Interventions to improve water supply and quality, sanitation and handwashing facilities in healthcare facilities, and their effect on healthcare-associated infections in low-income and middle-income countries: a systematic review and supplementary scoping review

IntroductionHealthcare-associated infections (HCAIs) are the most frequent adverse event compromising patient safety globally. Patients in healthcare facilities (HCFs) in low-income and middle-income countries (LMICs) are most at risk. Although water, sanitation and hygiene (WASH) interventions are likely important for the prevention of HCAIs, there have been no systematic reviews to date.MethodsAs per our prepublished protocol, we systematically searched academic databases, trial registers, WHO databases, grey literature resources and conference abstracts to identify studies assessing the impact of HCF WASH services and practices on HCAIs in LMICs. In parallel, we undertook a supplementary scoping review including less rigorous study designs to develop a conceptual framework for how WASH can impact HCAIs and to identify key literature gaps.ResultsOnly three studies were included in the systematic review. All assessed hygiene interventions and included: a cluster-randomised controlled trial, a cohort study, and a matched case-control study. All reported a reduction in HCAIs, but all were considered at medium-high risk of bias. The additional 27 before-after studies included in our scoping review all focused on hygiene interventions, none assessed improvements to water quantity, quality or sanitation facilities. 26 of the studies reported a reduction in at least one HCAI. Our scoping review identified multiple mechanisms by which WASH can influence HCAI and highlighted a number of important research gaps.ConclusionsAlthough there is a dearth of evidence for the effect of WASH in HCFs, the studies of hygiene interventions were consistently protective against HCAIs in LMICs. Additional and higher quality research is urgently needed to fill this gap to understand how WASH services in HCFs can support broader efforts to reduce HCAIs in LMICs.PROSPERO registration numberCRD42017080943.

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Theory of change for the delivery of talking therapies by lay workers to survivors of humanitarian crises in low-income and middle-income countries: protocol of a systematic review

BMJ Open ◽

10.1136/bmjopen-2017-018193 ◽

2018 ◽

Vol 8 (2) ◽

pp. e018193 ◽

Cited By ~ 2

Author(s):

Grace Kathryn Ryan ◽

Andreas Bauer ◽

Judith K Bass ◽

Julian Eaton

Keyword(s):

Mental Health ◽

Systematic Review ◽

Low Income ◽

Tertiary Education ◽

Grey Literature ◽

Theory Of Change ◽

Cochrane Library ◽

Middle Income ◽

Middle Income Countries ◽

Humanitarian Crises

IntroductionThere is a severe shortage of specialist mental healthcare providers in low-income and middle-income countries (LMICs) affected by humanitarian crises. In these settings, talking therapies may be delivered by non-specialists, including lay workers with no tertiary education or formal certification in mental health. This systematic review will synthesise the literature on the implementation and effectiveness of talking therapies delivered by lay workers in LMICs affected by humanitarian crises, in order to develop a Theory of Change (ToC).Methods and analysisQualitative, quantitative and mixed-methods studies assessing the implementation or effectiveness of lay-delivered talking therapies for common mental disorders provided to adult survivors of humanitarian crises in LMICs will be eligible for inclusion. Studies set in high-income countries will be excluded. No restrictions will be applied to language or year of publication. Unpublished studies will be excluded. Seven electronic databases will be searched: MEDLINE, Embase, PsycINFO, PsycEXTRA, Global Health, Cochrane Library and ClinicalTrials.gov. Contents pages of three peer-reviewed journals will be hand-searched. Sources of grey literature will include resource directories of two online mental health networks (MHPSS.net and MHInnovation.net) and expert consultation. Forward and backward citation searches of included studies will be performed. Two reviewers will independently screen studies for inclusion, extract data and assess study quality. A narrative synthesis will be conducted, following established guidelines. A ToC map will be amended iteratively to take into account the review results and guide the synthesis.Ethics and disseminationFindings will be presented in a manuscript for publication in a peer-reviewed journal and disseminated through a coordinated communications strategy targeting knowledge generators, enablers and users.PROSPERO registration numberCRD42017058287.

