Job morale of physicians in low-income and middle-income countries: a systematic literature review of qualitative studies

ObjectivesTo systematically review the available literature on physicians’ and dentists’ experiences influencing job motivation, job satisfaction, burnout, well-being and symptoms of depression as indicators of job morale in low-income and middle-income countries.DesignThe review was reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies evaluating outcomes of interest using qualitative methods. The framework method was used to analyse and integrate review findings.Data sourcesA primary search of electronic databases was performed by using a combination of search terms related to the following areas of interest: ‘morale’, ‘physicians and dentists’ and ‘low-income and middle-income countries’. A secondary search of the grey literature was conducted in addition to checking the reference list of included studies and review papers.ResultsTen papers representing 10 different studies and involving 581 participants across seven low-income and middle-income countries met the inclusion criteria for the review. However, none of the studies focused on dentists’ experiences was included. An analytical framework including four main categories was developed: work environment (physical and social), rewards (financial, non-financial and social respect), work content (workload, nature of work, job security/stability and safety), managerial context (staffing levels, protocols and guidelines consistency and political interference). The job morale of physicians working in low-income and middle-income countries was mainly influenced by negative experiences. Increasing salaries, offering opportunities for career and professional development, improving the physical and social working environment, implementing clear professional guidelines and protocols and tackling healthcare staff shortage may influence physicians’ job morale positively.ConclusionsThere were a limited number of studies and a great degree of heterogeneity of evidence. Further research is recommended to assist in scrutinising context-specific issues and ways of addressing them to maximise their utility.PROSPERO registration numberCRD42017082579.

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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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Older People, Mobility and Transport in Low- and Middle-Income Countries: A Review of the Research

Sustainability ◽

10.3390/su11216157 ◽

2019 ◽

Vol 11 (21) ◽

pp. 6157 ◽

Cited By ~ 4

Author(s):

Mark Gorman ◽

Sion Jones ◽

Jeffrey Turner

Keyword(s):

Older People ◽

Low Income ◽

Well Being ◽

The State ◽

Small Scale ◽

Knowledge Gaps ◽

Middle Income ◽

Middle Income Countries ◽

The Impact ◽

Low And Middle Income

Older populations are rising globally, which in high-income countries has helped to generate a growing literature on the impact of ageing on travel requirements and transport policy. This article aims to provide an initial assessment of the state of knowledge on the impact on transportation policy and usage of the increasing numbers of older people in low- and middle-income countries (LAMICs), through a review of the literature relating to older people and transportation. As both the academic and policy/practice-related literature specifically addressing ageing and transport in LAMICs is limited, the study looks beyond transportation to assess the state of knowledge regarding the ways in which older people’s mobility is affected by issues, such as health, well-being, social (dis)engagement and gender. We find significant knowledge gaps, resulting in an evidence base to support the implementation of policy is lacking. Most research in low-income countries (LICs) is either broad quantitative analysis based on national survey data or small-scale qualitative studies. We conclude that, although study of the differing contexts of ageing in LAMICs as they relate to older people’s mobilities and transport use has barely begun, institutions which both make and influence policymaking recognise the existence of significant knowledge gaps. This should provide the context in which research agendas can be established.

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Stigma and discrimination related to mental illness in low- and middle-income countries

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796015000359 ◽

2015 ◽

Vol 24 (5) ◽

pp. 382-394 ◽

Cited By ~ 65

Author(s):

M. Semrau ◽

S. Evans-Lacko ◽

M. Koschorke ◽

L. Ashenafi ◽

G. Thornicroft

Keyword(s):

Mental Illness ◽

Large Scale ◽

Grey Literature ◽

Middle Income ◽

Middle Income Countries ◽

Stigma And Discrimination ◽

Effective Interventions ◽

Long Term Follow Up ◽

Context Specific ◽

Low And Middle Income

Aims.This paper aims to provide an overview of evidence from low- and middle-income countries (LAMICs) worldwide to address: the nature of stigma and discrimination, relevant context-specific factors, global patterns of these phenomena and their measurement and quantitative and qualitative evidence of interventions intended to reduce their occurrence and impact. The background to this study is that the large majority of studies concerned with identifying effective interventions to reduce stigma and discrimination originate in high-income countries (HICs). This paper therefore presents such evidence from, and relevant to, LAMICs.Methods.Conceptual overview of the relevant peer-reviewed and grey literature on stigma and discrimination related to mental illness in LAMICs are available in English, Spanish, French and Russian.Results.Few intervention studies were identified related to stigma re-education in LAMICs. None of these addressed behaviour change/discrimination, and there were no long-term follow-up studies. There is therefore insufficient evidence at present to know which overall types of intervention may be effective and feasible and in LAMICs, how best to target key groups such as healthcare staff, and how far they may need to be locally customised to be acceptable for large-scale use in these settings. In particular, forms of social contacts, which have been shown to be the most effective intervention to reduce stigma among adults in HICs, have not yet been assessed sufficiently to know whether these methods are also effective in LAMICs.Conclusion.Generating information about effective interventions to reduce stigma and discrimination in LAMICs is now an important mental health priority worldwide.

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Effects of integrated economic and health interventions with women’s groups on health-related knowledge, behaviours and outcomes in low-income and middle-income countries: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2020-046856 ◽

2021 ◽

Vol 11 (7) ◽

pp. e046856

Author(s):

Sapna Desai ◽

Kala M Mehta ◽

Roopal Jyoti Singh ◽

Allie K Westley ◽

Osasuyi Dirisu ◽

...

