion criteria. The lack of importance given to data in decision making, corruption and insecurity, lack of training and poor infrastructure were considered to be major challenges to implementing HIE, but strong leadership and clear policy direction coupled with the financial support to acquire essential technology, improve the communication network, and provide training for staff all helped to promote implementation. The body of work also highlighted how implementers of HIE needed to take into account local needs to ensure that stakeholders saw HIE as relevant and advantageous. HIE interventions implemented through leapfrog technologies such as telehealth/telemedicine and mHealth in Brazil, Kenya, and South Africa, provided successful examples of exchanging health information in LMICs despite limited resources and capability. It is important that implementation of HIE is aligned with national priorities and local needs.

  11. What is the prevalence of musculoskeletal problems in the elderly population in developed countries? A systematic critical literature review

    PubMed Central

    2012-01-01

    Background The proportion of older people will be tripled by the year 2050. In addition, the incidence of chronic musculoskeletal (MSK) conditions will also increase among the elderly people. Thus, in order to prepare for future health care demands, the magnitude and impact of MSK conditions from this growing population is needed. The objective of this literature review is to determine the current prevalence of MSK disorders in the elderly population. Methods A systematic literature search was conducted in Pubmed on articles in English, published between January 2000 and July 2011. Studies from developed countries with prevalence estimates on elderly people (60+) on the following MSK conditions were included: Non-specific extremity pain, rheumatoid arthritis, osteoarthritis, osteoporosis, and back pain. The included articles were extracted for information and assessed for risk of bias. Results A total of 85 articles were included with 173 different prevalence estimates. Musculoskeletal disorders are common in the elderly population, but due to heterogeneity of the studies, no general estimate on the prevalence of MSK can be determined. Women report more often MSK pain than men. Overall, prevalence estimates either remain fairly constant or increase slightly with increasing age, but with a tendency to decrease in the oldest (80+) people. Conclusions Musculoskeletal disorders remain prevalent in the elderly population. Given the increasing proportion of elderly population in the world population and the burden of MSK diseases among the elderly people, efforts must be made to maintain their functional capacity for as long as possible through optimal primary and secondary health care. PMID:23006836

  12. Social capital and health in the least developed countries: A critical review of the literature and implications for a future research agenda

    PubMed Central

    Story, William T.

    2015-01-01

    Research on the linkage between social capital and health has grown in recent years; however, there is a dearth of evidence from resource-poor countries. This review examines the association between social capital and physical health (including health behaviours) in the least developed countries (LDCs). Citations were searched using three databases from 1990 to 2011 using the keyword ‘social capital’ combined with the name of each of the 48 LDCs. Of the 14 studies reviewed, 12 took place in Africa and two in South Asia. All used cross-sectional study designs, including five qualitative and nine quantitative studies. The literature reviewed suggests that social capital is an important factor for improving health in resource-poor settings; however, more research is needed in order to determine the best measures for social capital and elucidate the mechanisms through which social capital affects health in the developing world. Future research on social capital and health in the developing world should focus on applying appropriate theoretical conceptualizations of social capital to the developing country context, adapting and validating instruments for measuring social capital, and examining multilevel models of social capital and health in developing countries. PMID:24172027

  13. Field inter-comparison of eleven atmospheric ammonia measurement techniques

    NASA Astrophysics Data System (ADS)

    von Bobrutzki, K.; Braban, C. F.; Famulari, D.; Jones, S. K.; Blackall, T.; Smith, T. E. L.; Blom, M.; Coe, H.; Gallagher, M.; Ghalaieny, M.; McGillen, M. R.; Percival, C. J.; Whitehead, J. D.; Ellis, R.; Murphy, J.; Mohacsi, A.; Pogany, A.; Junninen, H.; Rantanen, S.; Sutton, M. A.; Nemitz, E.

    2010-01-01

    Eleven instruments for the measurement of ambient concentrations of atmospheric ammonia gas (NH3), based on eight different measurement methods were inter-compared above an intensively managed agricultural field in late summer 2008 in Southern Scotland. To test the instruments over a wide range of concentrations, the field was fertilised with urea midway through the experiment, leading to an increase in the average concentration from 10 to 100 ppbv. The instruments deployed included three wet-chemistry systems, one with offline analysis (annular rotating batch denuder, RBD) and two with online-analysis (Annular Denuder sampling with online Analysis, AMANDA; AiRRmonia), two Quantum Cascade Laser Absorption Spectrometers (a large-cell dual system; DUAL-QCLAS, and a compact system; c-QCLAS), two photo-acoustic spectrometers (WaSul-Flux; Nitrolux-100), a Cavity Ring Down Spectrosmeter (CRDS), a Chemical Ionisation Mass Spectrometer (CIMS), an ion mobility spectrometer (IMS) and an Open-Path Fourier Transform Infra-Red (OP-FTIR) Spectrometer. The instruments were compared with each other and with the average concentration of all instruments. An overall good agreement of hourly average concentrations between the instruments (R2>0.84), was observed for NH3 concentrations at the field of up to 120 ppbv with the slopes against the average ranging from 0.67 (DUAL-QCLAS) to 1.13 (AiRRmonia) with intercepts of -0.74 ppbv (RBD) to +2.69 ppbv (CIMS). More variability was found for performance for lower concentrations (<10 ppbv). Here the main factors affecting measurement precision are (a) the inlet design, (b) the state of inlet filters (where applicable), and (c) the quality of gas-phase standards (where applicable). By reference to the fast (1 Hz) instruments deployed during the study, it was possible to characterize the response times of the slower instruments.

  14. Field inter-comparison of eleven atmospheric ammonia measurement techniques

    NASA Astrophysics Data System (ADS)

    von Bobrutzki, K.; Braban, C. F.; Famulari, D.; Jones, S. K.; Blackall, T.; Smith, T. E. L.; Blom, M.; Coe, H.; Gallagher, M.; Ghalaieny, M.; McGillen, M. R.; Percival, C. J.; Whitehead, J. D.; Ellis, R.; Murphy, J.; Mohacsi, A.; Junninen, H.; Pogany, A.; Rantanen, S.; Sutton, M. A.; Nemitz, E.

    2009-08-01

    Eleven instruments for the measurement of ambient concentrations of atmospheric ammonia gas (NH3), based on eight different measurement methods were inter-compared above an intensively managed agricultural field in late summer 2008 in S. Scotland. To test the instruments over a wide range of concentrations, the field was fertilised with urea midway through the experiment, leading to an increase in the average concentration from 10 to 100 ppbv. The instruments deployed included three wet-chemistry systems, one with offline analysis (annular rotating batch denuder, RBD) and two with online-analysis (Annular Denuder sampling with online Analysis, AMANDA; AiRRmonia), two Quantum Cascade Laser Absorption Spectrometers (a large-cell dual system, DUAL-QCLAS, and a compact system, c-QCLAS), two photo-acoustic spectrometers (WaSul-Flux, Nitrolux-100), a Cavity Ring Down Spectrosmeter (CRDS), a Chemical Ionisation Mass Spectrometer (CIMS), an ion mobility spectrometer (IMS) and an Open-Path Fourier Transform Infra-Red (OP-FTIR) spectroscopy. Each instrument was compared with each other and with the average concentration of all instruments. An overall good agreement of hourly average concentrations between the instruments (R2>0.84), was observed for NH3 concentrations at the field of up to 120 ppbv with the slopes against the average ranging from 0.67 (DUAL-QCLAS) to 1.13 (AiRRmonia) with intercepts of -0.74 ppbv (RBD) to +2.69 ppbv (CIMS). More variability was found for performance for lower concentrations (<10 ppbv). Here the overruling factors affecting measurement precision are (a) the inlet design, (b) the state of inlet filters (where applicable), and (c) the quality of gas-phase standards (where applicable). By reference to the fast (1 Hz) instruments deployed during the study, it was possible to characterize the response times of the slower instruments.

  15. The Missing Link: Deficits of Country-Level Studies. A Review of 22 Articles Explaining Life Satisfaction

    ERIC Educational Resources Information Center

    Nonnenmacher, Alexandra; Friedrichs, Jurgen

    2013-01-01

    To explain country differences in an analytical or structural dependent variable, the application of a macro-micro-model containing contextual hypotheses is necessary. Our methodological study examines whether empirical studies apply such a model. We propose that a theoretical base for country differences is well described in multilevel studies,…

  16. 75 FR 82424 - 2011 Special 301 Review: Identification of Countries Under Section 182 of the Trade Act of 1974...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-30

    ... practices that are the basis of a country's identification as a Priority Foreign Country can be subject to... accompanied by the methodology used in calculating such estimated losses. Comments must be in English. All... limited to one five-minute presentation in English. A five-minute period will be allowed for...

  17. Diet and Physical Activity for the Prevention of Noncommunicable Diseases in Low- and Middle-Income Countries: A Systematic Policy Review

    PubMed Central

    Lachat, Carl; Otchere, Stephen; Roberfroid, Dominique; Abdulai, Abubakari; Seret, Florencia Maria Aguirre; Milesevic, Jelena; Xuereb, Godfrey; Candeias, Vanessa; Kolsteren, Patrick

    2013-01-01

    Background Diet-related noncommunicable diseases (NCDs) are increasing rapidly in low- and middle-income countries (LMICs) and constitute a leading cause of mortality. Although a call for global action has been resonating for years, the progress in national policy development in LMICs has not been assessed. This review of strategies to prevent NCDs in LMICs provides a benchmark against which policy response can be tracked over time. Methods and Findings We reviewed how government policies in LMICs outline actions that address salt consumption, fat consumption, fruit and vegetable intake, or physical activity. A structured content analysis of national nutrition, NCDs, and health policies published between 1 January 2004 and 1 January 2013 by 140 LMIC members of the World Health Organization (WHO) was carried out. We assessed availability of policies in 83% (116/140) of the countries. NCD strategies were found in 47% (54/116) of LMICs reviewed, but only a minority proposed actions to promote healthier diets and physical activity. The coverage of policies that specifically targeted at least one of the risk factors reviewed was lower in Africa, Europe, the Americas, and the Eastern Mediterranean compared to the other two World Health Organization regions, South-East Asia and Western Pacific. Of the countries reviewed, only 12% (14/116) proposed a policy that addressed all four risk factors, and 25% (29/116) addressed only one of the risk factors reviewed. Strategies targeting the private sector were less frequently encountered than strategies targeting the general public or policy makers. Conclusions This review indicates the disconnection between the burden of NCDs and national policy responses in LMICs. Policy makers urgently need to develop comprehensive and multi-stakeholder policies to improve dietary quality and physical activity. Please see later in the article for the Editors' Summary PMID:23776415

  18. Review of Progress in Vocational Education and Training Reform of the Candidate Countries for Accession to the European Union in the Light of Developments in European Policy on Vocational Training.

    ERIC Educational Resources Information Center

    European Training Foundation, Turin (Italy).

    This document reviews progress in vocational education and training (VET) reform in the candidate countries for accession to the European Union in light of developments in European policy on vocational training. The document consists of a cross-country overview and individual overviews of VET in 12 candidate countries: Bulgaria, the Czech…

  19. Do national medicinal drug policies and essential drug programs improve drug use?: a review of experiences in developing countries.

    PubMed

    Ratanawijitrasin, S; Soumerai, S B; Weerasuriya, K

    2001-10-01

    Increasing concerns regarding access to and appropriateness of medicinal drug use have led many governments in developing countries to develop national policies and regulations intended to increase the affordability, supply, safety, and rational use of pharmaceuticals. However, little is known about the intended and unintended impacts of these social experiments on actual drug use. We conducted a critical review and synthesis of the international literature in an attempt to define the current state of knowledge regarding drug policy effects on drug use, and to extract from the evidence important lessons for future policy and research. Literature sources included the archives and computerized databases, articles published in medical and pharmacy journals, as well as published annotated bibliographies. The evaluated interventions included three broad categories: (1) multi-component national drug policies including essential drug programs; (2) drug supply and cost-sharing programs; and (3) regulatory measures. Most of these studies utilized weak research designs that evaluated programs solely on the basis of post-intervention measures. Only two studies measured pre-policy utilization, but did not include a control group. Thus, none of the results are conclusive, and the findings represent, at best, hypotheses for more rigorous studies of policy impacts. Some suggestive findings include an association between increases in the supply of essential drugs (combined with training) and more appropriate use of medications in primary care settings. In addition, preliminary data suggest some unintended effects of de-registration of drugs or upward reclassification of specific medicines. Similarly, loosening restrictions have sometimes been accompanied by increased dispensing of specific drugs by unqualified personnel. The available studies focused only on a few categories of national and regulatory policies. Because of poor study design, the results do not provide valid data to

  20. 76 FR 58855 - Request for Public Comments on Annual Review of Country Eligibility for Benefits Under the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-22

    ... the Federal Register (76 FR 50284, August 12, 2011). The following sub-Saharan African countries that...: Angola, Republic of Benin, Republic of Botswana, Burkina Faso, Burundi, Republic of Cape Verde,...

  1. 78 FR 70092 - 2013 Special 301 Out-of-Cycle Review of El Salvador: Identification of Countries Under Section...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-22

    ...-Cycle Reviews would be conducted for El Salvador and Spain. At this time, USTR requests written... submissions relating to the review of Spain will be made in a separate notice at a later date....

  2. A Review of OIE Country Status Recovery Using Vaccinate-to-Live Versus Vaccinate-to-Die Foot-and-Mouth Disease Response Policies II: Waiting Periods After Emergency Vaccination in FMD Free Countries.

    PubMed

    Geale, D W; Barnett, P V; Clarke, G W; Davis, J; Kasari, T R

    2015-08-01

    For countries with OIE status, FMD free country where vaccination is not practised, vaccinate-to-live policies have a significant economic disincentive as the trade restriction waiting period is double that of vaccinate-to-die policies. The disposal of healthy vaccinated animals strictly for the purpose of regaining markets with debatable scientific justification is a global concern. The feasibility of aligning the waiting periods to facilitate vaccinate-to-live is explored. The first article of this two-part review (Barnett et al., 2015) explored the qualities of higher potency Foot-and-Mouth Disease (FMD) vaccines, performance of differentiating infected from vaccinated animals (DIVA) diagnostic assays particularly in vaccinates and carriers, as well as aspects of current limitations of post-outbreak surveillance. Here, the history behind the OIE waiting periods for FMD free status is reviewed as well as whether the risk of vaccinated animals and their subsequent products differ appreciably at 3 versus 6 months. It is concluded that alignment is feasible for vaccinate-to-live using higher potency FMD vaccines within the current OIE waiting period framework of 3 and 6 months blocks of time. These waiting periods reflect precedence, historical practicalities and considered expert opinion rather than a specific scientific rationale. The future lies in updated epidemiological and diagnostic technology to establish an acceptable level of statistical certainty for surveillance or target probability of freedom of FMDV (infection or circulation) not time restricted waiting periods. The OIE Terrestrial Code limits trade from a FMD free country where vaccination is not practiced to animal products and live non-vaccinated animals. The risk of FMDV in products derived from higher potency vaccinated animals is appreciably less than for countries with infected FMD status or even from a FMD free country where vaccination is practised for which the Code has Articles with

  3. Moving forward monitoring of the social determinants of health in a country: lessons from England 5 years after the Marmot Review

    PubMed Central

    Goldblatt, Peter O.

    2016-01-01

    Background England has a long history of government-commissioned reviews of national inequalities. The latest review, the Marmot Review, was commissioned by a government headed by the same party (the Labour Party) that had introduced the National Health Service in 1948, but the review was implemented by a coalition of different parties (Conservatives and Liberal Democrats). At the same time, a government reform of health services took place, and the monitoring of the existing inequality strategy was changed. Objectives This paper examines the lessons that can be learned about indicators for monitoring social determinants of health inequalities from the Marmot Review and recent health inequality strategies in England. Design The paper provides a narrative review of key findings on the collection, presentation, and analysis of routine data in England in the past 5 years, comparing what has been learned from the Marmot Review and other evaluations of the first health inequality strategy in England. Results The emphasis on monitoring has progressively shifted from monitoring a small number of targets and supporting information to frameworks that monitor across a wide range of determinants of both the causes of ill-health and of health service performance. As these frameworks become ever larger, some consideration is being given to the key indicators. Conclusions Although the frameworks used in England for monitoring health inequality strategies have developed considerably since the first strategy began, lessons continue to be learned about how monitoring could be improved. Many of these are applicable to countries initiating or reviewing their strategies. PMID:26928216

  4. A Systematic Review of Cost-Sharing Strategies Used within Publicly-Funded Drug Plans in Member Countries of the Organisation for Economic Co-Operation and Development

    PubMed Central

    Barnieh, Lianne; Clement, Fiona; Harris, Anthony; Blom, Marja; Donaldson, Cam; Klarenbach, Scott; Husereau, Don; Lorenzetti, Diane; Manns, Braden

    2014-01-01

    Background Publicly-funded drug plans vary in strategies used and policies employed to reduce continually increasing pharmaceutical expenditures. We systematically reviewed the utilization of cost-sharing strategies and physician-directed prescribing regulations in publicly-funded formularies within member nations of the Organization of Economic Cooperation and Development (OECD). Methods & Findings Using the OECD nations as the sampling frame, a search for cost-sharing strategies and physician-directed prescribing regulations was done using published and grey literature. Collected data was verified by a system expert within the prescription drug insurance plan in each country, to ensure the accuracy of key data elements across plans. Significant variation in the use of cost-sharing mechanisms was seen. Copayments were the most commonly used cost-containment measure, though their use and amount varied for those with certain conditions, most often chronic diseases (in 17 countries), and by socio-economic status (either income or employment status), or with age (in 15 countries). Caps and deductibles were only used by five systems. Drug cost-containment strategies targeting physicians were also identified in 24 countries, including guideline-based prescribing, prescription monitoring and incentive structures. Conclusions There was variable use of cost-containment strategies to limit pharmaceutical expenditures in publicly funded formularies within OECD countries. Further research is needed to determine the best approach to constrain costs while maintaining access to pharmaceutical drugs. PMID:24618721

  5. How to find information on national food and nutrient consumption surveys across Europe: systematic literature review and questionnaires to selected country experts are both good strategies.

    PubMed

    Blanquer, Maria; García-Alvarez, Alicia; Ribas-Barba, Lourdes; Wijnhoven, Trudy M A; Tabacchi, Garden; Gurinovic, Mirjana; Serra-Majem, Lluís

    2009-07-01

    The present research was conducted within the framework of the EURopean micronutrient RECommendations Aligned project. In order to identify the best practice in assessing nutrient intakes, a search strategy for collecting data from national food consumption surveys/studies in Europe was developed. Systematic literature searches were carried out on twenty-eight European and the four European Free Trade Association countries. A questionnaire was also sent to two to five experts in each country. Systematic reviews using PubMed yielded 12 703 abstracts that were reduced to 200 studies using inclusion and exclusion criteria. Similarly, a search of ministry web sites yielded 3033 hits, and subsequently reduced to nine surveys. Belgium, France, Germany, Ireland, Sweden, Spain and the United Kingdom were the countries with most data and Slovenia and Liechtenstein were those with the least. Seventy-eight expert questionnaires were obtained from all countries except for Liechtenstein, Luxembourg and Slovakia. Detailed results and references are given. A systematic search and questionnaires are equally good at identifying national surveys across countries. Literature searching provides globally accessible and objective information albeit limited, whereas the questionnaire provides information that, depending upon responders, can be more complete. A combination of both strategies is recommended.

  6. The political economy of the public-private mix in heath expenditure: an empirical review of thirteen OECD countries.

    PubMed

    Mou, Haizhen

    2013-12-01

    This study investigates the factors that may have influenced the public-private mix of health expenditure in 13 OECD countries from 1981 to 2007. The degree to which health services are socialized is regarded as the product of a trade-off between the desire to redistribute income through the fiscal system and the losses some citizens will incur when the public health care system expands. The estimation results show that, greater income inequality and population aging are associated with a smaller share of public health expenditure in total health expenditure. The more ideologically left-leaning the electorate is, the larger the share of public health expenditure. Private health insurance tends to erode the political support for the public health care systems in countries with private duplicate health insurance, but not in countries with private primary health insurance. The findings suggest that the role of private sources of funding for health care is likely to grow in developed countries. The expansion of public coverage to include pharmaceuticals and long-term care in some countries may (theoretically) encounter less opposition if the current insurance holders have no duplicate coverage, if the voters as a whole share more left-leaning political ideology, and if low-income voters are more politically mobilized. PMID:23910734

  7. Eleven-dimensional supergravity from filtered subdeformations of the Poincaré superalgebra

    NASA Astrophysics Data System (ADS)

    Figueroa-O'Farrill, José; Santi, Andrea

    2016-07-01

    We summarise recent results concerning the classification of filtered deformations of graded subalgebras of the Poincaré superalgebra in eleven dimensions, highlighting what could be considered a novel Lie-algebraic derivation of eleven-dimensional supergravity. EMPG-15-23.

  8. Vector-borne disease surveillance in livestock populations: A critical review of literature recommendations and implemented surveillance (BTV-8) in five European countries.

    PubMed

    Dórea, Fernanda C; Elbers, Armin R W; Hendrikx, Pascal; Enoe, Claes; Kirkeby, Carsten; Hoinville, Linda; Lindberg, Ann

    2016-03-01

    Preparedness against vector-borne threats depends on the existence of a long-term, sustainable surveillance of vector-borne disease and their relevant vectors. This work reviewed the availability of such surveillance systems in five European countries (Denmark, France, The Netherlands, Sweden and United Kingdom, part of the CoVetLab network). A qualitative assessment was then performed focusing on surveillance directed particularly to BTV-8. Information regarding surveillance activities were reviewed for the years 2008 and 2012. The results were then complemented with a critical scoping review of the literature aimed at identifying disease surveillance strategies and methods that are currently suggested as best suited to target vector-borne diseases in order to guide future development of surveillance in the countries in question. Passive surveillance was found to be efficient for early detection of diseases during the early phase of introduction into a free country. However, its value diminished once the disease has been established in a territory. Detection of emerging diseases was found to be very context and area specific, and thus active surveillance designs need to take the available epidemiological, ecological and entomological information into account. This was demonstrated by the effectiveness of the bulk milk surveillance in detecting the first case in Sweden, highlighting the need for output based standards to allow the most effective, context dependent, surveillance strategies to be used. Preparedness was of fundamental importance in determining the timeliness of detection and control in each country and that this in turn was heavily influenced by knowledge of emerging diseases in neighboring countries. Therefore it is crucial to share information on outbreaks between researchers and decision-makers and across borders continuously in order to react timely in case of an outbreak. Furthermore, timely reaction to an outbreak was heavily influenced by

  9. 75 FR 28234 - Eleven Point Resource Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-20

    ... committee is meeting as authorized under the Secure Rural Schools and Community Self-Determination Act (Pub... is to initiate review of proposed forest management projects so that recommendations may be made to the Forest Service on which should be funded through Title II of the Secure Rural Schools...

  10. 76 FR 16726 - Eleven Point Resource Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-25

    ... committee is meeting as authorized under the Secure Rural Schools and Community Self-Determination Act (Pub... is to review proposed forest management projects so that recommendations may be made to the Forest Service on which should be funded through Title II of the Secure Rural Schools and Community...

  11. 75 FR 38457 - Eleven Point Resource Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-02

    ... committee is meeting as authorized under the Secure Rural Schools and Community Self-Determination Act (Pub... is initiate review of proposed forest management projects so that recommendations may be made to the Forest Service on which should be funded through Title II of the Secure Rural Schools and Community...

  12. 75 FR 59680 - Eleven Point Resource Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-28

    ... committee is meeting as authorized under the Secure Rural Schools and Community Self-Determination Act (Pub... is initiate review of proposed forest management projects so that recommendations may be made to the Forest Service on which should be funded through Title II of the Secure Rural Schools and Community...

  13. 76 FR 1402 - Eleven Point Resource Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-10

    ... committee is meeting as authorized under the Secure Rural Schools and Community Self-Determination Act (Pub... is to review proposed forest management projects so that recommendations may be made to the Forest Service on which should be funded through Title II of the Secure Rural Schools and Community...

  14. 75 FR 47535 - Eleven Point Resource Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-06

    ... committee is meeting as authorized under the Secure Rural Schools and Community Self-Determination Act (Pub... is to initiate review of proposed forest management projects so that recommendations may be made to the Forest Service on which should be funded through Title II of the Secure Rural Schools...

  15. 75 FR 71068 - Eleven Point Resource Advisory Committee

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-22

    ... committee is meeting as authorized under the Secure Rural Schools and Community Self-Determination Act (Pub... is to review proposed forest management projects so that recommendations may be made to the Forest Service on which should be funded through Title II of the Secure Rural Schools and Community...

