A questionnaire study of the negative outcomes for UK health professional volunteers in low and middle income countries

IntroductionPast research has reported considerable benefits of international health professional volunteering for British healthcare professionals; however, there are also some negative outcomes reported. Negative outcomes reportedly happen on a personal, professional and organisational level. However, there is little evidence of the frequency they might occur.MethodsWe aimed to understand what the negative outcomes of health professional volunteering in low-income and middle-income countries were, and how frequently they occurred, in an opportunistic sample of UK health professionals. We used a questionnaire developed using potential negative outcomes reported in the peer-reviewed papers. We conducted secondary analysis on cross-sectional questionnaire data from 222 healthcare professionals.ResultsThis research provides an indication of the frequency that negative outcomes might occur. Post hoc analyses revealed that some outcomes were experienced by the majority of health professional volunteers, for example, lack of formal recognition (131/169, 78%) and financial cost (92/169, 68%). While others happened less, for example, a reliance on agency or locum work (12/169, 7%) and loss of pension (31/169, 18%).ConclusionThe outcomes reported in this research quantify some of the concerns that have been raised in previous literature. Negative outcomes might be associated with certain features of volunteering and further research is needed to prospectively compare different features. Organisers of volunteering opportunities should be aware of the potential negative outcomes and engage with the research into negative outcomes to generate and apply findings about minimising potential negative outcomes, carefully balancing these against the needs of the host country.

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Labour companionship and women’s experiences of mistreatment during childbirth: results from a multi-country community-based survey

BMJ Global Health ◽

10.1136/bmjgh-2020-003564 ◽

2020 ◽

Vol 5 (Suppl 2) ◽

pp. e003564

Author(s):

Mamadou Dioulde Balde ◽

Khalidha Nasiri ◽

Hedieh Mehrtash ◽

Anne-Marie Soumah ◽

Meghan A Bohren ◽

...

Keyword(s):

Physical Abuse ◽

Low Income ◽

Descriptive Analysis ◽

Secondary Analysis ◽

Cross Sectional ◽

Middle Income ◽

Middle Income Countries ◽

Country Level ◽

Context Specific ◽

The Relationship

BackgroundEvidence has shown the benefits of labour companions during childbirth. Few studies have documented the relationship between the absence of labour companions and mistreatment of women during childbirth in low-income and middle-income countries using a standardised tool.MethodsWe conducted a secondary analysis of the WHO multi-country study on how women are treated during childbirth, where a cross-sectional community survey was conducted with women up to 8 weeks after childbirth in Ghana, Guinea, Nigeria and Myanmar. Descriptive analysis and multivariable logistic regression were used to examine whether labour companionship was associated with various types of mistreatment.ResultsOf 2672 women, about half (50.4%) reported the presence of a labour companion. Approximately half (49.6%) of these women reported that the timing of support was during labour and after childbirth and most of the labour companions (47.0%) were their family members. Across Ghana, Guinea and Nigeria, women without a labour companion were more likely to report physical abuse, non-consented medical procedures and poor communication compared with women with a labour companion. However, there were country-level variations. In Guinea, the absence of labour companionship was associated with any physical abuse, verbal abuse, or stigma or discrimination (adjusted OR (AOR) 3.6, 1.9–6.9) and non-consented vaginal examinations (AOR 3.2, 1.6–6.4). In Ghana, it was associated with non-consented vaginal examinations (AOR 2.3, 1.7–3.1) and poor communication (AOR 2.0, 1.3–3.2). In Nigeria, it was associated with longer wait times (AOR 0.6, 0.3–0.9).ConclusionLabour companionship is associated with lower levels of some forms of mistreatment that women experience during childbirth, depending on the setting. Further work is needed to ascertain how best to implement context-specific labour companionship to ensure benefits while maintaining women’s choices and autonomy.

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Impact of informal caregiving on older adults’ physical and mental health in low-income and middle-income countries: a cross-sectional, secondary analysis based on the WHO’s Study on global AGEing and adult health (SAGE)

BMJ Open ◽

10.1136/bmjopen-2017-017236 ◽

2017 ◽

Vol 7 (11) ◽

pp. e017236 ◽

Cited By ~ 5

Author(s):

Sylvie D Lambert ◽

Steven J Bowe ◽

Patricia M Livingston ◽

Leila Heckel ◽

Selina Cook ◽

...

