Building leadership capacity to prevent and control noncommunicable diseases: evaluation of an international short-term training program for program managers from low- and middle-income countries

Abstract Background: The global COVID-19 pandemic has disrupted healthcare worldwide. In low- and middle-income countries (LMICs), where people may have limited access to affordable quality care, the COVID-19 pandemic has the potential to have a particularly adverse impact on the health and healthcare of individuals with noncommunicable diseases (NCDs). A World Health Organization survey found that disruption of delivery of healthcare for NCDs was more significant in LMICs than in high-income countries. However, the study did not elicit insights into the day-to-day impacts of COVID-19 on healthcare by front-line healthcare workers (FLHCWs). Aim: To gain insights directly from FLHCWs working in countries with a high NCD burden, and thereby identify opportunities to improve the provision of healthcare during the current pandemic and in future healthcare emergencies. Methods: We recruited selected frontline healthcare workers (general practitioners, pharmacists, and other medical specialists) from nine countries to complete an online survey (n = 1347). Survey questions focused on the impact of COVID-19 pandemic on clinical practice and NCDs; barriers to clinical care during the pandemic; and innovative responses to the many challenges presented by the pandemic. Findings: The majority of FLHCWs responding to our survey reported that their care of patients had been impacted both adversely and positively by the public health measures imposed. Most FLHCs (95%) reported a deterioration in the mental health of their patients. Conclusions: Continuity of care for NCDs as part of pandemic preparedness is needed so that chronic conditions are not exacerbated by public health measures and the direct impacts of the pandemic.

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The burgeoning role of global health diplomacy to alleviate suffering of cancer patients in low- and middle-income countries

International Health ◽

10.1093/inthealth/ihaa004 ◽

2020 ◽

Vol 12 (3) ◽

pp. 231-233

Author(s):

Melissa Adomako ◽

Alaei Kamiar ◽

Abdulla Alshaikh ◽

Lyndsay S Baines ◽

Desiree Benson ◽

...

Keyword(s):

Global Health ◽

Evidence Base ◽

International Affairs ◽

Global Health Diplomacy ◽

Middle Income ◽

Middle Income Countries ◽

Health Diplomacy ◽

Health Practitioners ◽

And Control ◽

Low And Middle Income

Abstract The science of global health diplomacy (GHD) consists of cross-disciplinary, multistakeholder credentials comprised of national security, public health, international affairs, management, law, economics and trade policy. GHD is well placed to bring about better and improved multilateral stakeholder leverage and outcomes in the prevention and control of cancer. It is important to create an evidence base that provides clear and specific guidance for health practitioners in low- and middle-income countries (LMICs) through involvement of all stakeholders. GHD can assist LMICs to negotiate across multilateral stakeholders to integrate prevention, treatment and palliative care of cancer into their commercial and trade policies.

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Using mHealth to Predict Noncommunicable Diseases: A Public Health Opportunity for Low- and Middle-Income Countries

Journal of Medical Internet Research ◽

10.2196/jmir.7593 ◽

2017 ◽

Vol 19 (5) ◽

pp. e129 ◽

Cited By ~ 3

Author(s):

Ellen Rosskam ◽

Adnan A Hyder

Keyword(s):

Public Health ◽

Noncommunicable Diseases ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Noncommunicable Diseases in Low- and Middle-Income Countries: A Strategic Approach to Develop a Global Implementation Research Workforce

Global Heart ◽

10.1016/j.gheart.2018.05.001 ◽

2018 ◽

Vol 13 (2) ◽

pp. 131 ◽

Cited By ~ 7

Author(s):

Michael M. Engelgau ◽

Joshua P. Rosenthal ◽

Bradley J. Newsome ◽

LeShawndra Price ◽

Deshiree Belis ◽

...

Keyword(s):

Implementation Research ◽

Noncommunicable Diseases ◽

Middle Income ◽

Middle Income Countries ◽

Strategic Approach ◽

Research Workforce ◽

Low And Middle Income

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Large-Scale Food Fortification and Biofortification in Low- and Middle-Income Countries: A Review of Programs, Trends, Challenges, and Evidence Gaps

Food and Nutrition Bulletin ◽

10.1177/0379572118774229 ◽

2018 ◽

Vol 39 (2) ◽

pp. 315-331 ◽

Cited By ~ 29

Author(s):

Saskia J. M. Osendarp ◽

Homero Martinez ◽

Greg S. Garrett ◽

Lynnette M. Neufeld ◽

Luz Maria De-Regil ◽

...

