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.

Key Factors to Consider When Introducing a New Vaccine in Low-Income Settings: Lessons from Malawi Expanded Program on Immunization

Introduction: As new vaccines become available, countries must assess the relevance to introduce them into their vaccination schedules. Malawi has recently introduced several new vaccines and plans to introduce more. This study was conducted to identify key factors that need to be considered when deciding to introduce a new vaccine and current challenges faced by low and middle income countries using Malawi as an example. Methodology: The study employed a desk review approach, examining published literature from various sources such as PubMed, Medline, and Google Scholar. Policy documents from organizations like the World Health Organization, GAVI the Alliance, and the Ministry of Health for Malawi were also included. A total of 99 articles and documents on new vaccine introduction, challenges of immunization, policy documents in immunization and health systems strengthening were included. The review focused on addressing five key areas critical to new vaccine introduction namely: the need for a vaccine, availability of the vaccine, safety and effectiveness of the vaccine, demand for the vaccine, and the prudent use of public or private funds. Results: Malawi considered the burden of cervical cancer and the significance of malaria in the country when introducing the HPV and malaria vaccines. The country opted for vaccines that can be handled by the cold chain capacity and available human resources. Despite that malaria vaccine and Typhoid Conjugate Vaccine trials were done in country, there are limited vaccine safety and efficacy trials conducted in Malawi, leading to a reliance on WHO-prequalified vaccines. Demand for newly introduced vaccines varied, with high demand for Oral Cholera Vaccine during a cholera outbreak, while demand for COVID-19 vaccines decreased over time. Although cost-effectiveness studies were limited in the country, 2 studies indicated that Typhoid Conjugate Vaccine and malaria vaccine would be cost effective. All these have been implemented despite having challenges like lack of accurate surveillance data, inadequate cold chain capacity, limited safety and efficacy vaccine clinical trials, political influence, and limited funding. Conclusion: Despite several challenges Malawi set a good example of the careful considerations required before introducing a new vaccine. The process involves data review, priority setting, precise planning, and consultation with stakeholders. Low-income countries should invest in vaccine safety, efficacy, and cost-effectiveness trials.

Epidemiological, Clinical Aspects and Outcome of Measles in a Low-Income Country in 2023

Introduction: Measles remains a worrying health problem in sub-Saharan African countries. There have been measles outbreaks in Cameroon with the most recent occurring between October 2022 and September 2023. The Centre region of Cameroon was the most affected in the country and being at the frontline of the fight against this illness, we conducted this study in order to determine the epidemiological and clinical characteristics as well as the outcome of children who contracted the measles and were hospitalized at the Yaoundé Gynaeco-Obstetric and Pediatric Hospital. Methodology: We conducted a cross-sectional descriptive and prospective study for one year from October 2022 to November 2023 corresponding to the duration of the outbreak. We included all children admitted in the pediatric unit for measles and its complications during this period. Results: In total, 60 children were enrolled. Their caregivers were mostly their mothers who had a mean age of 34.71 ± 9.55 years living in significant precarious conditions for the majority. The median age of children was 16 months (09 - 30 months). Twenty six percent of children (16) were less than 9 months. Girls were predominant (55%). Most children were not up to date with their routine EPI vaccination (80%) and most did not receive the measles and Rubella vaccine (76.67%). Clinical manifestations, included fever, conjunctivitis, and cough. Skin rash and catarrh (98.33% and 86.67% respectively) are the case definition signs of measles. The outcome was unfavorable for 4 children. One had a neurological disorder: coma and three presented with pneumonia and severe respiratory distress (6.67%). Conclusion: Measles is still being a reality and claiming lives in our context, emphasis should be made on immunization coverage and if possible, advocacies should be formulated to decrease the age of measles vaccine administration.

