Abstract 38: Setting up a Cancer Clinic in a Low-and-Middle-Income Country (LMIC) in Sub-Saharan Africa: A Case of Taita Taveta County in Kenya.

Author(s):  
Gloria Kitur ◽  
Emmah Achieng ◽  
Rebecca Mwakichako ◽  
Felix Kimotho ◽  
Chite Asirwa
2019 ◽  
Vol 12 (1) ◽  
pp. 1646036 ◽  
Author(s):  
Steffie Heemelaar ◽  
Leonard Kabongo ◽  
Taati Ithindi ◽  
Christian Luboya ◽  
Fidelis Munetsi ◽  
...  

2019 ◽  
Author(s):  
Quan-Hoang Vuong

Valian rightly made a case for better recognition of women in science during the Nobel week in October 2018 (Valian, 2018). However, it seems most published views about gender inequality in Nature focused on the West. This correspondence shifts the focus to women in the social sciences and humanities (SSH) in a low- and middle-income country (LMIC).


Author(s):  
Bridget Pratt

Health research funded by organizations from HICs and conducted in low- and middle-income countries has grown significantly since 1990. Power imbalances and inequities frequently (but not always) exist at each stage of the international research process. Unsurprisingly then, a variety of ethical concerns commonly arise in the context of international health research, such as inequities in funding, the semi-colonial nature of international research models, the brain drain of low- and middle-income country researchers, and inequities in partnerships between HIC and low- and middle-income country researchers. In this chapter, these (and other) ethical concerns are introduced and the following ethical concepts to address the concerns are then discussed: responsiveness, standard of care, benefit sharing, community engagement, and social value. Existing guidance and remaining debates about how to specify each of the concepts are summarized. The chapter concludes by highlighting the existence of epistemic injustices within the field of international research ethics.


2020 ◽  
Vol 5 (2) ◽  
pp. e001850
Author(s):  
Ashley A Leech ◽  
David D Kim ◽  
Joshua T Cohen ◽  
Peter J Neumann

IntroductionSince resources are finite, investing in services that produce the highest health gain ‘return on investment’ is critical. We assessed the extent to which low and middle-income countries (LMIC) have included cost-saving interventions in their national strategic health plans.MethodsWe used the Tufts Medical Center Global Health Cost-Effectiveness Analysis Registry, an open-source database of English-language cost-per-disability-adjusted life year (DALY) studies, to identify analyses published in the last 10 years (2008–2017) of cost-saving health interventions in LMICs. To assess whether countries prioritised cost-saving interventions within their latest national health strategic plans, we identified 10 countries, all in sub-Saharan Africa, with the highest measures on the global burden of disease scale and reviewed their national health priority plans.ResultsWe identified 392 studies (63%) targeting LMICs that reported 3315 cost-per-DALY ratios, of which 207 ratios (6%) represented interventions reported to be cost saving. Over half (53%) of these targeted sub-Saharan Africa. For the 10 countries we investigated in sub-Saharan Africa, 58% (79/137) of cost-saving interventions correspond with priorities identified in country plans. Alignment ranged from 95% (21/22 prioritised cost-saving ratios) in South Africa to 17% (2/12 prioritised cost-saving ratios) in Cameroon. Human papillomavirus vaccination was a noted priority in 70% (7/10) of national health prioritisation plans, while 40% (4/10) of countries explicitly included prenatal serological screening for syphilis. HIV prevention and treatment were stated priorities in most country health plans, whereas 40% (2/5) of countries principally outlined efforts for lymphatic filariasis. From our sample of 45 unique interventions, 36% of interventions (16/45) included costs associated directly with the implementation of the intervention.ConclusionOur findings indicate substantial variation across country and disease area in incorporating economic evidence into national health priority plans in a sample of sub-Saharan African countries. To make health economic data more salient, the authors of cost-effectiveness analyses must do more to reflect implementation costs and other factors that could limit healthcare delivery.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mamuda Aminu ◽  
Sarah Bar-Zeev ◽  
Sarah White ◽  
Matthews Mathai ◽  
Nynke van den Broek

Abstract Background Every year, an estimated 2.6 million stillbirths occur worldwide, with up to 98% occurring in low- and middle-income countries (LMIC). There is a paucity of primary data on cause of stillbirth from LMIC, and particularly from sub-Saharan Africa to inform effective interventions. This study aimed to identify the cause of stillbirths in low- and middle-income settings and compare methods of assessment. Methods This was a prospective, observational study in 12 hospitals in Kenya, Malawi, Sierra Leone and Zimbabwe. Stillbirths (28 weeks or more) were reviewed to assign the cause of death by healthcare providers, an expert panel and by using computer-based algorithms. Agreement between the three methods was compared using Kappa (κ) analysis. Cause of stillbirth and level of agreement between the methods used to assign cause of death. Results One thousand five hundred sixty-three stillbirths were studied. The stillbirth rate (per 1000 births) was 20.3 in Malawi, 34.7 in Zimbabwe, 38.8 in Kenya and 118.1 in Sierra Leone. Half (50.7%) of all stillbirths occurred during the intrapartum period. Cause of death (range) overall varied by method of assessment and included: asphyxia (18.5–37.4%), placental disorders (8.4–15.1%), maternal hypertensive disorders (5.1–13.6%), infections (4.3–9.0%), cord problems (3.3–6.5%), and ruptured uterus due to obstructed labour (2.6–6.1%). Cause of stillbirth was unknown in 17.9–26.0% of cases. Moderate agreement was observed for cause of stillbirth as assigned by the expert panel and by hospital-based healthcare providers who conducted perinatal death review (κ = 0.69; p < 0.0005). There was only minimal agreement between expert panel review or healthcare provider review and computer-based algorithms (κ = 0.34; 0.31 respectively p < 0.0005). Conclusions For the majority of stillbirths, an underlying likely cause of death could be determined despite limited diagnostic capacity. In these settings, more diagnostic information is, however, needed to establish a more specific cause of death for the majority of stillbirths. Existing computer-based algorithms used to assign cause of death require revision.


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