First experience in laparoscopic surgery in low and middle income countries: A systematic review

BACKGROUND Laparoscopic surgery has reduced morbidity and mortality rates,shorter post-operative recovery periods and lower complication rates than open surgery.It is routine practice in high-income countries and is becoming increasingly common in countries with limited resources.However,introducing laparoscopic surgery in low-and-middle-income countries(LMIC)can be expensive and requires resour-ces,equipment,and trainers.AIM To report the challenges and benefits of introducing laparoscopic surgery in LMIC as well as to identify solutions to these challenges for countries with limited finances and resources.METHODS MEDLINE,EMBASE and Cochrane databases were searched for studies reporting first experience in laparoscopic surgery in LMIC.Included studies were published between 1996 and 2022 with full text available in English.Exclusion criteria were studies considering only open surgery,ear,nose,and throat,endoscopy,arthro-scopy,hysteroscopy,cystoscopy,transplant,or bariatric surgery.RESULTS Ten studies out of 3409 screened papers,from eight LMIC were eligible for inclusion in the final analysis,totaling 2497 patients.Most reported challenges were related to costs of equipment and training programmes,equipment pro-blems such as faulty equipment,and access to surgical kits.Training-related challenges were reliance on foreign trainers and lack of locally trained surgeons and theatre staff.The benefits of introducing laparoscopic surgery were economic and clinical,including a reduction in hospital stay,complications,and morbidi-ty/mortality.The introduction of laparoscopic surgery also provided training opportunities for junior doctors.CONCLUSION Despite financial and technical challenges,many studies emphasise the overall benefit of introducing laparoscopic surgery in LMICs such as reduced hospital stay and the related lower cost for patients.While many of the clinical centres in LMICs have proposed practical solutions to the challenges reported,more support is critically required,in particular regarding training.

Effect of nutrition-related infodemics and social media on maternal experience: A nationwide survey in a low/middle income country

BACKGROUND Undernutrition is a crucial cause of morbidity and mortality among children in low-or middle-income countries(LMICs).A better understanding of maternal general healthy nutrition knowledge,as well as misbeliefs,is highly essential,especially in such settings.In the current era of infodemics,it is very strenuous for mothers to select not only the right source for maternal nutrition information but the correct information as well.AIM To assess maternal healthy nutritional knowledge and nutrition-related misbeliefs and misinformation in an LMIC,and to determine the sources of such information and their assessment methods.METHODS This cross-sectional analytical observational study enrolled 5148 randomly selected Egyptian mothers who had one or more children less than 15 years old.The data were collected through online questionnaire forms:One was for the general nutrition knowledge assessment,and the other was for the nutritional myth score.Sources of information and ways of evaluating internet sources using the Currency,Relevance,Authority,Accuracy,and Purpose test were additionally analyzed.RESULTS The mean general nutrition knowledge score was 29±9,with a percent score of 70.8%±12.1%(total score:41).The median myth score was 9(interquartile range:6,12;total score:18).The primary sources of nutrition knowledge for the enrolled mothers were social media platforms(55%).Half of the mothers managed information for currency and authority,except for considering the author's contact information.More than 60%regularly checked information for accuracy and purpose.The mothers with significant nutrition knowledge checked periodically for the author's contact information(P=0.012).The nutrition myth score was significantly lower among mothers who periodically checked the evidence of the information(P=0.016).Mothers dependent on their healthcare providers as the primary source of their general nutritional knowledge were less likely to hold myths by 13%(P=0.044).However,using social media increased the likelihood of having myths among mothers by approximately 1.2(P=0.001).CONCLUSION Social media platforms were found to be the primary source of maternal nutrition information in the current era of infodemics.However,healthcare providers were the only source for decreasing the incidence of maternal myths among the surveyed mothers.

