scholarly journals How community participation in water and sanitation interventions impacts human health, WASH infrastructure and service longevity in low-income and middle-income countries: a realist review

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e053320
Author(s):  
Sarah Nelson ◽  
Dorothy Drabarek ◽  
Aaron Jenkins ◽  
Joel Negin ◽  
Seye Abimbola
Keyword(s):  
Community Participation ◽  
Low Income ◽  
Community Dynamics ◽  
Realist Review ◽  
Eligibility Criteria ◽  
Water And Sanitation ◽  
Middle Income ◽  
Middle Income Countries ◽  
Community Water ◽  
Contextual Elements

ObjectiveTo understand how, and under what circumstances community participation in water and sanitation interventions impacts the availability of safe water and sanitation, a change in health status or behaviour and the longevity of water, sanitation and hygiene (WASH) resources and services.DesignRealist review.Data sourcesPubMed, Web of Science and Scopus databases were used to identify papers from low-income and middle-income countries from 2010 to 2020.Eligibility criteria for selecting studiesCriteria were developed for papers to be included. The contribution of each paper was assessed based on its relevance and rigour (eg, can it contribute to context, mechanism or outcome, and is the method used to generate that information credible).AnalysisInductive and deductive coding was used to generate context–mechanism–outcome configurations.Results73 studies conducted in 29 countries were included. We identified five mechanisms that explained the availability, change and longevity outcomes: (1) accountability (policies and procedures to hold communities responsible for their actions and outcomes of an intervention), (2) diffusion (spread of an idea or behaviour by innovators over time through communication among members of a community), (3) market (the interplay between demand and supply of a WASH service or resource), (4) ownership (a sense of possession and control of the WASH service or resource) and (5) shame (a feeling of disgust in one’s behaviour or actions). Contextual elements identified included community leadership and communication, technical skills and knowledge, resource access and dependency, committee activity such as the rules and management plans, location and the level of community participation.ConclusionsThe findings highlight five key mechanisms impacted by 19 contextual factors that explain the outcomes of community water and sanitation interventions. Policymakers, programme implementers and institutions should consider community dynamics, location, resources, committee activity and practices and nature of community participation, before introducing community water and sanitation interventions.

scholarly journals Economics of physical activity in low-income and middle- income countries: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e037784
Author(s):  
Priyanga Diloshini Ranasinghe ◽  
Subhash Pokhrel ◽  
Nana Kwame Anokye
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Economic Evaluation ◽  
Drug Treatment ◽  
Chronic Diseases ◽  
Low Income ◽  
Economic Burden ◽  
Eligibility Criteria ◽  
Middle Income ◽  
Middle Income Countries

BackgroundPromotion of physical activity (PA) among populations is a global health investment. However, evidence on economic aspects of PA is sparse and scattered in low-income and middle-income countries (LMICs).ObjectiveThe objective of this study was to summarise the available evidence on economics of PA in LMICs, identify potential target variables for policy and report gaps in the existing economic evidence alongside research recommendations.Data sourcesA systematic review of the electronic databases (Scopus, Web of Science and SPORTDiscus) and grey literature.Study eligibility criteriaCost-of-illness studies, economic evaluations, interventions and descriptive studies on economic factors associated with PA using preset eligibility criteria.Study appraisal and synthesis of methodsScreening, study selection and quality appraisal based on standard checklists performed by two reviewers with consensus of a third reviewer. Descriptive synthesis of data was performed.ResultsThe majority of the studies were from upper-middle-income countries (n=16, 88.8%) and mainly from Brazil (n=9, 50%). Only one economic evaluation study was found. The focus of the reviewed literature spanned the economic burden of physical inactivity (n=4, 22%), relationship between PA and costs (n=6, 46%) and socioeconomic determinants of PA (n=7, 39%). The findings showed a considerable economic burden due to insufficient PA, with LMICs accounting for 75% of disability-adjusted life years (DALYs) globally due to insufficient PA. Socioeconomic correlates of PA were identified, and inverse relationship of PA with the cost of chronic diseases was established. Regular PA along with drug treatment as a treatment scheme for chronic diseases showed advantages with a cost–utility ratio of US$3.21/quality-adjusted life year (QALY) compared with the drug treatment-only group (US$3.92/QALY) by the only economic evaluation conducted in the LMIC, Brazil.LimitationsMeta-analysis was not performed due to heterogeneity of the studies.Conclusions and recommendationsEconomic evaluation studies for PA promotion interventions/strategies and local research from low-income countries are grossly inadequate. Setting economic research agenda in LMICs ought to be prioritised in those areas.PROSPERO registration numberCRD42018099856.

