The State of Stroke Services across the Globe: Report of World Stroke Organization-World Health Organization Surveys

Background: Improving stroke services is critical for reducing the global stroke burden. The World Stroke Organization (WSO)-World Health Organisation (WHO)-Lancet Neurology Commission on Stroke conducted a survey of the status of stroke services in low and middle income countries (LMICs) compared to high income countries (HICs). Methods: Using a validated WSO comprehensive questionnaire, we collected and compared data on stroke services along four pillars of the stroke quadrangle (surveillance, prevention, acute stroke, and rehabilitation) in 84 countries across WHO regions and economic strata. The WHO also conducted a survey of non-communicable diseases in 194 countries in 2019. Results: Fewer surveillance activities (including presence of registries, presence of recent risk factors surveys and participation in research) were reported in low-income countries (LICs) than HICs. The overall global score for prevention was 40.2%. Stroke units were present in 91% of HICs in contrast to 18% of LICs (p<0.001). Acute stroke treatments were offered in ~60% of HICs compared to 26% of LICs (p=0.009). Compared to HICs, LMICs provided less rehabilitation services including in-patient rehabilitation, home assessment, community rehabilitation, education, early hospital discharge program, and presence of rehabilitation protocol. Conclusions: There is an urgent need to improve stroke services globally especially in LMICs. Countries with less stroke services can adapt strategies from those with better services. This could include establishment of a framework for regular monitoring of stroke burden and services, implementation of integrated prevention activities and essential acute stroke care services, and provision of interdisciplinary care for stroke rehabilitation.

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The burden of serious health-related suffering among cancer decedents: Global projections study to 2060

Palliative Medicine ◽

10.1177/0269216320957561 ◽

2020 ◽

pp. 026921632095756

Author(s):

Katherine E Sleeman ◽

Barbara Gomes ◽

Maja de Brito ◽

Omar Shamieh ◽

Richard Harding

Keyword(s):

Palliative Care ◽

Low Income ◽

Population Based ◽

World Health ◽

Low Income Countries ◽

Cancer Type ◽

Middle Income ◽

Middle Income Countries ◽

Health Related ◽

Health Organization

Background: Palliative care improves outcomes for people with cancer, but in many countries access remains poor. Understanding future needs is essential for effective health system planning in response to global policy. Aim: To project the burden of serious health-related suffering associated with death from cancer to 2060 by age, gender, cancer type and World Bank income region. Design: Population-based projections study. Global projections of palliative care need were derived by combining World Health Organization cancer mortality projections (2016–2060) with estimates of serious health-related suffering among cancer decedents. Results: By 2060, serious health-related suffering will be experienced by 16.3 million people dying with cancer each year (compared to 7.8 million in 2016). Serious health-related suffering among cancer decedents will increase more quickly in low income countries (407% increase 2016–2060) compared to lower-middle, upper-middle and high income countries (168%, 96% and 39% increase 2016-2060, respectively). By 2060, 67% of people who die with cancer and experience serious health-related suffering will be over 70 years old, compared to 47% in 2016. In high and upper-middle income countries, lung cancer will be the single greatest contributor to the burden of serious health-related suffering among cancer decedents. In low and lower-middle income countries, breast cancer will be the single greatest contributor. Conclusions: Many people with cancer will die with unnecessary suffering unless there is expansion of palliative care integration into cancer programmes. Failure to do this will be damaging for the individuals affected and the health systems within which they are treated.

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Recruitment of consultant psychiatrists from low- and middle-income countries

International Psychiatry ◽

10.1192/s1749367600006986 ◽

2004 ◽

Vol 1 (6) ◽

pp. 15-18 ◽

Cited By ~ 11

Author(s):

David Ndetei ◽

Salman Karim ◽

Malik Mubbashar

Keyword(s):

Low Income ◽

Health Sector ◽

World Health ◽

Low Income Countries ◽

Middle Income ◽

Middle Income Countries ◽

Fellowship Programme ◽

Health Organization ◽

Rich Countries ◽

Low And Middle Income

The UK's 2-year International Fellowship Programme for consultant doctors has inadvertently highlighted the long-standing issues of the costs and benefits of such recruitment for the countries of origin, and of whether it is ethical for rich countries to recruit health personnel not only from other rich countries but also from low- and middle-income countries. The ‘brain drain’ from poor to rich countries has been recognised for decades; it occurs in the health sector as well as other sectors, such as education, science and engineering. It has had serious ramifications for the health service infrastructure in low-income countries, where poverty, morbidity, disability and mortality are increasing rather than decreasing, and it is a matter of serious concern for both the World Health Organization and the International Monetary Fund (Carrington & Detragiache, 1998; Lee, 2003).

