Search Results (599)

Background/Objectives: Colorectal cancer remains a significant global health challenge, particularly in resource-limited settings where patient-centered outcomes following surgery are often suboptimal. Although more prevalent in low- and middle-income countries (LMICs), segments of the United States have similarly limited healthcare resources, resulting in stark inequities even within close geographic proximity. Methods: This review compares and contrasts colorectal cancer outcomes in LMICs with those in resource-constrained communities in rural America, utilizing an established implementation science framework to identify key determinants of practice for delivering high-quality colorectal cancer care. Results: Barriers and innovative, community-based strategies aimed at improving patient-centered outcomes for colorectal cancer patients in low resource settings are identified. We explore innovative approaches and community-based strategies aimed at improving patient-centered outcomes, highlighting the newly developed colorectal surgery fellowship in Sub-Saharan Africa as a model of innovation in this field. Conclusions: By exploring these diverse contexts, this paper proposes actionable solutions and strategies to enhance surgical care of colorectal cancer and patient outcomes, ultimately aiming to inform global health practices, inspire collaboration between LMIC and rural communities, and improve care delivery across various resource settings. Full article

In this work, we describe compatibility assessments of a recombinant, trivalent non-replicating rotavirus vaccine (t-NRRV) candidate with a mock trivalent Sabin inactivated polio vaccine (t-sIPV). Both t-sIPV and t-NRRV are incompatible with thimerosal (TH), a preservative commonly used in pediatric pentavalent combination vaccines (DTwP-Hib-HepB) distributed in low- and middle-income countries (LMICs), preventing the development of a heptavalent combination. The compatibility of t-NRRV with a mock DTwP-Hib-HepB formulation is described in a companion paper. This case study highlights the analytical and formulation challenges encountered when combining a mock t-sIPV vaccine (unadjuvanted) with Alhydrogel^® (AH) adjuvanted t-NRRV. Selective and stability-indicating competition ELISAs were implemented to monitor antibody binding to each of the six antigens (±AH). Simple mixing caused the undesired desorption of t-NRRV from AH with the concomitant binding of t-sIPV to AH. Although the former effect was mitigated by dialyzing sIPV bulks, decreased sIPV storage stability was observed at accelerated temperatures in the bivalent combination with a rank-ordering of P[8] > P[6] > P[4] and sIPV3 > sIPV2 > sIPV1. The compatibility of AH-adsorbed t-sIPV with alternative preservatives was evaluated, and parabens (methyl, propyl) were identified for potential use in this multi-dose bivalent formulation. Along with a companion paper, the lessons learned are discussed to facilitate the future formulation development of pediatric combination vaccines with new antigens. Full article

High titres of rotavirus-specific maternal antibodies may contribute to lower rotavirus vaccine efficacy in low- and middle-income countries (LMICs). RV3-BB vaccine (G3P[6]) is based on a neonatal rotavirus strain that replicates well in the newborn gut in the presence of breast milk. This study investigated the association between maternal serum antibodies and vaccine response in infants administered the RV3-BB vaccine. Serum was collected antenatally from mothers of 561 infants enrolled in the RV3-BB Phase II study conducted in Blantyre, Malawi, and analysed for rotavirus-specific serum IgA and IgG antibodies using enzyme-linked immunosorbent assay. Infant vaccine take was defined as cumulative IgA seroconversion (≥3 fold increase) and/or stool vaccine shedding. Maternal IgA or IgG antibody titres did not have a negative impact on vaccine-like stool shedding at any timepoint. Maternal IgG (but not IgA) titres were associated with reduced take post dose 1 (p < 0.005) and 3 (p < 0.05) in the neonatal vaccine schedule group but not at study completion (week 18). In LMICs where high maternal antibodies are associated with low rotavirus vaccine efficacy, RV3-BB in a neonatal or infant vaccine schedule has the potential to provide protection against severe rotavirus disease. Full article