  16. Hysterical identification in an eleven-year-old girl.

    PubMed

    Sherick, Ivan

    2014-10-01

    The concept of hysterical identification was reviewed and illustrated in child analytic process material obtained in the treatment of a latencyage girl. It is the author's contention that "hysteria" and its dynamics, for example, hysterical identification, have fallen into disuse, to the disservice of our child patients. This contribution is aimed at getting child analysts to reconsider the merits of this outcome. PMID:25247286

  17. A Review of the Evidence to Support Influenza Vaccine Introduction in Countries and Areas of WHO's Western Pacific Region

    PubMed Central

    Samaan, Gina; McPherson, Michelle; Partridge, Jeffrey

    2013-01-01

    Background Immunization against influenza is considered an essential public health intervention to control both seasonal epidemics and pandemic influenza. According to the World Health Organization (WHO), there are five key policy and three key programmatic issues that decision-makers should consider before introducing a vaccine. These are (a) public health priority, (b) disease burden, (c) efficacy, quality and safety of the vaccine, (d) other inventions, (e) economic and financial issues, (f) vaccine presentation, (g) supply availability and (h) programmatic strength. We analyzed the body of evidence currently available on these eight issues in the WHO Western Pacific Region. Methodology/Principal Findings Studies indexed in PubMed and published in English between 1 January 2000 and 31 December 2010 from the 37 countries and areas of the Western Pacific Region were screened for keywords pertaining to the five policy and three programmatic issues. Studies were grouped according to country income level and vaccine target group. There were 133 articles that met the selection criteria, with most (90%) coming from high-income countries. Disease burden (n = 34), vaccine efficacy, quality and safety (n = 27) and public health priority (n = 27) were most frequently addressed by studies conducted in the Region. Many studies assessed influenza vaccine policy and programmatic issues in the general population (42%), in the elderly (24%) and in children (17%). Few studies (2%) addressed the eight issues relating to pregnant women. Conclusions/Significance The evidence for vaccine introduction in countries and areas in this Region remains limited, particularly in low- and middle-income countries that do not currently have influenza vaccination programmes. Surveillance activities and specialized studies can be used to assess the eight issues including disease burden among vaccine target groups and the cost-effectiveness of influenza vaccine. Multi-country studies

  18. Routine Immunization Consultant Program in Nigeria: A Qualitative Review of a Country-Driven Management Approach for Health Systems Strengthening

    PubMed Central

    O’Connell, Meghan; Wonodi, Chizoba

    2016-01-01

    ABSTRACT Background: Since 2002, the Nigerian government has deployed consultants to states to provide technical assistance for routine immunization (RI). RI consultants are expected to play a role in supportive supervision of health facility staff, capacity building, advocacy, and monitoring and evaluation. Methods: We conducted a retrospective review of the RI consultant program’s strengths and weaknesses in 7 states and at the national level from June to September 2014 using semi-structured interviews and online surveys. Participants included RI consultants, RI program leaders, and implementers purposively drawn from national, state, and local government levels. Thematic analysis was used to analyze qualitative data from the interviews, which were triangulated with results from the quantitative surveys. Findings: At the time of data collection, 23 of 36 states and the federal capital territory had an RI consultant. Of the 7 states visited during the study, only 3 states had present and visibly working consultants. We conducted 84 interviews with 101 participants across the 7 states and conducted data analysis on 70 interviews (with 82 individuals) that had complete data. Among the full sample of interview respondents (N = 101), most (66%) were men with an average age of 49 years (±5.6), and the majority were technical officers (63%) but a range of other roles were also represented, including consultants (22%), directors (13%), and health workers (2%). Fifteen consultants and 44 program leaders completed the online surveys. Interview data from the 3 states with active RI consultants indicated that the consultants’ main contribution was supportive supervision at the local level, particularly for collecting and using RI data for decision making. They also acted as effective advocates for RI funding. In states without an RI consultant, gaps were highlighted in data management capacity and in monitoring of RI funds. Program design strengths: the broad terms

  19. Eleven-year results of the ABG I hip replacement

    PubMed Central

    Muddu, B. N.

    2006-01-01

    The ABG I uncemented hip prosthesis has demonstrated an unacceptably high failure rate and poor functional outcome in our patients. A prospective review was performed of 38 implanted hips with a mean follow-up of 11 years. Sixteen hips have been revised or are candidates for revision hip surgery, due principally to polyethylene wear and pelvic osteolysis. Contributing factors were likely to be the poor wear characteristics of the polyethylene liners—which were gamma irradiated in air—and the thinness of these liners. Of further concern were the poor pain and function scores in the remaining hips [mean Harris Hip Scores (HHS) of 70 (SD 22) at 11-year follow-up]. The influence of the surgical learning curve on clinical results may have been an important factor. Undersized femoral components were associated with poor pain and functional scores in five patients with HHS < 60. All ABG I hip implants must remain under careful, long-term review. PMID:16521011

  20. 78 FR 2210 - Review of New Sources and Modifications in Indian Country: Notice of Action Partially Granting...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-10

    ... Petitioners asked, among other things, that the EPA reconsider the synthetic minor source provisions of the... New Sources and Modifications in Indian Country,'' published on July 1, 2011, 76 FR 38748, under... may not be publicly available, i.e., confidential business information or other information...

  1. Sociological Perspectives on Energy and Rural Development: A Review of Major Frameworks for Research on Developing Countries.

    ERIC Educational Resources Information Center

    Koppel, Bruce; Schlegel, Charles

    The principal sociological frameworks used in energy research on developing countries can be appraised in terms of the view of the energy-rural development problem that each framework implies. "Socio-Technical Analysis," which is used most in industrial and organizational sociology and in ecological anthropology, is oriented to the decomposition…

  2. Restoring Fiscal Discipline for Poverty Reduction in Peru: A Public Expenditure Review. A World Bank Country Study.

    ERIC Educational Resources Information Center

    Lopez-Calix, Jose; Melo, Alberto

    Since his inauguration in July 2001, Peruvian President Alejandro Toledo has proposed to take actions in the areas of macroeconomic stabilization; reopening of country's access to international financial markets; budget modernization and state decentralization; social policy; revamping of the armed forces, police, and internal security services;…

  3. Vocational Education in Developing Countries. A Review of Studies and Project Experience. Education Division Documents No. 34.

    ERIC Educational Resources Information Center

    Hultin, Mats

    This paper looks at the position taken in available literature and evaluation reports of multinational and bilateral agencies in regard to vocational education in developing countries. Section 1 provides background on such topics as links between education and development, support of vocational education, diversified secondary education, foreign…

  4. Prevalence of Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

    PubMed

    Sarki, Ahmed M; Nduka, Chidozie U; Stranges, Saverio; Kandala, Ngianga-Bakwin; Uthman, Olalekan A

    2015-12-01

    We aimed to obtain overall and regional estimates of hypertension prevalence, and to examine the pattern of this disease condition across different socio-demographic characteristics in low-and middle-income countries. We searched electronic databases from inception to August 2015. We included population-based studies that reported hypertension prevalence using the current definition of blood pressure ≥140/90 mm Hg or self-reported use of antihypertensive medication. We used random-effects meta-analyses to pool prevalence estimates of hypertension, overall, by World Bank region and country income group. Meta-regression analyses were performed to explore sources of heterogeneity across the included studies. A total of 242 studies, comprising data on 1,494,609 adults from 45 countries, met our inclusion criteria. The overall prevalence of hypertension was 32.3% (95% confidence interval [CI] 29.4-35.3), with the Latin America and Caribbean region reporting the highest estimates (39.1%, 95% CI 33.1-45.2). Pooled prevalence estimate was also highest across upper middle income countries (37.8%, 95% CI 35.0-40.6) and lowest across low-income countries (23.1%, 95% CI 20.1-26.2). Prevalence estimates were significantly higher in the elderly (≥65 years) compared with younger adults (<65 years) overall and across the geographical regions; however, there was no significant sex-difference in hypertension prevalence (31.9% vs 30.8%, P = 0.6). Persons without formal education (49.0% vs 24.9%, P < 0.00001), overweight/obese (46.4% vs 26.3%, P < 0.00001), and urban settlers (32.7% vs 25.2%, P = 0.0005) were also more likely to be hypertensive, compared with those who were educated, normal weight, and rural settlers respectively. This study provides contemporary and up-to-date estimates that reflect the significant burden of hypertension in low- and middle-income countries, as well as evidence that hypertension remains a major public health issue across the

  5. Prevalence of Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

    PubMed

    Sarki, Ahmed M; Nduka, Chidozie U; Stranges, Saverio; Kandala, Ngianga-Bakwin; Uthman, Olalekan A

    2015-12-01

    We aimed to obtain overall and regional estimates of hypertension prevalence, and to examine the pattern of this disease condition across different socio-demographic characteristics in low-and middle-income countries. We searched electronic databases from inception to August 2015. We included population-based studies that reported hypertension prevalence using the current definition of blood pressure ≥140/90 mm Hg or self-reported use of antihypertensive medication. We used random-effects meta-analyses to pool prevalence estimates of hypertension, overall, by World Bank region and country income group. Meta-regression analyses were performed to explore sources of heterogeneity across the included studies. A total of 242 studies, comprising data on 1,494,609 adults from 45 countries, met our inclusion criteria. The overall prevalence of hypertension was 32.3% (95% confidence interval [CI] 29.4-35.3), with the Latin America and Caribbean region reporting the highest estimates (39.1%, 95% CI 33.1-45.2). Pooled prevalence estimate was also highest across upper middle income countries (37.8%, 95% CI 35.0-40.6) and lowest across low-income countries (23.1%, 95% CI 20.1-26.2). Prevalence estimates were significantly higher in the elderly (≥65 years) compared with younger adults (<65 years) overall and across the geographical regions; however, there was no significant sex-difference in hypertension prevalence (31.9% vs 30.8%, P = 0.6). Persons without formal education (49.0% vs 24.9%, P < 0.00001), overweight/obese (46.4% vs 26.3%, P < 0.00001), and urban settlers (32.7% vs 25.2%, P = 0.0005) were also more likely to be hypertensive, compared with those who were educated, normal weight, and rural settlers respectively. This study provides contemporary and up-to-date estimates that reflect the significant burden of hypertension in low- and middle-income countries, as well as evidence that hypertension remains a major public health issue across the

  6. School Choice and Equity: Current Policies in OECD Countries and a Literature Review. OECD Education Working Papers, No. 66

    ERIC Educational Resources Information Center

    Musset, Pauline

    2012-01-01

    This literature review on school choice analyses the impact of choice schemes on students and on school systems focusing on equity. Reviewing the evidence can be difficult, as the literature is often fragmented and inconclusive, and the political importance of this research often results in high-profile attention given to individual studies rather…

  7. Rotavirus vaccine RIX4414 (Rotarix™): a pharmacoeconomic review of its use in the prevention of rotavirus gastroenteritis in developed countries.

    PubMed

    Plosker, Greg L

    2011-05-01

    The most common cause of severe diarrhoea in infants and young children is rotavirus gastroenteritis (RVGE), which is associated with significant morbidity, healthcare resource use and direct and indirect costs in industrialized nations. The monovalent rotavirus vaccine RIX4414 (Rotarix™) is administered as a two-dose oral series in infants and has demonstrated protective efficacy against RVGE in clinical trials conducted in developed countries. In addition, various naturalistic studies have demonstrated 'real-world' effectiveness after the introduction of widespread rotavirus vaccination programmes in the community setting. Numerous cost-effectiveness analyses have been conducted in developed countries in which a universal rotavirus vaccination programme using RIX4414 was compared with no universal rotavirus vaccination programme. There was a high degree of variability in base-case results across studies even when conducted in the same country, often reflecting differences in the selection of data sources or assumptions used to populate the models. In addition, results were sensitive to plausible changes in a number of key input parameters. As such, it is not possible to definitively state whether a universal rotavirus vaccination programme with RIX4414 is cost effective in developed countries, although results of some analyses in some countries suggest this is the case. In addition, international guidelines advocate universal vaccination of infants and children against rotavirus. It is also difficult to draw conclusions regarding the cost effectiveness of rotavirus vaccine RIX4414 relative to that of the pentavalent rotavirus vaccine, which is administered as a three-dose oral series. Although indirect comparisons in cost-effectiveness analyses indicate that RIX4414 provided more favourable incremental cost-effectiveness ratios when each vaccine was compared with no universal rotavirus vaccination programme, results were generally sensitive to vaccine costs

  8. Detailed Methodology for Systematic Reviews of Interventions to Improve the Sexual and Reproductive Health of Young People in Low- and Middle-Income Countries.

    PubMed

    Hindin, Michelle J; Kalamar, Amanda M

    2016-09-01

    The goal of this project was to systematically review and compile evidence on interventions in low- and middle-income countries, which targeted three adverse health-related outcomes for young people (ages 10-24): (1) early pregnancy and repeat pregnancy; (2) child marriage; and (3) sexually transmitted infections including human immunodeficiency virus. We searched the gray and published literature to identify interventions and developed a scoring system to assess whether these interventions and their evaluations were of high quality. The three review articles in this volume focus on behavioral outcomes and provide a summary of interventions and evaluations that were both successful and unsuccessful in their impact on the targeted outcomes. This commentary provides the details of the methodology that are common across all three review articles. PMID:27562451

  9. Relative Importance of Hepatitis B and C Viruses in Hepatocellular Carcinoma in EMRO Countries and the Middle East: A Systematic Review

    PubMed Central

    Alavian, Seyed Moayed; Haghbin, Hossein

    2016-01-01

    Context Hepatocellular carcinoma (HCC) is the second most common cancer-related death worldwide. Although many factors including dietary aflatoxin B1 (AFB1) and alcoholic and non-alcoholic fatty liver diseases can lead to HCC, globally most HCC cases are due to hepatitis B virus (HBV) and hepatitis C virus (HCV). Considering the importance of these viral factors in most HCC cases and relative lack of literature from eastern Mediterranean region office of world health organization (EMRO) countries and the Middle East, we decided to perform this systematic review to find distribution of viral etiology of HCC in these regions. Evidence Acquisition In this systemic review, we included all studies from 1 January 1989 to 1 September 2015 with at least 20 samples that measured HBV surface antigen (HBsAg) and antibodies to HCV (anti-HCV). The authors searched MEDLINE, Embase, Popline, Web of Science and WHO indexed databases. We searched the following MeSH terms; hepatocellular carcinoma, hepatitis B virus and hepatitis C virus or hepacvirus. Only studies using second- and third-generation HCV assays were included. Only articles studying HCC patients from EMRO countries and the Middle East were analyzed. Duplicate results that reported the same cases more than once were found and omitted. Studies in English and Farsi were reviewed. If the study was eligible, we recorded the following data; the first author, publication year and journal, study population and number and percentage of patients with different serologic statuses. Results We found 44 studies from 12 countries in EMRO and the Middle East. HCC cases from Iran, Lebanon, Turkey and Yemen were mainly due to HBV, while those of North African nations (Egypt, Tunisia, Morocco, Algeria and Somalia) in addition to Saudi Arabia and Pakistan were mostly HCV related. Sudan showed a high seronegativity and HBV infection in its HCC cases. Unfortunately, some countries from EMRO and the Middle East did not have eligible studies

  10. Local production of medical technologies and its effect on access in low and middle income countries: a systematic review of the literature

    PubMed Central

    Kaplan, Warren Allan; Ritz, Lindsay Sarah; Vitello, Marie

    2011-01-01

    Objectives: The objective of this study was to assess the existing theoretical and empirical literature examining the link between "local production" of pharmaceuticals and medical devices and increased local access to these products. Our preliminary hypothesis is that studies showing a robust relationship between local production and access to medical products are sparse, at best. Methods: An extensive literature search was conducted using a wide variety of databases and search terms intending to capture as many different aspects of this issue as possible. The results of the search were reviewed and categorized according to their relevance to the research question. The literature was also reviewed to determine the rigor used to examine the effects of local production and what implications these experiences hold for other developing countries. Results: Literature addressing the benefits of local production and the link between it and access to medical products is sparse, mainly descriptive and lacking empirical evidence. Of the literature we reviewed that addressed comparative economics and strategic planning of multinational and domestic firms, there are few dealing with emerging markets and lower-middle income countries and even fewer that compare local biomedical producers with multinational corporations in terms of a reasonable metric. What comparisons exist mainly relate to prices of local versus foreign/multinational produced medicines. Conclusions: An assessment of the existing theoretical and empirical literature examining the link between "local production" of pharmaceuticals and medical devices and increased local access to these products reveals a paucity of literature explicitly dealing with this issue. Of the literature that does exist, methods used to date are insufficient to prove a robust relationship between local production of medical products and access to these products. There are mixed messages from various studies, and although the studies may

  11. A systematic review of behavioral interventions to prevent HIV infection and transmission among heterosexual, adult men in low-and middle-income countries.

    PubMed

    Townsend, Loraine; Mathews, Catherine; Zembe, Yanga

    2013-02-01

    Prevention of new HIV infections needs to move to the forefront in the fight against HIV and AIDS. In the current economic crisis, low- and middle-income countries (LMICs) should invest limited resources to amass reliable evidence-based information about behavioral prevention efforts, and on behaviors that are driving the epidemic among people who are engaging in those behaviors. This paper aims to provide a systematic review and synthesis of behavioral interventions among a group of people in high HIV-burden countries: heterosexual men in LMICs. The review includes articles published between January 2001 and May 2010 that evaluated behavioral prevention interventions among heterosexual males aged 18+ years in LMICs. The studies were evaluated using the quality assessment tool for quantitative studies developed by the Effective Public Health Practice Project. The review identified 19 articles that met the review's inclusion criteria. Most studies were conducted in South Africa (n=6); two each in Uganda and Thailand; and one in each of Angola, Brazil, Bulgaria, India, Nigeria, the Philippines, Russia, Ukraine and Zimbabwe. Eight of 19 interventions increased condom use among their respective populations. Those interventions that sought to reduce the number of sexual partners had little effect, and those that addressed alcohol consumption and intimate partner violence had mixed effects. There was no evidence for any specific format of intervention that impacted best on any of the targeted risk behaviors. The paucity of evaluated interventions for heterosexual men in LMICs suggests that adult men in these countries remain underrepresented in HIV prevention efforts. PMID:23111548

  12. Strong nutrition governance is a key to addressing nutrition transition in low and middle-income countries: review of countries’ nutrition policies

    PubMed Central

    2014-01-01

    Methods We reviewed nutrition policies, nutrition governance, and the trends of nutrition status from LAMICs. We retrieved data on the policies from the global database on the implementation of nutrition actions (GINA). We also retrieved data on the trends of nutrition status and nutrition governance from the nutrition landscape information system (NLiS), and on LAMICs from the World Bank database. We then analyzed the data both descriptively and by using a mixed effects model with random-intercept by country. Results Of the 139 LAMICs reviewed, only 39.6% had policies to address both undernutrition and overweight/obesity. A higher proportion of low-income countries (LICs) had policies to address undernutrition compared to that of middle-income countries (MICs) (86.1% vs. 63.1%, p = 0.002), and a low proportion of both had policy to address overweight. Having a nutrition policy that addresses undernutrition was not associated with better nutrition status outcomes. Strong nutrition governance in LAMICS was associated with low magnitudes of stunting (beta = -4.958, p = 0.015); wasting (beta = -5.418, p = 0.003); and underweight (beta = -6.452, p = 0.001). Conclusion Despite high magnitudes of undernutrition and overweight/obesity in LAMICs, only about one third of them had nutrition policies to address such nutrition transition. Having strong nutrition governance may help to bring down the magnitudes of undernutrition in LAMICs. Nutrition transition necessitates low and middle-income countries (LAMICs) to scale up their efforts in addressing the burdens of undernutrition and overweight/obesity. Magnitudes of undernutrition and overweight are high in LAMICs, but no study has reviewed the existence of nutrition policies to address it. No evidence is also available on the effect of nutrition policies and governance on the undernutrition and overweight/obesity patterns in such countries. We conducted a policy review to examine the presence and associations of nutrition

  13. The experiences of implementing generic medicine policy in eight countries: A review and recommendations for a successful promotion of generic medicine use

    PubMed Central

    Hassali, Mohamed Azmi; Alrasheedy, Alian A.; McLachlan, Andrew; Nguyen, Tuan Anh; AL-Tamimi, Saleh Karamah; Ibrahim, Mohamed Izham Mohamed; Aljadhey, Hisham

    2013-01-01

    Generic medicines are clinically interchangeable with original brand medicines and have the same quality, efficacy and safety profiles. They are, nevertheless, much cheaper in price. Thus, while providing the same therapeutic outcomes, generic medicines lead to substantial savings for healthcare systems. Therefore, the quality use of generic medicines is promoted in many countries. In this paper, we reviewed the role of generic medicines in healthcare systems and the experiences of promoting the use of generic medicines in eight selected countries, namely the United States (US), the United Kingdom (UK), Sweden, Finland, Australia, Japan, Malaysia and Thailand. The review showed that there are different main policies adopted to promote generic medicines such as generic substitution in the US, generic prescribing in the UK and mandatory generic substitution in Sweden and Finland. To effectively and successfully implement the main policy, different complementary policies and initiatives were necessarily introduced. Barriers to generic medicine use varied between countries from negative perceptions about generic medicines to lack of a coherent generic medicine policy, while facilitators included availability of information about generic medicines to both healthcare professionals and patients, brand interchangeability guidelines, regulations that support generic substitution by pharmacists, and incentives to both healthcare professionals and patients. PMID:25561861

  14. Maximizing protection from use of oral cholera vaccines in developing country settings: an immunological review of oral cholera vaccines.

    PubMed

    Desai, Sachin N; Cravioto, Alejandro; Sur, Dipika; Kanungo, Suman

    2014-01-01

    When oral vaccines are administered to children in lower- and middle-income countries, they do not induce the same immune responses as they do in developed countries. Although not completely understood, reasons for this finding include maternal antibody interference, mucosal pathology secondary to infection, malnutrition, enteropathy, and previous exposure to the organism (or related organisms). Young children experience a high burden of cholera infection, which can lead to severe acute dehydrating diarrhea and substantial mortality and morbidity. Oral cholera vaccines show variations in their duration of protection and efficacy between children and adults. Evaluating innate and memory immune response is necessary to understand V. cholerae immunity and to improve current cholera vaccine candidates, especially in young children. Further research on the benefits of supplementary interventions and delivery schedules may also improve immunization strategies.

  15. Pneumocystis and Pneumocystosis: first meeting of experts from Latin-American and Portuguese-speaking countries - a mini-review.

    PubMed

    Esteves, Francisco; Medrano, Francisco J; de Armas, Yaxsier; Wissmann, Gustavo; Calderón, Enrique J; Matos, Olga

    2014-05-01

    The Pneumocystis and Pneumocystosis: first meeting of experts from Latin-American and Portuguese-speaking countries was held in Lisbon, Portugal, on 24-26 October 2013. A total of 20 speakers from Latin America, Africa and Europe participated in the meeting. The epidemiological studies presented in this meeting begin to change the misconception that since the AIDS epidemic, Pneumocystis pneumonia (PcP) has become an infrequent disease, showing that today PcP remains a major opportunistic infection in HIV-infected patients in both developed and developing countries and an emerging problem in immunocompromised patients without HIV infection worldwide. PcP management remains a challenge. Right now, the combination of caspofungin and trimethoprim-sulfamethoxazole (TMP-SMX) is a promising therapeutic approach that needs to be assessed in controlled clinical trials. PMID:24617414

  16. Pneumocystis and Pneumocystosis: first meeting of experts from Latin-American and Portuguese-speaking countries - a mini-review.

    PubMed

    Esteves, Francisco; Medrano, Francisco J; de Armas, Yaxsier; Wissmann, Gustavo; Calderón, Enrique J; Matos, Olga

    2014-05-01

    The Pneumocystis and Pneumocystosis: first meeting of experts from Latin-American and Portuguese-speaking countries was held in Lisbon, Portugal, on 24-26 October 2013. A total of 20 speakers from Latin America, Africa and Europe participated in the meeting. The epidemiological studies presented in this meeting begin to change the misconception that since the AIDS epidemic, Pneumocystis pneumonia (PcP) has become an infrequent disease, showing that today PcP remains a major opportunistic infection in HIV-infected patients in both developed and developing countries and an emerging problem in immunocompromised patients without HIV infection worldwide. PcP management remains a challenge. Right now, the combination of caspofungin and trimethoprim-sulfamethoxazole (TMP-SMX) is a promising therapeutic approach that needs to be assessed in controlled clinical trials.

  17. 76 FR 81555 - 2012 Special 301 Review: Identification of Countries Under Section 182 of the Trade Act of 1974...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-28

    ... review process. USTR is hereby requesting written submissions from the public concerning foreign... United States Trade Representative. ACTION: Request for written submissions from the public and... issues arising under Special 301. Written submissions from interested persons are a key source...

  18. Animal leptospirosis in Latin America and the Caribbean countries: reported outbreaks and literature review (2002-2014).

