Hospitals’responsibility in response to the threat of infectious disease outbreak in the context of the coronavirus disease 2019(COVID-19)pandemic:implications for low-and middle-income countries

The WHO declared the coronavirus disease 2019(COVID-19)outbreak as a public health emergency of international concern on January 30,2020,and then a pandemic on March 11,2020.COVID-19 affected over 200 countries and territories worldwide,with 25,541,380 confirmed cases and 852,000 deaths associated with COVID-19 globally,as of September 1,2020.1 While facing such a public health emergency,hospitals were on the front line to deliver health care and psychological services.The early detection,diagnosis,reporting,isolation,and clinical management of patients during a public health emergency required the extensive involvement of hospitals in all aspects.The response capacity of hospitals directly determined the outcomes of the prevention and control of an outbreak.The COVID-19 pandemic has affected almost all nations and territories regardless of their development level or geographic location,although suitable risk mitigation measures differ between developing and developed countries.In low-and middle-income countries(LMICs),the consequences of the pandemic could be more complicated because incidence and mortality might be associated more with a fragile health care system and shortage of related resources.2-3 As evidenced by the situation in Bangladesh,India,Kenya,South Africa,and other LMICs,socioeconomic status(SES)disparity was a major factor in the spread of disease,potentially leading to alarmingly insufficient preparedness and responses in dealing with the COVID-19 pandemic.4 Conversely,the pandemic might also bring more unpredictable socioeconomic and long-term impacts in LMICs,and those with lower SES fare worse in these situations.This review aimed to summarize the responsibilities of and measures taken by hospitals in combatting the COVID-19 outbreak.Our findings are hoped to provide experiences,as well as lessons and potential implications for LMICs.

Lessons from the coronavirus disease 2019(COVID-19)pandemic response in China,Italy,and the U.S.:a guide for Africa and low-and middle-income countries

Africa can be"left behind"after other advanced continents recover from the coronavirus disease 2019(COVID-19)pandemic as reflected by the global pandemic of HIV/MDS.In this paper,we summarize potentially adaptable,effective and innovative strategies from China,Italy,and the U.S.The purpose is to help African countries with weaker healthcare systems better respond to the COVID-19 pandemic.China,being the first to report COVID-19 infection swiftly swung into anti-epidemic actions by the use of innovative risk communication and epidemic containment strategies.Italy and U.S.,the next rapidly hit countries after China,however,experienced sustained infections and deaths due to delayed and ineffective response.Many African countries responded poorly to the COVID-19 pandemic as evidenced by the limited capacity for public health surveillance,poor leadership,low education and socioeconomic status,among others.Experience from China,Italy and U.S.suggests that a better response to the COVID-19 pandemic in Mrica needs a strong public health leadership,proactive strategies,innovative risk communication about the pandemic,massive tests and isolation,and scaling-up community engagement.Lastly,African countries must collaborate with other countries to facilitate real-time information and experience exchange with other countries to avoid being left behind.

Digital psychiatry in low-and-middle-income countries:New developments and the way forward

Low-and middle-income countries(LMICs)bear the greater share of the global mental health burden but are ill-equipped to deal with it because of severe resource constraints leading to a large treatment gap.The remote provision of mental health services by digital means can effectively augment conventional services in LMICs to reduce the treatment gap.Digital psychiatry in LMICs has always lagged behind high-income countries,but there have been encouraging developments in the last decade.There is increasing research on the efficacy of digital psychiatric interventions.However,the evidence is not adequate to conclude that digital psychiatric interventions are invariably effective in LMICs.A striking development has been the rise in mobile and smartphone ownership in LMICs,which has driven the increasing use of mobile technologies to deliver mental health services.An innovative use of mobile technologies has been to optimize task-shifting,which involves delivering mental healthcare services in community settings using non-specialist health professionals.Emerging evidence from LMICs shows that it is possible to use digital tools to train non-specialist workers effectively and ensure that the psychosocial interventions they deliver are efficacious.Despite these promising developments,many barriers such as service costs,underdeveloped infrastructure,lack of trained professionals,and significant disparities in access to digital services impede the progress of digital psychiatry in LMICs.To overcome these barriers,digital psychiatric services in LMICs should address contextual factors influencing the delivery of digital services,ensure collaboration between different stakeholders,and focus on reducing the digital divide.