Cardiovascular disease (CVD) risk factors are frequently reported among firefighters, yet no studies have compared these factors between male and female firefighters, specifically from a low- to middle-income country (LMIC). This study aimed to determine the prevalence of CVD risk factors and their relationship with cardiorespiratory fitness (VO_2max) in 254 active career firefighters (mean age: 42.6 ± 7.8 years). The assessments included anthropometry, blood pressure, blood glucose, cholesterol, triglycerides, and VO_2max. The results indicated that 48.0% and 51.8% of females and males were pre-hypertensive, respectively. Hypertension was identified in 15.8% of the firefighters. According to body mass index (BMI), 37.3% of males and 25% of females were found to be overweight, while an additional 44.9% of males and 45.7% of females were classified as obese. Only 17.3% of males and 18.2% of females were found to be of normal weight. These findings were corroborated by categories of central obesity using waist circumference (WC), which were 47.7% for males and 41.6% for females. Low HDL-C was found in 95.2% of males and 86.4% of females, with 28.3% of males also having elevated triglyceride levels (TG). VO_2max was “excellent” in 48.8% of males and 12.6% of females, though it had no significant association with most CVD risk factors. The only notable link was a small correlation between VO_2max and triglycerides (r = −0.215; p = 0.001). These findings suggest that while cardiorespiratory fitness may have no impact, additional factors likely contribute to the cardiovascular health of firefighters, necessitating the need for comprehensive health and fitness programmes. Full article

Measles and rubella micro-array patches (MR-MAPs) are a promising innovation to address limitations of the current needle and syringe (N&S) presentation due to their single-dose presentation, ease of use, and improved thermostability. To direct and accelerate further research and interventions, an initial full value vaccine assessment (iFVVA) was initiated prior to MR-MAPs entering phase I trials to quantify their value and identify key data gaps and challenges. The iFVVA utilized a mixed-methods approach with rapid assessment of literature, stakeholder interviews and surveys, and quantitative data analyses to (i) assess global need for improved MR vaccines and how MR-MAPs could address MR problem statements; (ii) estimate costs and benefits of MR-MAPs; (iii) identify the best pathway from development to delivery; and (iv) identify outstanding areas of need where stakeholder intervention can be helpful. These analyses found that if MR-MAPs are broadly deployed, they can potentially reach an additional 80 million children compared to the N&S presentation between 2030–2040. MR-MAPs can avert up to 37 million measles cases, 400,000 measles deaths, and 26 million disability-adjusted life years (DALYs). MR-MAPs with the most optimal product characteristics of low price, controlled temperature chain (CTC) properties, and small cold chain volumes were shown to be cost saving for routine immunization (RI) in low- and middle-income countries (LMICs) compared to N&S. Uncertainties about price and future vaccine coverage impact the potential cost-effectiveness of introducing MR-MAPs in LMICs, indicating that it could be cost-effective in 16–81% of LMICs. Furthermore, this iFVVA highlighted the importance of upfront donor investment in manufacturing set-up and clinical studies and the critical influence of an appropriate price to ensure country and manufacturer financial sustainability. To ensure that MR-MAPs achieve the greatest public health benefit, MAP developers, vaccine manufacturers, donors, financiers, and policy- and decision-makers will need close collaboration and open communications. Full article

This review critically examines the integration of Virtual Reality (VR) and Augmented Reality (AR) in medical training across Low- and Middle-Income Countries (LMICs), offering a novel perspective by combining quantitative analysis with qualitative insights from medical students in Egypt and Ghana. Through a systematic review process, 17 peer-reviewed studies published between 2010 and 2023 were analysed. Altogether, these studies involved a total of 887 participants. The analysis reveals a growing interest in VR and AR applications for medical training in LMICs with a peak in published articles in 2023, indicating an expanding research landscape. A unique contribution of this review is the integration of feedback from 35 medical students assessed through questionnaires, which demonstrates the perceived effectiveness of immersive technologies over traditional 2D illustrations in understanding complex medical concepts. Key findings highlight that VR and AR technologies in medical training within LMICs predominantly focus on surgical skills. The majority of studies focus on enhancing surgical training, particularly general surgery. This emphasis reflects the technology’s strong alignment with the needs of LMICs, where surgical skills training is often a priority. Despite the promising applications and expanding interest in VR and AR, significant challenges such as accessibility and device limitations remain, demonstrating the need for ongoing research and integration with traditional methods to fully leverage these technologies for effective medical education. Therefore, this review provides a comprehensive analysis of existing VR and AR applications, their evaluation methodologies, and student perspectives to address educational challenges and enhance healthcare outcomes in LMICs. Full article