    PubMed

    Petrakovsky, Jessica; Bianchi, Alejandra; Fisun, Helen; Nájera-Aguilar, Patricia; Pereira, Martha Maria

    2014-10-16

    Leptospirosis is a worldwide zoonotic disease whose transmission is linked through multiple factors in the animal-human-ecosystem interface. The data on leptospirosis reported to the World Organization for Animal Health (OIE) for Latin America and Caribbean (LAC) countries/sovereign territories from 2005-2011 were mapped, showing a wide distribution of outbreaks in the region. Tropical terrestrial biomes are the predominate ecosystems showing reports of outbreaks. Climatic and ecological factors were relevant to the occurrence of epidemic outbreaks. The available scientific information from 2002-2014 was summarized to obtain a general overview and identify key issues related to the One Health approach. The primary serological test used for diagnosis and for conducting surveys was the microscopic agglutination test (MAT). Reports regarding the isolation and typing of leptospires were scattered and limited to data from a few countries, but their results revealed considerable biodiversity at the species and serovar levels. A total of six out of 11 currently named pathogenic species were found in the region. There was also high diversity of animal species showing evidence of infection by leptospires, including rodents, pets, livestock and wild animals. Prevention and control measures for leptospirosis should consider issues of animal and human health in the context of ecosystems, the territorial land borders of countries and trade.

  19. Animal Leptospirosis in Latin America and the Caribbean Countries: Reported Outbreaks and Literature Review (2002–2014)

    PubMed Central

    Petrakovsky, Jessica; Bianchi, Alejandra; Fisun, Helen; Nájera-Aguilar, Patricia; Pereira, Martha Maria

    2014-01-01

    Leptospirosis is a worldwide zoonotic disease whose transmission is linked through multiple factors in the animal-human-ecosystem interface. The data on leptospirosis reported to the World Organization for Animal Health (OIE) for Latin America and Caribbean (LAC) countries/sovereign territories from 2005–2011 were mapped, showing a wide distribution of outbreaks in the region. Tropical terrestrial biomes are the predominate ecosystems showing reports of outbreaks. Climatic and ecological factors were relevant to the occurrence of epidemic outbreaks. The available scientific information from 2002–2014 was summarized to obtain a general overview and identify key issues related to the One Health approach. The primary serological test used for diagnosis and for conducting surveys was the microscopic agglutination test (MAT). Reports regarding the isolation and typing of leptospires were scattered and limited to data from a few countries, but their results revealed considerable biodiversity at the species and serovar levels. A total of six out of 11 currently named pathogenic species were found in the region. There was also high diversity of animal species showing evidence of infection by leptospires, including rodents, pets, livestock and wild animals. Prevention and control measures for leptospirosis should consider issues of animal and human health in the context of ecosystems, the territorial land borders of countries and trade. PMID:25325360

  20. Taxonomic review of the Genus Deltoplastis Meyrick (Lepidoptera: Lecithoceridae) in China and its neibouring countries, with a world catalogue of the genus.

    PubMed

    Wang, Yuqi; Park, Kyu-Tek; Wang, Shuxia

    2015-12-10

    The genus Deltoplastis Meyrick is reviewed from China and its neibouring countries. Fifteen species are recognized, including nine new species: D. angustifoliacea sp. nov., D. conjugata sp. nov., D. dentata sp. nov., D. curviloba sp. nov., D. gyroflexa sp. nov., D. hippocrepica sp. nov., D. mamillata sp. nov., D. acutiprocessa sp. nov., and D. maehongsonensis sp. nov. The male of D. causidica (Meyrick, 1910) and the female of D. prionaspis Gozmány, 1978 are described for the first time. Deltoplastis causidica (Meyrick, 1910) from China and Thailand, D. gypsopeda Meyrick, 1934 from Thailand and India, D. commatopa Meyrick, 1932 from Vietnam and India, D. lobigera Gozmány from India are newly recorded for each country. Photographs of adults and genitalia are provided, along with a key to the species and a world catalogue of Deltoplastis.

  1. Clinical aspects and adrenal functions in eleven Japanese children with X-linked adrenoleukodystrophy.

    PubMed

    Miyoshi, Yoko; Sakai, Norio; Hamada, Yusuke; Tachibana, Makiko; Hasegawa, Yasuhiro; Kiyohara, Yuki; Yamada, Hiroyuki; Murakami, Mari; Kondou, Hiroki; Kimura-Ohba, Shihoko; Mine, Junji; Sato, Tatsuharu; Kamio, Noriko; Ueda, Hitoshi; Suzuki, Yasuhiro; Shiomi, Masashi; Ohta, Hideaki; Shimozawa, Nobuyuki; Ozono, Keiichi

    2010-01-01

    X-linked adrenoleukodystrophy (X-ALD) is a genetic disease associated with demyelination of the central nervous system, adrenocortical insufficiency and accumulation of very long chain fatty acids. It is a clinically heterogeneous disorder ranging from a severe childhood cerebral form to an asymptomatic form. The incidence in Japan is estimated to be between 1:30,000 and 1:50,000 boys as determined by a nationwide retrospective survey between 1990 and 1999, which found no cases with Addison's form. We reviewed the medical records of eleven Japanese boys with X-ALD from 1990 to 2010 in our institute. Eight patients were detected by neuropsychological abnormalities, whereas a higher prevalence of unrecognized adrenocortical insufficiency (5/11: 45%) was observed than previously recognized. While no neurological abnormalities were demonstrated in two brothers, the elder brother had moderate Addison's disease at diagnosis and the presymptomatic younger brother progressed to Addison's disease six months after the diagnosis of X-ALD. Early detection of impaired adrenal function as well as early identification of neurologically presymptomatic patients by genetic analysis is essential for better prognosis. Addison's form might be overlooked in Japan; therefore, X-ALD should be suspected in patients with adrenocortical insufficiency.

  2. Mobile Health (mHealth) Approaches and Lessons for Increased Performance and Retention of Community Health Workers in Low- and Middle-Income Countries: A Review

    PubMed Central

    2013-01-01

    Background Mobile health (mHealth) describes the use of portable electronic devices with software applications to provide health services and manage patient information. With approximately 5 billion mobile phone users globally, opportunities for mobile technologies to play a formal role in health services, particularly in low- and middle-income countries, are increasingly being recognized. mHealth can also support the performance of health care workers by the dissemination of clinical updates, learning materials, and reminders, particularly in underserved rural locations in low- and middle-income countries where community health workers deliver integrated community case management to children sick with diarrhea, pneumonia, and malaria. Objective Our aim was to conduct a thematic review of how mHealth projects have approached the intersection of cellular technology and public health in low- and middle-income countries and identify the promising practices and experiences learned, as well as novel and innovative approaches of how mHealth can support community health workers. Methods In this review, 6 themes of mHealth initiatives were examined using information from peer-reviewed journals, websites, and key reports. Primary mHealth technologies reviewed included mobile phones, personal digital assistants (PDAs) and smartphones, patient monitoring devices, and mobile telemedicine devices. We examined how these tools could be used for education and awareness, data access, and for strengthening health information systems. We also considered how mHealth may support patient monitoring, clinical decision making, and tracking of drugs and supplies. Lessons from mHealth trials and studies were summarized, focusing on low- and middle-income countries and community health workers. Results The review revealed that there are very few formal outcome evaluations of mHealth in low-income countries. Although there is vast documentation of project process evaluations, there are few

  3. IMPROVED GROUND TRUTH IN SOUTHERN ASIA USING IN-COUNTRY DATA, ANALYST WAVEFORM REVIEW, AND ADVANCED ALGORITHMS

    SciTech Connect

    Engdahl, Eric, R.; Bergman, Eric, A.; Myers, Stephen, C.; Ryall, Floriana

    2009-06-19

    A new catalog of seismicity at magnitudes above 2.5 for the period 1923-2008 in the Iran region is assembled from arrival times reported by global, regional, and local seismic networks. Using in-country data we have formed new events, mostly at lower magnitudes that were not previously included in standard global earthquake catalogs. The magnitude completeness of the catalog varies strongly through time, complete to about magnitude 4.2 prior to 1998 and reaching a minimum of about 3.6 during the period 1998-2005. Of the 25,722 events in the catalog, most of the larger events have been carefully reviewed for proper phase association, especially for depth phases and to eliminate outlier readings, and relocated. To better understand the quality of the data set of arrival times reported by Iranian networks that are central to this study, many waveforms for events in Iran have been re-picked by an experienced seismic analyst. Waveforms at regional distances in this region are often complex. For many events this makes arrival time picks difficult to make, especially for smaller magnitude events, resulting in reported times that can be substantially improved by an experienced analyst. Even when the signal/noise ratio is large, re-picking can lead to significant differences. Picks made by our analyst are compared with original picks made by the regional networks. In spite of the obvious outliers, the median (-0.06 s) and spread (0.51 s) are small, suggesting that reasonable confidence can be placed in the picks reported by regional networks in Iran. This new catalog has been used to assess focal depth distributions throughout Iran. A principal result of this study is that the geographic pattern of depth distributions revealed by the relatively small number of earthquakes (~167) with depths constrained by waveform modeling (+/- 4 km) are now in agreement with the much larger number of depths (~1229) determined using reanalysis of ISC arrival-times (+/-10 km), within their

  4. Opening the 'black box' of performance-based financing in low- and lower middle-income countries: a review of the literature.

    PubMed

    Renmans, Dimitri; Holvoet, Nathalie; Orach, Christopher Garimoi; Criel, Bart

    2016-11-01

    Although performance-based financing (PBF) receives increasing attention in the literature, a lot remains unknown about the exact mechanisms triggered by PBF arrangements. This article aims to summarize current knowledge on how PBF works, set out what still needs to be investigated and formulate recommendations for researchers and policymakers from donor and recipient countries alike. Drawing on an extensive systematic literature review of peer-reviewed journals, we analysed 35 relevant articles. To guide us through this variety of studies, point out relevant issues and structure findings, we use a comprehensive analytical framework based on eight dimensions. The review inter alia indicates that PBF is generally welcomed by the main actors (patients, health workers and health managers), yet what PBF actually entails is less straightforward. More research is needed on the exact mechanisms through which not only incentives but also ancillary components operate. This knowledge is essential if we really want to appreciate the effectiveness, desirability and appropriate format of PBF as one of the possible answers to the challenges in the health sector of low-and lower middle-income countries. A clear definition of the research constructs is a primordial starting point for such research.

  5. Opening the 'black box' of performance-based financing in low- and lower middle-income countries: a review of the literature.

    PubMed

    Renmans, Dimitri; Holvoet, Nathalie; Orach, Christopher Garimoi; Criel, Bart

    2016-11-01

    Although performance-based financing (PBF) receives increasing attention in the literature, a lot remains unknown about the exact mechanisms triggered by PBF arrangements. This article aims to summarize current knowledge on how PBF works, set out what still needs to be investigated and formulate recommendations for researchers and policymakers from donor and recipient countries alike. Drawing on an extensive systematic literature review of peer-reviewed journals, we analysed 35 relevant articles. To guide us through this variety of studies, point out relevant issues and structure findings, we use a comprehensive analytical framework based on eight dimensions. The review inter alia indicates that PBF is generally welcomed by the main actors (patients, health workers and health managers), yet what PBF actually entails is less straightforward. More research is needed on the exact mechanisms through which not only incentives but also ancillary components operate. This knowledge is essential if we really want to appreciate the effectiveness, desirability and appropriate format of PBF as one of the possible answers to the challenges in the health sector of low-and lower middle-income countries. A clear definition of the research constructs is a primordial starting point for such research. PMID:27126200

  6. Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review

    PubMed Central

    2013-01-01

    Background Community Health Workers are widely utilised in low- and middle-income countries and may be an important tool in reducing maternal and child mortality; however, evidence is lacking on their effectiveness for specific types of programmes, specifically programmes of a preventive nature. This review reports findings on a systematic review analysing effectiveness of preventive interventions delivered by Community Health Workers for Maternal and Child Health in low- and middle-income countries. Methods A search strategy was developed according to the Evidence for Policy and Practice Information and Co-ordinating Centre’s (EPPI-Centre) guidelines and systematic searching of the following databases occurred between June 8 – 11th, 2012: CINAHL, Embase, Ovid Nursing Database, PubMed, Scopus, Web of Science and POPLINE. Google, Google Scholar and WHO search engines, as well as relevant systematic reviews and reference lists from included articles were also searched. Inclusion criteria were: i) Target beneficiaries should be pregnant or recently pregnant women and/or children under-5 and/or caregivers of children under-5; ii) Interventions were required to be preventive and delivered by Community Health Workers at the household level. No exclusion criteria were stipulated for comparisons/controls or outcomes. Study characteristics of included articles were extracted using a data sheet and a peer tested quality assessment. A narrative synthesis of included studies was compiled with articles being coded descriptively to synthesise results and draw conclusions. Results A total of 10,281 studies were initially identified and through the screening process a total of 17 articles detailing 19 studies were included in the review. Studies came from ten different countries and consisted of randomized controlled trials, cluster randomized controlled trials, before and after, case control and cross sectional studies. Overall quality of evidence was found to be moderate

  7. HIV among immigrants living in high-income countries: a realist review of evidence to guide targeted approaches to behavioural HIV prevention

    PubMed Central

    2012-01-01

    Background Immigrants from developing and middle-income countries are an emerging priority in HIV prevention in high-income countries. This may be explained in part by accelerating international migration and population mobility. However, it may also be due to the vulnerabilities of immigrants including social exclusion along with socioeconomic, cultural and language barriers to HIV prevention. Contemporary thinking on effective HIV prevention stresses the need for targeted approaches that adapt HIV prevention interventions according to the cultural context and population being addressed. This review of evidence sought to generate insights into targeted approaches in this emerging area of HIV prevention. Methods We undertook a realist review to answer the research question: ‘How are HIV prevention interventions in high-income countries adapted to suit immigrants’ needs?’ A key goal was to uncover underlying theories or mechanisms operating in behavioural HIV prevention interventions with immigrants, to uncover explanations as how and why they work (or not) for particular groups in particular contexts, and thus to refine the underlying theories. The realist review mapped seven initial mechanisms underlying culturally appropriate HIV prevention with immigrants. Evidence from intervention studies and qualitative studies found in systematic searches was then used to test and refine these seven mechanisms. Results Thirty-four intervention studies and 40 qualitative studies contributed to the analysis and synthesis of evidence. The strongest evidence supported the role of ‘consonance’ mechanisms, indicating the pivotal need to incorporate cultural values into the intervention content. Moderate evidence was found to support the role of three other mechanisms – ‘understanding’, ‘specificity’ and ‘embeddedness’ – which indicated that using the language of immigrants, usually the ‘mother tongue’, targeting (in terms of ethnicity) and the use of

  8. One century of arsenic exposure in Latin America: a review of history and occurrence from 14 countries.

    PubMed

    Bundschuh, Jochen; Litter, Marta I; Parvez, Faruque; Román-Ross, Gabriela; Nicolli, Hugo B; Jean, Jiin-Shuh; Liu, Chen-Wuing; López, Dina; Armienta, María A; Guilherme, Luiz R G; Cuevas, Alina Gomez; Cornejo, Lorena; Cumbal, Luis; Toujaguez, Regla

    2012-07-01

    The global impact on public health of elevated arsenic (As) in water supplies is highlighted by an increasing number of countries worldwide reporting high As concentrations in drinking water. In Latin America, the problem of As contamination in water is known in 14 out of 20 countries: Argentina, Bolivia, Brazil, Chile, Colombia, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Peru and Uruguay. Considering the 10 μg/L limit for As in drinking water established by international and several national agencies, the number of exposed people is estimated to be about 14 million. Health effects of As exposure were identified for the first time already in the 1910s in Bellville (Córdoba province, Argentina). Nevertheless, contamination of As in waters has been detected in 10 Latin American countries only within the last 10 to 15 years. Arsenic is mobilized predominantly from young volcanic rocks and their weathering products. In alluvial aquifers, which are water sources frequently used for water supply, desorption of As from metal oxyhydroxides at high pH (>8) is the predominant mobility control; redox conditions are moderate reducing to oxidizing and As(V) is the predominant species. In the Andes, the Middle American cordillera and the Transmexican Volcanic Belt, oxidation of sulfide minerals is the primary As mobilization process. Rivers that originate in the Andean mountains, transport As to more densely populated areas in the lowlands (e.g. Rímac river in Peru, Pilcomayo river in Bolivia/Argentina/Paraguay). In many parts of Latin America, As often occurs together with F and B; in the Chaco-Pampean plain As is found additionally with V, Mo and U whereas in areas with sulfide ore deposits As often occurs together with heavy metals. These co-occurrences and the anthropogenic activities in mining areas that enhance the mobilization of As and other pollutants make more dramatic the environmental problem.

  9. Inequities in postnatal care in low- and middle-income countries: a systematic review and meta-analysis

    PubMed Central

    Miszkurka, Malgorzata; Zunzunegui, Maria Victoria; Ghaffar, Abdul; Ziegler, Daniela; Karp, Igor

    2015-01-01

    Abstract Objective To assess the socioeconomic, geographical and demographic inequities in the use of postnatal health-care services in low- and middle-income countries. Methods We searched Medline, Embase and Cochrane Central databases and grey literature for experimental, quasi-experimental and observational studies that had been conducted in low- and middle-income countries. We summarized the relevant studies qualitatively and performed meta-analyses of the use of postnatal care services according to selected indicators of socioeconomic status and residence in an urban or rural setting. Findings A total of 36 studies were included in the narrative synthesis and 10 of them were used for the meta-analyses. Compared with women in the lowest quintile of socioeconomic status, the pooled odds ratios for use of postnatal care by women in the second, third, fourth and fifth quintiles were: 1.14 (95% confidence interval, CI : 0.96–1.34), 1.32 (95% CI: 1.12–1.55), 1.60 (95% CI: 1.30–1.98) and 2.27 (95% CI: 1.75–2.93) respectively. Compared to women living in rural settings, the pooled odds ratio for the use of postnatal care by women living in urban settings was 1.36 (95% CI: 1.01–1.81). A qualitative assessment of the relevant published data also indicated that use of postnatal care services increased with increasing level of education. Conclusion In low- and middle-income countries, use of postnatal care services remains highly inequitable and varies markedly with socioeconomic status and between urban and rural residents. PMID:26229190

  10. Scientific publications in ophthalmic journals from China and other top-ranking countries: a 12-year review of the literature

    PubMed Central

    2013-01-01

    Background Eye diseases with increasing mortality are common health problems that affect people of all ages and demographic backgrounds. In this study, we study the publication characteristics in international ophthalmic journals of the US, the UK, Germany, Australia, Japan, and China. Methods Articles published in 53 ophthalmic journals from 2000 to 2011 were retrieved from the PubMed database. We recorded the number of articles published each year, analyzed the publication type, and evaluated the accumulated and average impact factors (IFs), and the distribution of articles in ophthalmic journals in relation to IFs. The characteristics of publication outputs from China and other top-ranking countries were compared. Results The total number of articles increased significantly during the past 12 years, with an increase of 51.0%. The growth in the annual number of articles from the US, the UK, Australia, and China showed a significantly positive trend. Publications from the US exceeded those from any other country and had the highest IFs, largest number of total citations of articles, and the most articles published in leading ophthalmic journals. During the past 12 years, China contributed 3.5% of the total publications, and the number of Chinese articles showed a more than 6-fold increase (from 99 to 605, R2 =0.947, P<0.001). The numbers of IFs and citations of articles originating in China were mostly lower than for other top-ranking counties. Conclusions Research on ophthalmic journals has maintained an upward growing trend from 2000 to 2011. Chinese ophthalmology research has developed rapidly, but the gap still exists between China and other top-ranking countries for the advanced level of research. PMID:23802511

  11. One century of arsenic exposure in Latin America: a review of history and occurrence from 14 countries.

    PubMed

    Bundschuh, Jochen; Litter, Marta I; Parvez, Faruque; Román-Ross, Gabriela; Nicolli, Hugo B; Jean, Jiin-Shuh; Liu, Chen-Wuing; López, Dina; Armienta, María A; Guilherme, Luiz R G; Cuevas, Alina Gomez; Cornejo, Lorena; Cumbal, Luis; Toujaguez, Regla

    2012-07-01

    The global impact on public health of elevated arsenic (As) in water supplies is highlighted by an increasing number of countries worldwide reporting high As concentrations in drinking water. In Latin America, the problem of As contamination in water is known in 14 out of 20 countries: Argentina, Bolivia, Brazil, Chile, Colombia, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Peru and Uruguay. Considering the 10 μg/L limit for As in drinking water established by international and several national agencies, the number of exposed people is estimated to be about 14 million. Health effects of As exposure were identified for the first time already in the 1910s in Bellville (Córdoba province, Argentina). Nevertheless, contamination of As in waters has been detected in 10 Latin American countries only within the last 10 to 15 years. Arsenic is mobilized predominantly from young volcanic rocks and their weathering products. In alluvial aquifers, which are water sources frequently used for water supply, desorption of As from metal oxyhydroxides at high pH (>8) is the predominant mobility control; redox conditions are moderate reducing to oxidizing and As(V) is the predominant species. In the Andes, the Middle American cordillera and the Transmexican Volcanic Belt, oxidation of sulfide minerals is the primary As mobilization process. Rivers that originate in the Andean mountains, transport As to more densely populated areas in the lowlands (e.g. Rímac river in Peru, Pilcomayo river in Bolivia/Argentina/Paraguay). In many parts of Latin America, As often occurs together with F and B; in the Chaco-Pampean plain As is found additionally with V, Mo and U whereas in areas with sulfide ore deposits As often occurs together with heavy metals. These co-occurrences and the anthropogenic activities in mining areas that enhance the mobilization of As and other pollutants make more dramatic the environmental problem. PMID:21959248

  12. An Eleven-Year Retrospective Study of Endogenous Bacterial Endophthalmitis

    PubMed Central

    Nishida, Takashi; Ishida, Kyoko; Niwa, Yoshiaki; Kawakami, Hideaki; Mochizuki, Kiyofumi; Ohkusu, Kiyofumi

    2015-01-01

    Purpose. To determine the clinical features, microbial profiles, treatment outcomes, and prognostic factors for endogenous bacterial endophthalmitis (EBE). Methods. The medical records of 27 eyes of 21 patients diagnosed with EBE for 11 years were reviewed. Collected data included age, site of infection, visual acuities (VAs), microbial profiles, and treatment regimen. Results. The mean age was 68.5 years. Gram-positive organisms accounted for 76.2%, while gram-negative ones accounted for 19.0%. Staphylococcus aureus was the most common causative organism (52.3%) of which 72.7% was methicillin-resistant S. aureus. A final VA of ≥20/40 was achieved in 44% and 20/200 or better was in 64%. Eyes with initial VA of ≥20/200 (P = 0.003) and focal involvements (P = 0.011) had significantly better final VA. Initial VA (P = 0.001) and the interval between onset of ocular symptoms and intravitreal antibiotic injection (P = 0.097) were associated with final VA in eyes receiving intravitreal antibiotics. Conclusions. EBE is generally associated with poor visual outcome; however the prognosis may depend on initial VA, extent of ocular involvement, and an interval between onset of ocular symptoms and intravitreal antibiotic injection. Early diagnosis and early intravitreal injection supplement to systemic antibiotics might lead to a relatively good visual outcome. PMID:25802752

  13. Physical and Psychological Well-being of University Students: Survey of Eleven Faculties in Egypt

    PubMed Central

    El Ansari, Walid; Labeeb, Shokria; Moseley, Lawrence; Kotb, Safaa; El-Houfy, Amira

    2013-01-01

    Background: We examined perceived health status and physical and psychological well-being of 3,271 undergraduate students attending eleven faculties in a university in Egypt. Methods: During 2009-2010, participants completed a self-administered questionnaire that gathered socio-demographic, physical and psychological health data. Body mass index (BMI) was calculated from students’ measured height and weight. Differences across these variables were computed by gender and participating faculties. Results: Whilst more females watched and rated their health favorably, they were more likely to feel psychosomatic/physical health problems, to have seen a medical practitioner or been ill that they had to stay in bed. Females were consistently more likely to feel burdened overall, and across several aspects apart from financial problems. Less females had ‘normal’ BMI, were satisfied with current weight, perceived their body image as ‘just right’, or were not worried about their shape. More males rated their quality of life favorably. About 25% of males and 32% of females were either overweight/obese. Exams, presentations, and the lack of time for studies were the frequently-reported burdens. Comparisons of health/well-being indicators across the participating faculties suggested some evidence of ‘clustering’: Favorable indicators would cluster at some faculties; and conversely, less favorable variables would cluster at other faculties. Conclusions: Generally, the levels of some health complaints and psychological problems/burdens are higher than in other countries. Increased vigilance of university administrators and leaders to monitoring the health and well-being of their students, as well as their health needs is required if policy makers are to operate from a valid evidence base platform. Given cultural factors prevalent in the Eastern Mediterranean region generally, female students might require particular attention. The clustering effects suggest the need

  14. Eleven new replacement names in the genus Mesochorus Gravenhorst, 1829 (Ichneumonidae: Mesochorinae).

    PubMed

    Araujo, Rodrigo De Oliveira; Vivallo, Felipe

    2015-01-01

    Eleven new replacement names in the genus Mesochorus Gravenhorst, 1829 are proposed due the synonymy with Plectochorus Uchida, 1933 and Stictopisthus Thomson, 1886 made by Wahl in his cladistic analysis of the genera of Mesochorinae.

  15. Comparative Review of Education Programs of Family Medicine (FM) in Bosnia and Herzegovina and Several Transition Countries.