Keyword(s):

Risk Factors ◽

Health Risk ◽

Perceived Stress ◽

Low Income ◽

Secondary Analysis ◽

Adult Health ◽

Cross Sectional ◽

Middle Income ◽

Middle Income Countries ◽

Global Ageing

ObjectivesA high proportion of care stemming from chronic disease or disability in low-income and middle-income countries is provided by informal caregivers. The goal of this study was to determine the level of burden experienced by these caregivers, explore associated factors and assess whether caregivers’ and non-caregivers’ health differed.Design and settingThis cross-sectional study was a secondary analysis of data on caregivers’ burden, health and health risk factors in Ghana, India and the Russian Federation collected as part of the WHO’s Study on global AGEing and adult health (SAGE) Wave 1.ParticipantsCaregivers in Ghana (n=143), India (n=490) and Russia (n=270) completed the measures.Outcome measuresFactors associated (ie, demographics and caregiving profile variables) with burden were explored among caregivers. Then, quality of life (QOL), perceived stress, depression, self-rated health (SRH) and health risk factors were compared between caregivers and matched non-caregivers (1:2).ResultsThe largest caregiving subgroups were spouses and adult children. Caregivers mostly cared for one person and provided financial, social/emotional and/or physical support, but received little support themselves. Burden level ranged from 17.37 to 20.03. Variables associated with burden were mostly country-specific; however, some commonality for wealth, type of care and caregiving duration was noted. Caregivers with a moderate or high level of burden reported lower QOL and higher perceived stress than those experiencing low burden. Caregivers reported lower QOL and SRH than non-caregivers.ConclusionGiven the lack of support received and consequences of the burden endured by caregivers, policy and programme initiatives are needed to ensure that caregivers in low- and middle-income countries can fulfil their role without compromising their own health.

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Efficacy of deep learning methods for predicting under-five mortality in 34 low-income and middle-income countries

BMJ Open ◽

10.1136/bmjopen-2019-034524 ◽

2020 ◽

Vol 10 (8) ◽

pp. e034524

Author(s):

Adeyinka Emmanuel Adegbosin ◽

Bela Stantic ◽

Jing Sun

Keyword(s):

Neural Network ◽

Deep Learning ◽

Low Income ◽

Maternal Education ◽

Household Wealth ◽

Secondary Outcome ◽

Cross Sectional ◽

Middle Income ◽

Under Five ◽

Middle Income Countries

ObjectivesTo explore the efficacy of machine learning (ML) techniques in predicting under-five mortality (U5M) in low-income and middle-income countries (LMICs) and to identify significant predictors of U5M.DesignThis is a cross-sectional, proof-of-concept study.Settings and participantsWe analysed data from the Demographic and Health Survey. The data were drawn from 34 LMICs, comprising a total of n=1 520 018 children drawn from 956 995 unique households.Primary and secondary outcome measuresThe primary outcome measure was U5M; secondary outcome was comparing the efficacy of deep learning algorithms: deep neural network (DNN); convolution neural network (CNN); hybrid CNN-DNN with logistic regression (LR) for the prediction of child’s survival.ResultsWe found that duration of breast feeding, number of antenatal visits, household wealth index, postnatal care and the level of maternal education are some of the most important predictors of U5M. We found that deep learning techniques are superior to LR for the classification of child survival: LR sensitivity=0.47, specificity=0.53; DNN sensitivity=0.69, specificity=0.83; CNN sensitivity=0.68, specificity=0.83; CNN-DNN sensitivity=0.71, specificity=0.83.ConclusionOur findings provide an understanding of determinants of U5M in LMICs. It also demonstrates that deep learning models are more efficacious than traditional analytical approach.

