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.

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).

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.

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.

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.

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.

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.

NCD Countdown 2030:efficient pathways and strategic investments to accelerate progress towards the Sustainable Development Goal target 3.4 in low-income and middle-income countries

Most countries have made little progress in achieving the Sustainable Development Goal(SDG)target 3.4,which calls for a reduction in premature mortality from non-communicable diseases(NCDs)by a third from 2015 to 2030.In this Health Policy paper,we synthesise the evidence related to interventions that can reduce premature mortality from the major NCDs over the next decade and that are feasible to implement in countries at all levels of income.Our recommendations are intended as generic guidance to help 123 low-income and middle-income countries meet SDG target 3.4;country-level applications require additional analyses and consideration of the local implementation and utilisation context.Protecting current investments and scaling up these interventions is especially crucial in the context of COVID-19-related health system disruptions.

Necrotizing Fasciitis in Low Income Countries: About 23 Cases of Bujumbura Hospitals

Background: Necrotizing fasciitis is a rapidly spreading soft tissue infection involving the deep facial layers. It can cause secondary necrosis leading to significant morbidity and mortality. The most important predictor of mortality is a delay in diagnosis. In low income countries, that delay must be high and other predictors of morbidity and mortality must be pointed out. Objective: To determine necrotizing fasciitis (NF) prognostic factors in a low income country. Patients and Methods: It is a prospective and descriptive study conducted over a one-year period from November 1, 2017 to November 1, 2018 about 23 cases of necrotizing fasciitis in two hospitals of Bujumbura. Results: The incidence of necrotizing fasciitis in these 2 hospitals (Kamenge Teaching Hospital and Prince Regent Charles Hospital) was 1%. The average age of patients was 41.76 years. Males were predominant with a sex ratio of 1.55. The risk factors for NF were: NSAIDs in 39%;HIV infection in 13%, diabetes mellitus in 4% and high blood pressure in 4%. The average time from symptoms onset to admission was 17.13 days. The mean time from admission to surgical treatment was 4 days with extremes of 1 to 22 days. The most affected site was the lower limb in 82% of cases. All patients (96%) were treated with necrotic tissue debridement. It was associated with skin grafting in 48% of cases. One patient (4%) with diabetes mellitus and HIV infection was amputated. The mortality rate was 22% (n = 5). Among those 5 patients, there was a combination of risk factors (diabetes mellitus, NSAID use and HIV infection) in 80% (n = 4), 60% (n = 3) were over 60 years of age and 60% (n = 3) were operated 10 days after the onset of symptoms. The average time of hospital stay was 101 days with extremes of 14 to 400 days. Conclusion: Necrotizing fasciitis is associated with a high mortality rate in low income countries. The use of NSAIDs;delayed treatment, elderly and immunosuppressive conditions such as diabetes mellitus and HIV are the most prognostic factors in Bujumbura hospitals.

Crohn’s disease in low and lower-middle income countries: A scoping review

BACKGROUND While Crohn’s disease has been studied extensively in high-income countries,its epidemiology and care in low and lower-middle income countries(LLMICs)is not well established due to a lack of disease registries and diagnostic capacity.AIM To describe the published burden,diagnostic/treatment capacity,service utilization,challenges/barriers to individuals with Crohn’s in LLMICs and their providers.METHODS We conducted a scoping review utilizing a full search strategy was developed and conducted in PubMed,Embase and World Health Organization Global Index Medicus.Two independent reviewers screened the titles and abstracts of all of the publications found in this search,reviewed selected publications,and extracted relevant data,which underwent descriptive review and was analyzed in Excel.RESULTS The database search yielded 4486 publications,216 of which were determined to be relevant to the research questions.Of all 79 LLMICs,only 21(26.6%)have publications describing individuals with Crohn’s.Overall,the highest number of studies came from India,followed by Tunisia,and Egypt.The mean number of Crohn’s patients reported per study is 57.84 and the median is 22,with a wide range from one to 980.CONCLUSION This scoping review has shown that,although there is a severe lack of populationbased data about Crohn’s in LLMICs,there is a signal of Crohn’s in these settings around the world.

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.

Impact of taxes on the 2030 Agenda for Sustainable Development:Evidence from Organization for Economic Cooperation and Development(OECD)countries

Multiple ecological and socioeconomic problems have occurred worldwide,raising the awareness of sustainability.This study aims to examine the impact of taxes on Sustainable Development Goals(SDGs)in the context of Organization for Economic Co-operation and Development(OECD)countries.This research used effective average tax(EAT),tax on personal income(TPI),tax on corporate profits(TCP),and tax on goods and services(TGS)as the variables of taxes,and employed secondary data from 38 OECD countries covering 2000–2021.The study also used Breusch-Pagan Lagrange Multiplier(LM),Pesaran Scaled LM,Bias-Corrected Scaled LM,and Pesaran Cross-sectional dependence(CSD)tests to analyze the existence of crosssectional dependency.Then,we established the stationarity of variables through second-generation panel unit root tests(Cross-sectional Augmented Dickey-Fuller(CADF)and Cross-sectional Im,Pesaran,and Shin(CIPS)),and confirmed the long-run cointegration of the variables by using secondgeneration panel cointegration test(Westerlund cointegration test).The results showed that EAT,TPI,TCP,and TGS are positively associated with SDGs.However,the change in TPI has a smaller effect on SDGs than the change in EAT or TCP or TGS.The result of panel causality indicated that EAT,TPI,and TGS have a unidirectional causal relationship with SDGs.The study also found that TCP has a bi-directional causal relationship with SDGs.Moreover,the finding indicated that the OECD countries need to focus on tax policies to achieve the 2030 Agenda for Sustainable Development.This study is based on the theory of optimal taxation(TOT),which suggests that tax systems should be designed to maximize social welfare.Finally,we suggests the importance of taking a comprehensive approach for the managers and policy-makers when analyzing the impact of taxes on SDGs.