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Health of transgender men in low-income and middle-income countries: a scoping review

BMJ Global Health ◽

10.1136/bmjgh-2020-003471 ◽

2020 ◽

Vol 5 (11) ◽

pp. e003471

Author(s):

Ayden Scheim ◽

Vibhuti Kacholia ◽

Carmen Logie ◽

Venkatesan Chakrapani ◽

Ketki Ranade ◽

...

Keyword(s):

Scoping Review ◽

Low Income ◽

Grey Literature ◽

Men’S Health ◽

Men's Health ◽

Middle Income ◽

Middle Income Countries ◽

Trans Men ◽

Gender Based ◽

And Gender

IntroductionDespite the rapid growth of research on transgender (trans) health globally, the extent of research on trans men and other transmasculine persons assigned the female sex at birth remains unclear. We, therefore, conducted a scoping review on trans men’s health in low-income and middle-income countries (LMICs).MethodsThe review included peer-reviewed articles and conference abstracts, and grey literature published from 1 January 1999 to 5 July 2019 in English, French, Hindi or Spanish and reporting original quantitative and/or qualitative data on the health of trans men or transmasculine persons living in LMIC. Studies were excluded if they did not disaggregate data for trans men or if they only described surgical techniques or laboratory values.ResultsWe included 53 studies (42 peer-reviewed and 11 grey literature) from 19 LMIC. Most were conducted in higher-middle-income countries (n=12) and in Latin America (n=16, 30.2%), the Middle East (n=14, 26.4%) or Sub-Saharan Africa (n=12, 22.6%) and published in 2014 or later (n=44, 83.0%). Approximately half of studies used quantitative methods (52.8%, n=28), of which 64.3% (n=18) had fewer than 50 participants and 14.2% (n=4) had over 150. Across study designs, social determinants of health and gender-affirming care were the most commonly represented domains (49.1% and 47.1% of studies respectively), with common themes including gender-based violence, coercion and discrimination as well as unprescribed hormone use. Other domains represented included mental health (32.1%), sexual and reproductive health (24.5%), general healthcare access (18.9%), physical health (9.4%) and substance use (9.4%).ConclusionGreater inclusion and disaggregation of trans men and transmasculine persons in global health research is needed to support sex- and gender-based analyses of trans health. Community-based research approaches and theoretically driven research may help to increase the relevance and rigour of such research. Funders should invest in research on trans men’s health in LMIC.

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Barriers to the implementation of sexual and reproductive health education programmes in low-income and middle-income countries: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2019-030814 ◽

2019 ◽

Vol 9 (10) ◽

pp. e030814

Author(s):

Moreblessing Chipo Mashora ◽

Tafadzwa Dzinamarira ◽

Claude Mambo Muvunyi

Keyword(s):

Health Education ◽

Reproductive Health ◽

Scoping Review ◽

Low Income ◽

Sexual And Reproductive Health ◽

Emotional Health ◽

Grey Literature ◽

Middle Income ◽

Middle Income Countries ◽

Effective Implementation

IntroductionHealth education programmes (HEPs) have been associated with a number of benefits. These include providing individuals with information on matters related to their mental, social, physical as well as emotional health. HEPs also play a major role in preventing diseases and reducing the level of engagement of individuals in risky behaviours. While this is the case, there are barriers to the effective implementation of HEPs, especially in low-income and middle-income countries (LMICs) where resources are scarce. Available evidence has revealed socioeconomic challenges ranging from literacy issues, discomfort about issues of sexuality, and cultural barriers to financial constraints as key barriers to the implementation of sexual and reproductive health HEPs in LMICs. We will focus on HEPs related to sexual and reproductive health; all age groups will be considered with no restrictions on geographical setting nor model of HEP delivery. This review will map literature on the barriers to the effective implementation of HEPs in LMICs to guide future implementation research.MethodsArksey and O’Malley’s 2005 scoping methodological framework will act as the guide for this review. We will search the following electronic databases: EBSCOhost (Academic search complete, PsycINFO, Health Sources, CINAHL and MEDLINE with full text), Google Scholar, PubMed, SCOPUS, Science Direct and Web of Science. Grey literature from Mount Kenya University theses and dissertations, governments’ as well as international organisations’ reports, such as WHO, and reference lists of included studies will be searched for eligible studies. We will limit our search to publications from 1 January 2000 to 30 September 2019. Using thematic content analysis, we will employ NVivo V.12 to extract the relevant outcomes from the included articles. We will conduct a quality appraisal of the included articles using the mixed methods appraisal tool (MMAT) version 2018.Ethics and disseminationNo ethical approval is needed for the study as it will not include animal nor human participants. The results of the proposed scoping review will be disseminated electronically, in print and through conference presentation as well as at key stakeholder meetings.

