Atrial fibrillation in low- and middle-income countries: a narrative review

Abstract Preventing premature non-communicable disease mortality necessitates a thorough review of one of the most important risk factors for stroke, which is atrial fibrillation (AF). The latter and AF-related stroke are still considered to be problems of high-income countries and are frequently overlooked in low- and middle-income countries (LMICs). In this narrative review, we provide an overview of studies that evaluated at least one of the following determinants of AF burden in LMICs: current epidemiology and trends, stroke prevention, health outcomes, and economic burden. Studies focusing on samples close to the general population (including community- and primary care-based samples) indicate sex-specific prevalence rates up to 7.4% in LMICs. Although AF prevalence is still higher in high-income countries than LMICs, the gap in AF burden between these two groups has been reducing in the past three decades. Oral anticoagulant (OAC) therapy for stroke prevention is underused in LMICs, and there are little data on OAC therapy in relation to stroke risk scores, such as CHA2DS2-VASc. Available data also points to higher morbidity and mortality for patient with AF in LMICs than their counterparts in high-income countries. Data on the consequent economic burden in LMICs is scarce, but it is reasonable to consider it will follow the same trend as that observed for health outcomes. Raising the visibility of AF as a public health problem in LMICs is necessary as a first step to providing adequate care for patients with this condition.

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Abstract WP418: A Systematic Comparison of Key Features of Ischaemic Stroke Prevention Guidelines in Low- and Middle-income vs High-income Countries

Stroke ◽

10.1161/str.48.suppl_1.wp418 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Hernan O Bayona ◽

Mayowa Owolabi ◽

Wayne Feng ◽

James R Sawers ◽

Paul Olowoyo ◽

...

Keyword(s):

Stroke Prevention ◽

High Income ◽

Evidence Based ◽

Vascular Risk ◽

Eligibility Criteria ◽

Middle Income ◽

Middle Income Countries ◽

Prevention Guideline ◽

Prevention Guidelines ◽

Low And Middle Income

Introduction: Implementation of contextually appropriate, evidence-based, expert-recommended stroke prevention guideline is particularly important in Low- and Middle-Income Countries (LMICs), which bear disproportional larger burden of stroke while possessing fewer resources. Focus therefore, should be on approaches enabling healthcare systems to improve control of vascular risk factors. Objective: We aimed to compare important features of stroke prevention guidelines between LMICs and High Income Countries (HICs). Methods: We systematically searched PubMed, AJOL, SciELO, and LILACS databases for stroke prevention guidelines published between January 2005 and December 2015 by country. Primary search items included: “Stroke” and “Guidelines”. We critically appraised the articles for evidence level, issuance frequency and implementation aspects to clinical practice. Results: Among 45 stroke prevention guidelines published, 28 (62%) met eligibility criteria: 7 from LMICs (25%) and 21 from HICs (75%). LMIC-issued guidelines were less likely to have conflict of interest declarations (57% vs. 100%, p=0.01), involve high quality systematic reviews (57% vs. 95%, p= 0.03), had good dissemination channels (14% vs 71%, p=0.02). The patient views and preferences were the most significant stakeholder considerations in HICs (43%, p=0.04) compared with LMICs. Conclusion: The quality and quantity of stroke prevention guidelines in LMICs are less than those of HICs and need to be significantly improved upon.

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Population genomics of Cryptosporidium hominis across five continents identifies two subspecies that have diverged and recombined during 500 years of evolution

10.1101/2021.09.09.459610 ◽

2021 ◽

Author(s):

Swapnil Tichkule ◽

Simone M. Cacciò ◽

Guy Robinson ◽

Rachel M. Chalmers ◽

Ivo Mueller ◽

...

