scholarly journals Pattern of Severity of Road Traffic Injuries Among Pedestrians in Low- and Middle-Income Countries: A Systematic Review

2021 ◽  
Author(s):  
Neeraj Sharma ◽  
Mohan Bairwa ◽  
S. D. Gupta ◽  
D. K. Mangal
Keyword(s):  
Systematic Review ◽  
Injury Severity ◽  
Road Traffic ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
Road Traffic Injuries ◽  
Middle Income Countries ◽  
Sub Saharan ◽  
Low And Middle Income

ABSTRACTBackgroundLow-and middle-income countries (LMICs) contribute about 93 per cent of road traffic injuries (RTIs) and deaths worldwide with a significant proportion of pedestrians (22 per cent). Various scales are used to assess the pattern of injury severity, which are useful in predicting the outcomes of RTIs. We conducted this systematic review to determine the pattern of RTI severity among pedestrians in LMICs.MethodsWe searched the electronic databases PubMed, CINHAL, CENTRAL, Web of Science, Scopus, EMBASE, ProQuest and SciELO, and examined the references of the selected studies. Original research articles published on the RTI severity among pedestrians in LMICs during 1997-2016 were eligible for this review. Quality of publications was assessed using an adapted Newcastle-Ottawa Scale of observational studies. Findings of this study were presented as a meta-summary.ResultsFive articles from 3 LMICs were eligible for the systematic review. Abbreviated Injury Score, Glasgow Coma Scale and Maxillofacial Injury Severity Score were used to assess the injury severity in the selected studies. In a multicentric study from China (2013), 21, 38 and 19 per cent pedestrians with head injuries had AIS scores 1-2, 3-4 and 5-6, respectively. In another study from China (2010), the proportion of AIS score 1-2 and AIS score 3 and above (serious to un-survivable) injuries occurred due to crash with sedan cars were 65 and 35 per cent, respectively. Such injuries due to minivan crashes were 49.5 per cent and 50.5 per cent, respectively. Two studies Ikeja, Nigeria (2014) and Elazig, Turkey (2009) presented, 24.5 and 32.5 per cent injured had a severe head injury (GCS < 8), respectively. In another study from Ibadan, Nigeria (2014), the severe maxillofacial injuries were seen in the victims of car/minibus pedestrian crashes 46 per cent, and 17 per cent had a fatal outcome.ConclusionA varied percent of pedestrians (24.5 to 57 percent) had road traffic injuries of serious to fatal nature, depending on type of collision and injury severity scale. This study pressed the need to conduct studies with a robust methodology on the pattern of RTI severity among pedestrians to guide the programme managers, researchers and policymakers in LMICs to formulate the policies and programmes to save the pedestrian lives.African relevancePrior RTI research reveals that pedestrians and cyclists were at the highest risk of fatality of in Sub-Saharan Africa, whereas motorcyclists had significantly higher fatality rates in Asian countries such as Malaysia and Thailand (1–3).Fifty-seven type of injury severity scoring systems have been developed to assess the injury severity for triage and timely decision making for patient treatment need, outcome prediction, quality of trauma care, and epidemiological research and evaluation (4,5).We found two studies from sub-Saharan Africa in this review which showed that severe pedestrian injuries ranged from 24.5 to 46 per cent of total pedestrian RTIs.Despite the findings of review affected by limited and variegated sample, it could be useful to guide for future research.

scholarly journals Economic burden of road traffic injuries in sub-Saharan Africa: a systematic review of existing literature

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e048231
Author(s):  
Marcella Farrelle Dorothea Ryan-Coker ◽  
Justine Davies ◽  
Giulia Rinaldi ◽  
Marie Hasselberg ◽  
Dennis H Marke ◽  
...  
Keyword(s):  
Systematic Review ◽  
Economic Burden ◽  
Road Traffic ◽  
Health Economic Evaluation ◽  
Sub Saharan Africa ◽  
World Bank Group ◽  
Road Traffic Injuries ◽  
Severity Of Injury ◽  
Sub Saharan

ObjectiveThis systematic review aims to explore and synthesise existing literature on the direct and indirect costs from road traffic injuries (RTIs) in sub-Saharan Africa (SSA), the quality of existing evidence, methods used to estimate and report these costs, and the factors that drive the costs.MethodologyMEDLINE, SCOPUS, ProQuest Central, Web of Science, Global Index Medicus, Embase, World Bank Group e-Library, Econlit, Google Scholar and WHO webpages were searched for relevant literature. References of selected papers were also examined for related articles. Screening was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were included in this review if they were published by March 2019, written in English, conducted in SSA and reported original findings on the cost of illness or economic burden of RTIs. The results were systematically examined, and the quality assessed by two reviewers using a modified Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.ResultsEleven studies met the inclusion criteria. RTIs can cost between INT$119 and 178 634 per injury and INT$486 and 12 845 per hospitalisation. Findings show variability in costing methods and inadequacies in the quality of existing evidence. Prolonged hospital stays, surgical sundries and severity of injury were the most common factors associated with cost.ConclusionWhile available data are limited, evidence shows that the economic burden of RTIs in SSA is high. Poor quality of existing evidence and heterogeneity in costing methods limit the generalisability of costs reported.

scholarly journals Are low and middle-income countries prioritising high-value healthcare interventions?