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Reporting of inequalities in blindness in low income and middle income countries: a review of cross sectional surveys

Clinical and Experimental Ophthalmology ◽

10.1111/ceo.13001 ◽

2017 ◽

Vol 46 (1) ◽

pp. 99-100 ◽

Cited By ~ 1

Author(s):

Jacqueline Ramke ◽

Anna Palagyi ◽

Jennifer Petkovic ◽

Clare E Gilbert

Keyword(s):

Low Income ◽

Cross Sectional ◽

Middle Income ◽

Middle Income Countries

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Universal health coverage for elderly people with non-communicable diseases in low-income and middle-income countries: a cross-sectional analysis

The Lancet ◽

10.1016/s0140-6736(14)61869-9 ◽

2014 ◽

Vol 384 ◽

pp. S6 ◽

Cited By ~ 3

Author(s):

Christine Goeppel ◽

Patricia Frenz ◽

Peter Tinnemann ◽

Linus Grabenhenrich

Keyword(s):

Elderly People ◽

Universal Health Coverage ◽

Low Income ◽

Health Coverage ◽

Cross Sectional ◽

Middle Income ◽

Non Communicable Diseases ◽

Middle Income Countries ◽

Sectional Analysis ◽

Universal Health

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State of deworming coverage and equity in low-income and middle-income countries using household health surveys: a spatiotemporal cross-sectional study

The Lancet Global Health ◽

10.1016/s2214-109x(19)30413-9 ◽

2019 ◽

Vol 7 (11) ◽

pp. e1511-e1520 ◽

Cited By ~ 5

Author(s):

Nathan C Lo ◽

Sam Heft-Neal ◽

Jean T Coulibaly ◽

Leslie Leonard ◽

Eran Bendavid ◽

...

Keyword(s):

Low Income ◽

Health Surveys ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Middle Income ◽

Middle Income Countries

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Correlates of physical activity among depressed older people in six low-income and middle-income countries: A community-based cross-sectional study

International Journal of Geriatric Psychiatry ◽

10.1002/gps.4796 ◽

2017 ◽

Vol 33 (2) ◽

pp. e314-e322 ◽

Cited By ~ 7

Author(s):

Davy Vancampfort ◽

Brendon Stubbs ◽

Nicola Veronese ◽

James Mugisha ◽

Nathalie Swinnen ◽

...

Keyword(s):

Physical Activity ◽

Older People ◽

Low Income ◽

Cross Sectional Study ◽

Sectional Study ◽

Community Based ◽

Cross Sectional ◽

Middle Income ◽

Middle Income Countries

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Clubfoot treatment in 2015: a global perspective

BMJ Global Health ◽

10.1136/bmjgh-2018-000852 ◽

2018 ◽

Vol 3 (4) ◽

pp. e000852 ◽

Cited By ~ 4

Author(s):

Rosalind M Owen ◽

Beth Capper ◽

Christopher Lavy

Keyword(s):

Low Income ◽

Income Group ◽

Cross Sectional Study ◽

Global Perspective ◽

Access To Treatment ◽

Cross Sectional ◽

Permanent Disability ◽

Middle Income ◽

Middle Income Countries ◽

Treatment Services

IntroductionClubfoot affects around 174 000 children born annually, with approximately 90% of these in low-income and middle-income countries (LMIC). Untreated clubfoot causes life-long impairment, affecting individuals’ ability to walk and participate in society. The minimally invasive Ponseti treatment is highly effective and has grown in acceptance globally. The objective of this cross-sectional study is to quantify the numbers of countries providing services for clubfoot and children accessing these.MethodIn 2015–2016, expected cases of clubfoot were calculated for all countries, using an incidence rate of 1.24/1000 births. Informants were sought from all LMIC, and participants completed a standardised survey about services for clubfoot in their countries in 2015. Data collected were analysed using simple numerical analysis, country coverage levels, trends over time and by income group. Qualitative data were analysed thematically.ResultsResponses were received from 55 countries, in which 79% of all expected cases of clubfoot were born. More than 24 000 children with clubfoot were enrolled for Ponseti treatment in 2015. Coverage was less than 25% in the majority of countries. There were higher levels of response and coverage within the lowest income country group. 31 countries reported a national programme for clubfoot, with the majority provided through public–private partnerships.ConclusionThis is the first study to describe global provision of, and access to, treatment services for children with clubfoot. The numbers of children accessing Ponseti treatment for clubfoot in LMIC has risen steadily since 2005. However, coverage remains low, and we estimate that less than 15% of children born with clubfoot in LMIC start treatment. More action to promote the rollout of national clubfoot programmes, build capacity for treatment and enable access and adherence to treatment in order to radically increase coverage and effectiveness is essential and urgent in order to prevent permanent disability caused by clubfoot.

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

BMJ Open ◽

10.1136/bmjopen-2018-024226 ◽

2018 ◽

Vol 8 (7) ◽

pp. e024226 ◽

Cited By ~ 2

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.

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