Environmental impact of energy imports:Natural resources income and natural gas production profitability in the Asia-Pacific Economic Cooperation Countries

Environmental degradation is a pressing global concern,with the energy sector being one of the major contributors to this issue.The environmental impact of energy imports,particularly regarding natural resources income and natural gas production profitability,cannot be ignored.Countries must assess the environmental consequences of their energy choices and take steps to minimize their impact.By transitioning to cleaner and more sustainable energy sources,countries can ensure a better future for the environment and their economies.This study examines the impact of energy imports and natural resources income on environmental degradation in the Asia-Pacific Economic Cooperation(APEC)countries from 1990 to 2020,using revenue minus the production cost of natural gas and electricity production from renewable sources as moderating variables.Long-run estimates are derived using the Generalized Method of Moments and robust least squares.Our findings elucidate that importing energy from countries specializing in renewable energy can help reduce reliance on fossil fuels.This diversification of energy sources decreases the overall carbon footprint and contributes to a cleaner environment.Natural gas production often involves infrastructure construction,such as drilling rigs and pipelines,which can disrupt natural habitats and wildlife corridors.This destruction of ecosystems can have long-term consequences on biodiversity and ecological balance.The environmental impact of energy imports,particularly related to natural resource income and natural gas production profitability,requires BRICS countries to take proactive measures.These nations can address the environmental challenges associated with their energy demands by implementing policies prioritizing sustainable resource management,carbon pricing,stringent regulation,and investment in research and development.By doing so,they can balance economic growth and environmental sustainability,ensuring a greener future for the BRICS countries.

Comorbidities between tuberculosis and common mental disorders:a scoping review of epidemiological patterns and person-centred care interventions from low-to-middle income and BRICS countries

Background:There is increasing evidence that the substantial global burden of disease for tuberculosis unfolds in concert with dimensions of common mental disorders.Person-centred care holds much promise to ameliorate these comorbidities in low-to-middle income countries(LMICs)and emerging economies.Towards this end,this paper aims to review 1)the nature and extent of tuberculosis and common mental disorder comorbidity and 2)person-centred tuberculosis care in low-to-middle income countries and emerging economies.Main text:A scoping review of 100 articles was conducted of English-language studies published from 2000 to 2019 in peer-reviewed and grey literature,using established guidelines,for each of the study objectives.Four broad tuberculosis/mental disorder comorbidities were described in the literature,namely alcohol use and tuberculosis,depression and tuberculosis,anxiety and tuberculosis,and general mental health and tuberculosis.Rates of comorbidity varied widely across countries for depression,anxiety,alcohol use and general mental health.Alcohol use and tuberculosis were significantly related,especially in the context of poverty.The initial tuberculosis diagnostic episode had substantial sociopsychological effects on service users.While men tended to report higher rates of alcohol use and treatment default,women in general had worse mental health outcomes.Older age and a history of mental illness were also associated with pronounced tuberculosis and mental disorder comorbidity.Person-centred tuberculosis care interventions were almost absent,with only one study from Nepal identified.Conclusions:There is an emerging body of evidence describing the nature and extent of tuberculosis and mental disorders comorbidity in low-to-middle income countries.Despite the potential of person-centred interventions,evidence is limited.This review highlights a pronounced need to address psychosocial comorbidities with tuberculosis in LMICs,where models of person-centred tuberculosis care in routine care platforms may yield promising outcomes.

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.

Factors Determining Health Expenditure in the Asian and the OECD Countries

It is widely recognized that developed countries have been spending more than developing countries on health care. Objective of the study is to examine determinants of health expenditure and what factors influence it. Fifteen Asian countries and 30 OECD countries were chosen to explore the difference of their health expenditure structures. Model of health expenditure per person was estimated to be dependent on market demand, market supply, and other exogenous factors. A model with country specific and time effects of health expenditure was used and estimated. The study found a negative but insignificant relationship between price and health expenditure and a positive and significant relationship between GDP and health expenditure. Urban population density as proxy of urbanization was found to induce the health expenditure in the OECD. Out-of-pocket payment was also found to induce health expenditure for both the Asian and the OECD countries. A net effect of improvement in the health status or a lower mortality rate and a higher life expectancy caused an increase in the health expenditure among the Asian countries studied but decreased health expenditure in the OECD countries. In terms of income elasticity, it was found to be smaller than one in both groups of the countries. Since the income has changed faster than the other factors, the net effect of changes of all factors over period of time will cause rising in health care expenditure. Finally, the model indicated that both the Asian and OECD countries will continue to have a rising health expenditure per person over a period of time.

Radiation oncology practice during COVID-19 pandemic in developing countries

Radiation therapy(RT)is considered one of the cornerstone modalities of treatment for different cancer types.The preparation and delivery of RT requires a number of staff members from different disciplines within the radiation oncology department.Since the emergence of the corona virus disease 2019(COVID-19)pandemic,RT,similar to other cancer care modalities,has been adapted to minimize patient and staff exposure without compromising the oncological outcomes.This was reflected in the dramatic practice changes that occurred in the past year to address the lockdown restrictions and fulfill the infection control requirements.RT practices differ across regions based on financial and training levels,and developing countries with limited resources have struggled to maintain radiation treatment services at a level equivalent to that in developed countries while following pandemic control guidelines.The response during the COVID-19 pandemic varied between developing countries according to the infection rate and RT technological capabilities.In this editorial,we review recently published articles addressing radiotherapy practice reports during the COVID-19 pandemic in developing countries.