Characteristics of Infertile Clientele Attending a Public in Vitro Fertilization Clinic: Appraising Priorities in a Low-Income Country

Introduction: Infertilityaffects one in six couples, and it is an important public health issue largely due to thepervasive effects on the emotional and psychological wellbeing of affected couples. In many developing nations emphasis is placed on childbirth and inability to fulfill this role can be very distressing. There is an unmet need for assisted reproductive technology (ART) in many developing countries and where facilities exist, they are mostly privately owned, expensive and concentrated in urban areas. To bridge this gap, public fertility clinics have been established to provide subsidized care. Evaluating the characteristics and peculiarities of clientele presenting at these public facilities will aid planning and prioritization of care. Methodology: A descriptive retrospective study of 116 infertile patients presenting to the fertility clinic of the University College Hospital, Ibadan, Nigeria from inception on the 14th of February 2019 and 31st of December 2022.Data was analyzed using the Statical Package for Social Sciences (IBM, SPSS, New York) version 23. Descriptive statistics were used to summarize the results which were presented with the aid of bar charts and frequency tables. Result: The mean age of the patients was 40.70 ± 6.62 years. Post-menopausal patients accounted for about one-fifth of the study population while 80.2% (93 women) were older than 35 years. The mean duration of infertility was 9.39 ± 6.11years and nine patients (7.8%) had a duration greater than 2 decades. Secondary infertility occurred in 67.2% of the women. Twenty-nine women (25%) had undergone myomectomy prior to presentation. Hypertension (11.2%) was the most prevalent comorbidity. Nineteen patients (16.4%) had used contraceptives in the past with the male condom (36.8%)being the most preponderant. Sixty-seven patients had experienced pregnancy losses before 28 weeks of gestation while just 16 patients (13.8%) had undergone ART, and none was successful. Conclusion: Secondary infertility was the prevalent type of infertility and may not be unconnected with the low contraceptive usage and high risk of sexually transmitted infection. Late presentation coupled with a large proportion of post-menopausal clientele suggests delayed health-seeking behavior most probably due to the prohibitive cost of ART. The need to streamline services offered in public fertility clinics is paramount in low-income countries grappling with scarce resources. A pragmatic approach will involve the provision of low-cost ART, while enhancing gamete donation programs through the implementation of gamete sharing policies. This will invariably bridge the unmet need and skewed access to ART in developing countries.

Impact of Plastic Waste on the Human Health in Low-Income Countries: A Systematic Review

Background: Plastic pollution is the accumulation of waste composed of plastic and its derivatives all over the environment. Whether in the form of visible garbage or microparticles, as it slowly degrades, plastic pollution poses significant threats to terrestrial and aquatic habitats and the wildlife that call them home, whether through ingestion, entanglement or exposure to the chemicals contained in the material. Unfortunately, there is a lack of documentation on the impact of plastic waste on human health in low- and middle-income countries (LMICs). Methods: We searched five electronic databases (PubMed, Embase, Global Health, CINAHL and Web of Science) and gray literature, following the preferred reporting elements for systematic reviews and meta-analyses (PRISMA), for the impact of plastic waste on human health in developing countries. We included quantitative and qualitative studies written in English and French. We assessed the quality of the included articles using the Mixed Methods Appraisal tool (MMAT). Results: A total of 3779 articles were initially identified by searching electronic databases. After eliminating duplicates, 3167 articles were reviewed based on title and abstract, and 26 were selected for full-text review. Only three articles were retained. The three articles dealt with practices likely to lead to oral exposure to plastic chemicals in human health, as well as the level of awareness of participants concerning the possible impact of plastic on human health, namely, the use of plastic baby bottles, the use of microwaves to cook food and reheat precooked food, the use of plastic bottles to store water in the refrigerator, water purifier containers with plastic bodies and plastic lunch boxes, the reuse of plastic bags and the inadequacy of treatment facilities. Conclusion: Plastic waste poses different risks to human health at every stage of its life cycle. Hence, strategies must be adopted to raise public awareness of the dangers of plastic waste to their health. Trial registration: The review protocol is registered in the PROSPERO international prospective register of systematic reviews (ID = CRD42023409087).