    PubMed

    Masic, Izet; Skopljak, Amira; Jatic, Zaim

    2014-12-01

    Family Medicine as an independent medical discipline is relatively young in the countries of Southeast Europe. Still are used the old models of all forms of education in this module, although most countries accepted Bologna undergraduate teaching concept and already implement it with greater or lesser success. Measuring the effects of the qualities of these concepts and models is not done systematically nor in uniform manner, so it could not be compared by the unique variables measuring the quality of education curricula, and especially the quality of education level of the graduates at the first, second and third degree courses and other forms of education. This paper provides a comparative overview of the state of education in the area of family medicine in the region. It creates comparison according to the study duration for undergraduate and postgraduate studies, doctoral studies and specialized studies in specified areas. What stand out are the proposals to improve education in the field of family medicine in the region.

  16. Incentive-Based Conservation Programs in Developing Countries: A Review of Some Key Issues and Suggestions for Improvements

    NASA Astrophysics Data System (ADS)

    Spiteri, Arian; Nepalz, Sanjay K.

    2006-01-01

    Biodiversity conservation in developing countries has been a challenge because of the combination of rising human populations, rapid technological advances, severe social hardships, and extreme poverty. To address the social, economic, and ecological limitations of people-free parks and reserves, incentives have been incorporated into conservation programs in the hopes of making conservation meaningful to local people. However, such incentive-based programs have been implemented with little consideration for their ability to fulfill promises of greater protection of biodiversity. Evaluations of incentive-based conservation programs indicate that the approach continually falls short of the rhetoric. This article provides an overview of the problems associated with incentive-based conservation approaches in developing countries. It argues that existing incentive-based programs (IBPs) have yet to realize that benefits vary greatly at different “community” scales and that a holistic conceptualization of a community is essential to incorporate the complexities of a heterogeneous community when designing and implementing the IBPs. The spatial complexities involved in correctly identifying the beneficiaries in a community and the short-term focus of IBPs are two major challenges for sustaining conservation efforts. The article suggests improvements in three key areas: accurate identification of “target” beneficiaries, greater inclusion of marginal communities, and efforts to enhance community aptitudes.

  17. Violent Video Game Effects on Aggression, Empathy, and Prosocial Behavior in Eastern and Western Countries: A Meta-Analytic Review

    ERIC Educational Resources Information Center

    Anderson, Craig A.; Shibuya, Akiko; Ihori, Nobuko; Swing, Edward L.; Bushman, Brad J.; Sakamoto, Akira; Rothstein, Hannah R.; Saleem, Muniba

    2010-01-01

    Meta-analytic procedures were used to test the effects of violent video games on aggressive behavior, aggressive cognition, aggressive affect, physiological arousal, empathy/desensitization, and prosocial behavior. Unique features of this meta-analytic review include (a) more restrictive methodological quality inclusion criteria than in past…

  18. Dropping Out from School: A Cross Country Review of the Literature. Create Pathways to Access. Research Monograph, No. 16

    ERIC Educational Resources Information Center

    Hunt, Frances

    2008-01-01

    This paper provides an in-depth review and analysis of literature on dropping out from school, and focuses on children who have gained access, but fail to complete a basic education cycle. The main discussion is around why and how children drop out from school. Here drop out is not presented as a distinct event, but rather a process where a range…

  19. "Electric Power for Rural Growth: How Electricity Affects Rural Life in Developing Countries," by Douglas F. Barnes. [Book Review].

    ERIC Educational Resources Information Center

    Lodwick, Dora G.; McIntosh, William A., Ed.

    1989-01-01

    Reviews a book assessing the effects of central grid rural electrification on the social and economic development of 192 communities in India and Colombia. The study examines the impact on agricultural productivity (through increased irrigation), the quality of life of women and children, business activities, and regional inequities. (SV)

  20. Where literature is scarce: observations and lessons learnt from four systematic reviews of zoonoses in African countries.

    PubMed

    Alonso, Silvia; Lindahl, Johanna; Roesel, Kristina; Traore, Sylvain Gnamien; Yobouet, Bassa Antoine; Ndour, Andrée Prisca Ndjoug; Carron, Maud; Grace, Delia

    2016-06-01

    The success of a systematic review depends on the availability, accessibility and quality of literature related to the review question. This paper presents the literature found in four systematic reviews conducted for a selection of zoonotic hazards in four livestock value chains in Africa, as well as setting out the challenges in conducting the reviews. The protocol was designed following international standards, and addressed four questions around prevalence, risk factors, control options and impact of various hazards and populations. Searches were conducted in four online databases. Articles were screened for relevance, and quality was assessed before data extraction. Literature on zoonotic hazards was in general scarce and access to full articles was limited. Overall, 25-40% of papers were considered poor quality. The diversity of approaches and designs in the studies compromised the ability to generate summarized estimates. We found that the emphasis of veterinary research has been on livestock problems rather than public health issues, although this seems to be shifting in the last decade; we also found there are limited studies on impact and control. While increasing literature is being published around zoonoses in Africa, this is still inadequate to appropriately inform policy and guide research efforts. PMID:27427191

  1. Latinos in the United States on the HIV/AIDS care continuum by birth country/region: A systematic review of the literature

    PubMed Central

    Sheehan, Diana M.; Trepka, Mary Jo; Dillon, Frank R.

    2014-01-01

    Background Twenty percent of Latinos in the U.S. with HIV are unaware of their HIV status, 33% are linked to care late, and 74% do not reach viral suppression. Disparities along this HIV/AIDS care continuum may be present between various ethnic groups historically categorized as Latino. Objective To identify differences along the HIV/AIDS care continuum between U.S. Latinos of varying birth countries/regions. Methods A systematic review of articles published in English between 2002–2013 was conducted using MEDLINE, PsycINFO and Web of Science. Studies that reported on one or more steps of the HIV/AIDS care continuum and reported results by birth country/region for Latinos were included. Results Latinos born in Mexico and Central America were found to be at increased risk of late diagnosis compared with U.S.-born Latinos. No studies were found that reported on linkage to HIV care or viral load suppression by country/region of birth. Lower survival was found among Latinos born in Puerto Rico compared with Latinos born in mainland U.S. Inconsistent differences in survival were found among Latinos born in Mexico, Cuba and Central America. Discussion Socio/cultural context, immigration factors and documentation status are discussed as partial explanations for disparities along the HIV/AIDS care continuum. PMID:24810215

  2. Initial assessment of strategic plans for improving the performance of veterinary services in developing countries: a review of OIE PVS gap analysis reports.

    PubMed

    Weaver, J; Leon, E; Edan, M; D'Alessio, F

    2012-08-01

    The World Organisation for Animal Health (OIE) carries out Gap Analysis missions (if a country so wishes) as part of its programme to assess and improve the Performance of Veterinary Services (the 'PVS Pathway') in Member Countries. These Gap Analysis missions have found that many national Veterinary Services comply to only a limited extent with the international standards established by the OIE and that their competence is compromised by poor governance. This failure threatens animal and public health not only nationally but also internationally. The OIE PVS Gap Analysis reports reviewed found that all the Veterinary Services have a strong vision and commitmentto improvement but are held back by a weak chain of command, inadequate and outdated legislation, insufficient funding, weak technical competencies, compromised technical independence, poor communications and limited joint programmes. There are weaknesses across all the core technical areas of trade, animal health, veterinary public health and veterinary laboratories and also in the overall management of the Veterinary Services. The OIE PVS Gap Analysis missions recommend significant increases in budget in all countries.

  3. Recent advances in TeleStroke: a systematic review on applications in prehospital management and Stroke Unit treatment or TeleStroke networking in developing countries.

    PubMed

    Hubert, Gordian J; Müller-Barna, Peter; Audebert, Heinrich J

    2014-12-01

    TeleStroke has become an increasing means to overcome shortage of stroke expertise in underserved areas. This rapidly growing field has triggered a large amount of publications in recent years. We aimed to analyze recent advances in the field of telemedicine for acute stroke, with main focus on prehospital management, Stroke Unit treatment and network implementations in developing countries. Out of 260 articles, 25 were selected for this systematic review: 9 regarding prehospital management, 14 regarding Stroke Unit treatment and 2 describing a network in developing countries. Prehospital management showed that stroke recognition can start at the dispatch emergency call, important clinical information can be electronically transmitted to hospitals before admission and even acute treatment such as thrombolysis can be initiated in the prehospital field if ambulances are equipped with CT scan and point-of-care laboratory. Articles on remote clinical examination, telemedical imaging interpretation, trial recruitment and cost-effectiveness described various aspects of Stroke Unit treatment within TeleStroke networks, underlining reliability, safety and cost savings of these systems of care. Only one network was described to have been implemented in a developing/emerging nation. TeleStroke is a growing field expanding its focus to a broader spectrum of stroke care. It still seems to be underused, particularly in developing countries.

  4. Systematic review of studies evaluating the broader economic impact of vaccination in low and middle income countries

    PubMed Central

    2012-01-01

    Background Most health economic evaluations of childhood vaccination only capture the health and short-term economic benefits. Measuring broader, long-term effects of vaccination on productivity and externalities could provide a more complete picture of the value of vaccines. Method MEDLINE, EconLit and NHS-EED databases were searched for articles published between January 1990 and July 2011, which captured broader economic benefits of vaccines in low and middle income countries. Studies were included if they captured at least one of the following categories on broader economic impact: outcome-related productivity gains, behaviour-related productivity gains, ecological externalities, equity gains, financial sustainability gains or macroeconomic benefits. Results Twenty-six relevant studies were found, including observational studies, economic models and contingent valuation studies. Of the identified broader impacts, outcome-related productivity gains and ecological externalities were most commonly accounted for. No studies captured behaviour-related productivity gains or macroeconomic effects. There was some evidence to show that vaccinated children 8–14 years of age benefit from increased cognitive ability. Productivity loss due to morbidity and mortality was generally measured using the human capital approach. When included, herd immunity effects were functions of coverage rates or based on reduction in disease outcomes. External effects of vaccines were observed in terms of equitable health outcomes and contribution towards synergistic and financially sustainable healthcare programs. Conclusion Despite substantial variation in the methods of measurement and outcomes used, the inclusion of broader economic impact was found to improve the attractiveness of vaccination. Further research is needed on how different tools and techniques can be used in combination to capture the broader impact of vaccination in a way that is consistent with other health economic

  5. Risk Factors for Severe Neonatal Hyperbilirubinemia in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis

    PubMed Central

    Olusanya, Bolajoko O.; Osibanjo, Folasade B.; Slusher, Tina M.

    2015-01-01

    Background Available evidence suggests that low- and middle-income countries (LMICs) bear the greatest burden of severe neonatal hyperbilirubinemia characterized by disproportionately high rates of morbidity, mortality and neurodevelopmental disorders compared to high-income countries. We set out to identify the risk factors that contribute to the burden of severe hyperbilirubinemia in the most developmentally disadvantaged LMICs to highlight areas for action and further research. Methods We systematically searched PubMed, Scopus, Ovid EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), WHO Library Database (WHOLIS), African Index Medicus (AIM), African Journals Online (AJOL), LILACS, and IndMed for reports published between January 1990 and June 2014. We included only studies that controlled for the effects of confounding variables in determining maternal and infant risk factors for severe hyperbilirubinemia. We conducted meta-analysis of the eligible studies and computed the summary risk estimates with random effects models. Results A total of 13 studies with 1,951 subjects and 32,208 controls from India, Nigeria, Pakistan, Nepal and Egypt were identified and analyzed. The pooled data showed that primiparity (OR, 1.59; 95% CI:1.26-2.00), delivery outside public hospitals (OR, 6.42; 95% CI:1.76-23.36), ABO incompatibility (OR, 4.01; 95% CI:2.44-6.61), Rhesus hemolytic disease (OR, 20.63; 95% CI:3.95-107.65), G6PD deficiency (OR, 8.01; 95% CI:2.09-30.69), UGT1A1 polymorphisms (OR, 4.92; 95% CI:1.30-18.62), low gestational age (OR, 1.71; 95% CI:1.40-2.11), underweight/weight loss (OR, 6.26; 95% CI:1.23-31.86), sepsis (OR, 9.15; 95% CI:2.78-30.10) and high transcutaneous/total serum bilirubin levels (OR, 1.46; 95% CI:1.10-1.92) placed infants at increased risk of severe hyperbilirubinemia or bilirubin induced neurologic dysfunctions. Low social class was not associated with an increased risk of severe hyperbilirubinemia. Conclusions Infants at

  6. Prevalence of Hepatitis C Virus Genotypes Among Patients in Countries of the Eastern Mediterranean Regional Office of WHO (EMRO): A Systematic Review and Meta-Analysis

    PubMed Central

    Sadeghi, Farzin; Salehi-Vaziri, Mostafa; Almasi-Hashiani, Amir; Gholami-Fesharaki, Mohammad; Pakzad, Reza; Alavian, Seyed Moayed

    2016-01-01

    Context Hepatitis C virus (HCV) infection is a major global public health issue. The Eastern Mediterranean regional office (EMRO) of the world health organization (WHO) seems to have one of the highest prevalence rates worldwide, with at least 21.3 million HCV-infected patients. Objectives The aim of the present study was to review systematically all epidemiological data related to the prevalence of HCV genotypes in infected patients in EMRO countries. Data Sources A systematic search was conducted of peer-reviewed journals indexed in electronic databases (PubMed, Scopus, ISI, PakMediNet, and IMEMR, and Persian-specific databases including SID, Iran Medex, and MagIran). Study Selection A systematic search was performed with temporal limits (papers published between January 2000 up to June 2015), regarding the prevalence and distribution of HCV genotypes in EMRO countries. Data Extraction The prevalence rates of HCV genotypes were pooled by metan command in Stata 14. Statistical heterogeneity was explored using the I-square at the 5% significance level. Publication bias was assessed, graphically and statistically, by funnel plot and Begg and Egger tests. Results A total of 563 records were identified through the electronic search. Of these records, 134 studies comprising 67681 HCV-infected individuals were included in the meta-analysis. In Iran, subtype 1a was the predominant subtype with a rate of 42% (95% CI, 39 - 46), followed by subtype 3a, 35% (95% CI, 31 - 38). In Pakistan, Subtype 3a was the most common subtype with a rate of 56% (95% CI, 49 - 62), followed by subtype 3b, 10% (95% CI, 7 - 12). In Saudi Arabia and Egypt, genotype 4 was the most prevalent genotype with a rate of 65% (95% CI, 59 - 72) and 69% (95% CI, 36 - 100) respectively. In Tunisia and Morocco, subtype 1b was the most common subtype with a rate of 69% (95% CI, 50 - 88) and 32% (95% CI, 7 - 56) respectively. Conclusions The genotype distribution of HCV takes diverse patterns in EMRO countries

  7. Epidemiology of community-acquired pneumonia and implications for vaccination of children living in developing and newly industrialized countries: A systematic literature review.

    PubMed

    DeAntonio, Rodrigo; Yarzabal, Juan-Pablo; Cruz, James Philip; Schmidt, Johannes E; Kleijnen, Jos

    2016-09-01

    This systematic review evaluated the epidemiology of community-acquired pneumonia in children <6 y of age within 90 developing and newly industrialized countries. Literature searches (1990-2011), based on MEDLINE, EMBASE, Cochrane, CAB Global Health, WHO, UNICEF, country-specific websites, conferences, health-technology-assessment agencies, and the reference lists of included studies, yielded 8,734 records; 62 of 340 studies were included in this review. The highest incidence rate among included studies was 0.51 episodes/child-year, for children <5 y of age in Bangladesh. The highest prevalence was in Chinese children <6 months of age (37.88%). The main bacterial pathogens were Streptococcus pneumoniae, Haemophilus influenzae and Mycoplasma pneumoniae and the main viral pathogens were respiratory syncytial virus, adenovirus and rhinovirus. Community-acquired pneumonia remains associated with high rates of morbidity and mortality. Improved and efficient surveillance and documentation of the epidemiology and burden of community-acquired pneumonia across various geographical regions is warranted. PMID:27269963

  8. Epidemiology of community-acquired pneumonia and implications for vaccination of children living in developing and newly industrialized countries: A systematic literature review

    PubMed Central

    DeAntonio, Rodrigo; Yarzabal, Juan-Pablo; Cruz, James Philip; Schmidt, Johannes E.; Kleijnen, Jos

    2016-01-01

    ABSTRACT This systematic review evaluated the epidemiology of community-acquired pneumonia in children <6 y of age within 90 developing and newly industrialized countries. Literature searches (1990–2011), based on MEDLINE, EMBASE, Cochrane, CAB Global Health, WHO, UNICEF, country-specific websites, conferences, health-technology-assessment agencies, and the reference lists of included studies, yielded 8,734 records; 62 of 340 studies were included in this review. The highest incidence rate among included studies was 0.51 episodes/child-year, for children <5 y of age in Bangladesh. The highest prevalence was in Chinese children <6 months of age (37.88%). The main bacterial pathogens were Streptococcus pneumoniae, Haemophilus influenzae and Mycoplasma pneumoniae and the main viral pathogens were respiratory syncytial virus, adenovirus and rhinovirus. Community-acquired pneumonia remains associated with high rates of morbidity and mortality. Improved and efficient surveillance and documentation of the epidemiology and burden of community-acquired pneumonia across various geographical regions is warranted. PMID:27269963

  9. Current status of persistent organic pesticides residues in air, water, and soil, and their possible effect on neighboring countries: a comprehensive review of India.

    PubMed

    Yadav, Ishwar Chandra; Devi, Ningombam Linthoingambi; Syed, Jabir Hussain; Cheng, Zhineng; Li, Jun; Zhang, Gan; Jones, Kevin C

    2015-04-01

    Though the use of pesticides has offered significant economic benefits by enhancing the production and yield of food and fibers and the prevention of vector-borne diseases, evidence suggests that their use has adversely affected the health of human populations and the environment. Pesticides have been widely distributed and their traces can be detected in all areas of the environment (air, water and soil). Despite the ban of DDT and HCH in India, they are still in use, both in domestic and agricultural settings. In this comprehensive review, we discuss the production and consumption of persistent organic pesticides, their maximum residual limit (MRL) and the presence of persistent organic pesticides in multicomponent environmental samples (air, water and soil) from India. In order to highlight the global distribution of persistent organic pesticides and their impact on neighboring countries and regions, the role of persistent organic pesticides in Indian region is reviewed. Based on a review of research papers and modeling simulations, it can be concluded that India is one of the major contributors of global persistent organic pesticide distribution. This review also considers the health impacts of persistent organic pesticides, the regulatory measures for persistent organic pesticides, and the status of India's commitment towards the elimination of persistent organic pesticides.

  10. Hypoxaemia as a Mortality Risk Factor in Acute Lower Respiratory Infections in Children in Low and Middle-Income Countries: Systematic Review and Meta-Analysis

    PubMed Central

    Lazzerini, Marzia; Sonego, Michela; Pellegrin, Maria Chiara

    2015-01-01

    Objective To evaluate the association between hypoxaemia and mortality from acute lower respiratory infections (ALRI) in children in low- and middle-income countries (LMIC). Design Systematic review and meta-analysis. Study Selection Observational studies reporting on the association between hypoxaemia and death from ALRI in children below five years in LMIC. Data Sources Medline, Embase, Global Health Library, Lilacs, and Web of Science to February 2015. Risk of Bias Assessment Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger’s test to evaluate publication bias. Results Out of 11,627 papers retrieved, 18 studies from 13 countries on 20,224 children met the inclusion criteria. Twelve (66.6%) studies had either low or moderate risk of bias. Hypoxaemia defined as oxygen saturation rate (SpO2) <90% associated with significantly increased odds of death from ALRI (OR 5.47, 95% CI 3.93 to 7.63) in 12 studies on 13,936 children. An Sp02 <92% associated with a similar increased risk of mortality (OR 3.66, 95% CI 1.42 to 9.47) in 3 studies on 673 children. Sensitivity analyses (excluding studies with high risk of bias and using adjusted OR) and subgroup analyses (by: altitude, definition of ALRI, country income, HIV prevalence) did not affect results. Only one study was performed on children living at high altitude. Conclusions The results of this review support the routine evaluation of SpO2 for identifying children with ALRI at increased risk of death. Both a Sp02 value of 92% and 90% equally identify children at increased risk of mortality. More research is needed on children living at high altitude. Policy makers in LMIC should aim at improving the regular use of pulse oximetry and the availability of oxygen in order to decrease mortality from ALRI. PMID:26372640

  11. Retention of Adult Patients on Antiretroviral Therapy in Low- and Middle-Income Countries: Systematic Review and Meta-analysis 2008–2013

    PubMed Central

    Fox, Matthew P; MPA, Sydney Rosen

    2015-01-01

    Background We previously published systematic reviews of retention in care after antiretroviral therapy initiation among general adult populations in sub-Saharan Africa. We estimated 36-month retention at 73% for publications from 2007–2010. This report extends the review to cover 2008–2013 and expands it to all low- and middle-income countries. Methods We searched PubMed, Embase, Cochrane Register, and ISI Web of Science from January 1, 2008 to December 31, 2013 and abstracts from AIDS and IAS from 2008–2013. We estimated retention across cohorts using simple averages and interpolated missing times through the last time reported. We estimated all-cause attrition (death, loss to follow-up) for patients receiving first-line ART in routine settings in low- and middle-income countries. Results We found 123 papers and abstracts reporting retention for 154 patient cohorts and 1,554,773 patients in 42 countries. Overall, 43% of all patients not retained were known to have died. Unweighted averages of reported retention was 78%, 71% and 69% at 12, 24, and 36 months after treatment initiation, respectively. We estimated 36-month retention at 65% in Africa, 80% in Asia, and 64% in Latin America and the Caribbean. From lifetable analysis, we estimated retention at 12, 24, 36, 48 and 60 months at 83%, 74%, 68%, 64% and 60%, respectively. Conclusions Retention at 36 months on treatment averages 65–70%. There are several important gaps in the evidence-base, which could be filled by further research, especially in terms of geographic coverage and duration of follow-up. PMID:25942461

  12. The impact of antibiotics on growth in children in low and middle income countries: systematic review and meta-analysis of randomised controlled trials

    PubMed Central

    Gough, Ethan K; Moodie, Erica E M; Prendergast, Andrew J; Johnson, Sarasa M A; Humphrey, Jean H; Stoltzfus, Rebecca J; Walker, A Sarah; Trehan, Indi; Gibb, Diana M; Goto, Rie; Tahan, Soraia; de Morais, Mauro Batista

    2014-01-01

    Objectives To determine whether antibiotic treatment leads to improvements in growth in prepubertal children in low and middle income countries, to determine the magnitude of improvements in growth, and to identify moderators of this treatment effect. Design Systematic review and meta-analysis. Data sources Medline, Embase, Scopus, the Cochrane central register of controlled trials, and Web of Science. Study selection Randomised controlled trials conducted in low or middle income countries in which an orally administered antibacterial agent was allocated by randomisation or minimisation and growth was measured as an outcome. Participants aged 1 month to 12 years were included. Control was placebo or non-antimicrobial intervention. Results Data were pooled from 10 randomised controlled trials representing 4316 children, across a variety of antibiotics, indications for treatment, treatment regimens, and countries. In random effects models, antibiotic use increased height by 0.04 cm/month (95% confidence interval 0.00 to 0.07) and weight by 23.8 g/month (95% confidence interval 4.3 to 43.3). After adjusting for age, effects on height were larger in younger populations and effects on weight were larger in African studies compared with other regions. Conclusion Antibiotics have a growth promoting effect in prepubertal children in low and middle income countries. This effect was more pronounced for ponderal than for linear growth. The antibiotic growth promoting effect may be mediated by treatment of clinical or subclinical infections or possibly by modulation of the intestinal microbiota. Better definition of the mechanisms underlying this effect will be important to inform optimal and safe approaches to achieving healthy growth in vulnerable populations. PMID:24735883

  13. Fecal Contamination of Drinking-Water in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

    PubMed Central

    Bain, Robert; Cronk, Ryan; Wright, Jim; Yang, Hong; Slaymaker, Tom; Bartram, Jamie

    2014-01-01

    Background Access to safe drinking-water is a fundamental requirement for good health and is also a human right. Global access to safe drinking-water is monitored by WHO and UNICEF using as an indicator “use of an improved source,” which does not account for water quality measurements. Our objectives were to determine whether water from “improved” sources is less likely to contain fecal contamination than “unimproved” sources and to assess the extent to which contamination varies by source type and setting. Methods and Findings Studies in Chinese, English, French, Portuguese, and Spanish were identified from online databases, including PubMed and Web of Science, and grey literature. Studies in low- and middle-income countries published between 1990 and August 2013 that assessed drinking-water for the presence of Escherichia coli or thermotolerant coliforms (TTC) were included provided they associated results with a particular source type. In total 319 studies were included, reporting on 96,737 water samples. The odds of contamination within a given study were considerably lower for “improved” sources than “unimproved” sources (odds ratio [OR] = 0.15 [0.10–0.21], I2 = 80.3% [72.9–85.6]). However over a quarter of samples from improved sources contained fecal contamination in 38% of 191 studies. Water sources in low-income countries (OR = 2.37 [1.52–3.71]; p<0.001) and rural areas (OR = 2.37 [1.47–3.81] p<0.001) were more likely to be contaminated. Studies rarely reported stored water quality or sanitary risks and few achieved robust random selection. Safety may be overestimated due to infrequent water sampling and deterioration in quality prior to consumption. Conclusion Access to an “improved source” provides a measure of sanitary protection but does not ensure water is free of fecal contamination nor is it consistent between source types or settings. International estimates therefore greatly overstate use of safe

  14. Blood transfusion trigger in burns: a four-year retrospective analysis of blood transfusions in eleven burn centers in Ukraine

    PubMed Central

    Fuzaylov, G.; Anderson, R.; Lee, J.; Slesarenko, S.; Nagaychuk, V.; Grigorieva, T.; Kozinec, G.

