COVID-19 vaccine trials with children: ethics pointers

As healthcare authorities around the world strive to get as many citizens as possible vaccinated against the SAR-CoV-2 virus, many countries have begun including children in the population groups to be vaccinated. Properly designed clinical trials involving children are important to ensure safety, efficacy, and dosage of therapies in (developing) children. Within the complex health, social, and political scenario of the ongoing pandemic, ethics committees and policy makers in low-income and middle-income settings need to consider additional ethical questions when called on to review phase III COVID-19 vaccine trials involving in children. We set out some of the ethical questions to keep in mind before, during, and after the implementation of phase III COVID-19 vaccine trials in limited resource settings. Specifically, we discuss and offer succinct answers to the following questions: How relevant will the trial vaccine be for the population participating in the trial? Should vaccines that have not been approved for use among adults be approved for use in trials with children? Which children should be involved in COVID-19 vaccine trials? What criteria of informed consent are to be adopted with minors? Placebo versus an existing already approved vaccine? What specific duties of ancillary care should be taken into consideration for COVID-19 vaccines especially in low-income and middle-income countries? The answers we offer are considerations that can serve as ‘things to think about’ when reviewing or implementing COVID-19 trials involving children in low-income settings.

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Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052439 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2439

Author(s):

Brendon Stubbs ◽

Kamran Siddiqi ◽

Helen Elsey ◽

Najma Siddiqi ◽

Ruimin Ma ◽

...

Keyword(s):

Health Survey ◽

Low Income ◽

World Health ◽

Low Income Countries ◽

Multivariable Logistic Regression Analysis ◽

World Health Survey ◽

Middle Income ◽

Middle Income Countries ◽

The World ◽

Low And Middle Income

Tuberculosis (TB) is a leading cause of mortality in low- and middle-income countries (LMICs). TB multimorbidity [TB and ≥1 non-communicable diseases (NCDs)] is common, but studies are sparse. Cross-sectional, community-based data including adults from 21 low-income countries and 27 middle-income countries were utilized from the World Health Survey. Associations between 9 NCDs and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Eight out of 9 NCDs (all except visual impairment) were associated with TB (odds ratio (OR) ranging from 1.38–4.0). Prevalence of self-reported TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and ≥5 NCDs had 2.61 (95% confidence interval (CI) = 2.14–3.22), 4.71 (95%CI = 3.67–6.11), 6.96 (95%CI = 4.95–9.87), 10.59 (95%CI = 7.10–15.80), and 19.89 (95%CI = 11.13–35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs were three times higher than in people without multimorbidity or TB, and a third of the YLDs were attributable to NCDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed.

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Governing multisectoral action for health in low-income and middle-income countries: an agenda for the way forward

BMJ Global Health ◽

10.1136/bmjgh-2018-000890 ◽

2018 ◽

Vol 3 (Suppl 4) ◽

pp. e000890 ◽

Cited By ~ 8

Author(s):

Kumanan Rasanathan ◽

Vincent Atkins ◽

Charles Mwansambo ◽

Agnès Soucat ◽

Sara Bennett

Keyword(s):

Low Income ◽

Implementation Research ◽

Conflicts Of Interest ◽

Health Sector ◽

Middle Income ◽

Policy Makers ◽

Implementation Processes ◽

Existing Structures ◽

Middle Income Countries ◽

The Way

Drawing on experiences reviewed in the accompanying supplement and other literature, we present an agenda for the way forward for policy-makers, managers, civil society and development partners to govern multisectoral action for health in low-income and middle-income countries and consider how such an agenda might be realised. We propose the following key strategies: understand the key actors and political ecosystem, including type of multisectoral action required and mapping incentives, interests and hierarchies; frame the issue in the most strategic manner; define clear roles with specific sets of interventions according to sector; use existing structures unless there is a compelling reason not to do so; pay explicit attention to the roles of non-state sectors; address conflicts of interest and manage tradeoffs; distribute leadership; develop financing and monitoring systems to encourage collaboration; strengthen implementation processes and capacity; and support mutual learning and implementation research. To support countries to strengthen governance for multisectoral action, the global community can assist by further developing technical tools and convening peer learning by policy-makers (particularly from beyond the health sector), supporting knowledge management and sharing of experiences in multisectoral action beyond health, developing an agenda for and execution of implementation research and, finally, driving multilateral and bilateral development partners to transcend their own silos and work in a more multisectoral manner.