scholarly journals Theatres without borders: a systematic review of the use of intraoperative telemedicine in low- and middle-income countries (LMICs)

2021 ◽  
pp. bmjinnov-2021-000837
Author(s):  
Hariharan Subbiah Ponniah ◽  
Viraj Shah ◽  
Arian Arjomandi Rad ◽  
Robert Vardanyan ◽  
George Miller ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Income ◽  
Case Reports ◽  
Surgical Care ◽  
Cochrane Collaboration ◽  
Optimal Care ◽  
Eligibility Criteria ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries

ObjectiveThis systematic review aims to provide a summary of the use of real-time telementoring, telesurgical consultation and telesurgery in surgical procedures in patients in low/middle-income countries (LMICs).DesignA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Collaboration published guidelines.Data sourcesEMBASE, MEDLINE, Cochrane, PubMed and Google Scholar were searched for original articles and case reports that discussed telementoring, telesurgery or telesurgical consultation in countries defined as low-income or middle-income (as per the World Banks’s 2021–2022 classifications) from inception to August 2021.Eligibility criteria for selecting studiesAll original articles and case reports were included if they reported the use of telemedicine, telesurgery or telesurgical consultation in procedures conducted on patients in LMICs.ResultsThere were 12 studies which discussed the use of telementoring in 55 patients in LMICs and included a variety of surgical specialities. There was one study that discussed the use of telesurgical consultation in 15 patients in LMICs and one study that discussed the use of telesurgery in one patient.ConclusionThe presence of intraoperative telemedicine in LMICs represents a principal move towards improving access to specialist surgical care for patients in resource-poor settings. Not only do several studies demonstrate that it facilitates training and educational opportunities, but it remains a relatively frugal and efficient method of doing so, through empowering local surgeons in LMICs towards offering optimal care while remaining in their respective communities.

scholarly journals Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000–17

2020 ◽  
Vol 8 (9) ◽  
pp. e1162-e1185 ◽  
Author(s):  
Aniruddha Deshpande ◽  
Molly K Miller-Petrie ◽  
Paulina A Lindstedt ◽  
Mathew M Baumann ◽  
Kimberly B Johnson ◽  
...  
Keyword(s):  
Drinking Water ◽  
Low Income ◽  
Water And Sanitation ◽  
Middle Income ◽  
Middle Income Countries ◽  
Geographical Inequalities

scholarly journals How community engagement in water and sanitation interventions impacts human health, infrastructure and service longevity in low- and middle-income countries: a realist review

2020 ◽  
Author(s):  
Sarah Nelson ◽  
Dorothy Drabarek ◽  
Aaron Jenkins ◽  
Joel Negin ◽  
Seye Abimbola
Keyword(s):  
Community Engagement ◽  
Community Involvement ◽  
Community Dynamics ◽  
Realist Review ◽  
Limited Information ◽  
Community Based ◽  
Water And Sanitation ◽  
Middle Income ◽  
Safe Water ◽  
Low And Middle Income

Abstract Background Access to safe water and sanitation is considered a basic human right and a focus of the Sustainable Development Goals. However, many water and sanitation interventions do not have long lasting impacts in communities and are generally associated with high levels of failure. Limited information is available to understand what types of interventions work for whom and under what circumstances. Methods A realist review to understand how, and under what circumstances community engagement in water and sanitation interventions impacts access (to safe water and sanitation), change (in health status or behaviour), and sustainability (of resources and services). We systematically searched PubMed, Web of Science and Scopus databases to identify studies from low- and middle-income countries.Results We reviewed 56 studies conducted in 25 countries. We identified five mechanisms that explain access, change and sustainability outcomes: 1) accountability (policies and procedures to hold communities and committees responsible for their actions and outcomes of an initiative), 2) diffusion (spread of an idea or behaviour by innovators over time through communication amongst members of a community), 3) market (the interplay between demand and supply of a service or resource), 4) ownership (sense of possession and control of the service or resource), and 5) shame (a feeling of disgust in one’s behaviour or actions). Contextual elements identified include: community location, communities with similar characteristics, communication, leadership, fines/penalties, seasonality, resource dependency, access to resources and funding, community financial and technical skills and knowledge, leadership, ongoing support and acknowledgement of change, community connectedness and social cohesion, community willingness to pay, committees that followed and understood responsibilities, rules and management plans, active committees with women and community/committee involvement in the design, planning or implementation of the intervention. Conclusion The findings highlight five key mechanisms, impacted by 19 contextual factors that explain outcomes of community-based water and sanitation interventions. Policy makers, program implementers and institutions need to consider community dynamics, location, resources, committees and level of community involvement, prior to the introduction of community-based water and sanitation interventions.