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Mitotic Poisons in Research and Medicine

Molecules ◽

10.3390/molecules25204632 ◽

2020 ◽

Vol 25 (20) ◽

pp. 4632 ◽

Cited By ~ 2

Author(s):

Jan Škubník ◽

Michal Jurášek ◽

Tomáš Ruml ◽

Silvie Rimpelová

Keyword(s):

Low Income ◽

Cancer Therapeutics ◽

Modern Medicine ◽

World Health ◽

Low Income Countries ◽

Cancer Therapies ◽

Middle Income ◽

Treatment Services ◽

The World ◽

Health Organization

Cancer is one of the greatest challenges of the modern medicine. Although much effort has been made in the development of novel cancer therapeutics, it still remains one of the most common causes of human death in the world, mainly in low and middle-income countries. According to the World Health Organization (WHO), cancer treatment services are not available in more then 70% of low-income countries (90% of high-income countries have them available), and also approximately 70% of cancer deaths are reported in low-income countries. Various approaches on how to combat cancer diseases have since been described, targeting cell division being among them. The so-called mitotic poisons are one of the cornerstones in cancer therapies. The idea that cancer cells usually divide almost uncontrolled and far more rapidly than normal cells have led us to think about such compounds that would take advantage of this difference and target the division of such cells. Many groups of such compounds with different modes of action have been reported so far. In this review article, the main approaches on how to target cancer cell mitosis are described, involving microtubule inhibition, targeting aurora and polo-like kinases and kinesins inhibition. The main representatives of all groups of compounds are discussed and attention has also been paid to the presence and future of the clinical use of these compounds as well as their novel derivatives, reviewing the finished and ongoing clinical trials.

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AMR Surveillance in low and middle-income settings - A roadmap for participation in the Global Antimicrobial Surveillance System (GLASS)

Wellcome Open Research ◽

10.12688/wellcomeopenres.12527.1 ◽

2017 ◽

Vol 2 ◽

pp. 92 ◽

Cited By ~ 43

Author(s):

Anna C. Seale ◽

N. Claire Gordon ◽

Jasmin Islam ◽

Sharon J. Peacock ◽

J. Anthony G. Scott

Keyword(s):

Low Income ◽

Surveillance System ◽

World Health ◽

Low Income Countries ◽

Drug Resistant ◽

Middle Income ◽

Surveillance Programme ◽

Antimicrobial Surveillance ◽

Life Threatening ◽

Health Organization

Drug-resistant infections caused by bacteria with increasing antimicrobial resistance (AMR) threaten our ability to treat life-threatening conditions. Tackling AMR requires international collaboration and partnership. An early and leading priority to do this is to strengthen AMR surveillance, particularly in low-income countries where the burden of infectious diseases is highest and where data are most limited. The World Health Organization (WHO) has developed the Global AMR Surveillance System (GLASS) as one of a number of measures designed to tackle the problem of AMR, and WHO member states have been encouraged to produce National Action Plans for AMR by 2017. However, low-income countries are unlikely to have the resources or capacity to implement all the components in the GLASS manual. To facilitate their efforts, we developed a guideline that is aligned to the GLASS procedures, but written specifically for implementation in low-income countries. The guideline allows for flexibility across different systems, but has sufficient standardisation of core protocols to ensure that, if followed, data will be valid and comparable. This will ensure that the surveillance programme can provide health intelligence data to inform evidence-based interventions at local, national and international levels.