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Do combination HIV prevention programmes result in increased empowerment, inclusion and agency to demand equal rights for marginalised populations in low-income and middle-income countries? A systematic review

BMJ Global Health ◽

10.1136/bmjgh-2019-001560 ◽

2019 ◽

Vol 4 (5) ◽

pp. e001560

Author(s):

Carinne Brody ◽

Say Sok ◽

Sovannary Tuot ◽

Marija Pantelic ◽

Enrique Restoy ◽

...

Keyword(s):

Systematic Review ◽

Hiv Prevention ◽

Low Income ◽

Equal Rights ◽

Middle Income ◽

Policy Makers ◽

Combination Prevention ◽

Middle Income Countries ◽

Registration Number ◽

Prevention Programmes

IntroductionThis systematic review aims to determine if combination HIV prevention programmes include outcome measures for empowerment, inclusion and agency to demand equal rights and measure the relationship between empowerment and HIV prevention outcomes.MethodsAn electronic literature search of PubMed, POPLINE, Index Medicus and Google Scholar was conducted between August and October 2018. We included studies that evaluated combination prevention programmes that had all three types of intervention components and that specifically serve members of populations disproportionately affected by HIV published from 2008 to 2018. The selected studies were screened for inclusion, and relevant data abstracted, assessed for bias and synthesised.ResultsThis review included a total of 15 studies. Findings indicate that combination HIV prevention programmes for marginalised populations have delivered a variety of theory-based behavioural and structural interventions that support improvements in empowerment, inclusion and agency. However, empowerment, inclusion and least of all agency are not measured consistently or in a standardised way. In addition, analysis of their relationships with HIV prevention outcomes is rare. Out of our 15 included studies, only two measured a relationship between an empowerment, inclusion or agency outcome and an HIV prevention outcome.ConclusionThese findings suggest that policy-makers, programme planners and researchers might need to consider the intermediate steps on the pathway to increased condom use and HIV testing so as to explain the ‘how’ of their achievements and inform future investments in HIV prevention. This will support replication and expansion of programmes and ensure sustainability of the programmes.PROSPERO registration numberCRD42018106909

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Water Supply, Sanitation, and the Environment

Oxford Research Encyclopedia of Environmental Science ◽

10.1093/acrefore/9780199389414.013.782 ◽

2021 ◽

Author(s):

N. Vijay Jagannathan

Keyword(s):

Water Supply ◽

Low Income ◽

Poor Performance ◽

Low Income Countries ◽

General Interest ◽

Sustainable Development Goal ◽

Middle Income ◽

Development Goal ◽

Middle Income Countries ◽

The World

Sustainable Development Goal No. 6 (SDG 6) has committed all nations of the world to achieving ambitious water supply and sanitation targets by 2030 to meet the universal basic needs of humans and the environment. Many lower-middle-income countries and all low-income countries face an uphill challenge in achieving these ambitious targets. The cause of poor performance is explored, some possible ways to accelerate progress toward achieving SDG 6 are suggested. The analysis will be of interest to a three-part audience: (a) readers with a general interest on how SDG 6 can be achieved; (b) actors with policy interest on improving water supply and safe sanitation (WSS) service issues; and (c) activists skeptical of conventional WSS policy prescriptions who advocate out-of-the-box solutions to improve WSS delivery.

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Internet Use around the World: An Empirical Assessment

Perspectives on Global Development and Technology ◽

10.1163/15691497-12341456 ◽

2017 ◽

Vol 16 (6) ◽

pp. 683-699

Author(s):

Minh Dao

Keyword(s):

Developing Countries ◽

Low Income ◽

Internet Use ◽

Developed Countries ◽

Computer Access ◽

Middle Income ◽

Middle Income Countries ◽

The World ◽

Internet Application ◽

Developing And Developed Countries

Abstract This paper empirically assesses the effect of the determinants of Internet use, using several samples of both developed and developing countries. Based on a sample of 23 low-income economies in 2015, we find that Internet use depends upon computer access. Using a sample of 38 lower middle-income countries we find that Internet use depends upon Internet quality and Internet affordability. Using a sample of 41 upper middle-income countries, we find that computer access and Internet affordability influence Internet use. From a sample of 45 high-income countries, we are able to show that computer access, Internet quality, and affordability do affect Internet use. Using a sample of thirty oecd countries, we find that Internet use depends upon computer access and Internet quality. When a sample of 150 developing and developed countries is used, results show that Internet use is influenced by computer access, Internet quality, Internet affordability, and Internet application.