‘Middle-Income Trap’ and ‘High-Income Waft＇： Challenges and Opportunities to China

The history of international industrialization shows that Latin American countries and former Soviet Union and Eastern European countries experienced a siginificant drop in economic growth and fell into the middle-income trap when their per capita GDP reached 4,000-7,000 international dollar （based on the 1990 prices） as a result of long-term implemented import-oriented strategy and planned economic system. Fortunately, China adopted reform and opening-up policy beginning at a lower development phase and achieved sustained high-speed growth for more than thirty years. Currently, China has surpassed the phase which the above-mentioned countries fell into the middle-income trap. On the other side, experiences of successful runner-ups show that when per capita GDP reached II,000 international dollar （based on the 1990 prices）, economic growth speed will present regularly ＂natural drop ＂. Without internal and external shocks, China＇s economy is expected to reach this level by 2015 and the potential growth rate will possibly drop significantly. In this regard, China＇s toughest challenges will be whether it can effectively prevent and solve the financial risks accumulated during high-speed growth and make a shift to innovation-driven growth model Time is pressing for addressing the above challenges. A fundamental change in the growth model depends on the intensification of reform, in particular, the promotion of an ＂participatory and facilitative reform ＂approach.

Comparative Analysis on Transition Trap and Middle Income Trap in Current ＇ Economic Development

China now is in the vital stage of the economic transition,which is facing the severe challenge of spanning the middle- income trap.Only the clear recognization of current domestic and overseas situations,the vigorous implementation of self- dependent innovation,and the energetic exploitation of international market will contribute to the fundamental industrial restructuring and the early achievement of marching into high- income countries.

The ＂Middle Income Trap＂ in Economic Growth in Different Economies

Nowadays, more than 50% of the world population live in middle-income economies. Economies in the middle-income development stage are confronted with a number of challenges, such as economic restructuring, industrial upgrade and income growth. Therefore, academia around the worm have paid much attention to theoretical and empirical researches of the ＂middle income trap＂ and long-term trends of global economic growth. Based on analyses about the long-term growth path of the world economy and the characteristics of different stages of economic development, this paper defines the＂middle income trap＂ and its characteristics and examines, through a large number of cases from different economies, the reasons why ＂growth slowdown＂ arises during the middle-income development stage. These theoretic and empirical researches have reference value and heuristic meaning for China to actively respond to the challenges of the ＂middle income trap＂.

Causes for Middle Income Trap and Recommendations for China's Leaping Paths

The middle income trap is an objective challenge faced in the development of the economy. There is provision in both the amount and time. It is worth studying why some Latin American countries have fallen into this trap for decades. This paper analyzed the causes for the middle income trap of Latin American economies. On this basis,it came up with recommendations for China's leaping paths,including accelerating the structural reforms on the supply front to promote industrial transformation and upgrading,deepening the reform and increasing the efficiency with institutional innovation as the core,protecting legitimate property rights,reforming the income distribution,combining accurate poverty alleviation,narrowing the gap between the rich and the poor,performing administration according to laws,vigorously developing education,expanding the opening up,and keeping sustainable growth,so as to successfully leap over the middle income trap.

Income Gap and the Risk of MiddleIncome Trap Facing China

International experience shows that economic stagnation and deterioration of income distribution are both the cause and effect of each other and also reinforce each other.Such a relationship may put some high-growth countries into the middle-income trap.Income levels in China are above average,but economic growth is decelerating.At such a time,China should attach great importance to addressing the widening income gap.This paper attempts to integrate official data on income with researchers' surveys to examine income distribution in China.It reveals the causes for unequal and unfair income distribution and illustrates the policy significance of reforming primary and secondary distributions to adjust the pattern of income distribution.