Study on the Impact of Collective Commercial Construction Land Entering the Market on Rural Residents’Income:Taking Deqing County,Zhejiang Province as an Example

The entry of collective construction land for business purposes is an important measure for deepening the reform of the rural land system,promoting the flow of urban and rural factors,and realizing rural revitalization.Since the production of the first batch of pilot projects in 2015,33 county-level cities have participated in the pilot policy by 2023.Deqing County,Zhejiang Province,as the first area to participate in the pilot project,aims to achieve more fruitful results.This paper first examines how promoting farmers’income through the market entry of agricultural land can be achieved,then uses the synthetic control method to quantitatively study the impact of collective operational construction land on farmers’income using panel data from 2011 to 2019,and finally proposes relevant suggestions from the perspective of system reform.

Empirical Study on the Effect of Abolishing Agricultural Tax on Farmers' Income

The panel dataset which covered the socio-economic data of 31 provinces （municipalities and autonomous region） in China from 2000-2007 was used to do empirical analysis on the effect of abolishing agricultural taxes on farmers＇ income by referring to the fixed effect estimation method. It found that the abolition of agricultural taxes increased farmer＇s net income per capita by 2%. Combining with the results of empirical analysis, related policy suggestions were put forward to increase farmers＇ income.

The Countermeasures and Researches on Improving Farmers' Incomes of Shaanxi Province in the New Period

Combining the relative agricultural statistics from 2000 to 2009, the paper selects 20 major variables to carry out the analyses of factors. Through the component matrix, 3 common factors can be gained. They are investment on agricultural production, development of the second and the third agricultural industries and policies. On the basis of these 3 common factors, the paper suggests on how to improve farmers' incomes. Such as improving farmers' agricultural management incomes, improving farmers' salary and strengthening the construction of policies and so on.

Empirical Analysis on the Influencing Factors of the Net Income of Farmers——A Case of Hebei Province, China

According to the relevant data of farmers' net income from the Hebei Statistical Yearbook 2009, seven indicators are selected covering regional gross production x1, the total output of the primary industry x2, the number of the people employed x3 and the number of the large livestock at the end of year x4 and so on, to analyze the factors that affect the per capita net income of farmers. The results show that the regional gross production x1 is in positive proportion to the total output value of the primary industry and the influneces are great; the total output value of the non-agricultural industry x5 and the local financial expenditure x6 are the important factors that affect the income of farmers; though the total value of rural residents'fixed investment x7 is in positive proportion to the income of farmers, the degree is not so great; the regression coefficient of the number of people employed x3 and the number of the large livestock at the end of year x4 is negative and the number of people employed x3 is a positive correlation to the net income of farmers. Based on the above analysis, the countermeasures on improving the income of rural residents are put forward: firstly, optimizing the rural indutrial structure, promoting the developement of the primary industry and improving the regional total output of production; secondly, expanding the development channel of non-agricutlural economic and attracking the rural surplus laborers; thirdly, enlarging the local financial expenses and Expanding the developmental space of the three agricultural issues concerning peasants, countryside and agriculture.

Analysis on Consumption Behavior of Zhejiang Province's Farmers from the Perspective of Their Income Increase

With rapid development of industrialization in Zhejiang Province, surplus rural labor forces move to the secondary and tertiary industries. Farmers of Zhejiang Province are no exception. They turn to industrial workers and their income source has great changes. Wage income becomes their major source of income. Accordingly, farmers' consumption behavior has great changes. Apart from satisfying basic production and living demands, farmers start to pursue living quality and their life style tends to urbanization. Nevertheless, under the influence of rural physical environment, policies and systems, the existing consumption environment fails to follow farmers' urban lifestyle any more. In line with how to optimize rural consumption environment, improve farmers' consuming capacity, continue to expand farmers' consumption and promote urbanization development of rural areas, this paper presents pertinent countermeasures and recommendations.

