scholarly journals Evaluation of research on interventions aligned to WHO ‘Best Buys’ for NCDs in low-income and lower-middle-income countries: a systematic review from 1990 to 2015

2018 ◽  
Vol 3 (1) ◽  
pp. e000535 ◽  
Author(s):  
Luke N Allen ◽  
Jessica Pullar ◽  
Kremlin Khamarj Wickramasinghe ◽  
Julianne Williams ◽  
Nia Roberts ◽  
...  
Keyword(s):  
Low Income ◽  
Controlled Trial ◽  
Cervical Screening ◽  
Cost Effective ◽  
Evidence Base ◽  
Good Evidence ◽  
Media Campaigns ◽  
Middle Income ◽  
Mortality And Morbidity ◽  
Middle Income Countries

BackgroundNon-communicable diseases (NCDs) are the leading cause of death and disability worldwide, with low-income and middle-income countries experiencing a disproportionately high burden. Since 2010 WHO has promoted 24 highly cost-effective interventions for NCDs, dubbed ‘best buys’. It is unclear whether these interventions have been evaluated in low-income and lower-middle-income countries (LLMICs).AimTo systematically review research on interventions aligned to WHO ‘best buys’ for NCDs in LLMICs.MethodsWe searched 13 major databases and included papers conducted in the 83 World Bank-defined LLMICs, published between 1 January 1990 and 5 February 2015. Two reviewers independently screened papers and assessed risk of bias. We adopted a narrative approach to data synthesis. The primary outcomes were NCD-related mortality and morbidity, and risk factor prevalence.ResultsWe identified 2672 records, of which 36 were included (608 940 participants). No studies on ‘best buys’ were found in 89% of LLMICs. Nineteen of the 36 studies reported on the effectiveness of tobacco-related ‘best buys’, presenting good evidence for group interventions in reducing tobacco use but weaker evidence for interventions targeting individuals. There were fewer studies on smoking bans, warning labels and mass media campaigns, and no studies on taxes or marketing restrictions. There was supportive evidence that cervical screening and hepatitis B immunisation prevent cancer in LLMICs. A single randomised controlled trial supported polypharmacy for cardiovascular disease. Fourteen of the ‘best buy’ interventions did not have any good evidence for effectiveness in LLMICs.ConclusionsWe found studies on only 11 of the 24 interventions aligned with the WHO ‘best buys’ from LLMIC settings. Most LLMICs have not conducted research on these interventions in their populations. LLMICs should take action to implement and evaluate ‘best buys’ in their national context, based on national priorities, and starting with interventions with the strongest evidence base.

scholarly journals Immunisation financing and programme performance in the Middle East and North Africa, 2010 to 2017

2019 ◽  
Vol 4 (2) ◽  
pp. e001248
Author(s):  
Helen Saxenian ◽  
Nahad Sadr-Azodi ◽  
Miloud Kaddar ◽  
Kamel Senouci
Keyword(s):  
Economic Growth ◽  
Middle East ◽  
North Africa ◽  
Low Income ◽  
Health Sector ◽  
Cost Effective ◽  
Middle Income ◽  
Middle Income Countries ◽  
Life Saving ◽  
Fiscal Space

Immunisation is a cornerstone to primary health care and is an exceptionally good value. The 14 low-income and middle-income countries in the Middle East and North Africa region make up 88% of the region’s population and 92% of its births. Many of these countries have maintained high immunisation coverage even during periods of low or negative economic growth. However, coverage has sharply deteriorated in countries directly impacted by conflict and political unrest. Approximately 1.3 million children were not completely vaccinated in 2017, as measured by third dose of diphtheria–pertussis–tetanus vaccine. Most of the countries have been slow to adopt the newer, more expensive life-saving vaccines mainly because of financial constraints and the socioeconomic context. Apart from the three countries that have had long-standing assistance from Gavi, the Vaccine Alliance, most countries have not benefited appreciably from donor and partner activities in supporting their health sector and in achieving their national and subnational immunisation targets. Looking forward, development partners will have an important role in helping reconstruct health systems in conflict-affected countries. They can also help with generating evidence and strategic advocacy for high-priority and cost-effective services, including immunisation. Governments and ministries of health would ensure important benefits to their populations by investing further in their immunisation programmes. Where possible, the health system can create and expand fiscal space from efficiency gains in harmonising vaccine procurement mechanisms and service integration; broader revenue generation from economic growth; and reallocation of government budgets to health, and from within health, to immunization.

scholarly journals Antiparasitic phytotherapy perspectives, scope and current development

Infectio ◽  
2019 ◽  
Vol 23 (2) ◽  
pp. 189 ◽  
Author(s):  
Jhon Carlos Castaño Osorio ◽  
Alejandra María Giraldo García
Keyword(s):  
Low Income ◽  
Public Health Problem ◽  
Cost Effective ◽  
Prolonged Treatment ◽  
Major Public Health Problem ◽  
Middle Income ◽  
Middle Income Countries ◽  
Commercial Markets ◽  
Health And Economic Development ◽  
New Treatments