Hospital Acquired Infections in Low and Middle Income Countries: Root Cause Analysis and the Development of Infection Control Practices in Bangladesh

Nosocomial or hospital acquired infections are a major challenge for low and middle income countries (LMICs) which have limited healthcare resources. Risk factors include the lack of appropriate hospital facilities such as isolation units, bed space, and sinks;inadequate waste management, contaminated equipment, inappropriate use of antibiotics and transmission of infection from the hands of healthcare workers and family caretakers due to inadequate hand washing. Nosocomial infections increase the costs of healthcare due to added antimicrobial treatment and prolonged hospitalization. Since the prevalence of nosocomial infections is generally higher in developing countries with limited resources, the socio-economic burden is even more severe in these countries. This review summarizes the current knowledge on the risks of hospital acquired infections and summarizes current recommendations for the development of hospital infrastructure and the institution of protocols to reduce these infections in LMICs such as Bangladesh.

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

AIM:To identify the newest approaches to type 2diabetes(T2DM)prevention and control in the developingworld 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 Pub Med 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.

Why Are Risk-Pooling and Risk-Sharing Arrangements Necessary for Financing Healthcare and Improving Health Outcomes in Low and Lower Middle-Income Countries

Health is important to economic development, and economic development has an important impact on health outcomes. Health Expenditure makes up a substantial part of the global economy. In the world, the costs of healthcare are increasing;patients are compelled to pay more for treatment, and that makes a lot of people faced to Catastrophic Health Expenditures (CHE) and in long run fall below the poverty line. One of the most urgent and vexing challenges faced by many low- and middle-income countries is how to provide health care for the more than two billion poor people who live in these areas (developing countries). As much as more than 65% (in 2014) of total private health care expenditure in low-income countries comes from out-of-pocket payment by patients. In addition, according to World Bank report (2007), in low and lower middle-income countries was speared nearly 13% of global health spending with 87% the global disease burden. The WHO considers health financing models with high risk pooled, such as health insurance and prepaid schemes, a promising means for achieving universal health-care coverage and promotion health care. A crucial concept in health financing is that of pooling. The WHO defines risk-pooling as the “accumulation and management of revenues in such a way as to ensure that the risk of having to pay for health care is borne by all members of the pool and not by each contributor individually”. The larger degree of pooling, the less people will have to bear the health financial risks. Furthermore, adopting and operating financing policies based on greeter risk pooling/sharing (prepayments) are recommended to all countries (especially in low and lower-middle income countries). It means risk sharing/pooling plays a key role in all financing systems for achieving effectiveness and efficiency health systems.

The Prospects of Blue Economy to Promote Bangladesh into a Middle-Income Country

This paper draws attention to the prospects of sea-based economy to promote Bangladesh in a middle-income country through the sustainable use of marine resources. About three-fourths of the earth is covered by the seas. It plays the vital role in two important functions from ancient time known as the means of communication and the source of huge living and non-living natural resources. At present, the countries are becoming very much concerned about their marine resources to resolve many of the present and future challenges of their economies. Generally for Bangladesh, ocean is contributing a significant role to its overall socio-economic progress through rising up the economic activities across the country and especially to the coastal zone at southern part. This paper investigates how much Bangladesh is capable to take of or handle the challenges to become a middle income country through the Sustainable Development Goals (SDGs). In addition, it has attempted with a closer-look to find out the barriers or limitations of these activities from different angles if exist.

Adapting chronic care models for diabetes care delivery in low-and-middle-income countries:A review

A contextual review of models for chronic care was done to develop a context-adapted chronic care model-based service delivery model for chronic conditions including diabetes.The Philippines was used as the setting of a low-to-middle-income country.A context-based narrative review of existing models for chronic care was conducted.A situational analysis was done at thegrassroots level,involving the leaders and members of the community,the patients,the local health system and the healthcare providers.A second analysis making use of certain organizational theories was done to explore on improving feasibility and acceptability of organizing care for chronic conditions.The analyses indicated that care for chronic conditions may be introduced,considering the needs of people with diabetes in particular and the community in general as recipients of care,and the issues and factors that may affect the healthcare workers and the health system as providers of this care.The context-adapted chronic care model-based service delivery model was constructed accordingly.Key features are:incorporation of chronic care in the health system's services; assimilation of chronic care delivery with the other responsibilities of the healthcare workers but with redistribution of certain tasks; and ensuring that the recipients of care experience the whole spectrum of basic chronic care that includes education and promotion in the general population,risk identification,screening,counseling including self-care development,and clinical management of the chronic condition and any co-morbidities,regardless of level of control of the condition.This way,low-to-middle income countries can introduce and improve care for chronic conditions without entailing much additional demand on their limited resources.