    2015-01-01

    Summary One focus of improvement of burn care in Ukraine was the management of blood loss and blood transfusions in burn patients. The aim of this project was to analyze blood transfusion triggers in burn patients and outcomes at eleven major burn centers in Ukraine. This multicenter retrospective study reviewed four years of data on blood-transfused burn patients admitted to eleven major burn centers in Ukraine. Data analyzed included: demographics, characteristics of the burns, complications of burn injury, triggers for blood transfusions and outcomes. A total of 928 burn patients who received 2,693 blood transfusions from 11 major burn centers over a four-year period, were studied. Regardless of the total body surface area (TBSA) that was burned, blood transfusions were administered with a hemoglobin (Hb) trigger value of around 9 g/dL. Roughly one third (30.5%) of all transfusions were given in patients with a TBSA ≤ 10%. We demonstrated that Ukrainian doctors were using the same Hb trigger for blood transfusions for all Ukrainian burn patients, which suggested a need to change blood transfusion policy. PMID:27279803

  15. Evidence on feasibility and effective use of mHealth strategies by frontline health workers in developing countries: systematic review*

    PubMed Central

    Agarwal, Smisha; Perry, Henry B; Long, Lesley-Anne; Labrique, Alain B

    2015-01-01

    Objectives Given the large-scale adoption and deployment of mobile phones by health services and frontline health workers (FHW), we aimed to review and synthesise the evidence on the feasibility and effectiveness of mobile-based services for healthcare delivery. Methods Five databases – MEDLINE, EMBASE, Global Health, Google Scholar and Scopus – were systematically searched for relevant peer-reviewed articles published between 2000 and 2013. Data were extracted and synthesised across three themes as follows: feasibility of use of mobile tools by FHWs, training required for adoption of mobile tools and effectiveness of such interventions. Results Forty-two studies were included in this review. With adequate training, FHWs were able to use mobile phones to enhance various aspects of their work activities. Training of FHWs to use mobile phones for healthcare delivery ranged from a few hours to about 1 week. Five key thematic areas for the use of mobile phones by FHWs were identified as follows: data collection and reporting, training and decision support, emergency referrals, work planning through alerts and reminders, and improved supervision of and communication between healthcare workers. Findings suggest that mobile based data collection improves promptness of data collection, reduces error rates and improves data completeness. Two methodologically robust studies suggest that regular access to health information via SMS or mobile-based decision-support systems may improve the adherence of the FHWs to treatment algorithms. The evidence on the effectiveness of the other approaches was largely descriptive and inconclusive. Conclusions Use of mHealth strategies by FHWs might offer some promising approaches to improving healthcare delivery; however, the evidence on the effectiveness of such strategies on healthcare outcomes is insufficient. PMID:25881735

  16. Is there scope for cost savings and efficiency gains in HIV services? A systematic review of the evidence from low- and middle-income countries

    PubMed Central

    Siapka, Mariana; Remme, Michelle; Obure, Carol Dayo; Maier, Claudia B; Dehne, Karl L

    2014-01-01

    Abstract Objective To synthesize the data available – on costs, efficiency and economies of scale and scope – for the six basic programmes of the UNAIDS Strategic Investment Framework, to inform those planning the scale-up of human immunodeficiency virus (HIV) services in low- and middle-income countries. Methods The relevant peer-reviewed and “grey” literature from low- and middle-income countries was systematically reviewed. Search and analysis followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Findings Of the 82 empirical costing and efficiency studies identified, nine provided data on economies of scale. Scale explained much of the variation in the costs of several HIV services, particularly those of targeted HIV prevention for key populations and HIV testing and treatment. There is some evidence of economies of scope from integrating HIV counselling and testing services with several other services. Cost efficiency may also be improved by reducing input prices, task shifting and improving client adherence. Conclusion HIV programmes need to optimize the scale of service provision to achieve efficiency. Interventions that may enhance the potential for economies of scale include intensifying demand-creation activities, reducing the costs for service users, expanding existing programmes rather than creating new structures, and reducing attrition of existing service users. Models for integrated service delivery – which is, potentially, more efficient than the implementation of stand-alone services – should be investigated further. Further experimental evidence is required to understand how to best achieve efficiency gains in HIV programmes and assess the cost–effectiveness of each service-delivery model. PMID:25110375

  17. Psychosocial interventions for disruptive behavioural problems in children living in low- and middle-income countries: study protocol of a systematic review

    PubMed Central

    Burkey, Matthew D; Hosein, Megan; Purgato, Marianna; Morton, Isabella

    2015-01-01

    Introduction Disruptive behaviour disorders (DBDs) are among the most common forms of child psychopathology and have serious long-term academic, social, and mental health consequences worldwide. Psychosocial treatments are the first line of evidence-based treatments for DBDs, yet their effectiveness often varies according to patient sociodemographic characteristics, practice setting, and implementation procedures. While a large majority of the world's children live in low- and middle-income countries (LMIC), most studies have evaluated psychosocial treatments for DBDs in high-income Anglo countries. Methods and analysis The primary objective of this systematic review is to assess the effects of psychosocial treatments for DBDs in children and adolescents (under age 18) diagnosed with oppositional defiant disorder, conduct disorder, or other disruptive behavioural problems living in LMIC. The secondary objectives are to: (1) describe the range and types of psychosocial treatments used to address DBDs in LMIC and (2) identify key dissemination and implementation factors (adaptation processes, training/supervision processes, and financial costs). All controlled trials comparing psychosocial treatments versus waiting list, no treatment, or treatment as usual in children living in LMIC will be included. Studies will be identified using the methods outlined in the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines without restrictions on language, publication type, status, or date of publication. The primary outcome measures will be disruptive behavioural problems (eg, oppositionality, defiance, aggression or deceit). Secondary outcomes will be positive mental health outcomes (eg, prosocial behaviour), function impairment, institutionalisation (or hospitalisation), academic outcomes and caregiver outcomes. Ethics and dissemination This study uses data from published studies; therefore ethical review is not required. Findings will be

  18. A review of nasal cancer in furniture manufacturing and woodworking in North Carolina, the United States, and other countries.

    PubMed

    Imbus, H R; Dyson, W L

    1987-09-01

    Nasal adenocarcinoma in the High Wycombe furniture industry of England during 1956-1965 had an annual incidence of 500 to 1,000 times greater than that of the general population. Excesses of nasal cancer have also been described in France, Australia, Denmark, Finland, Italy, and Holland. Interestingly, one limited study in Canada revealed no excess, whereas a more recent one showed a slight excess. In contrast to the strikingly large excesses of nasal adenocarcinoma in other countries, there has never been any evidence of similarly large excesses in the US woodworking and furniture industry. Modern manufacturing conditions may not present the same degree of risk of developing nasal cancer as was present in the English furniture manufacturing industry. The incidence of nasal cancer associated with furniture manufacturing in the United States is examined in considerable detail in North Carolina, the leading furniture manufacturing state. Furniture manufacturing in the state began around 1890 and has grown steadily since. Utilizing statistics available from the North Carolina Department of Vital Statistics, the absolute mortality of nasal cancer in North Carolina was calculated from 1964 to 1977. The average mortality was approximately 3.5 times greater in the furniture manufacturing industry than in the general population.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Dengue vector-control services: how do they work? A systematic literature review and country case studies.

    PubMed

    Horstick, Olaf; Runge-Ranzinger, Silvia; Nathan, Michael B; Kroeger, Axel

    2010-06-01

    The increasing incidence and geographic expansion of dengue suggest limitations of vector-control operations. We undertook an analysis of services with two methods: a systematic literature review; and case studies (stakeholder interviews, questionnaires) in Brazil, Guatemala, The Philippines and Viet Nam. In the systematic literature review there were only a few studies (strict criteria, 9 studies; less strict criteria, a further 16 studies and 3 guidelines). Of the 9 studies, 3 showed little change of control operations over time but did show strategic changes (decentralisation, intersectoral collaboration). Staffing levels, capacity building, management and organisation, funding and community engagement were insufficient. The case studies confirmed most of this information: (1) a lack of personnel (entomologists, social scientists, operational vector-control staff); (2) a lack of technical expertise at decentralised levels of services; (3) insufficient budgets; (4) inadequate geographical coverage; (5) interventions relying mostly on insecticides; (6) difficulties in engaging communities; (7) little capacity building; (8) almost no monitoring and evaluation. Stakeholders' doubts about service effectiveness were widespread, but interventions were assumed to be effective with increased resources. The analysis underlined the need for: operational standards; evidence-based selection/delivery of combinations of interventions; development/application of monitoring and evaluation tools; needs-driven capacity building. PMID:20400169

  20. Schistosomiasis Prevalence and Intensity of Infection in Latin America and the Caribbean Countries, 1942-2014: A Systematic Review in the Context of a Regional Elimination Goal

    PubMed Central

    2016-01-01

    Background In 2012 the World Health Assembly adopted resolution WHA65.21 on elimination of schistosomiasis, calling for increased investment in schistosomiasis control and support for countries to initiate elimination programs. This study aims to analyze prevalence and intensity of Schistosoma mansoni infection in children in Latin America and the Caribbean countries and territories (LAC), at the second administrative level or lower. Methodology A systematic review of schistosomiasis prevalence and intensity of infection was conducted by searching at PubMed, LILACS and EMBASE. Experts on the topic were informally consulted and institutional web pages were reviewed (PAHO/WHO, Ministries of Health). Only SCH infection among children was registered because it can be a ‘proxi-indicator’ of recent transmission by the time the study is conducted. Principal Findings One hundred thirty two full-text articles met the inclusion criteria and provided 1,242 prevalence and 199 intensity of infection data points. Most of them were from Brazil (69.7%). Only Brazil published studies after 2001, showing several 'hot spots' with high prevalence. Brazil, Venezuela, Suriname and Saint Lucia need to update the epidemiological status of schistosomiasis to re-design their national programs and target the elimination of Schistosoma mansoni transmission by 2020. In Antigua and Barbuda, Dominican Republic, Guadeloupe, Martinique, Montserrat and Puerto Rico schistosomiasis transmission may be interrupted. However the compilation of an elimination dossier and follow-up surveys, per WHO recommendations, are needed to verify that status. Hence, the burden of subtle SCH chronic infection may be still present and even high in countries that may have eliminated transmission. Heterogeneity in the methodologies used for monitoring and evaluating the progress of the schistosomiasis programs was found, making cross-national and chronological comparisons difficult. Conclusions There is a need for

  1. Australian news media framing of medical tourism in low- and middle-income countries: a content review

    PubMed Central

    2013-01-01

    Background Medical tourism – travel across international borders for health care – appears to be growing globally, with patients from high-income nations increasingly visiting low- and middle-income countries to access such services. This paper analyses Australian television and newspaper news and current affairs coverage to examine how medical tourism and these destinations for the practice are represented to media audiences. Methods Electronic copies of Australian television (n = 66) and newspaper (n = 65) items from 2005–2011 about medical care overseas were coded for patterns of reporting (year, format and type) and story characteristics (geographic and medical foci in the coverage, news actors featured and appeals, credibility and risks of the practice mentioned). Results Australian media coverage of medical tourism was largely focused on Asia, featuring cosmetic surgery procedures and therapies unavailable domestically. Experts were the most frequently-appearing news actors, followed by patients. Common among the types of appeals mentioned were access to services and low cost. Factors lending credibility included personal testimony, while uncertainty and ethical dilemmas featured strongly among potential risks mentioned from medical tourism. Conclusions The Australian media coverage of medical tourism was characterised by a narrow range of medical, geographic and ethical concerns, a focus on individual Australian patients and on content presented as being personally relevant for domestic audiences. Medical tourism was portrayed as an exercise of economically-rational consumer choice, but with no attention given to its consequences for the commodification of health or broader political, medical and ethical implications. In this picture, LMICs were no longer passive recipients of aid but providers of a beneficial service to Australian patients. PMID:23384294

  2. Sydenham Chorea and PANDAS in South Africa: Review of Evidence and Recommendations for Management in Resource-Poor Countries.

    PubMed

    Walker, Kathleen G; de Vries, Petrus J; Stein, Dan J; Wilmshurst, Jo M

    2015-06-01

    In South Africa, and worldwide, rheumatic fever represents a public health problem. Improved diagnosis and management of Sydenham chorea, a major manifestation of acute rheumatic fever is key to prevention of rheumatic heart disease. This article reviews Sydenham chorea from its original description to current opinions. Recommendations are founded on expert opinion as class 1 data is lacking. This South African perspective is relevant to resource-poor settings globally insofar as it provides diagnosis and management recommendations for primary- and secondary-level healthcare professionals who care for patients in such environments. Four basic tenets of care are recommended, namely, elimination of the streptococcal infection, symptomatic treatment, immunological treatment, and nonpharmacologic interventions. A user-friendly outcome measurement tool, viable for use in low-resource settings is presented. Introduction of this tool may lead to increased awareness of the neuropsychiatric manifestations of poststreptococcal movement disorders in Africa, where reports are limited. PMID:25227516

  3. Inequalities in Risks and Outcomes in a Health Transitioning Country: A Review of a Large National Cohort of Thai Adults.

    PubMed

    Yiengprugsawan, Vasoontara; Friel, Sharon; Seubsman, Sam-Ang; Sleigh, Adrian C

    2013-09-30

    This article reviews inequalities in health risks and outcomes based on a large longitudinal cohort study of distance-learning adult students enrolled at Sukhothai Thammathirat Open University (n = 87,134). The study began in 2005 and the first follow-up was completed in 2009. Risks analyzed for health inequalities were divided into demographic, socioeconomic, geographical, behavioral, and environmental groups. Unequal risks and outcomes identified that would be amenable to policy interventions in transitional Thailand include the following: heat stress-contributing to many adverse outcomes, including occupational injury, psychological distress, and kidney disease; urbanization-unhealthy eating, sedentary lifestyles, low social capital, and poor mental health; obesity-increasingly common especially with rising income and age among men; and injury-big problem for young males and associated with excessive alcohol and dangerous transport. These substantial inequalities require attention from multisectoral policy makers to reduce the gaps and improve health of the Thai population.

  4. Sydenham Chorea and PANDAS in South Africa: Review of Evidence and Recommendations for Management in Resource-Poor Countries.

    PubMed

    Walker, Kathleen G; de Vries, Petrus J; Stein, Dan J; Wilmshurst, Jo M

    2015-06-01

    In South Africa, and worldwide, rheumatic fever represents a public health problem. Improved diagnosis and management of Sydenham chorea, a major manifestation of acute rheumatic fever is key to prevention of rheumatic heart disease. This article reviews Sydenham chorea from its original description to current opinions. Recommendations are founded on expert opinion as class 1 data is lacking. This South African perspective is relevant to resource-poor settings globally insofar as it provides diagnosis and management recommendations for primary- and secondary-level healthcare professionals who care for patients in such environments. Four basic tenets of care are recommended, namely, elimination of the streptococcal infection, symptomatic treatment, immunological treatment, and nonpharmacologic interventions. A user-friendly outcome measurement tool, viable for use in low-resource settings is presented. Introduction of this tool may lead to increased awareness of the neuropsychiatric manifestations of poststreptococcal movement disorders in Africa, where reports are limited.

  5. Improving Access to Emergency Contraception Pills through Strengthening Service Delivery and Demand Generation: A Systematic Review of Current Evidence in Low and Middle-Income Countries

    PubMed Central

    Dawson, Angela; Tran, Nguyen-Toan; Westley, Elizabeth; Mangiaterra, Viviana; Festin, Mario

    2014-01-01

    Objectives Emergency contraception pills (ECP) are among the 13 essential commodities in the framework for action established by the UN Commission on Life-Saving Commodities for Women and Children. Despite having been on the market for nearly 20 years, a number of barriers still limit women's access to ECP in low- and middle-income countries (LMIC) including limited consumer knowledge and poor availability. This paper reports the results of a review to synthesise the current evidence on service delivery strategies to improve access to ECP. Methods A narrative synthesis methodology was used to examine peer reviewed research literature (2003 to 2013) from diverse methodological traditions to provide critical insights into strategies to improve access from a service delivery perspective. The studies were appraised using established scoring systems and the findings of included papers thematically analysed and patterns mapped across all findings using concept mapping. Findings Ten papers were included in the review. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs. Conclusion There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP. PMID:25285438

  6. The costs, effects and cost-effectiveness of strategies to increase coverage of routine immunizations in low- and middle-income countries: systematic review of the grey literature.

    PubMed Central

    Batt, Katherine; Fox-Rushby, J. A.; Castillo-Riquelme, Marianela

    2004-01-01

    Evidence-based reviews of published literature can be subject to several biases. Grey literature, however, can be of poor quality and expensive to access. Effective search strategies also vary by topic and are rarely known in advance. This paper complements a systematic review of the published literature on the costs and effects of expanding immunization services in developing countries. The quality of data on the effectiveness and cost-effectiveness of strategies to increase immunization coverage is shown to be similar across literatures, but the quality of information on costing is much lower in the grey literature. After excluding poorer quality studies from this review we found the quantity of available evidence almost doubled, particularly for more complex health-system interventions and cost or cost-effectiveness analyses. Interventions in the grey literature are more up to date and cover a different geographical spread. Consequently the conclusions of the published and grey literatures differ, although the number of papers is still too low to account for differences across types of interventions. We recommend that in future researchers consider using non-English keywords in their searches. PMID:15628207

  7. Sex Differences in Tuberculosis Burden and Notifications in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis

    PubMed Central

    Horton, Katherine C.; MacPherson, Peter; Houben, Rein M. G. J.; Corbett, Elizabeth L.

    2016-01-01

    Background Tuberculosis (TB) case notification rates are usually higher in men than in women, but notification data are insufficient to measure sex differences in disease burden. This review set out to systematically investigate whether sex ratios in case notifications reflect differences in disease prevalence and to identify gaps in access to and/or utilisation of diagnostic services. Methods and Findings In accordance with the published protocol (CRD42015022163), TB prevalence surveys in nationally representative and sub-national adult populations (age ≥ 15 y) in low- and middle-income countries published between 1 January 1993 and 15 March 2016 were identified through searches of PubMed, Embase, Global Health, and the Cochrane Database of Systematic Reviews; review of abstracts; and correspondence with the World Health Organization. Random-effects meta-analyses examined male-to-female (M:F) ratios in TB prevalence and prevalence-to-notification (P:N) ratios for smear-positive TB. Meta-regression was done to identify factors associated with higher M:F ratios in prevalence and higher P:N ratios. Eighty-three publications describing 88 surveys with over 3.1 million participants in 28 countries were identified (36 surveys in Africa, three in the Americas, four in the Eastern Mediterranean, 28 in South-East Asia and 17 in the Western Pacific). Fifty-six surveys reported in 53 publications were included in quantitative analyses. Overall random-effects weighted M:F prevalence ratios were 2.21 (95% CI 1.92–2.54; 56 surveys) for bacteriologically positive TB and 2.51 (95% CI 2.07–3.04; 40 surveys) for smear-positive TB. M:F prevalence ratios were highest in South-East Asia and in surveys that did not require self-report of signs/symptoms in initial screening procedures. The summary random-effects weighted M:F ratio for P:N ratios was 1.55 (95% CI 1.25–1.91; 34 surveys). We intended to stratify the analyses by age, HIV status, and rural or urban setting; however

  8. Idiopathic orthostatic hypotension: Recent data (eleven cases) and review of the literature

    NASA Technical Reports Server (NTRS)

    Ninet, J.; Annat, G.; Boisson, D.; Holzhapfel, L.; Vincent, M.; Peyrin, L.; Michel, D.; Schott, B.; Devic, M.; Levrat, R.

    1981-01-01

    Eight cases of Shy-Drager syndrome and three of Bradbury-Eggleston idiopathic orthostatic hypotension were examined. In all cases, examination of circulatory reflexes showed major dysfunction of the sympathetic vasoconstrictor system. Anomalies in the vagal cardiomoderator system were less constant. Normal urinary elimination of catecholamines was recorded daily. Characteristically, no elevation of blood or urine norepinephrine levels were found in orthostatism. Insulin hypoglycemia normally raised urinary adrenalin elimination in three of ten patients. Plasma dopa-beta-hydroxylase activity was normal. Renin-angiotensin-aldosterone system showed variable activity at basal state but usually rose during orthostatism. On the average, very low homovanillic acid levels were found in cerebrospinal fluid before and after probenecid; hydroxyindolacetic acid was normal. Cerebral autoregulation had deteriorated in two of four cases. Physiopathologically the two clinical types are indistinguishable with or without central neurological signs.

  9. A Review of the School Science Curricula in Eleven High Achieving Jurisdictions

    ERIC Educational Resources Information Center

    Hollins, Martin; Reiss, Michael J.

    2016-01-01

    The last two decades have seen unprecedented interest in science curricula, with many governments seeing improvements in the performance of their school students in science as key to future economic prosperity. We present the results of an analysis of the curriculum documents for primary and secondary science in Australia (New South Wales and…

  10. Community-based intervention packages for improving perinatal health in developing countries: a review of the evidence.

    PubMed

    Schiffman, Jessica; Darmstadt, Gary L; Agarwal, Siddharth; Baqui, Abdullah H

    2010-12-01

    The Lancet Neonatal Survival Series categorized neonatal health interventions into 3 service delivery modes: "Outreach," "Family-Community Care," and "Facility-based Clinical Care." Family-Community Care services generally have a greater potential impact on neonatal health than Outreach services, with similar costs. Combining interventions from all 3 service delivery modes is ideal for achievement of high impact. However, access to clinical care is limited in resource-poor settings with weak health systems. The current trend for those settings is to combine neonatal interventions into community-based intervention packages (CBIPs), which can be integrated into the local health care system. In this article, we searched several large databases to identify all published, large-scale, controlled studies that were implemented in a rural setting, included a control group, and reported neonatal and/or perinatal mortality as outcomes. We identified only 9 large-scale studies that fit these criteria. Several conclusions can be reached. (1) Family-Community Care interventions can have a substantial effect on neonatal and perinatal mortality. (2) Several important common strategies were used across the studies, including community mobilization, health education, behavior change communication sessions, care seeking modalities, and home visits during pregnancy and after birth. However, implementation of these interventions varied widely across the studies. (3) There is a need for additional, large-scale studies to test evidence-based CBIPs in developing countries, particularly in Africa, where no large-scale studies were identified. (4) We need to establish consistent, clearly defined terminology and protocols for designing trials and reporting outcomes so that we are able to compare results across different settings. (5) There is an urgent need to invest in research and program development focusing on neonatal health in urban areas. (6) It is crucial to integrate CBIPs in rural

  11. Wildlife-associated zoonotic diseases in some southern African countries in relation to game meat safety: a review.

    PubMed

    Bekker, Johan L; Hoffman, Louw C; Jooste, Piet J

    2012-01-01

    With on-going changes in land use practices from conventional livestock farming to commercial, wildlife-based activities, the interface or interaction between livestock and wildlife is increasing. As part of the wildlife-based activities of ecotourism, breeding and hunting, game farmers are also exploring the utilisation of meat from hunted or harvested game. The expanding interface or increased interaction between livestock and wildlife increases the risk of disease incidence and the emergence of new diseases or the re-emergence of previously diagnosed diseases. The risk is not only related to domestic and wild animal health, but also to the occupational hazards that it poses to animal handlers and the consumers of game meat. This review endeavours to highlight the role that game plays in the spreading of zoonotic diseases to other animals and humans. Examples of zoonotic diseases that have occurred in wild animals in the past, their relevance and risk have been summarised and should function as a quick reference guide for wildlife veterinarians, ecologists, farmers, hunters, slaughter staff, processors and public health professionals. PMID:23327327

  12. Wildlife-associated zoonotic diseases in some southern African countries in relation to game meat safety: a review.

    PubMed

    Bekker, Johan L; Hoffman, Louw C; Jooste, Piet J

    2012-12-05

    With on-going changes in land use practices from conventional livestock farming to commercial, wildlife-based activities, the interface or interaction between livestock and wildlife is increasing. As part of the wildlife-based activities of ecotourism, breeding and hunting, game farmers are also exploring the utilisation of meat from hunted or harvested game. The expanding interface or increased interaction between livestock and wildlife increases the risk of disease incidence and the emergence of new diseases or the re-emergence of previously diagnosed diseases. The risk is not only related to domestic and wild animal health, but also to the occupational hazards that it poses to animal handlers and the consumers of game meat. This review endeavours to highlight the role that game plays in the spreading of zoonotic diseases to other animals and humans. Examples of zoonotic diseases that have occurred in wild animals in the past, their relevance and risk have been summarised and should function as a quick reference guide for wildlife veterinarians, ecologists, farmers, hunters, slaughter staff, processors and public health professionals.