In the pursuit of sustainable mobility and the decarbonization of transport systems, public authorities are increasingly scrutinizing the impact of travel speed on emissions within both low-speed and high-speed environments. This study critically examines the evidence concerning emission impacts associated with speed limit changes in different traffic environments by conducting a systematic review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 25 studies that met the eligibility criteria were assessed. The results reveal mixed evidence for reducing emissions through speed limit reductions in low-speed areas. However, emerging evidence suggests that reduced urban speeds may abate emissions through enhanced traffic flow and a shift in modal preferences away from personal vehicle use. Additionally, in urban areas, minor observed emission reduction per vehicle can add up to large overall reductions due to the high number of vehicles. In high-speed contexts, the evidence is much clearer, showing that reduced speed limits correlate with significant reductions in NOx, CO₂, and particulate matter emissions. The extent of these reductions is highly variable and contingent upon the specific speed limits or limit reductions, the local context, the vehicle type, and the baseline types and levels of pollutants. Notably, there is a lack of research on the effects of speed on emissions, especially in low- and middle-income countries (LMICs), highlighting a critical area for future investigation. The findings of this study underscore the potential environmental benefits of speed management policies and advocate for the promotion of smoother and less aggressive driving behavior to mitigate emissions and enhance sustainable mobility in both low-speed and high-speed settings. Full article

Advancements in digital technologies have transformed the world by providing more opportunities and possibilities. However, elderly persons have several challenges utilizing modern technology, leading to digital exclusion, which can negatively impact sustainable development. This research attempts to address the current digital exclusion by addressing the challenges older people face considering evolving digital technologies, focusing on economic, social, and environmental sustainability. Three distinct goals are pursued in this study: to perform a detailed literature review to identify gaps in the current understanding of digital exclusion among the elderly, to identify the primary factors affecting digital exclusion in the elderly, and to analyze the patterns and trends in different countries, with a focus on differentiating between High-Income Countries (HICs) and Lower Middle-Income Countries (LMICs). The research strategies used in this study involve a combination of a literature review and a quantitative analysis of the digital exclusion data from five cohorts. This study uses statistical analysis, such as PCA, chi-square test, one-way ANOVA, and two-way ANOVA, to present a complete assessment of the digital issues that older persons experience. The expected results include the identification of factors influencing the digital divide and an enhanced awareness of how digital exclusion varies among different socio-economic and cultural settings. The data used in this study were obtained from five separate cohorts over a five-year period from 2019 to 2023. These cohorts include ELSA (UK), SHARE (Austria, Germany, France, Estonia, Bulgaria, and Romania), LASI (India), MHAS (Mexico), and ELSI (Brazil). It was discovered that the digital exclusion rate differs significantly across HICs and LMICs, with the UK having the fewest (11%) and India having the most (91%) digitally excluded people. It was discovered that three primary factors, including socio-economic status, health-related issues, and age-related limitations, are causing digital exclusion among the elderly, irrespective of the income level of the country. Further analysis showed that the country type has a significant influence on the digital exclusion rates among the elderly, and age group plays an important role in digital exclusion. Additionally, significant variations were observed in the life satisfaction of digitally excluded people within HICs and LMICs. The interaction between country type and digital exclusion also showed a major influence on the health rating. This study has a broad impact since it not only contributes to what we know academically about digital exclusion but also has practical applications for communities. By investigating the barriers that prevent older people from adopting digital technologies, this study will assist in developing better policies and community activities to help them make use of the benefits of the digital era, making societies more equitable and connected. This paper provides detailed insight into intergenerational equity, which is vital for the embedding principles of sustainable development. Furthermore, it makes a strong case for digital inclusion to be part of broader efforts (and policies) for creating sustainable societies. Full article