Breast cancer awareness in reproductive women in the low-and middle-income countries:a scoping review

Objective:This study aimed to assess breast cancer(BC)awareness among reproductive women in low-and middle-income countries(LMICs),identify influencing factors,and propose feasible interventions or programs.Methods:We followed a 5-step process using a modified version of Arksey and O’Malley framework methodology.A comprehensive search was conducted on the Embase,PubMed,and CINAHL electronic databases for literature published within 10 years(from 2012 to 2022).Results:Thirty-three papers published between 2012 and 2020,spanning 18 countries,were included.Of these,45.6%described a good level of knowledge,while 24.2%reported that women at reproductive ages had good awareness.Twelve influencing factors were identified in 3 categories:socio-demographic(family history,personal history,marital status,age,religion,income status,living place,and occupation),personal(self-efficacy,education,and perceived level),and external(advertisements promoting awareness).Educational programs were recommended in most(>72%)of the included studies.Conclusions:While most studies reported high levels of knowledge and awareness,some found low prevalence among certain groups.Factors affecting knowledge and awareness were classified into socio-demographic,personal,and external categories,with socio-demographic factors such as age,education,income,and marital status being the most frequently cited.The studies recommended implementing educational programs,health prevention strategies,and social interventions to increase BC knowledge and awareness.

Modeling vaccination strategies with limited early COVID-19 vaccine access in low-and middle-income countries:A case study of Thailand

Low-and middle-income countries faced significant challenges in accessing COVID-19 vaccines during the early stages of the pandemic.In this study,we utilized an agestructured modeling approach to examine the implications of various vaccination strategies,vaccine prioritization,and vaccine rollout speeds in Thailand,an upper-middleincome country experiencing vaccine shortages during the early stages of the pandemic.The model directly compares the effectiveness of several vaccination strategies,including the heterologous vaccination where CoronaVac(CV)vaccine was administered as the first dose,followed by ChAdOx1 nCoV-19(AZ)vaccine as the second dose,under varying disease transmission dynamics.We found that the traditional AZ homologous vaccination was more effective than the CV homologous vaccination,regardless of disease transmission dynamics.However,combining CV and AZ vaccines via either parallel homologous or heterologous vaccinations was more effective than relying solely on AZ homologous vaccination.Additionally,prioritizing vaccination for the elderly aged 60 years and above was the most effective way to reduce mortality when community transmission is wellcontrolled.On the other hand,prioritizing workers aged 20e59 was most effective in lowering COVID-19 cases,irrespective of the transmission dynamics.Lastly,despite the vaccine prioritization strategy,rapid vaccine rollout speeds were crucial in reducing COVID-19 infections and deaths.These findings suggested that in low-and middle-income countries where early access to high-efficacy vaccines might be limited,obtaining any accessible vaccines as early as possible and using them in parallel with other higherefficacy vaccines might be a better strategy than waiting for and relying solely on higher-efficacy vaccines.

Can Social Support be Protective against Depressive Symptoms in Adolescents from 24 Low- and Middle-Income Countries?

Background:Adolescents are highly vulnerable to depressive symptoms worldwide partially because of limited social supports.However,it still remains largely unknown regarding the associations between social support(s)and depressive symptoms among adolescents living in low-and middle-income countries(LMICs).The aim of this study aimed to explore the associations between different types of social support and depressive symptoms in adolescents from LMICs.Methods:Data were retrieved from the Global School-based Health Survey(GSHS)in which 92,551 adolescents(50.6%females)were included with mean of 15.6 years.Depressive symptoms in the past one month as the dependent variable were measured in combination with social support(was measured by“During the past 30 days,how often were most of the students in your school kind and helpful?”).Multivariable logistic regression and meta-analysis of country-wise estimates were performed to investigate the associations between social support and depressive symptoms,and the heterogeneity of the associations across the countries,respectively.Results:The prevalence of depressive symptoms was 30.9%of adolescents from LMICs.Peer support and parental connectedness were two major factors that were significantly associated with depression symptoms in adolescents.However,the associations of peer support and parental connectedness with depressive symptoms were significant in males and females,respectively.The country-wise analysis indicated that varied inconsistency(small to large)across the associations of peer support and parental connectedness with depressive symptoms in adolescents.Conclusion:Results in this study provides multi-national evidence of the protective roles of social support against depressive symptoms among adolescents.However,the association between social support and depression symptoms may be moderated by sex and types of social support.Although we found that social sup-port may be an important protective factor against depressive symptoms in adolescents from LMICs,specifically designed interventions should be implemented based on sex difference and country difference.