scholarly journals Implementation of clean cookstove interventions and its effects on blood pressure in low-income and middle-income countries: systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026517 ◽  
Author(s):  
Deborah Onakomaiya ◽  
Joyce Gyamfi ◽  
Juliet Iwelunmor ◽  
Jumoke Opeyemi ◽  
Mofetoluwa Oluwasanmi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Implementation Science ◽  
Low Income ◽  
Cochrane Library ◽  
Publication Date ◽  
Eligibility Criteria ◽  
Middle Income ◽  
Middle Income Countries ◽  
Implementation Outcomes

ObjectiveA review of the implementation outcomes of clean cookstove use, and its effects on blood pressure (BP) in low-income and middle-income countries (LMICs).DesignSystematic review of studies that reported the effect of clean cookstove use on BP among women, and implementation science outcomes in LMICs.Data sourcesWe searched PubMed, Embase, INSPEC, Scielo, Cochrane Library, Global Health and Web of Science PLUS. We conducted searches in November 2017 with a repeat in May 2018. We did not restrict article publication date.Eligibility criteria for selecting studiesWe included only studies conducted in LMICs, published in English, regardless of publication year and studies that examined the use of improved or clean cookstove intervention on BP. Two authors independently screened journal article titles, abstracts and full-text articles to identify those that included the following search terms: high BP, hypertension and or household air pollution, LMICs, cookstove and implementation outcomes.ResultsOf the 461 non-duplicate articles identified, three randomised controlled trials (RCTs) (in Nigeria, Guatemala and Ghana) and two studies of pre–post design (in Bolivia and Nicaragua) met eligibility criteria. These articles evaluated the effect of cookstove use on BP in women. Two of the three RCTs reported a mean reduction in diastolic BP of −2.8 mm Hg (−5.0, –0.6; p=0.01) for the Nigerian study; −3.0 mm Hg; (−5.7, –0.4; p=0.02) for the Guatemalan study; while the study conducted in Ghana reported a non-significant change in BP. The pre–post studies reported a significant reduction in mean systolic BP of −5.5 mm Hg; (p=0.01) for the Bolivian study, and −5.9 mm Hg (−11.3, –0.4; p=0.05) for the Nicaraguan study. Implementation science outcomes were reported in all five studies (three reported feasibility, one reported adoption and one reported feasibility and adoption of cookstove interventions).ConclusionAlthough this review demonstrated that there is limited evidence on the implementation of clean cookstove use in LMICs, the effects of clean cookstove on BP were significant for both systolic and diastolic BP among women. Future studies should consider standardised reporting of implementation outcomes.

scholarly journals Inclusion of participants from low-income and middle-income countries in core outcome sets development: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e049981
Author(s):  
Jamlick Karumbi ◽  
Sarah L Gorst ◽  
David Gathara ◽  
Elizabeth Gargon ◽  
Bridget Young ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Income ◽  
Data Extraction ◽  
Study Participant ◽  
Core Outcome ◽  
Eligibility Criteria ◽  
Middle Income ◽  
Core Outcome Sets ◽  
Middle Income Countries ◽  
Patient Reported

ObjectiveOur study aims to describe differences or similarities in the scope, participant characteristics and methods used in core outcome sets (COS) development when only participants from high-income countries (HICs) were involved compared with when participants from low-income and middle-income countries (LMICs) were also involved.DesignSystematic review.Data sourcesAnnual Core Outcome Measures in Effectiveness Trials systematic reviews of COS which are updated based on SCOPUS and MEDLINE, searches. The latest systematic review included studies published up to the end of 2019.Eligibility criteria for selecting studiesWe included studies reporting development of a COS for use in research regardless of age, health condition or setting. Studies reporting the development of a COS for patient-reported outcomes or adverse events or complications were also included.Data extraction and synthesisData were extracted in relation to scope of the COS study, participant categories and the methods used in outcome selection.ResultsStudies describing 370 COS were identified in the database. Of these, 75 (20%) included participants from LMICs. Only four COS were initiated from an LMIC setting. More than half of COS with LMIC participants were developed in the last 5 years. Cancer and rheumatology were the dominant disease domains. Overall, over 259 (70%) of COS explicitly reported including clinical experts; this was higher where LMIC participants were also included 340 (92%). Most LMIC participants were from China, Brazil and South Africa. Mixed methods for consensus building were used across the two settings.ConclusionProgress has been made in including LMIC participants in the development of COS, however, there is a need to explore how to enable initiation of COS development from a range of LMIC settings, how to ensure prioritisation of COS that better reflects the burden of disease in these contexts and how to improve public participation from LMICs.

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