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The Inequities of Motherhood: The Challenges of Obstetric Anesthesia in Low-Income Countries

10.28971/532018rm101 ◽

2018 ◽

Author(s):

Mary Ricci

Keyword(s):

Low Income ◽

Well Being ◽

Obstetric Anesthesia ◽

World Health ◽

Low Income Countries ◽

Extensive Literature ◽

Anesthetic Care ◽

Middle Income ◽

The World ◽

Health Organization

The maternal mortality rate (MMR) is unconscionably high around the world, with women in low to middle income countries (LMICs) disproportionately passing away from potentially preventable causes. While this is a complicated and multifaceted problem, anesthesia has been identified as a contributing cause of death. From the moment the parturient enters the operating room, the anesthetist is responsible for their well-being. This integrative review was designed to further explore relationship between anesthesia and the MMR in LMICs. Twelve articles published within the last 15 years were selected through an extensive literature search using Medline and CINAHL. Each article was examined using the Polit and Beck (2017) assessment criteria followed by a cross table analysis. The results identified common themes across the studies including lack of infrastructure such as access to reliable power, water and oxygen, resources such as medications and basic anesthesia equipment, training focusing on maternal care and anesthesia and continuing education for providers. Knowing these deficiencies in anesthetic care, nurse anesthetists can assist in implementing changes to help reduce the MMR. Recommendations include encouraging hospitals and governments to make updating hospital infrastructure a priority, reaching out to groups such as the World Health Organization who help fund basic equipment such as pulse oximeters, establishing relationships with medical institutions in other regions to provide training and guidance, and focusing on the development of non-physician anesthetist programs to increase the number of proficient providers.

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Current use and acceptability of novel diagnostic tests for active tuberculosis: a worldwide survey

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562017000000219 ◽

2017 ◽

Vol 43 (5) ◽

pp. 380-392 ◽

Cited By ~ 11

Author(s):

Massimo Amicosante ◽

Lia D’Ambrosio ◽

Marcela Munoz ◽

Fernanda Carvalho de Queiroz Mello ◽

Marc Tebruegge ◽

...

Keyword(s):

Low Income ◽

World Health ◽

Low Income Countries ◽

Smear Microscopy ◽

Middle Income ◽

Middle Income Countries ◽

Molecular Assays ◽

Molecular Tests ◽

Rapid Tests ◽

Health Organization

ABSTRACT Objective: To determine the current use and potential acceptance (by tuberculosis experts worldwide) of novel rapid tests for the diagnosis of tuberculosis that are in line with World Health Organization target product profiles. Methods: A multilingual survey was disseminated online between July and November of 2016. Results: A total of 723 individuals from 114 countries responded to the survey. Smear microscopy was the most commonly used rapid tuberculosis test (available to 90.9% of the respondents), followed by molecular assays (available to 70.7%). Only a small proportion of the respondents in middle- and low-income countries had access to interferon-gamma-release assays. Serological and lateral flow immunoassays were used by more than a quarter (25.4%) of the respondents. Among the respondents who had access to molecular tests, 46.7% were using the Xpert assay overall, that proportion being higher in lower middle-income countries (55.6%) and low-income countries (76.6%). The data also suggest that there was some alignment of pricing for molecular assays. Respondents stated they would accept novel rapid tuberculosis tests if available, including molecular assays (acceptable to 86.0%) or biomarker-based serological assays (acceptable to 81.7%). Simple biomarker-based assays were more commonly deemed acceptable in middle- and low-income countries. Conclusions: Second-generation molecular assays have become more widely available in high- and low-resource settings. However, the development of novel rapid tuberculosis tests continues to be considered important by tuberculosis experts. Our data also underscore the need for additional training and education of end users.

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Optimizing public health strategies in low-income countries: epidemiology, ecology and evolution for the control of malaria

10.1093/oso/9780198789833.003.0016 ◽

2018 ◽

Author(s):

Eve Miguel ◽

Florence Fournet ◽

Serge Yerbanga ◽

Nicolas Moiroux ◽

Franck Yao ◽

...

Keyword(s):

Low Income ◽

Evolutionary Biology ◽

World Health ◽

Low Income Countries ◽

Health Improvement ◽

Middle Income ◽

Resource Limited ◽

Spatio Temporal ◽

Health Organization ◽

Public Health Strategies

During the 20th century, health inequalities among countries have increased. Several factors explain this pattern, such as immunization and massive antibiotherapy, but nutrition, housing and hygiene are key parameters for health improvement. This heterogeneity among countries is well illustrated by malaria, although disappeared from many high-income countries, is still endemic and prevalent in low- and middle-income countries. We question these differences and detail the recommendations proposed by the World Health Organization to tackle malaria. We investigate the optimal combination of actions to deploy in resource-limited countries and the best spatio-temporal window to target. We propose a new framework for health program management based on evolutionary biology approaches to tailor global programs, to improve their local efficiency and avoid resistance. Thus, we explore all components of the ecological niche of the parasite (human, vector and environment) and consider the magnitude of actions to deploy to reach its local.