Reducing neonatal mortality and respiratory distress syndrome associated with preterm birth:a scoping review on the impact of antenatal corticosteroids in low-and middle-income countries

Background The most common cause of death among preterm infants in low-and middle-income countries is respiratory distress syndrome.The purpose of this review was to assess whether antenatal corticosteroids given to women at risk of preterm birth at≤34 weeks of gestation reduce rates of neonatal mortality and respiratory distress syndrome in low-and middle-income countries.Methods Two reviewers independently searched four databases including MEDLINE(through PubMed),CINAHL,Embase,and Cochrane Libraries.We did not apply any language or date restrictions.All publications up to April 2020 were included in this search.Results The search yielded 71 articles,10 of which were included in this review(3 randomized controlled trials,7 observa-tional studies,36,773 neonates).The majority of studies reported associations between exposure to antenatal corticosteroids and lower rates of neonatal mortality and respiratory distress syndrome.However,a few studies reported that antenatal corticosteroids were not associated with improved preterm birth outcomes.Conclusions Most of the studies in low-and middle-income countries showed that use of antenatal corticosteroids in hospitals with high levels of neonatal care was associated with lower rates of neonatal mortality and respiratory distress syndrome.However,the findings are inconclusive because some studies in low-resource settings reported that antenatal corticosteroids had no benefit in reducing rates of neonatal mortality or respiratory distress syndrome.Further research on the impact of antenatal corticosteroids in resource-limited settings in low-income countries is a priority.

Universities as catalysts of social innovation in health systems in low-and middle-income countries: a multi-country case study

Background Social innovation(SI)in health holds potential to contribute to health systems strengthening and universal health coverage(UHC).The role of universities in SI has been well described in the context of high-income countries.An evidence gap exits on SI in healthcare delivery in the context of low-and middle-income countries(LMICs)as well as on the engagement of universities from these contexts.There is thus a need to build capacity for research and engagement in SI in healthcare delivery within these universities.The aim of this study was to examine the adoption and implementation of network of university hubs focused on SI in healthcare delivery within five countries across Africa,Asia and Latin America.The objectives were to describe the model,components and implementation process of the hubs;identify the enablers and barriers experienced and draw implications that could be relevant to other LMIC universities interested in SI.Methods A case study design was adopted to study the implementation process of a network of university hubs.Data from documentation,team discussions and post-implementation surveys were collected from 2013 to 2018 and analysed with aid of a modified policy analysis framework.Results/discussion SI university-based hubs serve as cross-disciplinary and cross-sectoral platforms,established to catalyse SI within the local health system through four core activities:research,community-building,storytelling and institutional embedding,and adhering to values of inclusion,assets,co-creation and hope.Hubs were implemented as informal structures,managed by a small core team,in existing department.Enablers of hub implementation and functioning were the availability of strong in-country social networks,legitimacy attained from being part of a global network on SI in health and receiving a capacity building package in the initial stages.Barriers encountered were internal institutional resistance,administrative challenges associated with university bureaucracy and annual funding cycles.Conclusions This case study shows the opportunity that reside within LMIC universities to act as eco-system enablers of SI in healthcare delivery in order to fill the evidence gap on SI and enhance cross-sectoral participation in support of achieving UHC.