Keyword(s):

Systematic Review ◽

Low Income ◽

Public Health Intervention ◽

Well Being ◽

Health Interventions ◽

Women's Groups ◽

Middle Income ◽

Middle Income Countries ◽

Women’S Groups ◽

Health Related

IntroductionEconomic groups, such as microfinance or self-help groups are widely implemented in low-income and middle-income countries (LMICs). Women’s groups are voluntary groups, which aim to improve the well-being of members through activities, such as joint savings, credit, livelihoods development and/or health activities. Health interventions are increasingly added on to existing women’s economic groups as a public health intervention for women and their families. Here, we present the protocol for a mixed-methods systematic review we will conduct of the evidence on integrated economic and health interventions on women’s groups to assess whether and how they improve health-related knowledge, behaviour and outcomes in LMICs.Methods and analysisWe will search seven electronic databases for published literature, along with manual searches and consultation. The review will include (1) randomised trials and non-randomised quasiexperimental studies of intervention effects of integrated economic and health interventions delivered through women’s groups in LMICs, and (2) sibling studies that examine factors related to intervention content, context, implementation processes and costs. We will appraise risk of bias and study quality using standard tools. High and moderate quality studies will be grouped by health domain and synthesised without meta-analysis. Qualitative evidence will be thematically synthesised and integrated into the quantitative synthesis using a matrix approach.Ethics and disseminationThis protocol was reviewed and deemed exempt by the institutional review board at the American Institutes for Research. Findings will be shared through peer-reviewed publication and disseminated with programme implementers and policymakers engaged with women’s groups.PROSPERO registration numberCRD42020199998.

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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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A Narrative Synthesis of the Published Literature on Antenatal Care in Low and Middle Income Countries

Health Prospect ◽

10.3126/hprospect.v13i1.11341 ◽

2014 ◽

Vol 13 (1) ◽

pp. 12-23

Author(s):

Shanta Kumar Shrestha ◽

Joanne Travaglia ◽

Chandni Joshi

Keyword(s):

Antenatal Care ◽

English Language ◽

Universal Access ◽

Grey Literature ◽

Antenatal Visit ◽

Reference List ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

Background: Good quality antenatal care is one of the recommended strategies to reduce maternal and neonatal mortality and improve health outcomes of the mother and her child. The utilization and quality of antenatal care in low and middle income countries is not well documented and hence deserves further study. This is a literature review of antenatal care in low and middle income countries on its utilization, the barriers and facilitators, and the available evidence of effectiveness and quality of antenatal careMethod: A systematic review of the published literature was conducted which also included published systematic reviews. Studies published between 2002 and 2012 were identified by searching Medline, EMBASE and CINAHL. This was supplemented by papers provided by international advisors from grey literature and snowballing search of reference list of all included papers. Only English language studies in low and middle income countries on antenatal care were includedResults: Twenty-three papers met the inclusion criteria. Health-facility based studies reported near universal access to antenatal care, which was not the case for community based studies. Women received at least one antenatal visit but fewer women had the recommended number of visits. Socioeconomic status and women’s education were the most frequent and the strongest predictors of antenatal care use. Antenatal care promoted the use of skilled birth attendant at delivery, but did not contribute to reductions in maternal mortality and stillbirths. The quality of care was reported as unsatisfactory; major issues being poor client-provider relationship and inferior quality of counselling.Conclusion: In order to increase the utilization of antenatal care, in the short term, less educated women from socioeconomically disadvantaged households require targeting. Long-term improvements require a focus on improving female education. Further research is needed to explore the quality of antenatal care in order to validate its effect on maternal and child health.DOI: http://dx.doi.org/10.3126/hprospect.v13i1.11341 Health Prospect Vol.13(1) 2014: 12-23

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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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The reality of the Noncommunicable disease policy landscape in Low Income Countries: the example of Mozambique

10.21203/rs.3.rs-240060/v1 ◽

2021 ◽

Author(s):

Khatia Rebeca Munguambe ◽

Tavares Madede ◽

Vasco Muchanga ◽

Claire Somerville ◽

David Henri Beran ◽

...

Keyword(s):

Low Income ◽

Well Being ◽

Noncommunicable Disease ◽

Low Income Countries ◽

Noncommunicable Diseases ◽

Middle Income ◽

External Resources ◽

Low Income Country ◽

Middle Income Countries ◽

Government Documents

Abstract Background Noncommunicable diseases (NCD) are the leading cause of morbidity and mortality worldwide with a disproportionate burden affecting low- and middle-income countries (LMIC). Mozambique, is a low income country situated in Southern Africa with an emerging burden of NCDs, but still facing a large challenge with regards to communicable diseases. Using the policy prioritisation framework developed by Shiffman and Smith this study aims to present the different elements that have shaped the current policy landscape for NCDs in Mozambique.Results The policy review identified 18 documents, and seven KIs were interviewed. The policy community could be seen as cohesive in that a few leading experts in Mozambique agreed on both the challenges of NCDs and the possible response, but overall leadership was lacking. Although the Ministry of Health and its NCD Department were seen as the guiding institutions the Department was not resourced to be able to fulfil its mandate. Some external resources were available to assist, but these were insufficient. In addition civil society mobilisation was missing. With regards to ideas three disconnects were present: language used in overarching government documents and their translation into practice; the views of experts; and the perceptions of NCDs in a context like Mozambique in contrast to other health issues. The NCD Department and different strategies and government documents laid out the governing structure, but again a lack of resources hampered progress. This was compounded by a lack of understanding of the problem and solutions, as well as barriers to integrate the NCD response with HIV/AIDS for example. Conclusions This study shows that despite gaining prominence on the global health agenda, NCDs have yet to truly gain a strong foothold on the policy agenda of LMICs such as Mozambique. In order to do this both governments and donors need to be sensitised to this issue as well as clear guidance developed to enable countries to have practical solutions to address both prevention and treatment of NCDs in underfunded and weak health systems, but also be able to build on existing initiatives to improve the health and well-being of populations.

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