Keyword(s):

Gene Flow ◽

Low Income ◽

Population Genomics ◽

Balancing Selection ◽

Public Health Problem ◽

High Income ◽

Secondary Contact ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

AbstractCryptosporidium is a significant public health problem and one of the primary causes of diarrhoea in humans, particularly in very young children living in low- and middle-income countries. While the zoonotic Cryptosporidium parvum and anthroponotic C. hominis species collectively account for most cases globally, the latter is predominant in low- and middle-income countries. Here, we present a comprehensive whole genome study of C. hominis, comprising 114 isolates from 16 countries within five continents. We detect two highly diverged lineages with a distinct biology and demography that have diverged circa 500 years ago. We consider these lineages as two subspecies, and provisionally propose the names C. hominis hominis (clade 1) and C. hominis aquapotentis (clade 2 or gp60 subtype IbA10G2). C. h. hominis is mostly found in low-income countries in Africa and Asia, and it appears to have recently undergone population contraction. In marked contrast, C. h. aquapotentis was found in high-income countries, mainly in Europe, North America and Oceania, and we reveal a signature of population expansion. Moreover, we detected genomic regions of introgression representing gene flow after a secondary contact between the subspecies from low- and high-income countries. We demonstrate that this gene flow resulted in genomic island of high diversity and divergence, and that this diversity at potential virulence genes is maintained by balancing selection, suggesting that they are involved in a coevolutionary arms race.

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WHO Global Strategy in Eradication of Cervical Cancer

BioScientia Medicina ◽

10.32539/bsm.v5i9.328 ◽

2021 ◽

Vol 5 (9) ◽

pp. 818-824

Author(s):

Patiyus Agustiansyah ◽

Rizal Sanif ◽

Siti Nurmaini ◽

Irfannuddin ◽

Legiran

Keyword(s):

Public Health ◽

Cervical Cancer ◽

Health Problem ◽

Public Health Problem ◽

Global Strategy ◽

High Income ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

WHO has created a global strategy to accelerate the elimination of cervical canceras a public health problem and a world burden. Cervical cancer is a disease thatcan be prevented and cured, as long as it is detected early and treated effectively.Cervical cancer is also a disease that reflects global injustice. The burden isgreatest in low- and middle-income countries, where access to public healthservices is limited and screening and treatment for the disease has not been widelyapplied. In 2018, nearly 90% of all deaths worldwide occurred in low and middleincome countries. Furthermore, the proportion of women with cervical cancer whodie from the disease is more than 60% in these countries, more than double thenumber in many high-income countries, which is only 30%.

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WHO Global Strategy in Eradication of Cervical Cancer

BioScientia Medicina ◽

10.32539/bsm.v5i3.328 ◽

2021 ◽

Vol 5 (3) ◽

pp. 642-648

Author(s):

Patiyus Agustiansyah ◽

Rizal Sanif ◽

Siti Nurmaini ◽

Irfannuddin ◽

Legiran

Keyword(s):

Public Health ◽

Cervical Cancer ◽

Health Problem ◽

Public Health Problem ◽

Global Strategy ◽

High Income ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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The Economic Cost of Violence Against Women and Girls in Low- and Middle-Income Countries: A Systematic Review of the Evidence

Trauma Violence & Abuse ◽

10.1177/15248380211016018 ◽

2021 ◽

pp. 152483802110160

Author(s):

Seema Vyas ◽

Melissa Meinhart ◽

Katrina Troy ◽

Hannah Brumbaum ◽

Catherine Poulton ◽

...

Keyword(s):

South Africa ◽

Systematic Review ◽

Violence Against Women ◽

Economic Burden ◽

Data Availability ◽

Female Genital Cutting ◽

Middle Income ◽

Middle Income Countries ◽

Women And Girls ◽

Low And Middle Income

Evidence demonstrating the economic burden of violence against women and girls can support policy and advocacy efforts for investment in violence prevention and response programming. We undertook a systematic review of evidence on the costs of violence against women and girls in low- and middle-income countries published since 2005. In addition to understanding costs, we examined the consistency of methodological approaches applied and identified and assessed common methodological issues. Thirteen articles were identified, eight of which were from sub-Saharan Africa. Eight studies estimated costs associated with domestic or intimate partner violence, others estimated the costs of interpersonal violence, female genital cutting, and sexual assaults. Methodologies applied to estimate costs were typically based on accounting approaches. Our review found that out-of-pocket expenditures to individuals for seeking health care after an episode of violence ranged from US$29.72 (South Africa) to US$156.11 (Romania) and that lost productivity averaged from US$73.84 to US$2,151.48 (South Africa) per facility visit. Most studies that estimated provider costs of service delivery presented total programmatic costs, and there was variation in interventions, scale, and resource inputs measured which hampered comparability. Variations in methodological assumptions and data availability also made comparisons across countries and settings challenging. The limited scope of studies in measuring the multifaceted impacts of violence highlights the challenges in identifying cost metrics that extend beyond specific violence episodes. Despite the limited evidence base, our assessment leads us to conclude that the estimated costs of violence against women and girls are a fraction of its true economic burden.