Drug research and development opportunities in low-and middle-income countries:accelerating traditional medicine through systematic utilization and comprehensive synergy

Background:Though the utilization of traditional medicine has been proposed for modern drug research and development(R&D),limited research has discussed its feasible paths.In this commentary,we summarized key factors for new drug R&D under limited resources by reviewing China’s discovery of artemisinin,and raised suggestions to utilize traditional medicines in low-and middle-income countries(LMICs).Main text:We suggested that systematic utilization of traditional medicine,outstanding synergy of research units at all levels and timely information-sharing mechanism should be achieved to establish a comprehensive and efficient R&D system,especially under low-resource settings.In the case of artemisinin discovery,Chinese scientists integrated documented traditional medicine experiences and modern approaches to develop drug candidates timely.Due to limited R&D resources,China adopted a collaborative way,motivating nearly all domestic research units at different levels,to develop antimalarial products.Moreover,the excellent synergy among all units through efficient information-sharing mechanisms greatly avoided work repetition and accelerated the R&D process.Conclusion:Traditional medicines inspires drug discoveries in LMICs,while a comprehensive and efficient R&D system could accelerate its R&D process and save investment.The discovery of artemisinin in China gave a reliable pattern to promote sustainable development of traditional medicines and a good example to realize R&D of traditional medicine under low-resource settings.

Management of Preeclampsia in Low-and Middle-Income Countries:Lessons to Date,and Questions Arising,from the PRE-EMPT and Related Initiatives

Preeclampsia remains associated with an increased risk of maternal and perinatal morbidity and mortality,and the burden of that excess risk is largely borne by pregnant women and their families in low-and middle-income countries(LMICs).Therefore,the Bill&Melinda Gates Foundation funded the PREeclampsia–Eclampsia Monitoring,Prevention,and Treatment(PRE-EMPT)initiative to accelerate progress.From PRE-EMPT,and related activity,have come a number of impactful findings.First,there is increasing global support for broadening the definition of preeclampsia to include women with hypertension and either significant proteinuria or evidence of target organ damage or fetoplacental compromise(including evidence angiogenic imbalance).Second,using blood pressure(BP)data from the Community-Level Interventions for Preeclampsia trials in India,Mozambique,and Pakistan,acquired on validated-for-pregnancy,semi-automated,low-cost BP devices,there are now population-level,rather than facility-based,estimates for the burden of pregnancy hypertension(sub-categorized into preeclampsia(4%–6%),gestational hypertension(7%–12%),and chronic hypertension(0.3%–0.6%)).Third,there is an identified need to understand biological pathways that underlie the causation of preeclampsia in LMICs.Fourth,the Community-Level Interventions for Preeclampsia trials have shown that providing at least eight antenatal contacts,in this case using digital health-supported community health workers,cost-effectively reduces the burden of maternal(by 60%),fetal(60%),and neonatal(40%)mortality.Fifth,what is the utility and cost-effectiveness of routine proteinuria screening of normotensive pregnant women?Sixth,clinical risk factor-based prediction of preeclampsia remains most relevant for most women in LMICs;calcium replacement(≥1 g/day)and low-dose aspirin(100–175 mg/day)are the most useful directly preventative interventions.However,achieving sustainable development goals(SDGs)not directly related to health are more likely to reduce the global burden of preeclampsia and its consequences.Seventh,should a woman develop preeclampsia,personalized maternal time-of-disease risk estimates are available through the PIERS(Preeclampsia Integrated Estimate of RiSk)models,either with(fullPIERS)or without(miniPIERS)access to laboratory testing.Assessment of perinatal risks in LMICs is largely driven by gestational age;however,evidence of significant angiogenic imbalance may identify risk of intrauterine fetal death.Eighth,Control of Hypertension in Pregnancy Study trial data show that women with non-severe pregnancy hypertension(systolic BP 140–159 mmHg or diastolic BP(dBP)90–109 mmHg)should receive an antihypertensive medication for a target dBP of 85 mmHg.Ninth,for women with severe pregnancy hypertension(systolic BP≥160 mmHg or dBP≥110 mmHg),oral antihypertensive management with either nifedipine,labetalol,or,less so,methyldopa will lower BP into the non-severe hypertension range.Tenth,magnesium sulfate remains the sole agent of choice for preventing and treating eclamptic seizures.Eleventh,corticosteroids should be administered to women at risk of delivery<35+0 weeks’gestation.Twelfth,although delivery of the placenta initiates resolution of the maternal syndrome of preeclampsia,decisions to initiate delivery should be guided by gestational age and maternal and fetal status.Many women will experience significant postpartum deterioration;delivery should not be equated with“cure”.Thirteenth,whether the development of preeclampsia identifies women at increased risk for early-onset cardiovascular disease in LMICs must be determined.