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Evidence on Pulmonary Rehabilitation and the Challenges Faced in Low- and Middle-Income Countries: A Systematic Qualitative Review

10.21203/rs.3.rs-1086429/v1 ◽

2021 ◽

Author(s):

Rebecca Farah ◽

Wim Groot ◽

Milena Pavlova

Keyword(s):

Systematic Review ◽

Health Outcomes ◽

Low Income ◽

Pulmonary Rehabilitation ◽

Grey Literature ◽

Individual Characteristics ◽

Middle Income ◽

Middle Income Countries ◽

Rehabilitation Programs ◽

Low Middle Income Countries

Abstract Background In low-income countries (LIC) and low-middle-income countries (LMIC), the burden of chronic obstructive pulmonary disease (COPD) has increased due to the lack of prevention and the presence of barriers to enter rehabilitation programs. The aim of this systematic review is to analyze the evidence on pulmonary rehabilitation (PR) in LIC and LMIC. Methods A systematic literature review was conducted. Four electronic databases were searched for qualitative and quantitative studies that documented the presence of PR in LIC and LMIC. We report our findings following the Prisma guidelines. In addition, grey literature was also searched. Articles not in English, presenting a point of view and/or not treating an adult population (< 18 years old) were excluded from the review. Data were extracted by one reviewer and synthesized in the form of tables. Tables present individual characteristics of the PR reported within countries, including country of origin, study design, population attending, intervention (kind of program setting), frequency and duration of a program established (if available), with health outcomes. The PICO framework was used for every country with reported PR to assess population, intervention, comparison and outcomes found. This systematic review is registered on Prospero: CRD42020141655. Results In total, 47 publications were included in the review. In LIC, PR for HIV-infected patients was most frequently reported, while in LMIC, PR for COPD patients was most frequent. Duration and frequency of treatments reported were also different in LIC and LMIC. Health outcomes on cardiopulmonary function were established in all publications. Results found that the implementation of PR in LMIC is ongoing. The most important barriers to access are the lack of funds and know-how among professional healthcare givers. Conclusion Findings suggest that the literature on PR is scarce in LIC and LMIC. Structured or non-structured rehabilitation programs for patients suffering from COPD, HIV and Tuberculosis, are infrequently available. Strategic policy initiatives to diminish barriers and challenges are needed to implement more PR programs in LIC and LMIC.

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Exploring experiences of infertility amongst women and men in low-income and middle-income countries: protocol for a qualitative systematic review

BMJ Open ◽

10.1136/bmjopen-2021-050528 ◽

2021 ◽

Vol 11 (11) ◽

pp. e050528

Author(s):

Pooja Sripad ◽

Sapna Desai ◽

Ricardo Regules ◽

Suchandrima Chakraborty ◽

Helen Habib ◽

...

Keyword(s):