The Impact of Development of Rural Finance in Jiangxi Province on the Agricultural Economy and Farmers’ Income

Based on the rural economic data pertaining to the development of rural finance, the growth of agricultural economy and farmers' income in Jiangxi Province during the period 1990-2009, we conduct empirical research on the impact of development of rural finance on the growth of agricultural economy and farmers' income, using the ADF test method, the Granger causality test, and regression analysis. The results show that the development of rural finance in Jiangxi Province has a significant positive effect on the growth of rural economy and farmers' income. When the ending balance of agricultural loans increases by 1 unit, the agricultural added value will increase by 0.367 1 units; when the ending balance of agricultural loans increases by 1 unit, farmers' income will increase by 0.597 5 units, indicating that the development of rural finance plays a significant role in promoting the per capita net income of farmers.Finally we propose to increase agricultural credit efforts in the financial institutions, establish and improve the agricultural credit management system.

Increase of Income of Farmers and Herdsmen in Tibet in the New Period

The disposable income per capita of rural residents in Tibet was 7471 yuan in 2014. There is a high gap with the national average disposable income per capita of rural residents( 10489 yuan). Thus,it is urgent to increase income of farmers and herdsmen in Tibet. On the basis of literature in recent years,this paper analyzed methods for increasing income of farmers and herdsmen in Tibet,major factors restricting increase of their income,and approaches for increasing their income. It is expected to provide certain reference for further expanding ideas of increase of their income in the new period.

Prediction of Farmers' Income and Selection of Model ARIMA

Based on the research technology of scholars' prediction of farmers' income and the data of per capita annual net income in rural households in Henan Statistical Yearbook from 1979 to 2009,it is found that time series of farmers' income is in accordance with I(2)non-stationary process.The order-determination and identification of the model are achieved by adopting the correlogram-based analytical method of Box-Jenkins.On the basis of comparing a group of model properties with different parameters,model ARIMA(4,2,2)is built up.The testing result shows that the residual error of the selected model is white noise and accords with the normal distribution,which can be used to predict farmers' income.The model prediction indicates that income in rural households will continue to increase from 2009 to 2012 and will reach the value of 2 282.4,2 502.9,2 686.9 and 2 884.5 respectively.The growth speed will go down from fast to slow with weak sustainability.

Effect of Agricultural Comprehensive Development on Increasing Income of Farmers in Jiangsu Hilly and Mountainous Areas

To adapt to rural and agricultural economic development,Jiangsu Province adjusted main task of comprehensive development of hilly and mountainous areas to supporting and promoting agricultural structural adjustment of hilly and mountainous areas and promoting increase of agricultural benefits and farmers' income. Through typical survey,this paper made an objective evaluation of effect of agricultural comprehensive development of hilly and mountainous areas in Jiangsu Province from increasing farmers' income. Results indicated that agricultural comprehensive development investment projects in Jiangsu hilly and mountainous areas are closely coupled with local agricultural production structure; financial funds promote social capital input to construction of economic forest,fruit and grass planting,and livestock raising. Through demonstration and guidance of farmers,it promoted adjustment of agricultural production structure and increased farmers' income. Finally,it came up with pertinent policy recommendations.

Study on Deepening Rural Land Reform and Farmers’ Income

The rural land system reform is an essential part of China s rural economic system reform.In recent years,China s rural land system becomes gradually diversified,and is developing towards market and benefiting people,which is favorable for improving the rural economy.Through more than 40 years of reform and opening up,China s rural land system reform has been continuously deepened and sectionalized,which has also affected the income of farmers.Rural land reform provides great opportunities for farmers to increase their income and contribute to the realization of land asset income and interests.However,the rural land system reform also has some drawbacks,which limit the increase of farmers income.This paper attempts to analyze the internal logic of land system reform and farmers land interests,and accordingly comes up with recommendations for deepening the rural land reform.