Association between Active School Travel and Depressive Symptoms among 51,702 Adolescents in 26 Low- and Middle-Income Countries

Little is known about the role of active school travel(AST)on mental health among adolescents.Thus,this study aimed to explore the AST-depression association among adolescents aged 12–15 years from 26 low-and middle-income countries(LMICs).Data from the Global School-based Student Health Survey were analyzed in 51,702 adolescents[mean(SD)age 13.8(1.0)years;49.3%boys).Both depressive symptoms and AST were assessed by a single question self-reported measure,respectively.Participants who reported having 5 days or above were considered as AST.Multivariable logistic regression analysis(accounting for sampling weights)was performed while controlling for gender,age,physical activity,sedentary behavior,and food insecurity,and a countrywide meta-analysis was undertaken.The prevalence of depressive symptoms and AST were 30.1%and 37.0%,respectively.Compared with those not having AST,adolescents with AST were less likely to have self-reported depressive symptoms(OR=0.88,95%CI:0.85-0.93)regardless of gender.Countrywide meta-analysis demonstrated that having AST versus not having AST was associated with 12%lower odds for depressive symptoms(OR=0.88;95%CI:0.82-0.94)but with a moderate between-country heterogeneity(I^(2)=59.0%).Based on large samples of adolescents from LMICs,it would be expected that AST may play a critical role in preventing adolescent depression worldwide.However,it is necessary to consider more country-specific factors when implementing AST-related mental health interventions.Future studies should adopt the solid study design to confirm or negate our researchfindings.

Food Insecurity and Depressive Symptoms in Adolescents Aged 12–15 Years from Low- and Middle-Income Countries

Purpose:Little is known about the role of food insecurity(FIS)on depressive symptoms among adolescents.Thus,this study aimed to explore the association between FIS and depressive symptoms among adolescents aged 12–15 years from low-and middle-income countries across the world.Methods:Data from the Global school-based Student Health Survey were analyzed in 51,702 adolescents[mean(SD)age 13.8(1.0)years;49.3% girls].Self-reported measures assessed depressive symptoms during the past 12 months,and food insecurity.Partici-pants reporting yes for depressive symptoms.FIS was categorized intofive levels,including‘never’,‘rarely’,‘some-times’,‘most of the time’and‘always’.Multivariable logistic regression analysis was performed,and a country-wise meta-analysis was undertaken to compare country difference in the associations between FIS and depressive symptoms.Results:The prevalence of depressive symptoms was 30.0%,respectively.Compared with those reporting never for FIS,adolescents with increased severity of FIS were more likely to report depressive symptoms regardless of gender.Country-wise meta-analysis demonstrated that having FIS versus not having FIS was asso-ciated with 60%greater odds for depressive symptoms(OR=1.60;95%CI:1.52–1.69)but with a moderate between-country heterogeneity(I^(2)=12.7%).Conclusion:The current study indicates that alleviating FIS may be an effective prevention against depressive symptoms among adolescents from LMICs.Future studies should adopt improved study design to confirm or negate our researchfindings,which informs more efficient public mental health interventions.

Environmental health perspectives for low- and middle-income countries

In recent decades, the ecological environment has been increasingly challenged by the development of global industrialization and urbanization all over the world, even as global attention for health has raised dramatically. Common global environmental issues, such as air pollution and noise pollution, are associated with lasting impacts on health and contribute significantly to the overall burden of disease. Moreover, a global disparity exists between the burden of such environmental health issues and the global resources available to address this issue. To alleviate the environmental health impacts and ensure a sustainable future for human beings, China has made an important contribution to improving access to ecological protection, environmental governance, patriotic health campaigns, smart city construction, and so on. Experiences gained in China may be useful for some other countries, particularly the low- and middle-income countries with limited sources.