Systematic Review ◽

Low Income ◽

Human Subjects ◽

Grey Literature ◽

Public Health Issue ◽

Global Public Health ◽

Related Factors ◽

Middle Income ◽

Middle Income Countries ◽

Qualitative Evidence

IntroductionInfertility is increasingly recognised as a global public health issue for women and men that merits further investigation to support policy and programming. While research in high-income settings has examined the consequences of infertility and access to services, there has been limited synthesis of how individuals experience infertility in low-income and middle-income countries (LMICs). This protocol describes a systematic review that will synthesise qualitative evidence on experiences of infertility among women and men in LMICs.Methods and analysisThe review will follow the Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) guidelines for reporting on qualitative evidence syntheses. The study team will search for published literature in PubMed, CINAHL and Scopus and PsycINFO databases and review available grey literature. Using Covidence software, two independent reviewers will conduct title and abstract screening based on inclusion and exclusion criteria, followed by full-text reviews and extraction by a larger team. Quality will be appraised using an adapted version of the Critical Appraisal Skills Programme guidelines. We will conduct thematic synthesis to characterise individual experiences and related factors at the individual, interpersonal, community and health system levels. We will develop a conceptual framework to describe evidence on experiences of infertility in LMICs and to help inform interventions across settings.Ethics and disseminationThis protocol has been internally approved as exempt by the Institutional Review Board of the Population Council, as it does not involve contact with human subjects or personally identifying data. Results of the review will be published in a peer-reviewed journal and will be used to inform future infertility research and programming in LMICs.PROSPERO registration numberCRD42021227742.

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Health actor approaches to financing universal coverage strategies for pneumococcal and rotavirus immunisation programmes in low-income and middle-income countries: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2021-052381 ◽

2021 ◽

Vol 11 (12) ◽

pp. e052381

Author(s):

Oluwasegun Jko Ogundele ◽

Shaza Fadel ◽

Paula Braitstein ◽

Erica Di Ruggiero

Keyword(s):

Scoping Review ◽

Low Income ◽

Implementation Research ◽

Grey Literature ◽

Universal Coverage ◽

Review Literature ◽

Middle Income ◽

Middle Income Countries ◽

Rotavirus Vaccines ◽

Sustainable Financing

IntroductionSustainable financing of immunisation programmes is an important step towards universal coverage of life-saving vaccines. Yet, financing mechanisms for health programmes could have consequences on the design of universal approaches to immunisation coverage. Effective implementation of immunisation interventions necessitates investigating the roles of institutions and power on interventions. This review aims to understand how sustainable financing and equitable immunisation are conceptualised by health actors like Gavi, and government-related entities across low-income and middle-income countries (LMICs) and how financing mechanisms can affect universal coverage of vaccines.Methods and analysisThis study protocol outline a scoping review of the peer-reviewed and the grey literature, using established methodological framework for scoping review. Literature will be identified through a comprehensive search of multiple databases and grey literature. All peer-reviewed implementation research studies from the year 2002 addressing financing and universal coverage of immunisation programmes for the pneumococcal conjugated vaccine and rotavirus vaccines immunisation interventions will be included and grey literature published in/after the year 2015. For the study scope, population, concept and context are defined: Population as international and national health stakeholders financing immunisation programmes; Concept as implementation research on pneumococcal conjugate and rotavirus vaccination interventions; and Context as LMICs. Findings will be quantitatively summarised to provide an overview and narratively synthesised and analysed. Studies that do not use implementation research approaches, frameworks or models will be excluded.Ethics and disseminationEthics approval is not required for this scoping review. Findings and recommendations will be presented to implementation researchers and health stakeholders.

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Interventions to improve district-level routine health data in low-income and middle-income countries: a systematic review

BMJ Global Health ◽

10.1136/bmjgh-2020-004223 ◽

2021 ◽

Vol 6 (6) ◽

pp. e004223

Author(s):

Jieun Lee ◽

Caroline A Lynch ◽

Lauren Oliveira Hashiguchi ◽

Robert W Snow ◽

Naomi D Herz ◽

...

Keyword(s):