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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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Examination of WHO/INRUD Core Drug Use Indicators at Public Primary Healthcare Centers in Kisii County, Kenya

10.1101/2020.03.15.20036269 ◽

2020 ◽

Author(s):

Faith A. Okalebo ◽

Eric M. Guantai ◽

Aggrey O. Nyabuti

Keyword(s):

Drug Use ◽

Low Income ◽

Primary Healthcare ◽

Essential Medicines ◽

World Health ◽

Low Income Countries ◽

Rational Use ◽

Health Organization ◽

Consultation Time ◽

Primary Healthcare Centers

ABSTRACTBackgroundIrrational drug use is a global problem. However, the extent of the problem is higher in low-income countries. This study set out to assess and characterize drug use at the public primary healthcare centers (PPHCCs) in a rural county in Kenya, using the World Health Organization/ International Network for the Rational Use of Drugs (WHO/INRUD) core drug use indicators methodology.MethodsTen PPHCCs were randomly selected. From each PPHCC, ninety prescriptions from October to December 2018 were sampled and data extracted. Three-hundred (30 per PPHCC) patients and ten (1 per PPHCC) dispensers were also observed and interviewed. The WHO/INRUD core drug use indicators were used to assess the patterns of drug use.ResultsThe average number of drugs per prescription was 2.9 (SD 0.5) (recommended: 1.6– 1.8), percentage of drugs prescribed by generic names was 27.7% (recommended: 100%); the percentage of prescriptions with an antibiotic was 84.8% (recommended: 20.0–26.8%), and with an injection prescribed was 24.9% (recommended: 13.4–24.1%). The percentage of prescribed drugs from the Kenya Essential Medicines List was 96.7% (recommended: 100%). The average consultation time was 4.1 min (SD 1.7) (recommended: ≥10 min), the average dispensing time was 131.5 sec (SD 41.5) (recommended: ≥90 sec), the percentage of drugs actually dispensed was 76.3% (recommended: 100%), the percentage of drugs adequately labeled was 22.6% (recommended: 100%) and percentage of patients with correct knowledge of dispensed drugs was 54.7% (recommended: 100%). Only 20% of the PPHCCs had a copy of KEML available, and 80% of the selected essential drugs assessed were available.ConclusionThe survey shows irrational drug use practices, particularly polypharmacy, non-generic prescribing, overuse of antibiotics, short consultation time and inadequacy of drug labeling. Effective programs and activities promoting the rational use of drugs are the key interventions suggested at all the health facilities.

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INTERNATIONAL DEVELOPMENT ISSUES

PEDIATRICS ◽

10.1542/peds.70.3.395 ◽

1982 ◽

Vol 70 (3) ◽

pp. 395-395

Author(s):

Keyword(s):

International Development ◽

Low Income ◽

Development Aid ◽

Military Expenditure ◽

World Health ◽

Low Income Countries ◽

River Blindness ◽

Eradication Programme ◽

Set Up ◽

Health Organization

The annual military bill is now approaching 450 billion US dollars, while official development aid accounts for less than 5 per cent of this figure. Four examples: 1. The military expenditure of only half a day would suffice to finance the whole malaria eradication programme of the World Health Organization, and less would be needed to conquer river-blindness, which is still the scourge of millions. 2. A modern tank costs about one million dollars; that amount could improve storage facilities for 100,000 tons of rice and thus save 4000 tons or more annually; one person can live on just over a pound of rice a day. The same sum of money could provide 1000 classrooms for 30,000 children. 3. For the price of one jet fighter (20 million dollars) one could set up about 40,000 village pharmacies. 4. One-half of one per cent of one year's world military expenditure would pay for all the farm equipment needed to increase food production and approach self-sufficiency in food-deficit low-income countries by 1990.

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