2020 ◽  
Vol 5 (2) ◽  
pp. e001850
Author(s):  
Ashley A Leech ◽  
David D Kim ◽  
Joshua T Cohen ◽  
Peter J Neumann
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
National Health ◽  
Sub Saharan Africa ◽  
Health Plans ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Priority ◽  
Sub Saharan ◽  
Low And Middle Income

IntroductionSince resources are finite, investing in services that produce the highest health gain ‘return on investment’ is critical. We assessed the extent to which low and middle-income countries (LMIC) have included cost-saving interventions in their national strategic health plans.MethodsWe used the Tufts Medical Center Global Health Cost-Effectiveness Analysis Registry, an open-source database of English-language cost-per-disability-adjusted life year (DALY) studies, to identify analyses published in the last 10 years (2008–2017) of cost-saving health interventions in LMICs. To assess whether countries prioritised cost-saving interventions within their latest national health strategic plans, we identified 10 countries, all in sub-Saharan Africa, with the highest measures on the global burden of disease scale and reviewed their national health priority plans.ResultsWe identified 392 studies (63%) targeting LMICs that reported 3315 cost-per-DALY ratios, of which 207 ratios (6%) represented interventions reported to be cost saving. Over half (53%) of these targeted sub-Saharan Africa. For the 10 countries we investigated in sub-Saharan Africa, 58% (79/137) of cost-saving interventions correspond with priorities identified in country plans. Alignment ranged from 95% (21/22 prioritised cost-saving ratios) in South Africa to 17% (2/12 prioritised cost-saving ratios) in Cameroon. Human papillomavirus vaccination was a noted priority in 70% (7/10) of national health prioritisation plans, while 40% (4/10) of countries explicitly included prenatal serological screening for syphilis. HIV prevention and treatment were stated priorities in most country health plans, whereas 40% (2/5) of countries principally outlined efforts for lymphatic filariasis. From our sample of 45 unique interventions, 36% of interventions (16/45) included costs associated directly with the implementation of the intervention.ConclusionOur findings indicate substantial variation across country and disease area in incorporating economic evidence into national health priority plans in a sample of sub-Saharan African countries. To make health economic data more salient, the authors of cost-effectiveness analyses must do more to reflect implementation costs and other factors that could limit healthcare delivery.

scholarly journals Psychological interventions for bipolar disorder in low- and middle-income countries: systematic review

BJPsych Open ◽  
2018 ◽  
Vol 4 (5) ◽  
pp. 375-384 ◽  
Author(s):  
Mekdes Demissie ◽  
Charlotte Hanlon ◽  
Rahel Birhane ◽  
Lauren Ng ◽  
Girmay Medhin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Bipolar Disorder ◽  
Low Income ◽  
Hospital Admissions ◽  
Psychological Interventions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

BackgroundAdjunctive psychological interventions for bipolar disorder have demonstrated better efficacy in preventing or delaying relapse and improving outcomes compared with pharmacotherapy alone.AimsTo evaluate the efficacy of psychological interventions for bipolar disorder in low- and middle-income countries.MethodA systematic review was conducted using PubMed, PsycINFO, Medline, EMBASE, Cochrane database for systematic review, Cochrane central register of controlled trials, Latin America and Caribbean Center on Health Science Literature and African Journals Online databases with no restriction of language or year of publication. Methodological heterogeneity of studies precluded meta-analysis.ResultsA total of 18 adjunctive studies were identified: psychoeducation (n = 14), family intervention (n = 1), group cognitive–behavioural therapy (CBT) (n = 2) and group mindfulness-based cognitive therapy (MBCT) (n = 1). In total, 16 of the 18 studies were from upper-middle-income countries and none from low-income countries. All used mental health specialists or experienced therapists to deliver the intervention. Most of the studies have moderately high risk of bias. Psychoeducation improved treatment adherence, knowledge of and attitudes towards bipolar disorder and quality of life, and led to decreased relapse rates and hospital admissions. Family psychoeducation prevented relapse, decreased hospital admissions and improved medication adherence. CBT reduced both depressive and manic symptoms. MBCT reduced emotional dysregulation.ConclusionsAdjunctive psychological interventions alongside pharmacotherapy appear to improve the clinical outcome and quality of life of people with bipolar disorder in middle-income countries. Further studies are required to investigate contextual adaptation and the role of non-specialists in the provision of psychological interventions to ensure scalability and the efficacy of these interventions in low-income country settings.Declaration of interestNone.

scholarly journals Who actually cares for children in slums? Why we need to think, and do, more about paid childcare in urbanizing sub-Saharan Africa

2021 ◽  
Vol 376 (1827) ◽  
Author(s):  
Robert C. Hughes ◽  
Patricia Kitsao-Wekulo ◽  
Ruth Muendo ◽  
Sunil S. Bhopal ◽  
Elizabeth Kimani-Murage ◽  
...  
Keyword(s):  
Public Health Practice ◽  
Developmental Trajectory ◽  
Early Years ◽  
Sub Saharan Africa ◽  
Maternal Child Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Sub Saharan ◽  
Low And Middle Income ◽  
Childcare Providers

The early years are critical and inform the developmental trajectory of children. This is justifiably attracting growing policy attention. Much of this attention is focused on interventions and policies directed at parents, especially mothers. Yet emerging evidence suggests that increasing numbers of children in rapidly urbanizing low- and middle-income countries are now spending much of their day with other formal and informal childcare providers, including largely unregulated paid childcare providers. This paper summarizes the limited literature about the use of such paid childcare in low- and middle-income countries in sub-Saharan Africa, before considering possible reasons behind the lack of research evidence. Finally, key research gaps and their implications for public health practice are explored, with reference to the ongoing British Academy funded Nairobi Early Childcare in Slums research programme in Nairobi, Kenya. We argue that improving childcare may be an under-explored strategy to help some of the world's most disadvantaged children in the most important period of their lives, and that interventions in this largely informal market should be built on a rigorous research base. This article is part of the theme issue ‘Multidisciplinary perspectives on social support and maternal–child health’.

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