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Product Space Perspective on Structural Change in Morocco

Review of Middle East Economics and Finance ◽

10.1515/rmeef-2016-0003 ◽

2016 ◽

Vol 12 (2) ◽

Author(s):

Israel Osorio Rodarte ◽

Hans Lofgren

Keyword(s):

Low Income ◽

Product Space ◽

High Growth ◽

High Tech ◽

Middle Income ◽

Policy Makers ◽

Middle Income Countries ◽

Moderate Growth ◽

Manufactured Products ◽

Space Approach

AbstractDrawing on international trade data, this paper uses the product space approach to analyze changes in Morocco’s goods exports in 1990–2010 and future export priorities. The level and moderate growth of Morocco’s gross domestic product match the predictions of product space analysis, informed by changes in the income potential of Morocco’s export basket, reflecting relatively strong capabilities in products with a relatively low potential to contribute to income growth and diversification. Morocco’s peripheral position in the product space points to the difficulty of diversification into more sophisticated products. Encouraging changes since 1990 include the development of a revealed comparative advantage in medium- and high-tech manufactures. However, the number of goods involved is relatively small and this transformation has not sufficed to raise per capita growth to the average for middle-income countries. Among sectors, high growth is likely for phosphate-based fertilizer exports. However, phosphates are hampered by low income and diversification potentials. Along with various other manufactured products, electronics and the automotive industry are promising sectors that may offer more lasting positive contributions. Beyond goods, policy makers should also consider the potential contributions of service exports, which in recent years have enjoyed rapid growth.

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Socioeconomic Inequality in Smoking in Low-Income and Middle-Income Countries: Results from the World Health Survey

PLoS ONE ◽

10.1371/journal.pone.0042843 ◽

2012 ◽

Vol 7 (8) ◽

pp. e42843 ◽

Cited By ~ 62

Author(s):

Ahmad Reza Hosseinpoor ◽

Lucy Anne Parker ◽

Edouard Tursan d'Espaignet ◽

Somnath Chatterji

Keyword(s):

Health Survey ◽

Low Income ◽

Socioeconomic Inequality ◽

World Health ◽

World Health Survey ◽

Middle Income ◽

Middle Income Countries ◽

The World

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A patient–clinician James Lind Alliance partnership to identify research priorities for hyperemesis gravidarum

BMJ Open ◽

10.1136/bmjopen-2020-041254 ◽

2021 ◽

Vol 11 (1) ◽

pp. e041254

Author(s):

Caitlin R Dean ◽

Hyke Bierma ◽

Ria Clarke ◽

Brian Cleary ◽

Patricia Ellis ◽

...

Keyword(s):

Low Income ◽

Online Survey ◽

Hyperemesis Gravidarum ◽

Research Priorities ◽

Developed Countries ◽

Middle Income ◽

Policy Makers ◽

Middle Income Countries ◽

James Lind Alliance ◽

Research Questions

ObjectiveThere are many uncertainties surrounding the aetiology, treatment and sequelae of hyperemesis gravidarum (HG). Prioritising research questions could reduce research waste, helping researchers and funders direct attention to those questions which most urgently need addressing. The HG priority setting partnership (PSP) was established to identify and rank the top 25 priority research questions important to both patients and clinicians.MethodsFollowing the James Lind Alliance (JLA) methodology, an HG PSP steering group was established. Stakeholders representing patients, carers and multidisciplinary professionals completed an online survey to gather uncertainties. Eligible uncertainties related to HG. Uncertainties on nausea and vomiting of pregnancy and those on complementary treatments were not eligible. Questions were verified against the evidence. Two rounds of prioritisation included an online ranking survey and a 1-hour consensus workshop.Results1009 participants (938 patients/carers, 118 professionals with overlap between categories) submitted 2899 questions. Questions originated from participants in 26 different countries, and people from 32 countries took part in the first prioritisation stage. 66 unique questions emerged, which were evidence checked according to the agreed protocol. 65 true uncertainties were narrowed via an online ranking survey to 26 unranked uncertainties. The consensus workshop was attended by 19 international patients and clinicians who reached consensus on the top 10 questions for international researchers to address. More patients than professionals took part in the surveys but were equally distributed during the consensus workshop. Participants from low-income and middle-income countries noted that the priorities may be different in their settings.ConclusionsBy following the JLA method, a prioritised list of uncertainties relevant to both HG patients and their clinicians has been identified which can inform the international HG research agenda, funders and policy-makers. While it is possible to conduct an international PSP, results from developed countries may not be as relevant in low-income and middle-income countries.