Systematic Review ◽

Data Quality ◽

Health System ◽

Low Income ◽

Controlled Trial ◽

Grey Literature ◽

Health Data ◽

Post Intervention ◽

Middle Income ◽

Middle Income Countries

BackgroundRoutine health information system(s) (RHIS) facilitate the collection of health data at all levels of the health system allowing estimates of disease prevalence, treatment and preventive intervention coverage, and risk factors to guide disease control strategies. This core health system pillar remains underdeveloped in many low-income and middle-income countries. Efforts to improve RHIS data coverage, quality and timeliness were launched over 10 years ago.MethodsA systematic review was performed across 12 databases and literature search engines for both peer-reviewed articles and grey literature reports on RHIS interventions. Studies were analysed in three stages: (1) categorisation of RHIS intervention components and processes; (2) comparison of intervention component effectiveness and (3) whether the post-intervention outcome improved above the WHO integrated disease surveillance response framework data quality standard of 80% or above.Results5294 references were screened, resulting in 56 studies. Three key performance determinants—technical, organisational and behavioural—were proposed as critical to RHIS strengthening. Seventy-seven per cent [77%] of studies identified addressed all three determinants. The most frequently implemented intervention components were ‘providing training’ and ‘using an electronic health management information systems’. Ninety-three per cent [93%] of pre–post or controlled trial studies showed improvements in one or more data quality outputs, but after applying a standard threshold of >80% post-intervention, this number reduced to 68%. There was an observed benefit of multi-component interventions that either conducted data quality training or that addressed improvement across multiple processes and determinants of RHIS.ConclusionHolistic data quality interventions that address multiple determinants should be continuously practised for strengthening RHIS. Studies with clearly defined and pragmatic outcomes are required for future RHIS improvement interventions. These should be accompanied by qualitative studies and cost analyses to understand which investments are needed to sustain high-quality RHIS in low-income and middle-income countries.

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Exploration of recovery of people living with severe mental illness (SMI) in low-income and middle-income countries (LMIC): a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2019-032912 ◽

2020 ◽

Vol 10 (2) ◽

pp. e032912 ◽

Cited By ~ 1

Author(s):

Fadia Gamieldien ◽

Roshan Galvaan ◽

Bronwyn Myers ◽

Katherine Sorsdahl

Keyword(s):

Mental Illness ◽

Severe Mental Illness ◽

Latin American ◽

Scoping Review ◽

Low Income ◽

Qualitative Content Analysis ◽

Grey Literature ◽

Mental Health Policy ◽

Middle Income ◽

Middle Income Countries

IntroductionThe construct of recovery was conceptualised in high-income countries and its applicability in low-income and middle- income countries is underexplored. A scoping review is proposed to synthesise knowledge, review conceptual overlap and map key elements of recovery from severe mental illness in low-income and middle-income countries. We aim to appraise the literature so as to inform future recovery-oriented services that consider the cultural and contextual influences on recovery from severe mental illness.Methods and analysisThe following electronic databases: MEDLINE via PubMed, SCOPUS (which included contents of Embase), PsycINFO, CINAHL, Africa-Wide Information, PsycARTICLES, Health source: Nursing/Academic Edition, Academic Search Premier and SocINDEX all via the EBSCOHOST platform, the Latin American and Caribbean Health Sciences Literature, the Cochrane Centre Register of Controlled Trials) and grey literature sources will be searched between May and December 2019. Eligible studies will be independently screened for inclusion and exclusion by two reviewers using a checklist developed for this purpose. Studies published between January 1993 and November 2019 that focus on recovery from severe mental illness in a low-income and middle-income country will be included. Findings will be compared and discrepancies will be discussed. Unresolved discrepancies will be referred to a third reviewer. All bibliographic data and study characteristics will be extracted and thematically analysed using a tool developed through an iterative process by the research team. Indicators will be classified according to a predefined conceptual framework and categorised and described using qualitative content analysis.Ethics and disseminationThe review aims to synthesise information from available publications, hence it does not require ethical approval. The results will be disseminated through publications, conference presentations and future workshops with stakeholders involved within the recovery paradigm of mental health policy and practice. The scoping review title is registered with the Joanna Briggs Institute.

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Timing of Pubertal Milestones in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Advances in Nutrition ◽

10.1093/advances/nmaa007 ◽

2020 ◽

Vol 11 (4) ◽

pp. 951-959 ◽

Cited By ~ 3

Author(s):

Jenna L Moodie ◽

Susan C Campisi ◽

Kristen Salena ◽

Megan Wheatley ◽

Ashley Vandermorris ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Grey Literature ◽