Size and proportion of urban and rural middle-income group in China: A comparative analysis based on CHNS and CHIP data

To enlarge the middle-income group and construct the "olivary" income distribution becomes one of the important issues of the economic development and income distribution reform in China. The income distribution function is estimated with kernel density, and the income distribution M-curve is constructed with CHNS and CHIP data to calculate the middle-income group. Furthermore, a comparative analysis is carried out for the changing trend of the size and proportion of middle-income group. Research conclusion: it is discovered according to the income distribution M-curve that the key to the enlargement of urban middle-income group lies in the lower middle-income group, while the key to the enlargement of rural middle-income group lies in the improvement of the upper middle-income group. The range of middle-income group is expanding, but due to the small scale, low proportion, and poor stability, it has not developed the "olivary" income distribution structure yet, and income inequality tends to be deepened.

Enablers and Barriers to Respectful Maternity Care in Low and Middle-Income Countries: A Literature Review of Qualitative Research

Background: Low and Middle-Income Countries (LMIC) account for 94% of maternal deaths annually. Interventions to reduce these deaths include;access to Emergency Obstetric Care (EmOC) and Skilled Birth Attendant (SBA) at childbirth. However, evidence indicates increasing access to EmOC, and SBA only does not translate into positive maternal and newborn outcome due to disrespectful care faced by women during labour. World Health Organization (WHO) guidelines emphasize on positive birth experience through Respectful Maternity Care (RMC). Therefore, this review aims to explore enablers and barriers to respectful maternity care in low and middle-income countries. Methods: We conducted an exhaustive literature search for studies that reported on enablers and barriers to respectful maternity care. Qualitative studies done in low and middle-income countries, published in English Language from the year 2000 to June 2020 were included in this study. Articles were screened by two researchers for eligibility and critical appraisal skills programme checklist was used to appraise the quality. The themes and quotes from the studies were extracted and synthesized using thematic synthesis. Results: The search strategy generated 14,190 articles and 54 studies met the inclusion criteria. Two main themes: interpersonal relationship and support, and privacy and confidential care were reported as both enablers and barriers to respectful maternity care. Strategies to promote RMC were: health education to pregnant women on care expected during labour, good communication between maternity staff and women, capacity building of staff on RMC and staff motivation. Conclusion: Respectful maternity care plays a big role in promoting health-seeking behaviours among pregnant women. However, women experience barriers ranging from provider behaviour, work environment and health system challenges. Ensuring a dignified and respectful working environment could contribute to an increase in health seeking-behaviours and consequently reduction of maternal mortality.

The Economics of Reorganizing Otolaryngology Out-Patient Services for COVID-19 Pandemic in Low- and Middle-Income Countries

The Coronavirus 2019 (COVID-19) pandemic has widespread implications for clinical practice of otolaryngologists in clinics and hospitals. With various reports of otolaryngology practitioners catching infection, a profound structural reorganization of ENT services in the clinic is mandatory for protecting both patients and healthcare workers. The present study focused on quantifying the cost involved in reorganizing the otolaryngology out-patient services in a third world country during the ongoing Covid-19 pandemic. Though the pandemic has increased the cost of running of an otolaryngology practice world over, the impact is huge in India as penetration of health insurance/social security is minimal. As out of pocket expenditure forms a significant proportion of healthcare spending by majority in India, any transfer of additional cost incurred because of Covid-19 pandemic to the patient will burn a bigger hole in their pocket.