Tropical protozoan diseases are currently a major public health problem throughout the world and are strongly linked with poverty, this combined with a lack of commercial markets for potential drugs has created a large burden on the health and economic development of low-income and middle-income countries in Africa, Asia, and the Americas. Due to the low research interest and the high increase of resistance against the existing treatments, as well as increasing inefficiency, toxicity, prolonged treatment schedules and costs, there is an urgent need for cost-effective, safe and easy-to-administer, new effective compounds with novel mechanisms of action. Several studies of crude plant extracts have already identified potential compounds to treat Chagas’ disease, Leishmaniasis, Toxoplasmosis, Giardiasis, and Malaria among other protozoan parasites. Natural compounds of medicinal plants have shown lower toxicity together with higher specificity, creating an optimistic view of new treatments for diseases. Out of 1010 new active substances approved as drugs for medical conditions by regulatory agencies during the past 25 years, 490(48.5%) were from a natural origin.

scholarly journals Cost and cost-effectiveness of a parenting programme to prevent violence against adolescents in South Africa

2019 ◽  
Vol 4 (3) ◽  
pp. e001147 ◽  
Author(s):  
Alice Redfern ◽  
Lucie D Cluver ◽  
Marisa Casale ◽  
Janina I Steinert
Keyword(s):  
South Africa ◽  
Cost Effectiveness ◽  
Low Income ◽  
Emotional Abuse ◽  
Controlled Trial ◽  
Cost Effective ◽  
Cluster Randomised Controlled Trial ◽  
Economic Benefits ◽  
Parenting Programme ◽  
Middle Income

IntroductionThis paper presents the costs and cost-effectiveness of ‘Parenting for Lifelong Health: Sinovuyo Teen’, a non-commercialised parenting programme aimed at preventing violence against adolescents in low-income and middle-income countries.MethodsThe effectiveness of Sinovuyo Teen was evaluated with a cluster randomised controlled trial in 40 villages and peri-urban townships in the Eastern Cape of South Africa from 2015 to 2016. The costs of implementation were calculated retrospectively and models of costs at scale estimated, from the perspective of the programme provider. Cost-effectiveness analysis considers both the cost per incident of abuse averted, and cost per disability-adjusted life year averted. Potential economic benefits from the societal perspective were estimated by developing a framework of possible savings.ResultsThe total implementation cost for Sinovuyo Teen over the duration of the trial was US$135 954, or US$504 per family enrolled. Among the 270 families in the treatment group, an estimated 73 incidents of physical and emotional abuse were averted (95% CI 29 to 118 incidents averted). During the trial, the total cost per incident of physical or emotional abuse averted was US$1837, which is likely to decrease to approximately US$972 if implemented at scale. By comparison, the economic benefits of averting abuse in South Africa are large with an estimated lifetime saving of US$2724 minimum per case.ConclusionParenting programmes are a cost-effective intervention to prevent the abuse of adolescents by their caregivers in South Africa, when compared with existing violence prevention programmes and cost-effectiveness thresholds based on GDP per capita.

Efetividade do Método Canguru em Relação à Redução da Mortalidade e Morbidade Neonatal

2018 ◽  
Vol 22 (3) ◽  
pp. 186
Author(s):  
Dayane Cristina Da Silva Santos ◽  
Mirian Dos Santos Pereira
Keyword(s):  
Low Income ◽  
Neonatal Morbidity ◽  
Neonatal Care ◽  
Morbidity And Mortality ◽  
Low Income Countries ◽  
Middle Income ◽  
Mortality And Morbidity ◽  
Premature Newborn ◽  
Middle Income Countries ◽  
Low Weight