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Systematic review of lay consultation in symptoms and illness experiences in informal urban settlements of low-income and middle-income countries

BMJ Open ◽

10.1136/bmjopen-2021-050766 ◽

2021 ◽

Vol 11 (12) ◽

pp. e050766

Author(s):

Chinwe Onuegbu ◽

Maxwell Larweh ◽

Jenny Harlock ◽

Frances Griffiths

Keyword(s):

Systematic Review ◽

Social Networks ◽

Low Income ◽

Middle Income ◽

Policy Makers ◽

Middle Income Countries ◽

Illness Experiences ◽

Urban Settlements ◽

Lay Consultation ◽

Informal Urban Settlements

ObjectivesLay consultation is the process of discussing a symptom or an illness with lay social network members. This can have positive or negative consequences on health-seeking behaviours. Understanding how consultation with lay social networks works in informal urban settlements of low-income and middle-income countries (LMICs) is important to enable health and policy-makers to maximise its potential to aid healthcare delivery and minimise its negative impacts. This study explored the composition, content and consequences of lay consultation in informal urban settlements of LMICs.DesignMixed-method systematic review.Data sourcesSix key public health and social science databases, Google Scholar and reference lists of included studies were searched for potential articles.Eligibility criteriaPapers that described discussions with lay informal social network members during symptoms or illness experiences.Data analysis and synthesisQuality assessment was done using the Mixed Methods Appraisal Tool. Data were analysed and synthesised using a stepwise thematic synthesis approach involving two steps: identifying themes within individual studies and synthesising themes across studies.Results13 studies were included in the synthesis. Across the studies, three main categories of networks consulted during illness: kin, non-kin associates and significant community groups. Of these, kin networks were the most commonly consulted. The content of lay consultations were: asking for suggestions, negotiating care-seeking decisions, seeking resources and non-disclosure due to personal or social reasons. Lay consultations positively and negatively impacted access to formal healthcare and adherence to medical advice.ConclusionLay consultation is mainly sought from social networks in immediate environments in informal urban settlements of LMICs. Policy-makers and practitioners need to utilise these networks as mediators of healthcare-seeking behaviours.PROSPERO registration numberCRD42020205196.

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Conclusion: The Frontiers of PB

Participatory Budgeting in Global Perspective ◽

10.1093/oso/9780192897756.003.0008 ◽

2021 ◽

pp. 181-204

Author(s):

Brian Wampler ◽

Stephanie McNulty ◽

Michael Touchton

Keyword(s):

Low Income ◽

Authoritarian Regimes ◽

Policy Recommendations ◽

Middle Income ◽

Large Cities ◽

Middle Income Countries ◽

Industrialized Democracies ◽

The World ◽

Key Policy ◽

Institutional Contexts

This chapter summarizes the main findings about PB’s adoption, adaptation, and impact. It raises questions about PB’s future and the limited evidence that continues to hamper researchers and policymakers’ ability to make key policy recommendations. PB is now used in settings as diverse as large cities in wealthy industrialized democracies, rural, low-income villages in countries governed by semi-authoritarian regimes, municipalities of middle-income countries in the Global South, and a variety of contexts in authoritarian countries. This diversity of program types and institutional contexts showcases the allure of PB around the world. Yet, it also highlights the challenges facing policymakers as they consider creating their own programs. The chapter ends with a conceptual discussion to guide policymakers as they adopt or support PB in the future.

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