  13. Water and sanitation issues for persons with disabilities in low- and middle-income countries: a literature review and discussion of implications for global health and international development.

    PubMed

    Groce, N; Bailey, N; Lang, R; Trani, J F; Kett, M

    2011-12-01

    The critical importance of unrestricted access to clean drinking water and basic sanitation for all is highlighted in Millennium Development Goal 7, which calls for the reduction by half of the proportion of people without such access by 2015. Unfortunately, little attention has been paid to the needs of such access for the one billion people living with a disability worldwide, despite the fact that the right to equal access for all international development initiatives is guaranteed in the new United Nations Convention on the Rights of Persons with Disabilities. In this paper, we review what is currently known about access to water and sanitation for persons with disabilities in low- and middle-income countries from the perspective of both international development and global health, and identify existing gaps in research, practice and policy that are of pressing concern if the water and sanitation needs of this large - and largely overlooked - population are to be addressed.

  14. Immigrant and non-immigrant women’s experiences of maternity care: a systematic and comparative review of studies in five countries

    PubMed Central

    2014-01-01

    Background Understanding immigrant women’s experiences of maternity care is critical if receiving country care systems are to respond appropriately to increasing global migration. This systematic review aimed to compare what we know about immigrant and non-immigrant women’s experiences of maternity care. Methods Medline, CINAHL, Health Star, Embase and PsychInfo were searched for the period 1989–2012. First, we retrieved population-based studies of women’s experiences of maternity care (n = 12). For countries with identified population studies, studies focused specifically on immigrant women’s experiences of care were also retrieved (n = 22). For all included studies, we extracted available data on experiences of care and undertook a descriptive comparison. Results What immigrant and non-immigrant women want from maternity care proved similar: safe, high quality, attentive and individualised care, with adequate information and support. Immigrant women were less positive about their care than non-immigrant women. Communication problems and lack of familiarity with care systems impacted negatively on immigrant women’s experiences, as did perceptions of discrimination and care which was not kind or respectful. Conclusion Few differences were found in what immigrant and non-immigrant women want from maternity care. The challenge for health systems is to address the barriers immigrant women face by improving communication, increasing women’s understanding of care provision and reducing discrimination. PMID:24773762

  15. A systematic review of the effects of behavioral counseling on sexual risk behaviors and HIV/STI prevalence in low- and middle-income countries

    PubMed Central

    Zajac, Kristyn; Kennedy, Caitlin E.; Fonner, Virginia A.; Armstrong, Kevin S.; O’Reilly, Kevin R.; Sweat, Michael D.

    2014-01-01

    The purpose of this study was to assess the effectiveness of behavioral counseling interventions in reducing sexual risk behaviors and HIV/STI prevalence in low- and middle-income countries. A systematic review of papers published between 1990 and 2011 was conducted, identifying studies that utilized either a multi-arm or pre-post design and presented post-intervention data. Standardized methods of searching and data abstraction were used, and 30 studies met inclusion criteria. Results are summarized by intervention groups: a) people living with HIV; b) people who use drugs and alcohol; c) serodiscordant couples; d) key populations for HIV prevention; and e) people at low to moderate HIV risk. Evidence for the effectiveness of behavioral counseling was mixed, with more rigorously designed studies often showing modest or no effects. Recommendations about the use of behavioral counseling in developing countries are made based on study results and in light of the field’s movement towards combination prevention programs. PMID:25213302

  16. Women Who Have Sex with Women Living in Low- and Middle-Income Countries: A Systematic Review of Sexual Health and Risk Behaviors.

    PubMed

    Tat, Susana A; Marrazzo, Jeanne M; Graham, Susan M

    2015-06-01

    Women who have sex with women (WSW) have long been considered at low risk of acquiring and transmitting HIV and other sexually transmitted infections (STIs). However, limited research has been conducted on WSW, especially those living in low-and middle-income countries (LMICs). We reviewed available research on sexual health and risk behaviors of WSW in LMICs. We searched CINAHL, Embase, and PubMed for studies of WSW in LMICs published between January 1, 1980, and December 31, 2013. Studies of any design and subject area that had at least two WSW participants were included. Data extraction was performed to report quantifiable WSW-specific results related to sexual health and risk behaviors, and key findings of all other studies on WSW in LMICs. Of 652 identified studies, 56 studies from 22 countries met inclusion criteria. Reported HIV prevalence among WSW ranged from 0% in East Asia and Pacific and 0%-2.9% in Latin America and the Caribbean to 7.7%-9.6% in Sub-Saharan Africa. Other regions did not report WSW HIV prevalence. Overall, many WSW reported risky sexual behaviors, including sex with men, men who have sex with men (MSM), and HIV-infected partners; transactional sex; and substance abuse. WSW are at risk for contracting HIV and STIs. While the number of research studies on WSW in LMICs continues to increase, data to address WSW sexual health needs remain limited. PMID:26790114

  17. Maternal body mass index and risk of birth and maternal health outcomes in low- and middle-income countries: a systematic review and meta-analysis.

    PubMed

    Rahman, M M; Abe, S K; Kanda, M; Narita, S; Rahman, M S; Bilano, V; Ota, E; Gilmour, S; Shibuya, K

    2015-09-01

    We conducted a systematic review and meta-analysis of population-based cohort studies of maternal body mass index (BMI) and risk of adverse birth and health outcomes in low- and middle-income countries. PubMed, Embase, CINAHL and the British Nursing Index were searched from inception to February 2014. Forty-two studies were included. Our study found that maternal underweight was significantly associated with higher risk of preterm birth (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01-1.27), low birthweight (OR, 1.66; 95% CI, 1.50-1.84) and small for gestational age (OR, 1.85; 95% CI, 1.69-2.02). Compared with mothers with normal BMI, overweight or obese mothers were at increased odds of gestational diabetes, pregnancy-induced hypertension, pre-eclampsia, caesarean delivery and post-partum haemorrhage. The population-attributable risk (PAR) indicated that if women were entirely unexposed to overweight or obesity during the pre-pregnancy or early pregnancy period, 14% to 35% fewer women would develop gestational diabetes, pre-eclampsia or pregnancy-induced hypertension in Brazil, China, India, Iran or Thailand. The highest PAR of low birthweight attributable to maternal underweight was found in Iran (20%), followed by India (18%), Thailand (10%) and China (8%). Treatment and prevention of maternal underweight, overweight or obesity may help reduce the burden on maternal and child health in developing countries.

  18. Maternal body mass index and risk of birth and maternal health outcomes in low- and middle-income countries: a systematic review and meta-analysis.

    PubMed

    Rahman, M M; Abe, S K; Kanda, M; Narita, S; Rahman, M S; Bilano, V; Ota, E; Gilmour, S; Shibuya, K

    2015-09-01

    We conducted a systematic review and meta-analysis of population-based cohort studies of maternal body mass index (BMI) and risk of adverse birth and health outcomes in low- and middle-income countries. PubMed, Embase, CINAHL and the British Nursing Index were searched from inception to February 2014. Forty-two studies were included. Our study found that maternal underweight was significantly associated with higher risk of preterm birth (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01-1.27), low birthweight (OR, 1.66; 95% CI, 1.50-1.84) and small for gestational age (OR, 1.85; 95% CI, 1.69-2.02). Compared with mothers with normal BMI, overweight or obese mothers were at increased odds of gestational diabetes, pregnancy-induced hypertension, pre-eclampsia, caesarean delivery and post-partum haemorrhage. The population-attributable risk (PAR) indicated that if women were entirely unexposed to overweight or obesity during the pre-pregnancy or early pregnancy period, 14% to 35% fewer women would develop gestational diabetes, pre-eclampsia or pregnancy-induced hypertension in Brazil, China, India, Iran or Thailand. The highest PAR of low birthweight attributable to maternal underweight was found in Iran (20%), followed by India (18%), Thailand (10%) and China (8%). Treatment and prevention of maternal underweight, overweight or obesity may help reduce the burden on maternal and child health in developing countries. PMID:26094567

  19. Assessing the Effect of mHealth Interventions in Improving Maternal and Neonatal Care in Low- and Middle-Income Countries: A Systematic Review

    PubMed Central

    Sondaal, Stephanie Felicie Victoria; Browne, Joyce Linda; Amoakoh-Coleman, Mary; Borgstein, Alexander; Miltenburg, Andrea Solnes; Verwijs, Mirjam; Klipstein-Grobusch, Kerstin

    2016-01-01

    Introduction Maternal and neonatal mortality remains high in many low- and middle-income countries (LMIC). Availability and use of mobile phones is increasing rapidly with 90% of persons in developing countries having a mobile-cellular subscription. Mobile health (mHealth) interventions have been proposed as effective solutions to improve maternal and neonatal health. This systematic review assessed the effect of mHealth interventions that support pregnant women during the antenatal, birth and postnatal period in LMIC. Methods The review was registered with Prospero (CRD42014010292). Six databases were searched from June 2014–April 2015, accompanied by grey literature search using pre-defined search terms linked to pregnant women in LMIC and mHealth. Quality of articles was assessed with an adapted Cochrane Risk of Bias Tool. Because of heterogeneity in outcomes, settings and study designs a narrative synthesis of quantitative results of intervention studies on maternal outcomes, neonatal outcomes, service utilization, and healthy pregnancy education was conducted. Qualitative and quantitative results were synthesized with a strengths, weaknesses, opportunities, and threats analysis. Results In total, 3777 articles were found, of which 27 studies were included: twelve intervention studies and fifteen descriptive studies. mHealth interventions targeted at pregnant women increased maternal and neonatal service utilization shown through increased antenatal care attendance, facility-service utilization, skilled attendance at birth, and vaccination rates. Few articles assessed the effect on maternal or neonatal health outcomes, with inconsistent results. Conclusion mHealth interventions may be effective solutions to improve maternal and neonatal service utilization. Further studies assessing mHealth’s impact on maternal and neonatal outcomes are recommended. The emerging trend of strong experimental research designs with randomized controlled trials, combined with

  20. Interventions to Prevent Unintended and Repeat Pregnancy Among Young People in Low- and Middle-Income Countries: A Systematic Review of the Published and Gray Literature.

    PubMed

    Hindin, Michelle J; Kalamar, Amanda M; Thompson, Terri-Ann; Upadhyay, Ushma D

    2016-09-01

    Adolescent pregnancy, particularly unintended pregnancy, can have lasting social, economic, and health outcomes. The objective of this review is to identify high-quality interventions and evaluations to decrease unintended and repeat pregnancy among young people in low- and middle-income countries. PubMed, Embase, PsycInfo, Cinahl Plus, Popline, and the Cochrane Databases were searched for all languages for articles published through November 2015. Gray literature was searched by hand. Reference tracing was utilized, as well as unpacking systematic reviews. Selected articles were those that were evaluated as having high-quality interventions and evaluations using standardized scoring. Twenty-one high-quality interventions and evaluations were abstracted. Nine reported statistically significant declines in pregnancy rates (five cash transfer programs, one education curriculum, two life-skills curricula, and a provision of contraception intervention), seven reported increases in contraceptive use (three provision of contraception interventions, two life-skills curricula, a peer education program, and a mass media campaign), two reported decreases in sexual activity (a cash transfer program and an education and life-skills curriculum), and two reported an increase in age of sexual debut (both cash transfer programs). The selected high quality, effective interventions included in this review can inform researchers, donors, and policy makers about where to make strategic investments to decrease unintended pregnancy during young adulthood. Additionally, this review can assist with avoiding investments in interventions that failed to produce significant impact on the intended outcomes. The diversity of successful high-quality interventions, implemented in a range of venues, with a diversity of young people, suggests that there are multiple strategies that can work to prevent unintended pregnancy. PMID:27562452

  1. Interventions to Prevent Unintended and Repeat Pregnancy Among Young People in Low- and Middle-Income Countries: A Systematic Review of the Published and Gray Literature.

    PubMed

    Hindin, Michelle J; Kalamar, Amanda M; Thompson, Terri-Ann; Upadhyay, Ushma D

    2016-09-01

    Adolescent pregnancy, particularly unintended pregnancy, can have lasting social, economic, and health outcomes. The objective of this review is to identify high-quality interventions and evaluations to decrease unintended and repeat pregnancy among young people in low- and middle-income countries. PubMed, Embase, PsycInfo, Cinahl Plus, Popline, and the Cochrane Databases were searched for all languages for articles published through November 2015. Gray literature was searched by hand. Reference tracing was utilized, as well as unpacking systematic reviews. Selected articles were those that were evaluated as having high-quality interventions and evaluations using standardized scoring. Twenty-one high-quality interventions and evaluations were abstracted. Nine reported statistically significant declines in pregnancy rates (five cash transfer programs, one education curriculum, two life-skills curricula, and a provision of contraception intervention), seven reported increases in contraceptive use (three provision of contraception interventions, two life-skills curricula, a peer education program, and a mass media campaign), two reported decreases in sexual activity (a cash transfer program and an education and life-skills curriculum), and two reported an increase in age of sexual debut (both cash transfer programs). The selected high quality, effective interventions included in this review can inform researchers, donors, and policy makers about where to make strategic investments to decrease unintended pregnancy during young adulthood. Additionally, this review can assist with avoiding investments in interventions that failed to produce significant impact on the intended outcomes. The diversity of successful high-quality interventions, implemented in a range of venues, with a diversity of young people, suggests that there are multiple strategies that can work to prevent unintended pregnancy.

  2. Too little but not too late: Results of a literature review to improve routine immunization programs in developing countries

    PubMed Central

    Ryman, Tove K; Dietz, Vance; Cairns, K Lisa

    2008-01-01

    Background Globally, immunization services have been the center of renewed interest with increased funding to improve services, acceleration of the introduction of new vaccines, and the development of a health systems approach to improve vaccine delivery. Much of the credit for the increased attention is due to the work of the GAVI Alliance and to new funding streams. If routine immunization programs are to take full advantage of the newly available resources, managers need to understand the range of proven strategies and approaches to deliver vaccines to reduce the incidence of diseases. In this paper, we present strategies that may be used at the sub-national level to improve routine immunization programs. Methods We conducted a systematic review of studies and projects reported in the published and gray literature. Each paper that met our inclusion criteria was rated based on methodological rigor and data were systematically abstracted. Routine-immunization – specific papers with a methodological rigor rating of greater than 60% and with conclusive results were reported. Results Greater than 11,000 papers were identified, of which 60 met our inclusion criteria and 25 papers were reported. Papers were grouped into four strategy approaches: bringing immunizations closer to communities (n = 11), using information dissemination to increase demand for vaccination (n = 3), changing practices in fixed sites (n = 4), and using innovative management practices (n = 7). Conclusion Immunization programs are at a historical crossroads in terms of developing new funding streams, introducing new vaccines, and responding to the global interest in the health systems approach to improving immunization delivery. However, to complement this, actual service delivery needs to be strengthened and program managers must be aware of proven strategies. Much was learned from the 25 papers, such as the use of non-health workers to provide numerous services at the community level. However

  3. Are treatments for cervical precancerous lesions in less-developed countries safe enough to promote scaling-up of cervical screening programs? A systematic review

    PubMed Central

    2010-01-01

    Background Since the mid-1990s, there have been growing efforts to prevent cervical cancer in less-developed countries through the development of innovative screening approaches such as visual inspection of the cervix associated with same day management of cervical lesions with cryotherapy or loop electrosurgical excision procedure (LEEP). In the past, promising cancer screening interventions have been widely promoted despite incomplete evidence, only to become the subject of intense controversies about ensuing net health benefit. Because the efficacy and effectiveness of the new protocols for global cervical cancer screening have not been well characterized yet, and as a contribution to the evaluation of the balance between the benefits and risks of these protocols, we reviewed the literature on the safety of cryotherapy and LEEP for cervical intraepithelial neoplasia (CIN) in low- and middle-income countries. Methods We searched 12 databases (Medline, Google Scholar, Scopus, Cochrane Library, Web of Science, OCLC, PAIS International Database, WHO Global Health Library, CINAHL, Science.gov, NYAM Grey Literature Report, and POPLINE) for original research published between January 1995 and April 2009. Both peer-reviewed publications and items of "grey" literature were retrieved; no language restriction was applied. We calculated the median (minimum, maximum) reported rate for each harm considered. Because of limitations and heterogeneity in the data, no formal meta-analysis was performed. Results The search identified 32 articles that reported safety data from 24 cryotherapy and LEEP studies. The combined sample consisted of 6,902 women treated by cryotherapy and 4,524 women treated by LEEP. Most studies were conducted in reference or research settings in Asia and Africa. Short-term harms of cryotherapy and LEEP appeared to be similar to those described in the literature from high-income countries. Information was sparse on HIV-related harms and long

  4. Impact of education and provision of complementary feeding on growth and morbidity in children less than 2 years of age in developing countries: a systematic review

    PubMed Central

    2013-01-01

    Background About one third of deaths in children less than 5 years of age are due to underlying undernutrition. According to an estimate, 19.4% of children <5 years of age in developing countries were underweight (weight-for-age Z score <-2) and about 29.9% were stunted in the year 2011 (height-for-age Z score <-2). It is well recognized that the period of 6-24 months of age is one of the most critical time for the growth of the infant. Methods We included randomized, non-randomized trials and programs on the effect of complementary feeding (CF) (fortified or unfortified, but not micronutrients alone) and education on CF on children less than 2 years of age in low and middle income countries (LMIC). Studies that delivered intervention for at least 6 months were included; however, studies in which intervention was given for supplementary and therapeutic purposes were excluded. Recommendations are made for input to the Lives Saved Tool (LiST) model by following standardized guidelines developed by Child Health Epidemiology Reference Group (CHERG). Results We included 16 studies in this review. Amongst these, 9 studies provided education on complementary feeding, 6 provided complementary feeding (with our without education) and 1 provided both as separate arms. Overall, education on CF alone significantly improved HAZ (SMD: 0.23; 95% CI: 0.09, 0.36), WAZ (SMD 0.16, 95% CI: 0.05, 0.27), and significantly reduced the rates of stunting (RR 0.71; 95% CI: 0.56, 0.91). While no significant impact were observed for height and weight gain. Based on the subgroup analysis; ten studies from food secure populations indicated education on CF had a significant impact on height gain, HAZ scores, and weight gain, however, stunting reduced non-significantly. In food insecure population, CF education alone significantly improved HAZ scores, WAZ scores and significantly reduced the rates of stunting, while CF provision with or without education improved HAZ and WAZ scores significantly

  5. Three cases of human Sarcocystis infection with a review of human muscular sarcocystosis in Malaysia.

    PubMed

    Pathmanathan, R; Kan, S P

    1992-01-01

    Three cases of muscular sarcocystosis from West Malaysia are reported. The morphological features of the parasites from these three cases are similar to the eight cases previously reported from this country. A review of this total of eleven cases of muscular sarcocystosis showed that they were all incidental findings, where man acted as intermediate hosts of as yet unknown Sarcocystis spp. These cases of muscular sarcocystosis were probably zoonotic in origin and associated with close contact with definitive hosts (both domestic and wild animals) thus permitting the contamination of food and drink with sporocysts shed by these definitive hosts. These infections were probably acquired locally as most of the subjects were born in Malaysia and none had ever left the country to stay elsewhere. Eight of the eleven cases reported were associated with malignancies, especially of the tongue and nasopharynx.

  6. How effective is good domestic kitchen hygiene at reducing diarrhoeal disease in developed countries? A systematic review and reanalysis of the UK IID study

    PubMed Central

    Stenberg, Anna; Macdonald, Clare; Hunter, Paul R

    2008-01-01

    Background To assess whether domestic kitchen hygiene is an important contributor to the development of diarrhoea in the developed world. Methods Electronic searches were carried out in October 2006 in EMBASE, MEDLINE, Web of Knowledge, Cochrane central register of clinical trials and CINAHL. All publications, irrespective of study design, assessing food hygiene practices with an outcome measure of diarrhoea were included in the review. All included studies underwent data extraction and the data was subsequently analysed. The analysis was conducted by qualitative synthesis of the results. Given the substantial heterogeneity in study design and outcome measures meta-analysis was not done. In addition the existing dataset of the UK IID study was reanalysed to investigate possible associations between self-reported diarrhoea and variables indicative of poor domestic kitchen hygiene Results Some 14 studies were finally included in subsequent analyses. Of the 14 studies included in this systematic review, 11 were case-control studies, 2 cross-sectional surveys, and 1 RCT. Very few studies identified any significant association with good environmental kitchen hygiene. Although some of the variables in the reanalysis of the UK IID study were statistically significant no obvious trend was seen. Conclusion The balance of the available evidence does not support the hypothesis that poor domestic kitchen hygiene practices are important risk factors for diarrhoeal disease in developed countries. PMID:18294383

  7. Interventions for Children Affected by Armed Conflict: a Systematic Review of Mental Health and Psychosocial Support in Low- and Middle-Income Countries.

    PubMed

    Jordans, Mark J D; Pigott, Hugo; Tol, Wietse A

    2016-01-01

    Over one billion children under the age of 18 live in countries affected by armed conflict. This systematic review replicates an earlier study, aiming to provide a comprehensive update of the most current developments in interventions for children affected by armed conflict. For the period 2009-2015, a total of 1538 records were collected from PubMed, PsycINFO, and PILOTS. Twenty-four studies met the inclusion criteria, and the included interventions involve data from 4858 children. Although the number of publications and level of evidence has improved since the previous review, there is still a general lack of rigor and clarity in study design and reported results. Overall, interventions appeared to show promising results demonstrating mostly moderate effect sizes on mental health and psychosocial well-being. However, these positive intervention benefits are often limited to specific subgroups. There is a need for increased diversification in research focus, with more attention to interventions that focus at strengthening community and family support, and to young children, and improvements in targeting and conceptualizing of interventions.

  8. Interventions for Children Affected by Armed Conflict: a Systematic Review of Mental Health and Psychosocial Support in Low- and Middle-Income Countries.

    PubMed

    Jordans, Mark J D; Pigott, Hugo; Tol, Wietse A

    2016-01-01

    Over one billion children under the age of 18 live in countries affected by armed conflict. This systematic review replicates an earlier study, aiming to provide a comprehensive update of the most current developments in interventions for children affected by armed conflict. For the period 2009-2015, a total of 1538 records were collected from PubMed, PsycINFO, and PILOTS. Twenty-four studies met the inclusion criteria, and the included interventions involve data from 4858 children. Although the number of publications and level of evidence has improved since the previous review, there is still a general lack of rigor and clarity in study design and reported results. Overall, interventions appeared to show promising results demonstrating mostly moderate effect sizes on mental health and psychosocial well-being. However, these positive intervention benefits are often limited to specific subgroups. There is a need for increased diversification in research focus, with more attention to interventions that focus at strengthening community and family support, and to young children, and improvements in targeting and conceptualizing of interventions. PMID:26769198

  9. Diagnostic tests in HIV management: a review of clinical and laboratory strategies to monitor HIV-infected individuals in developing countries.

    PubMed Central

    Kimmel, April D.; Losina, Elena; Freedberg, Kenneth A.; Goldie, Sue J.

    2006-01-01

    We conducted a systematic review on the performance of diagnostic tests for clinical and laboratory monitoring of HIV-infected adults in developing countries. Diagnostic test information collected from computerized databases, bibliographies and the Internet were categorized as clinical (non-laboratory patient information), immunologic (information from immunologic laboratory tests), or virologic (information from virologic laboratory tests). Of the 51 studies selected for the review 28 assessed immunologic tests, 12 virologic tests and seven clinical and immunologic tests. Methods of performance evaluation were primarily sensitivity and specificity for the clinical category and correlation coefficients for immunologic and virologic categories. In the clinical category, the majority of test performance measures was reported as >70% sensitive and >65% specific. In the immunologic category, correlation coefficients ranged from r=0.54 to r=0.99 for different CD4 count enumeration techniques, while correlation for CD4 and total lymphocyte counts was between r=0.23 and r=0.74. In the virologic category, correlation coefficients for different human immunodeficiency virus (HIV) ribonucleic acid (RNA) quantification techniques ranged from r=0.54 to r=0.90. Future research requires consensus on designing studies, and collecting and reporting data useful for decision-makers. We recommend classifying information into clinically relevant categories, using a consistent definition of disease across studies and providing measures of both association and accuracy. PMID:16878233

  10. Country News.

    ERIC Educational Resources Information Center

    Population Education Newsletter and Forum, 1987

    1987-01-01

    Reports on the progress of population education programs in various countries in Asia and the Pacific region. Describes current developments in Bangladesh, China, India, Malaysia, Maldives, and Viet Nam. (TW)

  11. The Psychological Significance of Secondary Sexual Characteristics in Nine- to Eleven-Year-Old Girls.

    ERIC Educational Resources Information Center

    Brooks-Gunn, J.; Warren, Michelle P.

    1988-01-01

    Studied the onset of puberty in girls aged nine to eleven as represented by breast, pubic hair growth, and height. Breast growth, but not pubic hair growth was associated with a positive body image, positive peer relationships, and superior adjustment. Height was linked to superior adjustment and rating of career as important. (RJC)

  12. Spontaneous compactification of eleven-dimensional supergravity with higher-order corrections in the curvature

    NASA Astrophysics Data System (ADS)

    Brandyshev, P. E.

