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

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.

scholarly journals Evidence-based interventions to reduce mortality among preterm and low-birthweight neonates in low-income and middle-income countries: a systematic review and meta-analysis

2021 ◽  
Vol 6 (2) ◽  
pp. e003618
Author(s):  
Mirjam Y Kleinhout ◽  
Merel M Stevens ◽  
Kwabena Aqyapong Osman ◽  
Kwame Adu-Bonsaffoh ◽  
Floris Groenendaal ◽  
...  
Keyword(s):  
Low Income ◽  
Low Birthweight ◽  
Meta Analysis ◽  
Neonatal Resuscitation ◽  
Newborn Care ◽  
Evidence Based ◽  
Antenatal Corticosteroids ◽  
Essential Newborn Care ◽  
Middle Income ◽  
Middle Income Countries

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.

Challenges for Evidence-Based Care for Children With Developmental Delays in Nicaragua

2014 ◽  
Vol 28 (3) ◽  
pp. 226-237 ◽  
Author(s):  
Abraham A. Salinas-Miranda ◽  
Eric A. Storch ◽  
Robert Nelson ◽  
Claudia Evans-Baltodano
Keyword(s):  
Early Childhood ◽  
Low Income ◽  
Developmental Delays ◽  
Early Childhood Development ◽  
Economic Consequences ◽  
Childhood Development ◽  
Low Income Countries ◽  
Evidence Based ◽  
Low Income Country ◽  
Evidence Based Care

Evidence of successful models for promoting early childhood development and for effectively addressing developmental delays is available, yet the adoption of evidence-based strategies is limited in low-income countries. Nicaragua, a low-income country on the Central American isthmus, faces policy-, organizational-, and community-level obstacles which prevent families from receiving the benefits of early child development programs as well as other necessary services for children at risk of or with developmental delays. Failing to address developmental delays in a timely manner leads to detrimental social and economic consequences for families and society at large. In this article, we examine existing information on early childhood development in Nicaragua and discuss some programmatic implications for the recognition and early intervention of developmental delays in Nicaragua.

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

2019 ◽  
pp. bmjebm-2019-111272
Author(s):  
Peter J Gill ◽  
Shabana M Ali ◽  
Yasmin Elsobky ◽  
Raymond C Okechukwu ◽  
Tatiane B Ribeiro ◽  
...  
Keyword(s):  
Low Income ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Middle Income ◽  
Building Capacity ◽  
Middle Income Countries ◽  
Based Medicine

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

2020 ◽  
pp. 104420732091994 ◽  
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.

Ethical Challenges of Parenting Interventions in Low- to Middle-Income Countries

2017 ◽  
Vol 49 (1) ◽  
pp. 5-24 ◽  
Author(s):  
Gilda Morelli ◽  
Naomi Quinn ◽  
Nandita Chaudhary ◽  
Marga Vicedo ◽  
Mariano Rosabal-Coto ◽  
...  
Keyword(s):  
Parenting Practices ◽  
Ethical Issues ◽  
Positive Parenting ◽  
World Health ◽  
Parenting Interventions ◽  
Ethical Challenges ◽  
Middle Income ◽  
Developmental Potential ◽  
Middle Income Countries ◽  
Health Organization

This article explores ethical issues raised by parenting interventions implemented in communities in low- to middle-income countries (LMICs) with rural, subsistence lifestyles. Many of these interventions foster “positive parenting practices” to improve children’s chances of fulfilling their developmental potential. The practices are derived from attachment theory and presented as the universal standard of good care. But attachment-based parenting is typical primarily of people living Western lifestyles and runs counter to the different ways many people with other lifestyles care for their children given what they want for them. Thus, such parenting interventions involve encouraging caregivers to change their practices and views, usually with little understanding of how such changes affect child, family, and community. This undermines researchers’ and practitioners’ ability to honor promises to uphold ethic codes of respect and beneficence. Support for this claim is provided by comparing positive parenting practices advocated by the United Nations International Children’s Emergency Fund (UNICEF; with the world health organization [WHO]) Care for Child Development (CCD) intervention with parenting practices typical of communities with rural, subsistence lifestyles—the most common of lifestyles worldwide and largely observed in LMICs. As UNICEF has a considerable presence in these countries, the CCD intervention was selected as a case study. In addition, parenting interventions typically target people who are poor, and the issues this raises regarding ethics of fairness and justice are considered. Recommendations are made for ways change agents can be sensitive to the living conditions and worldviews of communities, and, thus, be appropriately effective and ethically sensitive to the diverse needs of different communities.

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