Tanner Stage ◽

High Income ◽

Age At Menarche ◽

Middle Income ◽

Middle Income Countries ◽

The Impact ◽

Low And Middle Income

ABSTRACT Despite increasing global attention to adolescent health in low- and middle-income countries (LMICs), limited literature exists on the timing of pubertal development in these settings. This study aimed to determine the age at menarche (AAM) and age of puberty onset [female Tanner Stage Breast 2 (B2) and male Tanner Stage Genital 2 (G2)] among healthy adolescents living in LMICs. It also aimed to explore the impact of nutritional status on pubertal timing in this population. MEDLINE, Embase, Cochrane CENTRAL, Web of Science, Scopus, and grey literature databases were searched. Observational studies and control arms of randomized controlled trials (RCTs) with healthy participants from LMICs born in or after 1998 were included. Pooled estimates with 95% CIs were calculated by random-effects meta-analyses using the DerSimonian and Laird inverse variance method for each pubertal milestone and by BMI category subgroups. Twenty-seven studies were included in the meta-analysis, representing 90,188 adolescents (78.3% female). Pooled mean estimates for AAM for normal, thin, and overweight BMI groupings were 12.3 y (95% CI: 12.1, 12.5), 12.4 y (95% CI: 12.2, 12.6), and 12.1 y (95% CI: 11.7, 12.5), respectively. For Tanner Stage B2, pooled mean age estimates for normal, thin, and overweight BMI groupings were 10.4 y (95% CI: 9.2, 11.6), 10.2 y (95% CI: 9.3, 11.4), and 8.4 y (95% CI: 6.8, 10.0), respectively. Finally, for Tanner Stage G2, pooled mean estimates for normal, thin, and overweight BMI groupings were 11.0 y (95% CI: 10.3, 11.7), 11.3 y (95% CI: 9.8, 12.9), and 10.3 y (95% CI: 10.0, 10.6), respectively. Data on the timing of pubertal milestones has traditionally come from high-income settings. In this systematic review of contemporary data from adolescents in LMICs, AAM, as well as age at pubertal onset, were similar to those reported from high-income settings.

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Improving outcomes for neonates with gastroschisis in low-income and middle-income countries: a systematic review protocol

BMJ Paediatrics Open ◽

10.1136/bmjpo-2018-000392 ◽

2018 ◽

Vol 2 (1) ◽

pp. e000392 ◽

Cited By ~ 5

Author(s):

Naomi J Wright ◽

Monica Langer ◽

Irena CF Norman ◽

Melika Akhbari ◽

Q Eileen Wafford ◽

...

Keyword(s):

Systematic Review ◽

Low Income ◽

Grey Literature ◽

Surgical Care ◽

Length Of Hospital Stay ◽

Review Literature ◽

Sub Saharan Africa ◽

Cochrane Library ◽

Middle Income ◽

Middle Income Countries

IntroductionThere is a significant disparity in outcomes for neonates with gastroschisis in high-income countries (HICs) compared with low-income and middle-income countries (LMICs). Many LMICs report mortality rates between 75% and 100% compared with <4% in HICs.AimTo undertake a systematic review identifying postnatal interventions associated with improved outcomes for gastroschisis in LMICs.Methods and analysisThree search strings will be combined: (1) neonates; (2) gastroschisis and other gastrointestinal congenital anomalies requiring similar surgical care; (3) LMICs. Databases to be searched include MEDLINE, EMBASE, Scopus, Web of Science, ProQuest Dissertations and Thesis Global, and the Cochrane Library. Grey literature will be identified through Open-Grey, ClinicalTrials.gov, WHO International Clinical Trials Registry and ISRCTN registry (Springer Nature). Additional studies will be sought from reference lists of included studies. Study screening, selection, data extraction and assessment of methodological quality will be undertaken by two reviewers independently and team consensus sought on discrepancies. The primary outcome of interest is mortality. Secondary outcomes include complications, requirement for ventilation, parenteral nutrition duration and length of hospital stay. Tertiary outcomes include service delivery and implementation outcomes. The methodology of the studies will be appraised. Descriptive statistics and outcomes will be summarised and discussed.Ethics and disseminationEthical approval is not required since no new data are being collected. Dissemination will be via open access publication in a peer-reviewed medical journal and distribution among global health, global surgery and children’s surgical collaborations and international conferences.ConclusionThis study will systematically review literature focused on postnatal interventions to improve outcomes from gastroschisis in LMICs. Findings can be used to help inform quality improvement projects in low-resource settings for patients with gastroschisis. In the first instance, results will be used to inform a Wellcome Trust-funded multicentre clinical interventional study aimed at improving outcomes for gastroschisis across sub-Saharan Africa.PROSPERO registration numberCRD42018095349.

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