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Adherence to Food-Based Dietary Guidelines: A Systemic Review of High-Income and Low- and Middle-Income Countries

Nutrients ◽

10.3390/nu13031038 ◽

2021 ◽

Vol 13 (3) ◽

pp. 1038

Author(s):

Ana Carolina B. Leme ◽

Sophia Hou ◽

Regina Mara Fisberg ◽

Mauro Fisberg ◽

Jess Haines

Keyword(s):

English Language ◽

Economic Status ◽

High Income ◽

Dietary Guidelines ◽

Systemic Review ◽

Healthy Children ◽

Future Health ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

Research comparing the adherence to food-based dietary guidelines (FBDGs) across countries with different socio-economic status is lacking, which may be a concern for developing nutrition policies. The aim was to report on the adherence to FBDGs in high-income (HIC) and low-and-middle-income countries (LMIC). A systematic review with searches in six databases was performed up to June 2020. English language articles were included if they investigated a population of healthy children and adults (7–65 years), using an observational or experimental design evaluating adherence to national FBDGs. Findings indicate that almost 40% of populations in both HIC and LMIC do not adhere to their national FBDGs. Fruit and vegetables (FV) were most adhered to and the prevalence of adhering FV guidelines was between 7% to 67.3%. HIC have higher consumption of discretionary foods, while results were mixed for LMIC. Grains and dairy were consumed below recommendations in both HIC and LMIC. Consumption of animal proteins (>30%), particularly red meat, exceeded the recommendations. Individuals from HIC and LMIC may be falling short of at least one dietary recommendation from their country’s guidelines. Future health policies, behavioral-change strategies, and dietary guidelines may consider these results in their development.

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Social Epidemiology and Global Mental Health: Expanding the Evidence from High-Income to Low- and Middle-Income Countries

Current Epidemiology Reports ◽

10.1007/s40471-017-0107-y ◽

2017 ◽

Vol 4 (2) ◽

pp. 166-173 ◽

Cited By ~ 15

Author(s):

Joanna Maselko

Keyword(s):

Mental Health ◽

Social Epidemiology ◽

Global Mental Health ◽

High Income ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Optimizing long‐term mental health outcomes in low‐and middle‐income countries (NIMH)

Federal Grants & Contracts ◽

10.1002/fgc.32013 ◽

2021 ◽

Vol 45 (22) ◽

pp. 7-7

Keyword(s):

Mental Health ◽

Health Outcomes ◽

Mental Health Outcomes ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Effective Strategies for Global Health Training Programs A Systematic Review of Training Outcomes in Low and Middle Income Countries

Global Journal of Health Science ◽

10.5539/gjhs.v8n11p278 ◽

2016 ◽

Vol 8 (11) ◽

pp. 278 ◽

Cited By ~ 2

Author(s):

Aprill Z. Dawson ◽

Rebekah J. Walker ◽

Jennifer A. Campbell ◽

Leonard E. Egede

Keyword(s):

Medical Training ◽

Skills Training ◽

High Income ◽

Training Methods ◽

Middle Income ◽

Training Outcomes ◽

Effective Strategies ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

Low And Middle Income

INTRODUCTION: Low and middle-income countries face a continued burden of chronic illness and non-communicable diseases while continuing to show very low health worker utilization. With limited numbers of medical schools and a workforce shortage the poor health outcomes seen in many low and middle income countries are compounded by a lack of within country medical training.METHODS: Using a systematic approach, this paper reviews the existing literature on training outcomes in low and middle-income countries in order to identify effective strategies for implementation in the developing world. This review examined training provided by high-income countries to low- and middle-income countries.RESULTS: Based on article eligibility, 24 articles were found to meet criteria. Training methods found include workshops, e-learning modules, hands-on skills training, group discussion, video sessions, and role-plays. Of the studies with statistically significant results training times varied from one day to three years. Studies using both face-to-face and video found statistically significant results.DISCUSSION: Based on the results of this review, health professionals from high-income countries should be encouraged to travel to low- middle-income countries to assist with providing training to health providers in those countries.

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