Continuity of cancer care in the era of COVID-19 pandemic: Role of social media in low- and middle-income countries

A novel coronavirus(severe acute respiratory syndrome coronavirus 2)first detected in Wuhan,China,has spread rapidly since December 2019,causing more than 1.4 million confirmed infections and 15000 fatalities(as of April 9,2020).The outbreak was declared a pandemic by the World Health Organization on March 11,2020.Isolation,quarantine,social distancing,and community containment measures were rapidly implemented in China,which helped in containing the disease.However,other low-and middle-income countries lack such extensive infrastructural capacities and resources.Cancer patients are particularly at high risk of infection and mortality due to immunosuppression.Hence self-quarantine is recommended for them.Additionally,it is becoming impossible to maintain the continuity of care when cancer patients have to avoid physical visits.Social media applications,e.g.,Facebook and WhatsApp,can provide educational group program and psychosocial support to these patients while maintain social distancing.We have analyzed their use in this review article and how it could change the follow-up of cancer patients during this pandemic.

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.

Mapping the quality of prenatal and postnatal care and demographic differences on child mortality in 26 low to middle-income countries

Background Closing the gap between child mortality in low-and middle-income countries(LMICs)and high-income countries is a priority set by the WHO in sustainable development goals(SDGs).We aimed to examine poor nutrition and prenatal and postnatal care that could increase the risk of child mortality in LMICs.Methods The Demographic and Health Survey(DHS)was used to examine data from 26 countries to compare prenatal,postnatal,nutritional,and demographic factors across LMICs.Outcome of child death was classified into death before one month of age,between 1 to 11 months,between one to two years,between three to five years,and overall death before five years.Chi-square analyses identified differences in prenatal care,postnatal care,nutrition,and demographic factors between children who died and those who survived.Logistic regression identified factors that increased child mortality risk.Results The majority of deaths occurred before the ages of one month and one year.Considerably poorer quality of prenatal care,postnatal care,and nutrition were found in low-income and low-middle-income countries in the contemporary 2020s.High child mortality and poor quality of prenatal and postnatal care coincide with low income.Children in LMICs were exposed to less vitamin A-rich foods than children in higher-middle-income countries.The use of intestinal parasite drugs and the absence of postpartum maternal vitamin A supplementation significantly increased child mortality risk.Significant socio-demographic risk factors were associated with an increased mortality rate in children,including lack of education,maternal marital status,family wealth index,living rurally,and financial problems hindering access to healthcare.Conclusions Poor nutrition remains a vital factor across all LMICs,with numerous children being exposed to foods low in iron and vitamin A.Significantly,most deaths occur in neonates and infants,indicating an urgent need to address risk factors associated with early child death.

Cervical cancer screening in developing countries at a crossroad:Emerging technologies and policy choices

Cervical cancer(CC) represents the fourth most common malignancy affecting women all over the world and is the second most common in developing areas. In these areas,the burden from disease remains important because of the difficulty in implementing cytology-based screening programmes. The main obstacles inherent to these countries are poverty and a lack of healthcare infrastructures and trained practitioners. With the availability of new technologies,researchers have attempted to find new strategies that are adapted to low- and middle-income countries(LMIC) to promote early diagnosis of cervical pathology. Current evidence suggests that human papillomavirus(HPV) testing is more effective than cytology for CC screening. Therefore,highly sensitive tests have now been developed for primary screening. Rapid molecular methods for detecting HPV DNA have only recently been commercially available. This constitutes a milestone in CC screening in low-resource settings because it may help overcome the great majority of obstacles inherent to previous screening programmes. Despite several advantages,HPV-based screening has a low positive predictive value for CC,so that HPVpositive women need to be triaged with further testing to determine optimal management. Visual inspection tests,cytology and novel biomarkers are some options. In this review,we provide an overview of current and emerging screening approaches for CC. In particular,we discuss the challenge of implementing an efficient cervical screening adapted to LMIC and the opportunity to introduce primary HPV-based screening with the availability of point-of-care(POC) HPV testing. The most adapted screening strategy to LMIC is still a work in progress,but we have reasons to believe that POC HPV testing makes part of the future strategies in association with a triage test that still needs to be defined.

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.

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.