    2016-07-01

    We investigate the Freund-Rubin-Englert spontaneous compactification mechanism. We consider a lowenergy effective action for a supermembrane in eleven dimensions with terms of the fourth order in curvature taken into account. From that action, we obtain equations of motion for the bosonic sector of elevendimensional N = 1 supergravity. We find cosmological-type vacuum solutions corresponding to Hubble's law.

  13. Eleven Lessons in Drug Abuse Education for Use in Junior High School Science.

    ERIC Educational Resources Information Center

    Dade County Public Schools, Miami, FL.

    Eleven lessons for use in junior high school science present two major themes: (1) the use of tobacco, alcohol, and narcotics represents a serious danger to the health of individuals and to national welfare in general; and (2) the best way to combat dangers involved in the use of tobacco, alcohol, and narcotics is through an educated public. Each…

  14. Brodie's abscess in the first decade of life. Report of eleven cases.

    PubMed

    Kozlowski, K

    1980-09-01

    Eleven cases of Brodie's abscess in the first decade of life are presented. Brodie's abscess in the first decade of life usually shows the "Variant type" of X-ray appearances. The X-ray diagnosis is easy if the clinical data is known to the radiologist. The preponderance of Brodie's abscesses in the lower extremities is probably due to trauma.

  15. Systematic review on human resources for health interventions to improve maternal health outcomes: evidence from low- and middle-income countries.

    PubMed

    Lassi, Zohra S; Musavi, Nabiha B; Maliqi, Blerta; Mansoor, Nadia; de Francisco, Andres; Toure, Kadidiatou; Bhutta, Zulfiqar A

    2016-03-12

    There is a broad consensus and evidence that shows qualified, accessible, and responsive human resources for health (HRH) can make a major impact on the health of the populations. At the same time, there is widespread recognition that HRH crises particularly in low- and middle-income countries (LMICs) impede the achievement of better health outcomes/targets. In order to achieve the Sustainable Development Goals (SDGs), equitable access to a skilled and motivated health worker within a performing health system is need to be ensured. This review contributes to the vast pool of literature towards the assessment of HRH for maternal health and is focused on interventions delivered by skilled birth attendants (SBAs). Studies were included if (a) any HRH interventions in management system, policy, finance, education, partnership, and leadership were implemented; (b) these were related to SBA; (c) reported outcomes related to maternal health; (d) the studies were conducted in LMICs; and (e) studies were in English. Studies were excluded if traditional birth attendants and/or community health workers were trained. The review identified 25 studies which revealed reasons for poor maternal health outcomes in LMICs despite the efforts and policies implemented throughout these years. This review suggested an urgent and immediate need for formative evidence-based research on effective HRH interventions for improved maternal health outcomes. Other initiatives such as education and empowerment of women, alleviating poverty, establishing gender equality, and provision of infrastructure, equipment, drugs, and supplies are all integral components that are required to achieve SDGs by reducing maternal mortality and improving maternal health.

  16. Systematic review on human resources for health interventions to improve maternal health outcomes: evidence from low- and middle-income countries.

    PubMed

    Lassi, Zohra S; Musavi, Nabiha B; Maliqi, Blerta; Mansoor, Nadia; de Francisco, Andres; Toure, Kadidiatou; Bhutta, Zulfiqar A

    2016-01-01

    There is a broad consensus and evidence that shows qualified, accessible, and responsive human resources for health (HRH) can make a major impact on the health of the populations. At the same time, there is widespread recognition that HRH crises particularly in low- and middle-income countries (LMICs) impede the achievement of better health outcomes/targets. In order to achieve the Sustainable Development Goals (SDGs), equitable access to a skilled and motivated health worker within a performing health system is need to be ensured. This review contributes to the vast pool of literature towards the assessment of HRH for maternal health and is focused on interventions delivered by skilled birth attendants (SBAs). Studies were included if (a) any HRH interventions in management system, policy, finance, education, partnership, and leadership were implemented; (b) these were related to SBA; (c) reported outcomes related to maternal health; (d) the studies were conducted in LMICs; and (e) studies were in English. Studies were excluded if traditional birth attendants and/or community health workers were trained. The review identified 25 studies which revealed reasons for poor maternal health outcomes in LMICs despite the efforts and policies implemented throughout these years. This review suggested an urgent and immediate need for formative evidence-based research on effective HRH interventions for improved maternal health outcomes. Other initiatives such as education and empowerment of women, alleviating poverty, establishing gender equality, and provision of infrastructure, equipment, drugs, and supplies are all integral components that are required to achieve SDGs by reducing maternal mortality and improving maternal health. PMID:26971317

  17. ECVAM'S activities in the EU candidate countries.

    PubMed

    Sladowski, Dariusz; Halder, Marlies

    2002-12-01

    ECVAM has been given a special grant for collaborative projects on alternative/advanced testing methods involving eleven Candidate Countries for membership of the European Union (Bulgaria, Cyprus, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia and Slovenia). The project involves the promotion of the Three Rs (reduction, refinement, replacement) concept of Russell & Burch, in cooperation with appropriate individuals and national and international organisations in the Candidate Countries themselves, and elsewhere. The scope of the programme's activities covers: conferences in some of the Candidate Countries, workshops, training courses, training visits, and technology development/transfer initiatives. A database of contacts in the Candidate Countries and in relevant institutions in other countries, is being compiled. PMID:12513675

  18. ECVAM'S activities in the EU candidate countries.

    PubMed

    Sladowski, Dariusz; Halder, Marlies

    2002-12-01

    ECVAM has been given a special grant for collaborative projects on alternative/advanced testing methods involving eleven Candidate Countries for membership of the European Union (Bulgaria, Cyprus, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia and Slovenia). The project involves the promotion of the Three Rs (reduction, refinement, replacement) concept of Russell & Burch, in cooperation with appropriate individuals and national and international organisations in the Candidate Countries themselves, and elsewhere. The scope of the programme's activities covers: conferences in some of the Candidate Countries, workshops, training courses, training visits, and technology development/transfer initiatives. A database of contacts in the Candidate Countries and in relevant institutions in other countries, is being compiled.

  19. Cultural consonance, constructions of science and co-existence: a review of the integration of traditional, complementary and alternative medicine in low- and middle-income countries.

    PubMed

    Lakshmi, Josyula K; Nambiar, Devaki; Narayan, Venkatesh; Sathyanarayana, Tamysetty N; Porter, John; Sheikh, Kabir

    2015-10-01

    This review examined the determinants, patterns and imports of official recognition, and incorporation of different traditional, complementary and alternative systems of medicine (TCAM) in the public health establishment of low- and middle-income countries, with a particular focus on India. Public health systems in most countries have tended to establish health facilities centred on allopathy, and then to recognize or derecognize different TCAM based on evidence or judgement, to arrive at health-care configurations that include several systems of medicine with disparate levels of authority, jurisdiction and government support. The rationale for the inclusion of TCAM providers in the public health workforce ranges from the need for personnel to address the disease burden borne by the public health system, to the desirability of providing patients with a choice of therapeutic modalities, and the nurturing of local culture. Integration, mostly described as a juxtaposition of different systems of medical practice, is often implemented as a system of establishing personnel with certification in different medical systems, in predominantly allopathic health-care facilities, to practise allopathic medicine. A hierarchy of systems of medicine, often unacknowledged, is exercised in most societies, with allopathy at the top, certain TCAM systems next and local healing traditions last. The tools employed by TCAM practitioners in diagnosis, research, pharmacy, marketing and education and training, which are seen to increasingly emulate those of allopathy, are sometimes inappropriate for use in therapeutic systems with widely divergent epistemologies, which call for distinct research paradigms. The coexistence of numerous systems of medicine, while offering the population greater choice, and presumably enhancing geographical access to health care as well, is often fraught with tensions related to the coexistence of philosophically disparate, even opposed, disciplines, with

  20. Cultural consonance, constructions of science and co-existence: a review of the integration of traditional, complementary and alternative medicine in low- and middle-income countries

    PubMed Central

    Lakshmi, Josyula K; Nambiar, Devaki; Narayan, Venkatesh; Sathyanarayana, Tamysetty N; Porter, John; Sheikh, Kabir

    2015-01-01

    This review examined the determinants, patterns and imports of official recognition, and incorporation of different traditional, complementary and alternative systems of medicine (TCAM) in the public health establishment of low- and middle-income countries, with a particular focus on India. Public health systems in most countries have tended to establish health facilities centred on allopathy, and then to recognize or derecognize different TCAM based on evidence or judgement, to arrive at health-care configurations that include several systems of medicine with disparate levels of authority, jurisdiction and government support. The rationale for the inclusion of TCAM providers in the public health workforce ranges from the need for personnel to address the disease burden borne by the public health system, to the desirability of providing patients with a choice of therapeutic modalities, and the nurturing of local culture. Integration, mostly described as a juxtaposition of different systems of medical practice, is often implemented as a system of establishing personnel with certification in different medical systems, in predominantly allopathic health-care facilities, to practise allopathic medicine. A hierarchy of systems of medicine, often unacknowledged, is exercised in most societies, with allopathy at the top, certain TCAM systems next and local healing traditions last. The tools employed by TCAM practitioners in diagnosis, research, pharmacy, marketing and education and training, which are seen to increasingly emulate those of allopathy, are sometimes inappropriate for use in therapeutic systems with widely divergent epistemologies, which call for distinct research paradigms. The coexistence of numerous systems of medicine, while offering the population greater choice, and presumably enhancing geographical access to health care as well, is often fraught with tensions related to the coexistence of philosophically disparate, even opposed, disciplines, with

  1. The Uptake of Integrated Perinatal Prevention of Mother-to-Child HIV Transmission Programs in Low- and Middle-Income Countries: A Systematic Review

    PubMed Central

    Tudor Car, Lorainne; Brusamento, Serena; Elmoniry, Hoda; van Velthoven, Michelle H. M. M. T.; Pape, Utz J.; Welch, Vivian; Tugwell, Peter; Majeed, Azeem; Rudan, Igor; Car, Josip; Atun, Rifat

    2013-01-01

    Background The objective of this review was to assess the uptake of WHO recommended integrated perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions in low- and middle-income countries. Methods and Findings We searched 21 databases for observational studies presenting uptake of integrated PMTCT programs in low- and middle-income countries. Forty-one studies on programs implemented between 1997 and 2006, met inclusion criteria. The proportion of women attending antenatal care who were counseled and who were tested was high; 96% (range 30–100%) and 81% (range 26–100%), respectively. However, the overall median proportion of HIV positive women provided with antiretroviral prophylaxis in antenatal care and attending labor ward was 55% (range 22–99%) and 60% (range 19–100%), respectively. The proportion of women with unknown HIV status, tested for HIV at labor ward was 70%. Overall, 79% (range 44–100%) of infants were tested for HIV and 11% (range 3–18%) of them were HIV positive. We designed two PMTCT cascades using studies with outcomes for all perinatal PMTCT interventions which showed that an estimated 22% of all HIV positive women attending antenatal care and 11% of all HIV positive women delivering at labor ward were not notified about their HIV status and did not participate in PMTCT program. Only 17% of HIV positive antenatal care attendees and their infants are known to have taken antiretroviral prophylaxis. Conclusion The existing evidence provides information only about the initial PMTCT programs which were based on the old WHO PMTCT guidelines. The uptake of counseling and HIV testing among pregnant women attending antenatal care was high, but their retention in PMTCT programs was low. The majority of women in the included studies did not receive ARV prophylaxis in antenatal care; nor did they attend labor ward. More studies evaluating the uptake in current PMTCT programs are urgently needed. PMID:23483887

  2. Cultural consonance, constructions of science and co-existence: a review of the integration of traditional, complementary and alternative medicine in low- and middle-income countries.

    PubMed

    Lakshmi, Josyula K; Nambiar, Devaki; Narayan, Venkatesh; Sathyanarayana, Tamysetty N; Porter, John; Sheikh, Kabir

    2015-10-01

    This review examined the determinants, patterns and imports of official recognition, and incorporation of different traditional, complementary and alternative systems of medicine (TCAM) in the public health establishment of low- and middle-income countries, with a particular focus on India. Public health systems in most countries have tended to establish health facilities centred on allopathy, and then to recognize or derecognize different TCAM based on evidence or judgement, to arrive at health-care configurations that include several systems of medicine with disparate levels of authority, jurisdiction and government support. The rationale for the inclusion of TCAM providers in the public health workforce ranges from the need for personnel to address the disease burden borne by the public health system, to the desirability of providing patients with a choice of therapeutic modalities, and the nurturing of local culture. Integration, mostly described as a juxtaposition of different systems of medical practice, is often implemented as a system of establishing personnel with certification in different medical systems, in predominantly allopathic health-care facilities, to practise allopathic medicine. A hierarchy of systems of medicine, often unacknowledged, is exercised in most societies, with allopathy at the top, certain TCAM systems next and local healing traditions last. The tools employed by TCAM practitioners in diagnosis, research, pharmacy, marketing and education and training, which are seen to increasingly emulate those of allopathy, are sometimes inappropriate for use in therapeutic systems with widely divergent epistemologies, which call for distinct research paradigms. The coexistence of numerous systems of medicine, while offering the population greater choice, and presumably enhancing geographical access to health care as well, is often fraught with tensions related to the coexistence of philosophically disparate, even opposed, disciplines, with

  3. Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses

    PubMed Central

    Price, Jennifer; Hayen, Andrew; Jan, Stephen; Wiseman, Virginia

    2016-01-01

    Introduction Health financing reforms in low- and middle- income countries (LMICs) over the past decades have focused on achieving equity in financing of health care delivery through universal health coverage. Benefit and financing incidence analyses are two analytical methods for comprehensively evaluating how well health systems perform on these objectives. This systematic review assesses progress towards equity in health care financing in LMICs through the use of BIA and FIA. Methods and Findings Key electronic databases including Medline, Embase, Scopus, Global Health, CinAHL, EconLit and Business Source Premier were searched. We also searched the grey literature, specifically websites of leading organizations supporting health care in LMICs. Only studies using benefit incidence analysis (BIA) and/or financing incidence analysis (FIA) as explicit methodology were included. A total of 512 records were obtained from the various sources. The full texts of 87 references were assessed against the selection criteria and 24 were judged appropriate for inclusion. Twelve of the 24 studies originated from sub-Saharan Africa, nine from the Asia-Pacific region, two from Latin America and one from the Middle East. The evidence points to a pro-rich distribution of total health care benefits and progressive financing in both sub-Saharan Africa and Asia-Pacific. In the majority of cases, the distribution of benefits at the primary health care level favoured the poor while hospital level services benefit the better-off. A few Asian countries, namely Thailand, Malaysia and Sri Lanka, maintained a pro-poor distribution of health care benefits and progressive financing. Conclusion Studies evaluated in this systematic review indicate that health care financing in LMICs benefits the rich more than the poor but the burden of financing also falls more on the rich. There is some evidence that primary health care is pro-poor suggesting a greater investment in such services and removal

  4. A Systematic Survey Instrument Translation Process for Multi-Country, Comparative Health Workforce Studies

    PubMed Central

    Squires, Allison; Aiken, Linda H.; van den Heede, Koen; Sermeus, Walter; Bruyneel, Luk; Lindqvist, Rikard; Schoonoven, Lisette; Stromseng, Ingeborg; Busse, Reinhard; Brozstek, Tomas; Ensio, Anneli; Moreno-Casbas, Mayte; Rafferty, Anne Marie; Schubert, Maria; Zikos, Dimitris

    2012-01-01

    Background As health services research (HSR) expands across the globe, researchers will adopt health services and health worker evaluation instruments developed in one country for use in another. This paper explores the cross-cultural methodological challenges involved in translating HSR in the language and context of different health systems. Objectives To describe the pre-data collection systematic translation process used in a twelve country, eleven language nursing workforce survey. Design & Settings We illustrate the potential advantages of Content Validity Indexing (CVI) techniques to validate a nursing workforce survey developed for RN4CAST, a twelve country (Belgium, England, Finland, Germany, Greece, Ireland, Netherlands, Norway, Poland, Spain, Sweden, and Switzerland), eleven language (with modifications for regional dialects, including Dutch, English, Finnish, French, German, Greek, Italian, Norwegian, Polish, Spanish, and Swedish), comparative nursing workforce study in Europe. Participants Expert review panels comprised of practicing nurses from twelve European countries who evaluated cross-cultural relevance, including translation, of a nursing workforce survey instrument developed by experts in the field. Methods The method described in this paper used Content Validity Indexing (CVI) techniques with chance correction and provides researchers with a systematic approach for standardizing language translation processes while simultaneously evaluating the cross-cultural applicability of a survey instrument in the new context. Results The cross-cultural evaluation process produced CVI scores for the instrument ranging from .61 to .95. The process successfully identified potentially problematic survey items and errors with translation. Conclusions The translation approach described here may help researchers reduce threats to data validity and improve instrument reliability in multinational health services research studies involving comparisons across

  5. Do Menstrual Hygiene Management Interventions Improve Education and Psychosocial Outcomes for Women and Girls in Low and Middle Income Countries? A Systematic Review

    PubMed Central

    Hennegan, Julie; Montgomery, Paul

    2016-01-01

    Background Unhygienic and ineffective menstrual hygiene management has been documented across low resource contexts and linked to negative consequences for women and girls. Objectives To summarise and critically appraise evidence for the effectiveness of menstruation management interventions in improving women and girls’ education, work and psychosocial wellbeing in low and middle income countries. Methods Structured systematic searches were conducted in peer-reviewed and grey literature to identify studies evaluating education and resource provision interventions for menstruation management. Individual and cluster randomised controlled trials were eligible for inclusion, as were non-randomised controlled trials. Study characteristics, outcomes and risk of bias were extracted using a piloted form. Risk of bias was independently assessed by two researchers. Results Eight studies described in ten citations were eligible for inclusion. Studies were highly heterogeneous in design and context. Six included assessment of education-only interventions, and three provided assessment of the provision of different types of sanitary products (menstrual cups, disposable sanitary pads, and reusable sanitary pads). A moderate but non-significant standardised mean difference was found for the two studies assessing the impact of sanitary pad provision on school attendance: 0.49 (95%CI -0.13, 1.11). Included studies were heterogeneous with considerable risk of bias. Trials of education interventions reported positive impacts on menstrual knowledge and practices, however, many studies failed to assess other relevant outcomes. No trials assessed or reported harms. Conclusions There is insufficient evidence to establish the effectiveness of menstruation management interventions, although current results are promising. Eight trials have been conducted, but a high risk of bias was found and clinical heterogeneity precluded synthesis of most results. Whilst trials provided some

  6. A Systematic Review and Meta-Analysis of the Performance of Two Point of Care Typhoid Fever Tests, Tubex TF and Typhidot, in Endemic Countries

    PubMed Central

    Thriemer, Kamala; Ley, Benedikt; Menten, Joris; Jacobs, Jan; van den Ende, Jef

    2013-01-01

    Background In the absence of well-equipped laboratory infrastructure in many developing countries the accurate diagnosis of typhoid fever is challenging. Rapid diagnostic tests (RDT) with good performance indicators would be helpful to improve clinical management of suspected cases. We performed a systematic literature review and meta- analysis to determine the performance of TUBEX TF and Typhidot for the diagnosis of typhoid fever using PRISMA guidelines. Methods Titles and abstracts were reviewed for relevance. Articles were screened for language, reference method and completeness. Studies were categorized according to control groups used. Meta-analysis was performed only for categories where enough data was available to combine sensitivity and specificity estimates. Sub-analysis was performed for the Typhidot test to determine the influence of indeterminate results on test performance. Results A total of seven studies per test were included. The sensitivity of TUBEX TF ranged between 56% and 95%, Specificity between 72% and 95%. Meta-analysis showed an average sensitivity of 69% (95%CI: 45–85) and an average specificity of 88% (CI95%:83–91). A formal meta-analysis for Typhidot was not possible due to limited data available. Across the extracted studies, sensitivity and specificity estimates ranged from 56% to 84% and 31% to 97% respectively. Conclusion The observed performance does not support the use of either rapid diagnostic test exclusively as the basis for diagnosis and treatment. There is a need to develop an RDT for typhoid fever that has a performance level comparable to malaria RDTs. PMID:24358109

  7. Adherence to Antiretroviral Therapy During and After Pregnancy in Low-, Middle and High Income Countries: A Systematic Review and Meta-Analysis

    PubMed Central

    Nachega, Jean B.; Uthman, Olalekan A.; Anderson, Jean; Peltzer, Karl; Wampold, Sarah; Cotton, Mark F.; Mills, Edward J.; Ho, Yuh-Shan; Stringer, Jeffrey S. A.; McIntyre, James A.; Mofenson, Lynne M.

    2016-01-01

    Objective To estimate ART adherence rates during pregnancy and postpartum in high-, middle- and low-income countries. Design Systematic review and meta-analysis Methods MEDLINE, EMBASE, SCI Web of Science, NLM Gateway and Google scholar databases were searched. We included all studies reporting adherence rates as a primary or secondary outcome among HIV-infected pregnant women. Two independent reviewers extracted data on adherence and study characteristics. A random-effects model was used to pool adherence rates; sensitivity, heterogeneity, and publication bias were assessed. Results Of 72 eligible articles, 51studies involving 20,153 HIV-infected pregnant women were included. Most studies were from United States (n=14, 27%) followed by Kenya (n=6, 12%), South Africa (n=5, 10%), and Zambia (n=5, 10%). The threshold defining good adherence to ART varied across studies (>80%, >90%, >95%, 100%). A pooled analysis of all studies indicated a pooled estimate of 73.5% (95% confidence interval [CI] 69·3–77·5%, I2=97·7%) of pregnant women had adequate (>=80%) ART adherence. The pooled proportion of women with adequate adherence levels was higher during the antepartum (75·7%, 95% CI 71·5–79·7%) than during postpartum (53·0%, 95% 32.8% to 72·7%) (p=0·005). Selected reported barriers for non-adherence included physical, economic and emotional stresses, depression (especially post-delivery), alcohol or drug use, and ART dosing frequency or pill burden. Conclusion Our findings indicate that only 73·5% of pregnant women achieved optimal ART adherence. Reaching adequate ART adherence levels was a challenge in pregnancy, but especially during the postpartum period. Further research to investigate specific barriers and interventions to address them are urgently needed globally. PMID:22951634

  8. Effectiveness of mHealth Interventions Targeting Health Care Workers to Improve Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review

    PubMed Central

    Borgstein, Alexander Berend-Jan; Sondaal, Stephanie FV; Grobbee, Diederick E; Miltenburg, Andrea Solnes; Verwijs, Mirjam; Ansah, Evelyn K; Browne, Joyce L; Klipstein-Grobusch, Kerstin

    2016-01-01

    Background Low- and middle-income countries (LMICs) face the highest burden of maternal and neonatal deaths. Concurrently, they have the lowest number of physicians. Innovative methods such as the exchange of health-related information using mobile devices (mHealth) may support health care workers in the provision of antenatal, delivery, and postnatal care to improve maternal and neonatal outcomes in LMICs. Objective We conducted a systematic review evaluating the effectiveness of mHealth interventions targeting health care workers to improve maternal and neonatal outcomes in LMIC. Methods The Cochrane Library, PubMed, EMBASE, Global Health Library, and Popline were searched using predetermined search and indexing terms. Quality assessment was performed using an adapted Cochrane Risk of Bias Tool. A strength, weakness, opportunity, and threat analysis was performed for each included paper. Results A total of 19 studies were included for this systematic review, 10 intervention and 9 descriptive studies. mHealth interventions were used as communication, data collection, or educational tool by health care providers primarily at the community level in the provision of antenatal, delivery, and postnatal care. Interventions were used to track pregnant women to improve antenatal and delivery care, as well as facilitate referrals. None of the studies directly assessed the effect of mHealth on maternal and neonatal mortality. Challenges of mHealth interventions to assist health care workers consisted mainly of technical problems, such as mobile network coverage, internet access, electricity access, and maintenance of mobile phones. Conclusions mHealth interventions targeting health care workers have the potential to improve maternal and neonatal health services in LMICs. However, there is a gap in the knowledge whether mHealth interventions directly affect maternal and neonatal outcomes and future research should employ experimental designs with relevant outcome measures to

  9. Study of social loss or gain from a particular cause: scope for the developing countries - a review with reference to cancer.