O Método Mãe Canguru (MC) é destinado ao atendimento do recém-nascido prematuro de baixo peso, e visa fortalecer o vínculo mãe-filho, aumentar a competência e a confiança dos pais no cuidado do bebê e incentivar a prática da amamentação. O objetivo do estudo foi demonstrar as evidências que apontam o uso de Método Canguru (MC) como uma alternativa aos cuidados neonatais, enfocando seus benefícios e avaliando se o método reduz a morbidade e mortalidade em neonatos de baixo peso. Trata-se de uma pesquisa descritiva, realizada a partir de um levantamento bibliográfico nas bases de dados BDEnf, Lilacs, SciELO e BIREME, considerando o período de 2000 a 2016. Foram analisados artigos sobre o Método Canguru (MC) e a redução da morbimortalidade neonatal. O estudo evidenciou que o Método Mãe Canguru (MC) reduz as taxas tanto de mortalidade como morbidade neonatal, porém demonstrou que existem poucos estudos referentes a este tema. O Método Mãe Canguru (MC) demonstrou ser mais que uma alternativa para países de baixa renda, nos quais faltam incubadoras ou salas de atendimento neonatal, constituindo-se, também, uma estratégia com múltiplas vantagens para o recém-nascido, tanto o prematuro quanto o nascido a termo. Destacou-se a eficácia do método na diminuição da morbimortalidade do neonato com baixo peso. Os estudos sobre mortalidade e morbidade do Método Mãe-Canguru (MC), em países de baixa e média renda, concluíram que o Método Mãe Canguru (MC) reduz, substancialmente, a mortalidade neonatal em bebês nascidos antes do termo com baixo peso em hospitais. Palavras-chave: Morbimortalidade Neonatal. Método Canguru. Recém-Nascido de Baixo Peso. Abstract: The Kangaroo Mother Method is intended for the care of the low weight premature newborn and aims to strengthen the mother-child bond, increase the parents’ competence and trust in the baby care and encourage the breastfeeding practice. The objective was  demonstrating the evidence supporting the use of KMM as an alternative to neonatal care, focusing on its benefits and evaluating whether the method reduces morbidity and mortality in low weight premature newborn. This is a descriptive research, based on a bibliographic survey in the databases BDEnf, Lilacs, SciELO and BIREME, considering the period from 2000 to 2016.  Articles were analyzed on the Kangaroo Method and the reduction of neonatal morbidity and mortality, the study showed that the Kangaroo Mother Method reduces the rates of both mortality and neonatal morbidity, but has shown that there are few studies related to this topic. The Kangaroo Mother Method has proven to be more than an alternative for low-income countries, where incubators or neonatal care rooms are lacking. It is also a strategy with multiple advantages for the newborn, both premature and full-term. The method efficacy in reducing neonatal morbidity and mortality and low weight was emphasized. Mortality and morbidity studies of the Kangaroo Method in low- and middle-income countries have concluded that the Kangaroo Mother Method substantially reduces neonatal mortality in preterm infants in hospitals and underweight. Keywords: Morbidity and Mortality Neonatal. Kangaroo Method. Low Birth Newborn. 

scholarly journals Acquired heart disease in low-income and middle-income countries

2017 ◽  
Vol 103 (1) ◽  
pp. 73-77 ◽  
Author(s):  
Chris Curry ◽  
Liesl Zuhlke ◽  
Ana Mocumbi ◽  
Neil Kennedy
Keyword(s):  
Heart Disease ◽  
Low Income ◽  
Burden Of Illness ◽  
Sub Saharan Africa ◽  
Endomyocardial Fibrosis ◽  
Middle Income ◽  
Mortality And Morbidity ◽  
Middle Income Countries ◽  
Acquired Heart Disease ◽  
Sub Saharan

The burden of illness associated with acquired cardiac disease in children in low-income and middle-income countries (LMIC) is significant and may be equivalent to that of congenital heart disease. Rheumatic heart disease, endomyocardial fibrosis, cardiomyopathy (including HIV cardiomyopathy) and tuberculosis are the most important causes. All are associated with poverty with the neediest children having the least access to care. The associated mortality and morbidity is high. There is an urgent need to improve cardiac care in LMIC, particularly in sub-Saharan Africa and parts of Southeast Asia where the burden is highest.

scholarly journals I keep looking at what I’m doing to my organs: Samoans’ responses to adapted anti-tobacco television advertisements

2020 ◽  
Author(s):  
Elaine Umali ◽  
Helen Tanielu ◽  
Robyn Whittaker ◽  
Cam Sugden ◽  
Judith McCool
Keyword(s):  
Pacific Islands ◽  
Cost Effective ◽  
Preliminary Evidence ◽  
Internal Organs ◽  
Media Campaigns ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Family ◽  
Television Advertisements ◽  
Promote Smoking Cessation

Abstract Background There has been an increase of adapted tobacco control media campaigns in low and middle countries. Adapting existing material offers many benefits especially to countries with limited resources. We adapted three television advertisements for the Tu’u Nei Loa Le Ulaula Tapa’a (Stop Smoking Now) campaign in Samoa. Adaption included rigorous efforts to ensure advertisements were culturally appropriate. Methods To determine audiences’ perception and perceived efficacy of anti-tobacco television advertisements to promote smoking cessation, we conducted eight talanoa , a Pacific Islands research methodology, among 54 smokers and non-smokers in Apia, Samoa. The talonoa were transcribed, translated and thematically coded. Results Qualitative results suggest that the advertisements raised the awareness of the participants on the negative health impacts of tobacco use, especially to the internal organs. Graphic, and emotionally evocative advertisements, especially those that impact on the family, have greater potential to motivate Samoans to quit.Conclusion Study findings provide preliminary evidence that adapting advertisements may offer a cost-effective strategy to reduce smoking rates for low- and middle-income countries to use existing campaigns that have been proven effective in other countries.