Non-communicable diseases (NCDs) continue to pose a threat to public health. Although their impact on the workforce is widely recognized, there needs to be more understanding of how NCDs affect peace and security, particularly in low-middle-income countries. To address this, we conducted a scoping review and presented a narrative to explore how NCDs in the workforce threaten peace and security. Out of 570 papers screened, 34 articles, comprising 26 peer review and 8 grey literature, met the study criteria. Our findings reveal that while no study has drawn a direct relationship between NCDs in the workforce in LMICs and peace and security, several studies have demonstrated a relationship between NCDs and economic growth on one hand and economic growth and peace and security on the other. Therefore, using economic growth as a proximal factor, our findings show three pathways that link NCDs in the workforce to peace and security: (i) NCDs lead to low productivity and poor economic growth, which can threaten public peace and security; (ii) NCDs in the workforce can result in long-term care needs, which then puts pressure on public resources and have implications for public expenditure on peace and security; and (iii) household expenditures on caring for a family member with an NCD can destabilize families and create an unfavourable condition that threatens peace and security. This research highlights the dual threat of NCDs to health and security, as they impact human resources and community structures crucial for peace and security. The results underscore the importance of considering the workplace as a strategic setting for NCD prevention, which will have long-term implications for economic growth and peace and security. Full article

Cardiovascular disease (CVD) poses a significant health burden, particularly among individuals of low socioeconomic status (SES) in low- and middle-income countries (LMICs). This study evaluates the clinical effectiveness of cardiac rehabilitation (CR) in addressing CVD outcomes among very low-SES patients in Colombia. Data from participants enrolled in a CR program in Colombia between 2022 and 2023 were analyzed retrospectively. Measures included heart-healthy behaviors, physical/psychological outcomes, and quality of life assessed at 18, 36, and 60 sessions. Significant improvements were observed in exercise capacity, psychological well-being, and quality of life metrics throughout the CR program. However, barriers to CR attendance and the critical need for expanded program availability remain evident, particularly in LMIC settings like Colombia. In conclusion, structured CR programs demonstrate substantial benefits for very low-SES individuals in a LMIC country, highlighting the urgent need for increased program accessibility and equitable healthcare provision to optimize cardiovascular health outcomes. Full article

Glioblastoma: a highly aggressive brain tumor, presents substantial challenges in treatment and management, with surgical intervention playing a pivotal role in improving patient outcomes. Disparities in access to brain tumor surgery arise from a multitude of factors, including socioeconomic status, geographical location, and healthcare resource allocation. Low- and middle-income countries (LMICs) often face significant barriers to accessing surgical services, such as shortages of specialized neurosurgical expertise, limited healthcare infrastructure, and financial constraints. Consequently, glioblastoma patients in LMICs experience delays in diagnosis, suboptimal treatment, and poorer clinical outcomes compared to patients in high-income countries (HICs). The clinical impact of these disparities is profound. Patients in LMICs are more likely to be diagnosed at advanced disease stages, receive less effective treatment, and have lower survival rates than their counterparts in HICs. Additionally, disparities in access to surgical care exacerbate economic and societal burdens, emphasizing the urgent need for targeted interventions and health policy reforms to address healthcare inequities. This review highlights the importance of addressing global disparities in access to brain tumor surgery for glioblastoma through collaborative efforts, policy advocacy, and resource allocation, aiming to improve outcomes and promote equity in surgical care delivery for all glioblastoma patients worldwide. Full article

Stroke is a leading cause of disability and mortality worldwide, and it disproportionately affects low- and middle-income countries (LMICs), which account for 88% of stroke fatalities. Prehospital stroke care delays are a crucial obstacle to successful treatment in these settings, especially given the limited therapeutic window for thrombolytic treatments, which may greatly improve recovery chances when initiated early after stroke onset. These delays are caused by a lack of public understanding of stroke symptoms, sociodemographic and cultural variables, and insufficient healthcare infrastructure. This review discusses these issues in detail, emphasizing the disparities in stroke awareness and reaction times between locations and socioeconomic classes. Innovative options for reducing these delays include the deployment of mobile stroke units and community-based educational campaigns. This review also discusses how technology improvements and personalized educational initiatives might improve stroke awareness and response in LMICs. The primary goal is to give a thorough assessment of the challenges and potential remedies that might serve as the foundation for policy reforms and healthcare improvements in LMICs, eventually improving stroke care and lowering disease-related mortality and disability. Full article

