Building capacity in evidence-based medicine in low-income and middle-income countries: problems and potential solutions

BackgroundPreterm birth is the leading cause of under-five-mortality worldwide, with the highest burden in low-income and middle-income countries (LMICs). The aim of this study was to synthesise evidence-based interventions for preterm and low birthweight (LBW) neonates in LMICs, their associated neonatal mortality rate (NMR), and barriers and facilitators to their implementation. This study updates all existing evidence on this topic and reviews evidence on interventions that have not been previously considered in current WHO recommendations.MethodsSix electronic databases were searched until 3 March 2020 for randomised controlled trials reporting NMR of preterm and/or LBW newborns following any intervention in LMICs. Risk ratios for mortality outcomes were pooled where appropriate using a random effects model (PROSPERO registration number: CRD42019139267).Results1236 studies were identified, of which 49 were narratively synthesised and 9 contributed to the meta-analysis. The studies included 39 interventions in 21 countries with 46 993 participants. High-quality evidence suggested significant reduction of NMR following antenatal corticosteroids (Pakistan risk ratio (RR) 0.89; 95% CI 0.80 to 0.99|Guatemala 0.74; 0.68 to 0.81), single cord (0.65; 0.50 to 0.86) and skin cleansing with chlorhexidine (0.72; 0.55 to 0.95), early BCG vaccine (0.64; 0.48 to 0.86; I2 0%), community kangaroo mother care (OR 0.73; 0.55 to 0.97; I2 0%) and home-based newborn care (preterm 0.25; 0.14 to 0.48|LBW 0.42; 0.27 to 0.65). No effects on perinatal (essential newborn care 1.02; 0.91 to 1.14|neonatal resuscitation 0.95; 0.84 to 1.07) or 7-day NMR (essential newborn care 1.03; 0.83 to 1.27|neonatal resuscitation 0.92; 0.77 to 1.09) were observed after training birth attendants.ConclusionThe findings of this study encourage the implementation of additional, evidence-based interventions in the current (WHO) guidelines and to be selective in usage of antenatal corticosteroids, to reduce mortality among preterm and LBW neonates in LMICs. Given the global commitment to end all preventable neonatal deaths by 2030, continuous evaluation and improvement of the current guidelines should be a priority on the agenda.

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How Poor Are People With Disabilities? Evidence Based on the Global Multidimensional Poverty Index

Journal of Disability Policy Studies ◽

10.1177/1044207320919942 ◽

2020 ◽

pp. 104420732091994 ◽

Cited By ~ 1

Author(s):

Monica Pinilla-Roncancio ◽

Sabina Alkire

Keyword(s):

Low Income ◽

People With Disabilities ◽

Multidimensional Poverty ◽

Low Income Countries ◽

High Risk Population ◽

Evidence Based ◽

Poverty Index ◽

Middle Income ◽

Multidimensional Poverty Index ◽

Middle Income Countries

People with disabilities and their families have been recognized as a high-risk population for poverty. Although the number of studies analyzing the levels of poverty of this group has increased, there is still a lack of empirical evidence that establishes whether and how people with disabilities are significantly poorer than families with no disabled members. This study analyses the levels of multidimensional poverty of people living in households with members with disabilities in 11 low- and middle-income countries in different regions of the world, using the global Multidimensional Poverty Index (MPI). The results reveal that in five of the 11 countries people living in households with disabled members face higher levels of multidimensional poverty compared with people without disabilities. In addition, we found that differences between the levels of poverty were larger in middle-income countries than in low-income countries, revealing the existence of a development disability gap.

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Africa is not a museum: the ethics of encouraging new parenting practices in rural communities in low-income and middle-income countries

BMJ Global Health ◽

10.1136/bmjgh-2021-006218 ◽

2021 ◽

Vol 6 (7) ◽

pp. e006218

Author(s):

Ann M Weber ◽

Yatma Diop ◽

Diane Gillespie ◽

Lisy Ratsifandrihamanana ◽

Gary L Darmstadt

Keyword(s):

Rural Communities ◽

Low Income ◽

Parenting Practices ◽

Early Childhood Development ◽

Childhood Development ◽

Evidence Based ◽

Middle Income ◽

Developmental Potential ◽

Parental Practices ◽

Middle Income Countries

The Nurturing Care Framework for Early Childhood Development urges stakeholders to implement strategies that help children worldwide achieve their developmental potential. Related programmes range from the WHO’s and UNICEF’s Care for Child Development intervention, implemented in 19 countries, to locally developed programmes, such as non-governmental organisation Tostan’s Reinforcement of Parental Practices in Senegal. However, some researchers argue that these programmes are unethical as they impose caregiving practices and values from high-income countries (HICs) on low-income communities, failing to consider local culture, communities’ goals for their children and generalisability of scientific findings from HICs. We explore these criticisms within a public health framework, applying principles of beneficence, autonomy and justice to the arguments. To facilitate the change communities themselves desire for their children, we recommend that practitioners codevelop programmes and cooperate with communities in implementation to harness local beliefs and customs and promote evidence-based and locally adapted practices.

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Evidence-based mental health care and implementation science in low- and middle-income countries

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796012000261 ◽

2012 ◽

Vol 21 (3) ◽

pp. 241-244 ◽

Cited By ~ 21

Author(s):

G. Thornicroft

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Implementation Science ◽

Low Income ◽

Routine Practice ◽

Evidence Based ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

Although the evidence base for what to do about the mental health gap in low- and middle-income countries (LAMICs) has improved significantly over the last decade, mental health care in LAMICs still provide services to only a small minority of people with mental disorders. The problem is how to translate the relevant body of scientific knowledge into routine practice. It is clear from over two decades of research that the creation of evidence-based guidelines is necessary but not sufficient for evidence-based practice, whether in high- or low-income settings. In this Editorial, I discuss whether the recent development of ‘implementation science’ may offer an opportunity towards effective guideline implementation in low- and medium-income settings, so that clinical practice is more often based on evidence that does lead to patient benefit.

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