The Future of Telemedicine in Europe and Methods for the Evaluation of Health Services

2012 ◽  
Vol 1 (3) ◽  
pp. 20-26 ◽  
Author(s):  
Paola Di Giacomo
Keyword(s):  
Low Income ◽  
New Technologies ◽  
Controlled Trial ◽  
Evaluation Methods ◽  
Low Income Countries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Randomized Controlled ◽  
Analytical Work ◽  
The One

Despite the accumulation of evidence for the effects of approaches to chronic illness, methodological and analytical work is still needed to develop widely accepted evaluation methods that are scientifically sound and also practicable in routine settings. Given all the diversity and variability of disease management, a key issue for this work concerns the difficulties in establishing a useful “comparator” in settings where it is not practical or possible to execute an evaluation as a randomized controlled trial (RCT). This is indeed an important task because evaluation methods are a precondition to select efficient and effective programs, or components within a program that can address the growing burden of chronic and more in general health conditions. This is evident, in particular, when it comes to new technologies in medicine and implementation and evaluation, in the healthcare sectors, distinguishing low-income countries, on the one-hand, and those in other middle income countries.

scholarly journals Protocol for process evaluation of CIVIC randomised controlled trial: Community-based InterVentions to prevent serIous Complications following spinal cord injury in Bangladesh

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e024226 ◽  
Author(s):  
Mohammad Sohrab Hossain ◽  
Lisa A Harvey ◽  
Hueiming Liu ◽  
Md. Shofiqul Islam ◽  
Md. Akhlasur Rahman ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Process Evaluation ◽  
Low Income ◽  
Quantitative Data ◽  
Healthcare Professionals ◽  
Controlled Trial ◽  
Ethics Committee ◽  
Middle Income ◽  
Middle Income Countries ◽  
Randomised Controlled

IntroductionPeople with spinal cord injuries in low-income and middle-income countries are highly vulnerable to life-threatening complications in the period immediately after discharge from hospital. We are conducting a randomised controlled trial in Bangladesh to determine whether all-cause mortality at 2 years can be reduced if health professionals regularly ring and visit participants in their homes following discharge. We will conduct a process evaluation alongside the trial to explain the trial results and determine the feasibility of scaling this intervention up in low-income and middle-income countries if it is found to be effective.Methods and analysisOur process evaluation is based on the Realist and Reach, Effectiveness, Adoption, Implementation and Maintenance frameworks. We will use a mixed methods approach that uses both qualitative and quantitative data. For example, we will audit a sample of telephone interactions between intervention participants and the healthcare professionals, and we will conduct semistructured interviews with people reflective of various interest groups. Quantitative data will also be collected to determine the number and length of interactions between the healthcare professionals and participants, the types of issues identified during each interaction and the nature of the support and advice provided by the healthcare professionals. All quantitative and qualitative data will be analysed iteratively before the final analysis of the trial results. These data will then be triangulated with the final results of the primary outcome.Ethics and disseminationEthics approval was obtained from the institutional ethics committee at the site in Bangladesh and from the University of Sydney, Australia. The study will be conducted in compliance with all stipulations of its protocol, the conditions of ethics committee approval and the relevant regulatory bodies. The results of the trial will be disseminated through publications in peer-reviewed scientific journals and presentations at scientific conferences.Trial registration numberACTRN12615000630516.

Advocacy in dementia

2019 ◽  
pp. 291-302
Author(s):  
Gorazd B. Stokin
Keyword(s):  
Cost Effective ◽  
Dementia Care ◽  
World Health ◽  
Political Systems ◽  
Media Campaigns ◽  
Middle Income ◽  
Global Epidemic ◽  
Effective Strategies ◽  
Middle Income Countries ◽  
Health Organization

Advocacy in dementia can be defined best as the act or process by an individual or a group influencing or otherwise supporting within social, health, economic, and political systems and organizations better dementia care at large. Dementia advocacy encompasses many activities including among others public speaking and media campaigns, sharing knowledge and experiences, providing resources including funding, establishing groups and organizations, developing and presenting guidelines, criteria, programmes, strategies, and policies and consulting regional, national, and international decision-makers to promote, support, and otherwise further dementia care. Recently, the World Health Organization recognized dementia as a global epidemic with the majority of people afflicted by dementia originating from low- to middle-income countries where access to dementia care is limited or absent. Indeed, there is an urgent need to develop cost-effective strategies to deliver sufficient and efficient dementia care as well as to optimize needed resources including finances. This need can only be fulfilled with diligent advocacy, which initially played a crucial role in defining the modern notion of dementia and more recently propelled dementia to the centre stage of healthcare priorities across the globe.

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