How China's Grain-for-Green Project Contributes to Farmers' Income Growth

Initially intended to prevent water and soil erosion, China＇s Grain-for-Green Project （GGP） also has had economic impacts on farmers＇incorne and employment. Based on the poverty monitoring survey data between 2006-2010 from National Bureau of Statistics （NBS）, this paper evaluates the GGP＇s policy effects with respect to farmers＇ income, non-agricultural employment and poverty alleviation. Our findings suggest that contributing to the GGP, farmers＇ income including GGP subsidies increased significantly compared with the pre-GGP level,＂ however, if GGP subsidies are not taken into account, the increase in farmers＇non-agricultural income after the GGP could only compensate.for the income losses from farmland reduction, showing an insignificant effect. Second, there exist significant differences on employment tendency among GGP households. High-income households tend to engage in operation business in forestry, livestock and fishery activities, while medium-income families are more inclined to seek employment outside, and the differences attribute to the inter-group intrinsic characteristics. Lastly, the GGP＇s poverty alleviation effect varies with the difference in poverty standard. Overall the GGP＇s poverty alleviation effect is significant.

The Changes of Fiscal Agriculture-Supporting Expenditure and Farmers' Income Based on Grey Correlation Theory

According to the relevant data of China Statistical Yearbook and Chinese Rural Statistical Yearbook in the year of 2009,the changes of grey correlation degree of farmers' net income,various items of incomes,national gross agriculture-supporting expenditure and various items of expenditures,farmers' net income and various items of fiscal agriculture-supporting expenditure in the Eighth Five-Year Plan,Ninth Five-Year Plan and Tenth Five-Year Plan by using grey correlation degree and the by choosing seven indicators covering income from wage and salary,income from household business,transfer income and property income,agricultural production-supporting expenditure,agricultural basic construction expenditure,expenses of three items of agricultural technology and the fee of rural relief.The results show that the grey correlation degree of each time period and household net income shows the downward trend;from overall perspective,the grey correlation degree of national gross agriculture-supporting expenditure,agricultural basic construction expenditure and agricultural production-supporting expenditure shows the descending trend;the grey correlation degree of fiscal agricultural supporting expenditure and the expenditure of three items of agricultural technology and fee of rural relief show the upward trend;the influence of agricultural production-supporting expenditure on farmers' income shows downward trend;the influence of agricultural basic construction on farmers' income shows upward trend;the fee of rural relief play an active role in the promoting the farmers' income increase;the role played by fee of rural relief in promoting farmers' income increase should be further increased;the increase of farmers' income shows great reliance on agricultural science and technology.In the end,the relevant suggestions on establishing stable increase mechanism of fiscal agricultural support and insisting on the dynamic adjustment of the structure of fiscal agricultural supporting capital are put forward.

Research on the Development of Economy and Farmers' Income Growth in Heilongjiang Province

Nowadays, increasing farmers＇ income is not only related to the development of rural economy, the improvement of farmers＇ lives and countryside stability but also related to the overall situation of economy and social development. Heilongjiang is a big agricultural province, however, the increase of farmers＇ per capital net income is rather slow in the last few years. On the basis of Lewis dual economic structure theory and our province＇s actual situation, the paper proposed the concrete countermeasures to increase farmers＇ income, so as to promote the development of economy.

The Relation between Financial Expenditure for Agriculture( FEA) and Per Capita Net Income of Farmers( PCIF):A Case Study of Jiangsu Province

Agricultural development is indispensible to financial support. On the basis of data of the financial expenditure for agriculture( FEA) and per capita net income of farmers( PCIF) of Jiangsu Province in 1990-2012,with the aid of software R,this paper established the linear regression model for the relation between financial expenditure for agriculture and per capita net income of farmers through the function lm. Using the function summary,this paper obtained the summary statistical data,and made diagnostic check of regression model from image command plot and variance analysis table. Finally,it came up with pertinent recommendations including increasing financial expenditure for agriculture,optimizing expenditure structure,and balancing regional development.