The needs for HIV treatment and care of children, adolescents, pregnant women and older people in low-income and middle-income countries

IntroductionPrivate sector provision of HIV treatment is increasing in low-income and middle-income countries (LMIC). However, there is limited documentation of its outcomes. This protocol reports a proposed systematic review that will synthesise clinical outcomes of private sector HIV treatment in LMIC.Methods and analysisThis review will be conducted in accordance with the preferred reporting items for systematic review and meta-analyses protocols. Primary outcomes will include: (1) proportion of eligible patients initiating antiretroviral therapy (ART); (2) proportion of those on ART with <1000 copies/mL; (3) rate of all-cause mortality among ART recipients. Secondary outcomes will include: (1) proportion receivingPneumocystis jirovecipneumonia prophylaxis; (2) proportion with >90% ART adherence (based on any measure reported); (3) proportion screened for non-communicable diseases (specifically cervical cancer, diabetes, hypertension and mental ill health); (iv) proportion screened for tuberculosis. A search of five electronic bibliographical databases (Embase, Medline, PsychINFO, Web of Science and CINAHL) and reference lists of included articles will be conducted to identify relevant articles reporting HIV clinical outcomes. Searches will be limited to LMIC. No age, publication date, study-design or language limits will be applied. Authors of relevant studies will be contacted for clarification. Two reviewers will independently screen citations and abstracts, identify full text articles for inclusion, extract data and appraise the quality and bias of included studies. Outcome data will be pooled to generate aggregative proportions of primary and secondary outcomes. Descriptive statistics and a narrative synthesis will be presented. Heterogeneity and sensitivity assessments will be conducted to aid interpretation of results.Ethics and disseminationThe results of this review will be disseminated through a peer-reviewed scientific manuscript and at international scientific conferences. Results will inform quality improvement strategies, replication of identified good practices, potential policy changes, and future research.PROSPERO registration numberCRD42016040053.

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Older People, Mobility and Transport in Low- and Middle-Income Countries: A Review of the Research

Sustainability ◽

10.3390/su11216157 ◽

2019 ◽

Vol 11 (21) ◽

pp. 6157 ◽

Cited By ~ 4

Author(s):

Mark Gorman ◽

Sion Jones ◽

Jeffrey Turner

Keyword(s):

Older People ◽

Low Income ◽

Well Being ◽

The State ◽

Small Scale ◽

Knowledge Gaps ◽

Middle Income ◽

Middle Income Countries ◽

The Impact ◽

Low And Middle Income

Older populations are rising globally, which in high-income countries has helped to generate a growing literature on the impact of ageing on travel requirements and transport policy. This article aims to provide an initial assessment of the state of knowledge on the impact on transportation policy and usage of the increasing numbers of older people in low- and middle-income countries (LAMICs), through a review of the literature relating to older people and transportation. As both the academic and policy/practice-related literature specifically addressing ageing and transport in LAMICs is limited, the study looks beyond transportation to assess the state of knowledge regarding the ways in which older people’s mobility is affected by issues, such as health, well-being, social (dis)engagement and gender. We find significant knowledge gaps, resulting in an evidence base to support the implementation of policy is lacking. Most research in low-income countries (LICs) is either broad quantitative analysis based on national survey data or small-scale qualitative studies. We conclude that, although study of the differing contexts of ageing in LAMICs as they relate to older people’s mobilities and transport use has barely begun, institutions which both make and influence policymaking recognise the existence of significant knowledge gaps. This should provide the context in which research agendas can be established.

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Potential for health economics to influence policies on tobacco use during pregnancy in low-income and middle-income countries: a qualitative case study

BMJ Open ◽

10.1136/bmjopen-2020-045624 ◽

2021 ◽

Vol 11 (12) ◽

pp. e045624

Author(s):

Tuba Saygın Avşar ◽

Louise Jackson ◽

Hugh McLeod

Keyword(s):