    PubMed

    Dhar, Murali; Lahiri, S; Vijayasimha, R; Ashok, N C; Murthy, N S

    2008-01-01

    Incidence rates have long been used to assess the burden of different diseases in a population, whereas loss due to occurrence of diseases is studied using the death rates. Death rates however, are based on and therefore describe, only number of lives lost. There have been two approaches to arrive at the actual loss or gain from a particular cause viz. Person years of life lost (PYLL) approach and cause elimination life table (CELT) approach. This review covers these approaches and the competing risk theory and models focusing on the methodological developments. A summary of the conceptual and methodological developments on these concepts has also been presented. There are eight possible approaches in dealing with the loss in the presence or gain in the absence of a particular cause of death depending upon the preferences related to PYLL/CELT approach, modeling/descriptive approach, considering or without considering competing causes. A close look at the two basic approaches reveals that PYLL and cause elimination are just different terminologies used to address the same quantity, loss in the presence or gain in the absence. As far as descriptive vs. modeling approaches are concerned, all the descriptive procedures can be put in the form of models and all the models can be presented in a descriptive way. Regarding results using different models, no practical difference exists in the results based on different models for competing risks. However, exclusion of the competing risks may result in a considerable bias in the developing countries where general mortality is relatively higher. This review study suggests freedom in the selection of a modeling or a descriptive approach without any considerable loss of accuracy but at the same time emphasizes the consideration of the competing risks. An empirical study may be recommended to confirm the conclusions of this study.

  10. Do Strategies to Improve Quality of Maternal and Child Health Care in Lower and Middle Income Countries Lead to Improved Outcomes? A Review of the Evidence

    PubMed Central

    Dettrick, Zoe; Firth, Sonja; Jimenez Soto, Eliana

    2013-01-01

    Objectives Efforts to scale-up maternal and child health services in lower and middle income countries will fail if services delivered are not of good quality. Although there is evidence of strategies to increase the quality of health services, less is known about the way these strategies affect health system goals and outcomes. We conducted a systematic review of the literature to examine this relationship. Methods We undertook a search of MEDLINE, SCOPUS and CINAHL databases, limiting the results to studies including strategies specifically aimed at improving quality that also reported a measure of quality and at least one indicator related to health system outcomes. Variation in study methodologies prevented further quantitative analysis; instead we present a narrative review of the evidence. Findings Methodologically, the quality of evidence was poor, and dominated by studies of individual facilities. Studies relied heavily on service utilisation as a measure of strategy success, which did not always correspond to improved quality. The majority of studies targeted the competency of staff and adequacy of facilities. No strategies addressed distribution systems, public-private partnership or equity. Key themes identified were the conflict between perceptions of patients and clinical measures of quality and the need for holistic approaches to health system interventions. Conclusion Existing evidence linking quality improvement strategies to improved MNCH outcomes is extremely limited. Future research would benefit from the inclusion of more appropriate indicators and additional focus on non-facility determinants of health service quality such as health policy, supply distribution, community acceptability and equity of care. PMID:24349435

  11. Country Reports.

    ERIC Educational Resources Information Center

    United Nations Educational, Scientific, and Cultural Organization, Paris (France). Environmental Education Section.

    The reports from five countries participating at a seminar on teacher training in environmental education for Asia are compiled in this document. The objectives of the seminar were: (1) to familiarize teacher educators with the contents of the series of teacher training modules in environmental education prepared by the International Environmental…

  12. Historical review of the changing pattern of infant feeding in developing countries: the case of Malaysia, the Caribbean, Nigeria and Zaire.

    PubMed

    King, J; Ashworth, A

    1987-01-01

    Prolonged lactation and early supplementation have been traditional practices among low-income mothers in Malaysia, the Caribbean, Nigeria and Zaire. Early supplementation is still the norm but there have been some substantial changes in the types of supplement offered. Thus, except in Zaire, there is now widespread use of processed milks as supplements for very young infants. The use of processed milks began in the 1920s in Malaysia and the Caribbean, but not until the 1960s in Nigeria. Processed milks are, as yet, rarely used in Zaire. The use of processed milks has not, however, led to the abandonment of traditional paps. The latter are still given as supplements to young infants in Nigeria and to older infants in Malaysia and the Caribbean. Breast-feeding duration has declined in Malaysia and the Caribbean although initiation is almost universal. In Nigeria and Zaire most low-income mothers continue to breast-feed for at least 12 months. The changes in the types of supplements used and in breast-feeding duration are analogous to the changes observed in industrialised countries from the mid-19th century, and many of the associated factors are similar: urbanisation; female participation in the labour force; increased availability of processed milks and their promotion both by companies and the health sector; and the regimentation of breast-feeding. This review highlights the negative role played by the health sector in the past, and discusses its future role in promoting and supporting breast-feeding. PMID:3324358

  13. Dairy product intake in children and adolescents in developed countries: trends, nutritional contribution, and a review of association with health outcomes.

    PubMed

    Dror, Daphna K; Allen, Lindsay H

    2014-02-01

    Despite its contribution to nutrient intake and status, consumption of milk and dairy products by children and adolescents in many countries has waned in recent decades, with a substantial proportion of youth failing to meet intake recommendations. Dairy products remain an important dietary source of multiple micronutrients, including calcium, phosphorus, magnesium, zinc, iodine, potassium, vitamin A, vitamin D, vitamin B12 , and riboflavin (vitamin B2 ). In addition, dairy products provide children with energy, high-quality protein, and essential and nonessential fatty acids. A review of evidence was conducted to evaluate associations between milk or dairy product intake and health outcomes in children and adolescents. Results suggest a neutral or inverse association between consumption of milk and dairy products in children and adolescents and indicators of adiposity, incidence of dental caries, and hypertension. Available data indicate that dairy products are important for linear growth and bone health during childhood. Additional research--in particular, controlled intervention trials and long-term prospective cohort studies--is warranted to better understand how dairy intake affects health outcomes in children and adolescents.

  14. Historical review of the changing pattern of infant feeding in developing countries: the case of Malaysia, the Caribbean, Nigeria and Zaire.

    PubMed

    King, J; Ashworth, A

    1987-01-01

    Prolonged lactation and early supplementation have been traditional practices among low-income mothers in Malaysia, the Caribbean, Nigeria and Zaire. Early supplementation is still the norm but there have been some substantial changes in the types of supplement offered. Thus, except in Zaire, there is now widespread use of processed milks as supplements for very young infants. The use of processed milks began in the 1920s in Malaysia and the Caribbean, but not until the 1960s in Nigeria. Processed milks are, as yet, rarely used in Zaire. The use of processed milks has not, however, led to the abandonment of traditional paps. The latter are still given as supplements to young infants in Nigeria and to older infants in Malaysia and the Caribbean. Breast-feeding duration has declined in Malaysia and the Caribbean although initiation is almost universal. In Nigeria and Zaire most low-income mothers continue to breast-feed for at least 12 months. The changes in the types of supplements used and in breast-feeding duration are analogous to the changes observed in industrialised countries from the mid-19th century, and many of the associated factors are similar: urbanisation; female participation in the labour force; increased availability of processed milks and their promotion both by companies and the health sector; and the regimentation of breast-feeding. This review highlights the negative role played by the health sector in the past, and discusses its future role in promoting and supporting breast-feeding.

  15. Use of mHealth systems and tools for non-communicable diseases in low- and middle-income countries: a systematic review.

    PubMed

    Peiris, David; Praveen, Devarsetty; Johnson, Claire; Mogulluru, Kishor

    2014-11-01

    With the rapid adoption of mobile devices, mobile health (mHealth) offers the potential to transform health care delivery, especially in the world's poorest regions. We systematically reviewed the literature to determine the impact of mHealth interventions on health care quality for non-communicable diseases in low- and middle-income countries and to identify knowledge gaps in this rapidly evolving field. Overall, we found few high-quality studies. Most studies narrowly focused on text messaging systems for patient behavior change, and few studies examined the health systems strengthening aspects of mHealth. There were limited literature reporting clinical effectiveness, costs, and patient acceptability, and none reporting equity and safety issues. Despite the bold promise of mHealth to improve health care, much remains unknown about whether and how this will be fulfilled. Encouragingly, we identified some registered clinical trial protocols of large-scale, multidimensional mHealth interventions, suggesting that the current limited evidence base will expand in coming years. PMID:25209729

  16. The management of risk arising from the use of antimicrobial agents in veterinary medicine in EU/EEA countries - a review.

    PubMed

    Törneke, K; Torren-Edo, J; Grave, K; Mackay, D K J

    2015-12-01

    Antimicrobials are essential medicines for the treatment of many microbial infections in humans and animals. Only a small number of antimicrobial agents with new mechanisms of action have been authorized in recent years for use in either humans or animals. Antimicrobial resistance (AMR) arising from the use of antimicrobial agents in veterinary medicine is a concern for public health due to the detection of increasing levels of resistance in foodborne zoonotic bacteria, particularly gram-negative bacteria, and due to the detection of determinants of resistance such as Extended-spectrum beta-lactamases (ESBL) in bacteria from animals and in foodstuffs of animal origin. The importance and the extent of the emergence and spread of AMR from animals to humans has yet to be quantified. Likewise, the relative contribution that the use of antimicrobial agents in animals makes to the overall risk to human from AMR is currently a subject of debate that can only be resolved through further research. Nevertheless, risk managers have agreed that the impact on public health of the use of antimicrobials in animals should be minimized as far as possible and a variety of measures have been introduced by different authorities in the EU to achieve this objective. This article reviews a range of measures that have been implemented within European countries to reduce the occurrence and the risk of transmission of AMR to humans following the use of antimicrobial agents in animals and briefly describes some of the alternatives to the use of antimicrobial agents that are being developed.

  17. Eleven nominal species of Burmoniscus are junior synonyms of B. kathmandius (Schmalfuss, 1983) (Crustacea, Isopoda, Oniscidea).

    PubMed

    Karasawa, Shigenori

    2016-01-01

    Holotypes, paratypes, and specimens newly collected from the type localities (i.e., topotypes) of Burmoniscus aokii (Nunomura, 1986), Burmoniscus boninensis (Nunomura, 1986), Burmoniscus daitoensis (Nunomura, 1986), Burmoniscus hachijoensis Nunomura, 2007, Burmoniscus japonicus (Nunomura, 1986), Burmoniscus kagoshimaensis Nunomura, 2003, Burmoniscus murotoensis (Nunomura, 1986), Burmoniscus okinawaensis (Nunomura, 1986), Burmoniscus shibatai (Nunomura, 1986), Burmoniscus tanabensis Nunomura, 2003, and Burmoniscus watanabei (Nunomura, 1986) were examined in order to clarify their taxonomic status. Observation of 13 morphological characters that were purposed to show species-level diagnostic variations in the original descriptions suggests that all eleven nominal species are identical, and molecular analysis based on three gene fragments supports this suggestion. Additionally, the morphology of the carpus of pereopod 1 and of the endo- and exopodites of pleopod 1 of these species are consistent with those of Burmoniscus kathmandius (Schmalfuss, 1983). The eleven above-mentioned species of Burmoniscus described from Japan are therefore relegated to junior synonyms of Burmoniscus kathmandius, originally reported from Nepal. PMID:27551227

  18. School Based Sex Education and HIV Prevention in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

    PubMed Central

    Fonner, Virginia A.; Armstrong, Kevin S.; Kennedy, Caitlin E.; O'Reilly, Kevin R.; Sweat, Michael D.

    2014-01-01

    Objectives School-based sex education is a cornerstone of HIV prevention for adolescents who continue to bear a disproportionally high HIV burden globally. We systematically reviewed and meta-analyzed the existing evidence for school-based sex education interventions in low- and middle-income countries to determine the efficacy of these interventions in changing HIV-related knowledge and risk behaviors. Methods We searched five electronic databases, PubMed, Embase, PsycInfo, CINAHL, and Sociological Abstracts, for eligible articles. We also conducted hand-searching of key journals and secondary reference searching of included articles to identify potential studies. Intervention effects were synthesized through random effects meta-analysis for five outcomes: HIV knowledge, self-efficacy, sexual debut, condom use, and number of sexual partners. Results Of 6191 unique citations initially identified, 64 studies in 63 articles were included in the review. Nine interventions either focused exclusively on abstinence (abstinence-only) or emphasized abstinence (abstinence-plus), whereas the remaining 55 interventions provided comprehensive sex education. Thirty-three studies were able to be meta-analyzed across five HIV-related outcomes. Results from meta-analysis demonstrate that school-based sex education is an effective strategy for reducing HIV-related risk. Students who received school-based sex education interventions had significantly greater HIV knowledge (Hedges g = 0.63, 95% Confidence Interval (CI): 0.49–0.78, p<0.001), self-efficacy related to refusing sex or condom use (Hedges g = 0.25, 95% CI: 0.14–0.36, p<0.001), condom use (OR = 1.34, 95% CI: 1.18–1.52, p<0.001), fewer sexual partners (OR = 0.75, 95% CI:0.67–0.84, p<0.001) and less initiation of first sex during follow-up (OR = 0.66, 95% CI: 0.54–0.83, p<0.001). Conclusions The paucity of abstinence-only or abstinence-plus interventions identified during the review made

  19. Home-based neonatal care by community health workers for preventing mortality in neonates in low- and middle-income countries: a systematic review.

    PubMed

    Gogia, S; Sachdev, H P S

    2016-05-01

    The objective of this review is to assess the effect of home-based neonatal care provided by community health workers (CHWs) for preventing neonatal, infant and perinatal mortality in resource-limited settings with poor access to health facility-based care. The authors conducted a systematic review, including meta-analysis and meta-regression of controlled trials. The data sources included electronic databases, with a hand search of reviews, abstracts and proceedings of conferences to search for randomized, or cluster randomized, controlled trials evaluating the effect of home-based neonatal care provided by CHWs for preventing neonatal, infant and perinatal mortality. Among the included trials, all from South Asian countries, information on neonatal, infant and perinatal mortality was available in five, one and three trials, respectively. The intervention package comprised three components, namely, home visits during pregnancy (four trials), home-based preventive and/or curative neonatal care (all trials) and community mobilization efforts (four trials). Intervention was associated with a reduced risk of mortality during the neonatal (random effects model relative risk (RR) 0.75; 95% confidence intervals (CIs) 0.61 to 0.92, P=0.005; I(2)=82.2%, P<0.001 for heterogeneity; high-quality evidence) and perinatal periods (random effects model RR 0.78; 95% CI 0.64 to 0.94, P=0.009; I(2)=79.6%, P=0.007 for heterogeneity; high-quality evidence). In one trial, a significant decline in infant mortality (RR 0.85; 95% CI 0.77 to 0.94) was documented. Subgroup and meta-regression analyses suggested a greater effect with a higher baseline neonatal mortality rate. The authors concluded that home-based neonatal care is associated with a reduction in neonatal and perinatal mortality in South Asian settings with high neonatal-mortality rates and poor access to health facility-based care. Adoption of a policy of home-based neonatal care provided by CHWs is justified in such settings

  20. Assessing emergency obstetric care provision in low- and middle-income countries: a systematic review of the application of global guidelines

    PubMed Central

    Banke-Thomas, Aduragbemi; Wright, Kikelomo; Sonoiki, Olatunji; Banke-Thomas, Oluwasola; Ajayi, Babatunde; Ilozumba, Onaedo; Akinola, Oluwarotimi

    2016-01-01

    Background Lack of timely and quality emergency obstetric care (EmOC) has contributed significantly to maternal morbidity and mortality, particularly in low- and middle-income countries (LMICs). Since 2009, the global guideline, referred to as the ‘handbook’, has been used to monitor availability, utilization, and quality of EmOC. Objective To assess application and explore experiences of researchers in LMICs in assessing EmOC. Design Multiple databases of peer-reviewed literature were systematically reviewed on EmOC assessments in LMICs, since 2009. Following set criteria, we included articles, assessed for quality based on a newly developed checklist, and extracted data using a pre-designed extraction tool. We used thematic summaries to condense our findings and mapped patterns that we observed. To analyze experiences and recommendations for improved EmOC assessments, we took a deductive approach for the framework synthesis. Results Twenty-seven studies met our inclusion criteria, with 17 judged as high quality. The highest publication frequency was observed in 2015. Most assessments were conducted in Nigeria and Tanzania (four studies each) and Bangladesh and Ghana (three each). Most studies (17) were done at subnational levels with 23 studies using the ‘handbook’ alone, whereas the others combined the ‘handbook’ with other frameworks. Seventeen studies conducted facility-based surveys, whereas others used mixed methods. For different reasons, intrapartum and very early neonatal death rate and proportion of deaths due to indirect causes in EmOC facilities were the least reported indicators. Key emerging themes indicate that data quality for EmOC assessments can be improved, indicators should be refined, a holistic approach is required for EmOC assessments, and assessments should be conducted as routine processes. Conclusions There is clear justification to review how EmOC assessments are being conducted. Synergy between researchers, EmOC program

  1. Home-based neonatal care by community health workers for preventing mortality in neonates in low- and middle-income countries: a systematic review

    PubMed Central

    Gogia, S; Sachdev, H P S

    2016-01-01

    The objective of this review is to assess the effect of home-based neonatal care provided by community health workers (CHWs) for preventing neonatal, infant and perinatal mortality in resource-limited settings with poor access to health facility-based care. The authors conducted a systematic review, including meta-analysis and meta-regression of controlled trials. The data sources included electronic databases, with a hand search of reviews, abstracts and proceedings of conferences to search for randomized, or cluster randomized, controlled trials evaluating the effect of home-based neonatal care provided by CHWs for preventing neonatal, infant and perinatal mortality. Among the included trials, all from South Asian countries, information on neonatal, infant and perinatal mortality was available in five, one and three trials, respectively. The intervention package comprised three components, namely, home visits during pregnancy (four trials), home-based preventive and/or curative neonatal care (all trials) and community mobilization efforts (four trials). Intervention was associated with a reduced risk of mortality during the neonatal (random effects model relative risk (RR) 0.75; 95% confidence intervals (CIs) 0.61 to 0.92, P=0.005; I2=82.2%, P<0.001 for heterogeneity; high-quality evidence) and perinatal periods (random effects model RR 0.78; 95% CI 0.64 to 0.94, P=0.009; I2=79.6%, P=0.007 for heterogeneity; high-quality evidence). In one trial, a significant decline in infant mortality (RR 0.85; 95% CI 0.77 to 0.94) was documented. Subgroup and meta-regression analyses suggested a greater effect with a higher baseline neonatal mortality rate. The authors concluded that home-based neonatal care is associated with a reduction in neonatal and perinatal mortality in South Asian settings with high neonatal-mortality rates and poor access to health facility-based care. Adoption of a policy of home-based neonatal care provided by CHWs is justified in such settings

  2. Hepatitis A Immunity in the District of Aveiro (Portugal): An Eleven-Year Surveillance Study (2002–2012)

    PubMed Central

    Pereira, Sara; Linhares, Inês; Neves, António Ferreira; Almeida, Adelaide

    2014-01-01

    Hepatitis A is a common viral liver disease and brings serious health and economic problems as its epidemiologic pattern changes over time. National serosurveys from developed countries have indicated a decline in HAV (hepatitis A virus) seroprevalence over time due to the improvement of economic and sanitation levels. The hepatitis A virus (HAV) immunity rate was surveyed throughout an eleven-year period by sex and age group in Aveiro District. In this retrospective study, blood samples from patients of Aveiro District, in ambulatory regime, collected at the Clinical Analysis Laboratory Avelab between 2002 and 2012 were screened for the presence of antibodies against HAV antigen using a chemiluminescence immunoassay. The global immunity (positive total anti-HAV) was 60% and only 0.3% of the patients presented recent infection by HAV (positive IgM anti-HAV). The HAV immunity was age-dependent (p < 0.05), but no significant differences (p > 0.05) between sexes were observed. The immunity was similar throughout the study period (p > 0.05). The results of this study indicate that young people (especially under 25 years old) from District of Aveiro are susceptible to HAV infection, constituting a high risk group. The elderly should be also a concern in the future of Hepatitis A infection. PMID:24638206

  3. Optimizing Federal Fleet Vehicle Acquisitions: An Eleven-Agency FY 2012 Analysis

    SciTech Connect

    Singer, M.; Daley, R.

    2015-02-01

    This report focuses on the National Renewable Energy Laboratory's (NREL) fiscal year (FY) 2012 effort that used the NREL Optimal Vehicle Acquisition (NOVA) analysis to identify optimal vehicle acquisition recommendations for eleven diverse federal agencies. Results of the study show that by following a vehicle acquisition plan that maximizes the reduction in greenhouse gas (GHG) emissions, significant progress is also made toward the mandated complementary goals of acquiring alternative fuel vehicles, petroleum use reduction, and alternative fuel use increase.

  4. Selected data from eleven wildcat wells in the National Petroleum Reserve in Alaska

    USGS Publications Warehouse

    Zihlman, F.N.; Oliver, H.L.

    1999-01-01

    Between 1978 and 1981, the U.S. Geological Survey drilled 27 wells in the National Petroleum Reserve in Alaska. This publication presents the following data from eleven of those 27 wells: general information, well core images, depths to specific stratigraphic units, well core gamma ray logs in LAS format, well log information in LAS format, geological and drilling history reports in Adobe Acrobat PDF format, and permeability and porosity data.

  5. [Eleven thesis on the archive of scientific research, for a new patrimonial and scientific policy].

    PubMed

    Müller, Bertrand

    2015-12-01

    Abstracting the main content of a recent report on the bad state of the archives of scientific research, this paper puts forward eleven thesis likely to feed, in this time of numeric transition to a new documentary regime and to a new patrimonial policy. The recent numeric conditions impose to set new archival pratices, more proactive, anticipative and prospective. Archives of scientific research must be thought in a double memorial and scientific dimension, and not only as a patrimonial or historical one.

  6. Nuclear fuel, refueling, fuel handling, and licensing and regulation. Volume eleven

    SciTech Connect

    Not Available

    1986-01-01

    Volume eleven covers nuclear fuel (what is nuclear fuel, the nuclear fuel cycle, uranium mining, milling, and refining, uranium enrichment, nuclear fuel fabrication, fuel reprocessing), refueling and fuel handling (fuel assembly identification, fuel handling equipment, the fueling and refueling process, PWR refueling, BWR refueling), and licensing and regulation requirements (development of nuclear energy, federal licensing and regulatory organization, schedule for nuclear power plants, contents of reports to the Federal regulatory agency, nuclear power plant operator qualification).

  7. The sequences of the eleven-residue peptaibiotics: suzukacillins-B.

    PubMed

    Röhrich, Christian René; Vilcinskas, Andreas; Brückner, Hans; Degenkolb, Thomas

    2013-05-01

    The filamentous fungus designated 'Trichoderma viride' strain 63 C-1 simultaneously produces suzukacillins (SZs), two microheterogeneous groups of peptaibols, under submerged culture conditions. Both groups are readily distinguishable by TLC: the major group is designated SZ-A, whereas the minor group with a higher Rf value is named SZ-B. The peptide mixture was obtained from a MeOH extract of the mycelium. SZ-B was separated from SZ-A by Sephadex LH-20 column chromatography. Although it provided one single spot on silica-gel TLC plates, 15 individual peptides could be separated by C8 reversed-phase (RP) HPLC, and their sequences were determined by HPLC/QqTOF-ESI-HRMS. Fourteen peptides exhibit the C-terminal sequence Pro(6) -Lxx-Lxx-Aib-Pro-Vxxol/Lxxol(11) , which is common for eleven-residue peptaibols. The remaining peptide is tentatively assigned as a ten-residue sequence, in which the C-terminal 1,2-amino alcohol is deleted, thus terminating in free proline. Nine of the peptides carry an Ac-Aib residue at the N-terminus, very frequently found in eleven-residue peptaibols. Four peptides comprise the rare Ac-Ala N-terminus, and for two peptides, N-terminal Ac-D-Iva residues were identified. One peptide contains a C-terminal residue of yet undetermined structure. Comparison with previously reported eleven-residue peptaibol sequences reveals that eight of the peptides represent new sequence analogs. PMID:23681728

  8. A review of antimalarial plants used in traditional medicine in communities in Portuguese-speaking countries: Brazil, Mozambique, Cape Verde, Guinea-Bissau, São Tomé and Príncipe and Angola.

    PubMed

    Silva, Jefferson Rocha de A; Ramos, Aline de S; Machado, Marta; de Moura, Dominique F; Neto, Zoraima; Canto-Cavalheiro, Marilene M; Figueiredo, Paula; do Rosário, Virgilio E; Amaral, Ana Claudia F; Lopes, Dinora

    2011-08-01

    The isolation of bioactive compounds from medicinal plants, based on traditional use or ethnomedical data, is a highly promising potential approach for identifying new and effective antimalarial drug candidates. The purpose of this review was to create a compilation of the phytochemical studies on medicinal plants used to treat malaria in traditional medicine from the Community of Portuguese-Speaking Countries (CPSC): Angola, Brazil, Cape Verde, Guinea-Bissau, Mozambique and São Tomé and Príncipe. In addition, this review aimed to show that there are several medicinal plants popularly used in these countries for which few scientific studies are available. The primary approach compared the antimalarial activity of native species used in each country with its extracts, fractions and isolated substances. In this context, data shown here could be a tool to help researchers from these regions establish a scientific and technical network on the subject for the CPSC where malaria is a public health problem.

  9. Efficacy and safety of surfactant replacement therapy for preterm neonates with respiratory distress syndrome in low- and middle-income countries: a systematic review

    PubMed Central

    Sankar, M J; Gupta, N; Jain, K; Agarwal, R; Paul, V K

    2016-01-01

    Surfactant replacement therapy (SRT) has been shown to reduce mortality and air leaks in preterm neonates from high-income countries (HICs). The safety and efficacy of SRT in low- and middle- income <