Strengthening Weak Healthcare Systems for Maternal and Neonatal Care in Low and Middle Income Countries: The Missing Link

Introduction: Preventable maternal and newborn mortalities still occur in local communities in Kenya since access to maternal and newborn healthcare services remains a big challenge. Barriers to access in resource-constrained settings have not been examined adequately in literature. The World Health Organization (WHO) has 6 building blocks for strengthening healthcare systems that informed this study. This paper examines how user-side and institutional factors influence access and use of Maternal and Newborn Healthcare (MNH) Services in Matayos sub-County-Busia County. Methods: A mixed method approach, with an ethnographic inquiry and a descriptive cross-sectional design, was adopted to assess access to MNH services in Matayos-Busia County, Western Kenya. Postpartum women who had delivered within the previous 12 months and health care providers in the study area were recruited as respondents. A total of 348 postpartum women were selected through stratified systematic random sampling for the survey. Purposive sampling was used to select postpartum women, conventional and traditional health care providers for 16 in-depth interviews and 7 focus group discussions. Data were analyzed using descriptive and inferential statistics. Qualitative data analysis was done thematically. Results: Institutional delivery was low at 68% and family planning at 75% although demand for services was high at 99%. User-side barriers to access included shared beliefs and practices in the community;high direct transport costs from home;and high costs for missing drugs and other supplies in hospitals. Middle (5th-7th) order deliveries occurred at home with traditional birth attendants. The choice of place of delivery in households was influenced by spouses to respondents and communities of residence where respondents lived or were married. All 6 WHO health system building blocks were weak in Matayos sub-County and needed system-wide strengthening involving all pillars. The user-community voice alone was insufficient and the 7th pillar for user-community engagement was absent. The underlying factors were weak governance and underfunding for healthcare. Conclusion: The six WHO building blocks were inadequate due to weak governance and inadequate funding. User-community engagement, the 7th Pillar, was absent in these resource-limited settings. We recommend user-community empowerment, engagement and participation, adoption of a system thinking approach and adequate funding.

How Can China Avoid The "Low-to-Moderate Income Trap"?

At present, China finds itself at a crucial moment of development. Economic growth should embody the requirement of "sound and fast" development, whose prerequisite should be reasonable and orderly income distribution. Theory and the experience of other countries show that when making the transformation from a moderate to high income society, wide income distribution discrepancies may hinder economic growth. To avoid falling into this trap, China needs to strike a balance between utilizing both market mechanisms and government regulation to achieve a "fair" and "efficient" income balance during the rudimentary and redistribution phase.

Causes of "High Income Trap" in Developed Countries and Coping Strategies

The economic crisis in 2008 dealt a heavy blow to the developed countries and even the whole world. The long-term stable growth of the western economy was broken,and it is mired into the so-called " high-income trap". This paper argues that the reasons why developed countries fall into the " high income trap" can be summarized as three aspects: internal factors,external factors and fundamental reasons. On this basis,this paper analyzes the response strategies and effects of developed countries,in order to provide a reference for our country to be a high-income country while maintaining sustained and stable economic growth.

The Slow-paced Development of the Middle Stratum in China: Reason Analysis and Solution

The comparison study of economic development levels and social structures reveals that the development of China's middle stratum is apparently lagging. Currently, China's GDP per capita is almost equivalent to that of developed economies like Europe and the USA in the middle and late 1970 s, when they became middle-stratum-dominated societies. However, China's middle stratum is still underdeveloped in scale and proportion. Reasons for this are the Chinese household share of wealth distribution is low and wealth polarization is sharp. The solution to this problem is to build a fair environment for wealth creation, let enterprises and government give away part of their income to residents, and increase residents' income. In the short run, China should make plans to increase incomes and develop plans aimed at key groups in a bid to increase the Chinese middle stratum in scale and proportion. Education resources must also be equally distributed, and the under-stratum must be helped to move up the social ladder.