Health Economics ◽

Pregnant Women ◽

Tobacco Use ◽

Low Income ◽

Tobacco Cessation ◽

Qualitative Case Study ◽

Middle Income ◽

Middle Income Countries ◽

Country Specific

IntroductionTobacco control during pregnancy is a policy priority in high-income countries (HICs) because of the significant health and inequality consequences. However, little evidence exists on interventions to reduce tobacco use in low-income and middle-income countries (LMICs), especially for pregnant women. This study aimed to assess how health economics evidence, which is mainly produced in HICs, could be adopted for tobacco cessation policies for pregnant women in LMICs.MethodsA qualitative case study was conducted in an international public health organisation. The organisation was chosen due to its capacity to influence health policies around the world. Tobacco control experts working in the organisation were identified through purposeful sampling and snowballing. Semistructured interviews were conducted with 18 informants with relevant experience of countries from all of the regions covered by the organisation. Data were analysed using the framework method.ResultsIn practice, tobacco cessation during pregnancy was not viewed as a priority in LMICs despite international recognition of the issue. In LMICs, factors including the recorded country-specific prevalence of tobacco use during pregnancy, availability of healthcare resources and the characteristics of potential interventions all affected the use of health economics evidence for policy making.ConclusionThe scale of tobacco use among pregnant women might be greater than reported in LMICs. Health economics evidence produced in HICs has the potential to inform health policies in LMICs around tobacco cessation interventions if the country-specific circumstances are addressed. Economic evaluations of cessation interventions integrated into antenatal care with a household perspective would be especially relevant in LMICs.

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Correlates of physical activity among depressed older people in six low-income and middle-income countries: A community-based cross-sectional study

International Journal of Geriatric Psychiatry ◽

10.1002/gps.4796 ◽

2017 ◽

Vol 33 (2) ◽

pp. e314-e322 ◽

Cited By ~ 7

Author(s):

Davy Vancampfort ◽

Brendon Stubbs ◽

Nicola Veronese ◽

James Mugisha ◽

Nathalie Swinnen ◽

...

Keyword(s):

Physical Activity ◽

Older People ◽

Low Income ◽

Cross Sectional Study ◽

Sectional Study ◽

Community Based ◽

Cross Sectional ◽

Middle Income ◽

Middle Income Countries

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Tobacco use in pregnant women: analysis of data from Demographic and Health Surveys from 54 low-income and middle-income countries

The Lancet Global Health ◽

10.1016/s2214-109x(14)70283-9 ◽

2014 ◽

Vol 2 (9) ◽

pp. e513-e520 ◽

Cited By ~ 45

Author(s):

Rishi Caleyachetty ◽

Christopher A Tait ◽

Andre P Kengne ◽

Camila Corvalan ◽

Ricardo Uauy ◽

...

Keyword(s):

Pregnant Women ◽

Tobacco Use ◽

Low Income ◽

Health Surveys ◽

Demographic And Health Surveys ◽

Middle Income ◽

Middle Income Countries

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Secondhand smoke exposure during pregnancy: a cross-sectional analysis of data from Demographic and Health Survey from 30 low-income and middle-income countries

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054288 ◽

2018 ◽

Vol 28 (4) ◽

pp. 420-426 ◽

Cited By ~ 9

Author(s):

Sian Reece ◽

Camille Morgan ◽

Mark Parascandola ◽

Kamran Siddiqi

Keyword(s):

Pregnant Women ◽

Health Survey ◽

Low Income ◽

Secondhand Smoke ◽

Demographic And Health Survey ◽

Active Smoking ◽

Middle Income ◽

Middle Income Countries ◽

Shs Exposure ◽

Exposure During Pregnancy

BackgroundSecondhand smoke (SHS) exposure during pregnancy increases the risk of infant stillbirth, congenital malformations, low birth weight and respiratory illnesses. However, little is known about the extent of SHS exposure during pregnancy. We assessed the prevalence of SHS exposure in pregnant women in low-income and middle-income countries (LMICs).MethodsWe used Demographic and Health Survey data collected between 2008 and 2013 from 30 LMICs. We estimated weighted country-specific prevalence of SHS exposure among 37 427 pregnant women. We accounted for sampling weights, clustering and stratification in the sampling methods. We also explored associations between sociodemographic variables and SHS exposure in pregnant women using pairwise multinomial regression model.FindingsThe prevalence of daily SHS exposure during pregnancy ranged from 6% (95% CI 5% to 7%) (Nigeria) to 73% (95% CI 62% to 81%) (Armenia) and was greater than active tobacco use in pregnancy across all countries studied. Being wealthier, maternal employment, higher education and urban households were associated with lower SHS exposure in full regression models. SHS exposure in pregnant women closely mirrors WHO Global Adult Tobacco Survey male active smoking patterns. Daily SHS exposure accounted for a greater population attributable fraction of stillbirths than active smoking, ranging from 1% of stillbirths (Nigeria) to 14% (Indonesia).InterpretationWe have demonstrated that SHS exposure during pregnancy is far more common than active smoking in LMICs, accounting for more stillbirths than active smoking. Protecting pregnant women from SHS exposure should be a key strategy to improve maternal and child health.

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