Keyword(s):

Large Scale ◽

Food System ◽

Food Fortification ◽

Micronutrient Deficiencies ◽

Middle Income ◽

Middle Income Countries ◽

Essential Components ◽

Quality Of Delivery ◽

And Control ◽

Low And Middle Income

Background: Food fortification and biofortification are well-established strategies to address micronutrient deficiencies in vulnerable populations. However, the effectiveness of fortification programs is not only determined by the biological efficacy of the fortified foods but also by effective and sustainable implementation, which requires continual monitoring, quality assurance and control, and corrective measures to ensure high compliance. Objective: To provide an overview of efficacy, effectiveness, economics of food fortification and biofortification, and status of and challenges faced by large-scale food fortification programs in low- and middle-income countries (LMIC). Methods: A literature review of PubMed publications in English from 2000 to 2017, as well as gray literature, targeting nongovernmental organizations whose work focuses on this topic, complemented by national reports and a “snowball” process of citation searching. The article describes remaining technical challenges, barriers, and evidence gap and prioritizes recommendations and next steps to further accelerate progress and potential of impact. Results: The review identifies and highlights essential components of successful programs. It also points out issues that determine poor program performance, including lack of adequate monitoring and enforcement and poor compliance with standards by industry. Conclusions: In the last 17 years, large-scale food fortification initiatives have been reaching increasingly larger segments of populations in LMIC. Large-scale food fortification and biofortification should be part of other nutrition-specific and nutrition-sensitive efforts to prevent and control micronutrient deficiencies. There are remaining technical and food system challenges, especially in relation to improving coverage and quality of delivery and measuring progress of national programs.

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2031. Impact of Education and Antibiotic Guidelines on Dispensing Antibiotics with Community Pharmacists in a Low- and Middle-Income Country

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1711 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S682-S682

Author(s):

Smitha Gudipati ◽

Deepak Bajracharya ◽

Lenjana Jimee ◽

Gina Maki ◽

Marcus Zervos ◽

...

Keyword(s):

Community Pharmacists ◽

Antibiotic Use ◽

Educational Assessment ◽

The Body ◽

Control Groups ◽

Post Intervention ◽

Middle Income ◽

Middle Income Countries ◽

And Control ◽

Low And Middle Income

Abstract Background Non-prescription use of antibiotics in low- and middle-income countries has contributed to significant antimicrobial resistance (AMR). Henry Ford Health System has partnered with multinational organizations in Nepal to address the need for increasing awareness of AMR and implementation of effective antimicrobial stewardship. This partnership confirmed the importance of increasing knowledge and awareness regarding AMR and antibiotic use to community pharmacists. The present pilot study assessed if outpatient antibiotic dispensing guidelines given to community pharmacists could result in a reduction of unneeded antibiotic use. Methods Nine community pharmacies from Kathmandu were selected of which two were used as controls. Seven pharmacists were educated on the appropriate use of antibiotics, and outpatient dispensing before and after guidelines at all pharmacies were evaluated. The pharmacists were given guidelines on antibiotic use and duration needed for common bacterial infections encountered. Controls were not given guidelines. At baseline and post-intervention (1 week), pill counts were performed of the top six antibiotics that were dispensed by the pharmacist. Pharmacists were requested to keep a log of how many antibiotics were dispensed for one week. The pharmacists also were requested to fill out a post-intervention educational assessment to evaluate retention. Results Pill count pre-intervention was 15,856 and 1512 and post-intervention was 11,168 and 1,440 in the intervention and control groups respectively (Table 1). A post-intervention educational assessment revealed that both the intervention and control groups believed antibiotics can treat viruses (57% vs. 50%) and that antibiotics do not kill good bacteria that protect the body from infection (57% vs. 50%) (Table 2). Conclusion There was no difference in the dispensing of antibiotics between pre- and post-intervention. The findings of this study show significant room for improvement in continuing education about antibiotic use in outpatient pharmacies. Further studies are needed to target outpatient antibiotic dispensing with education and identifying economic or other incentives in hopes of reducing the burden of AMR in low- and middle-income countries. Disclosures All authors: No reported disclosures.

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Antibiotic Use in Low and Middle-Income Countries and the Challenges of Antimicrobial Resistance in Surgery

Antibiotics ◽

10.3390/antibiotics9080497 ◽

2020 ◽

Vol 9 (8) ◽

pp. 497

Author(s):

Massimo Sartelli ◽

Timothy C. Hardcastle ◽

Fausto Catena ◽

Alain Chichom-Mefire ◽

Federico Coccolini ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Prevention And Control ◽

Infection Prevention ◽

Infection Prevention And Control ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Middle Income ◽

Middle Income Countries ◽

And Control ◽

Low And Middle Income

Antimicrobial resistance (AMR) is a phenomenon resulting from the natural evolution of microbes. Nonetheless, human activities accelerate the pace at which microorganisms develop and spread resistance. AMR is a complex and multidimensional problem, threatening not only human and animal health, but also regional, national, and global security, and the economy. Inappropriate use of antibiotics, and poor infection prevention and control strategies are contributing to the emergence and dissemination of AMR. All healthcare providers play an important role in preventing the occurrence and spread of AMR. The organization of healthcare systems, availability of diagnostic testing and appropriate antibiotics, infection prevention and control practices, along with prescribing practices (such as over-the-counter availability of antibiotics) differs markedly between high-income countries and low and middle-income countries (LMICs). These differences may affect the implementation of antibiotic prescribing practices in these settings. The strategy to reduce the global burden of AMR includes, among other aspects, an in-depth modification of the use of existing and future antibiotics in all aspects of medical practice. The Global Alliance for Infections in Surgery has instituted an interdisciplinary working group including healthcare professionals from different countries with different backgrounds to assess the need for implementing education and increasing awareness about correct antibiotic prescribing practices across the surgical pathways. This article discusses aspects specific to LMICs, where pre-existing factors make surgeons’ compliance with best practices even more important.

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