The role of primary care in low- and middle-income countries

2013 ◽  
pp. 96-113 ◽  
Author(s):  
David Goldberg ◽  
Graham Thornicroft ◽  
Nadja van Ginneken
Keyword(s):  
Primary Care ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Models of community-based primary care for epilepsy in low- and middle-income countries

Neurology ◽  
2020 ◽  
Vol 94 (4) ◽  
pp. 165-175 ◽  
Author(s):  
Gagandeep Singh ◽  
Meenakshi Sharma ◽  
Anand Krishnan ◽  
Tarun Dua ◽  
Francesco d'Aniello ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Treatment Adherence ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Community Awareness ◽  
Primary Health ◽  
Low And Middle Income

ObjectiveTo review systematically community-based primary care interventions for epilepsy in low- and middle-income countries to rationalize approaches and outcome measures in relation to epilepsy care in these countries.MethodsA systematic search of PubMed, EMBASE, Global Index Medicus, CINAHL, and Web of Science was undertaken to identify trials and implementation of provision of antiseizure medications, adherence reinforcement, and/or health care provider or community education in community-based samples of epilepsy. Data on populations addressed, interventions, and outcomes were extracted from eligible articles.ResultsThe 24 reports identified comprise mostly care programs addressing active convulsive epilepsy. Phenobarbital has been used most frequently, although other conventional antiseizure medications (ASMs) have also been used, but none of the newer. Tolerability rates in these studies are high, but overall attrition is considerable. Other approaches include updating primary health care providers, reinforcing treatment adherence in clinics, and raising community awareness. In these programs, the coverage of existing treatment gap in the community, epilepsy-related mortality, and comorbidity burden are only fleetingly addressed. None, however, explicitly describe sustainability plans.ConclusionsCost-free provision, mostly of phenobarbital, has resulted in short-term seizure freedom in roughly half of the people with epilepsy in low- and middle-income countries. Future programs should include a range of ASMs. These should cover apart from seizure control and treatment adherence, primary health care provider education, community awareness, and referral protocols for specialist care. Programs should incorporate impact assessment at the local level. Sustainability in the long term as much as resilience and scalability should be addressed in future initiatives.

scholarly journals The Effects of Adolescent Childbearing on Literacy and Numeracy in Bangladesh, Malawi, and Zambia

Demography ◽  
2019 ◽  
Vol 56 (5) ◽  
pp. 1899-1929 ◽  
Author(s):  
Stephanie R. Psaki ◽  
Erica Soler-Hampejsek ◽  
Jyotirmoy Saha ◽  
Barbara S. Mensch ◽  
Sajeda Amin
Keyword(s):  
Adolescent Mothers ◽  
School Dropout ◽  
Academic Skills ◽  
First Birth ◽  
Middle Income ◽  
Adolescent Childbearing ◽  
Middle Income Countries ◽  
English Literacy ◽  
Low And Middle Income

Abstract Global investments in girls’ education have been motivated, in part, by an expectation that more-educated women will have smaller and healthier families. However, in many low- and middle-income countries, the timing of school dropout and first birth coincide, resulting in a rapid transition from the role of student to the role of mother for adolescent girls. Despite growing interest in the effects of pregnancy on levels of school dropout, researchers have largely overlooked the potential effect of adolescent childbearing on literacy and numeracy. We hypothesize that becoming a mother soon after leaving school may cause the deterioration of skills gained in school. Using longitudinal data from Bangladesh, Malawi, and Zambia, we test our hypothesis by estimating fixed-effects linear regression models to address the endogeneity in the relationship between childbearing and academic skills. To our knowledge, this is the first study to examine the effects of adolescent childbearing on academic skills in low- and middle-income countries. Our results indicate that among those with low levels of grade attainment, first birth has a negative effect on English literacy and numeracy. Among those with higher levels of grade attainment, we find little evidence of effects of childbearing on academic skills. Childbearing also has little effect on local language literacy. Beyond the immediate loss of English literacy and numeracy, if these skills lead to better health and more economic productivity, then adolescent childbearing may have longer-term repercussions than previously understood. In addition to ongoing efforts to increase educational attainment and school quality in low- and middle-income countries, investments are needed to strengthen the academic skills of adolescent mothers to secure the demographic and economic promise of expanded education for girls and women.

scholarly journals Primary care financing: a systematic assessment of research priorities in low- and middle-income countries

2019 ◽  
Vol 4 (Suppl 8) ◽  
pp. e001483 ◽  
Author(s):  
Felicity Goodyear-Smith ◽  
Andrew Bazemore ◽  
Megan Coffman ◽  
Richard Fortier ◽  
Amanda Howe ◽  
...  
Keyword(s):  
Primary Care ◽  
Research Priorities ◽  
Knowledge Gaps ◽  
Middle Income ◽  
Policy Makers ◽  
Diverse Range ◽  
Middle Income Countries ◽  
Delphi Round ◽  
Research Questions ◽  
Low And Middle Income

IntroductionFinancing of primary healthcare (PHC) is the key to the provision of equitable universal care. We aimed to identify and prioritise the perceived needs of PHC practitioners and researchers for new research in low- and middle-income countries (LMIC) about financing of PHC.MethodsThree-round expert panel consultation using web-based surveys of LMIC PHC practitioners, academics and policy-makers sampled from global networks. Iterative literature review conducted in parallel. First round (Pre-Delphi survey) elicited possible research questions to address knowledge gaps about financing. Responses were independently coded, collapsed and synthesised to two lists of questions. Round 2 (Delphi Round 1) invited panellists to rate importance of each question. In Round 3 (Delphi Round 2), panellists ranked questions in order of importance.ResultsA diverse range of PHC practitioners, academics and policy-makers in LMIC representing all global regions identified 479 knowledge gaps as potentially critical to improving PHC financing. Round 2 provided 31 synthesised questions on financing for rating. The top 16 were ranked in Round 3e to produce four prioritised research questions.ConclusionsThis novel exercise created an expansive and prioritised list of critical knowledge gaps in PHC financing research questions. This offers valuable guidance to global supporters of primary care evaluation and implementation, including research funders and academics seeking research priorities. The source and context specificity of this research, informed by LMIC practitioners and academics on a global and local basis, should increase the likelihood of local relevance and eventual success in implementing the findings.

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