Polysubstance use (PSU), injection drug use (IDU), and equipment sharing are associated with bloodborne infection (BBI) transmission risk, particularly Hepatitis C Virus (HCV), yet data on PSU in low- and middle-income countries (LMICs) is limited. We report on baseline PSU, medication-assisted treatment (MAT) engagement, and motivation to reduce IDU among 95 people who inject drugs (PWID) who accessed needle and syringe programs (NSP) in Nairobi and Coastal Kenya prior to HCV treatment. Bivariate and multivariate logistic regression were used to examine the associations between PSU and behaviors that confer HCV transmission and acquisition risks. Most participants (70.5%) reported PSU in the last 30 days, and one-third (35.8%) reported PSU exclusive to just heroin and cannabis use. Common combinations were heroin and cannabis (49.3%), and heroin, cannabis, and bugizi (flunitrazepam) (29.9%). Participants at baseline were receiving MAT (69.5%), already stopped or reduced IDU (30.5%), and were HIV-positive (40%). PSU was significantly associated with IDU (p = 0.008) and the number of times (p = 0.016) and days (p = 0.007) injected in the last 30 days. Participants reported high PSU and equipment sharing, despite high MAT engagement. While co-locating BBI treatment within existing harm reduction services is necessary to promote uptake and curb re-infection, tailored services may be needed to address PSU, particularly in LMICs. Full article

Suicide accounts for 33% of deaths of women during the postnatal period in many low- and middle-income countries (LMICs). Resilience refers to an ability to adapt and recover from adversity or misfortune. Resilience building against mental health challenges during pregnancy and the postnatal period is critical for women to raise their child efficiently and maintain a healthy life. The exploration of maternal resilience against mental health challenges including its developmental processes and the determinants of its successful or unsuccessful cultivation among mothers during pregnancy and childbirth is of paramount importance. Understanding why a subset of mothers effectively develops resilience while others significantly struggle is critical for devising targeted interventions and support mechanisms aimed at improving maternal well-being. This inquiry not only seeks to delineate the factors that contribute to or hinder the development of resilience but also aims to inform the creation of comprehensive support systems that can bolster maternal health outcomes. This paper endeavors to present a comprehensive analysis of maternal resilience, aiming to cultivate a nuanced and profound understanding of the concept within the framework of previous traumatic events and adverse pregnancy outcomes in LMICs. The eight-step method approach proposed by Walker and Avant was utilized for this concept analysis. Several defining attributes were identified in the analysis including social adaptation, support system, optimistic approach, and mindfulness. This analysis contributes to knowledge advancement regarding maternal resilience and provides nurses and other healthcare professionals with a clear understanding of the concept of maternal resilience to help promote resilience among mothers. Full article

The COVID-19 pandemic, with over 775 million cases and 7 million deaths by May 2024, has drastically impacted global public health and exacerbated existing healthcare inequalities. The swift development and distribution of COVID-19 vaccines have been critical in combating the virus, yet disparities in access to and administration of the vaccine have highlighted deep-seated inequities at global, regional, and national levels. Wealthier nations have benefited from early access to vaccines, while low- and middle-income countries (LMICs) have faced persistent shortages. Initiatives such as COVAX aimed to address these disparities, but challenges persist. Socioeconomic factors, education, ethnic identity, and the healthcare infrastructure play crucial roles in vaccine equity. For example, lower-income individuals often face barriers such as poor access to healthcare, misinformation, and logistical challenges, particularly in rural areas. Addressing these inequities requires a multifaceted approach, integrating national policies with local strategies to enhance vaccines’ accessibility, counter misinformation, and ensure equitable distribution. Collaborative efforts at all levels are essential to promote vaccine equity and effectively control the pandemic, ensuring that all populations have fair access to life-saving vaccines. This review explores these complex issues, offering insights into the barriers and facilitators of vaccine equity and providing recommendations to promote more equitable and effective vaccination programs. With a focus on the different levels at which vaccination policies are planned and implemented, the text provides guidelines to steer vaccination strategies, emphasizing the role of international cooperation and local policy frameworks as keys to achieving equitable vaccination coverage. Full article