scholarly journals Effective treatment of perinatal depression for women in debt and lacking financial empowerment in a low-income country

2012 ◽  
Vol 201 (6) ◽  
pp. 451-457 ◽  
Author(s):  
Atif Rahman ◽  
Siham Sikander ◽  
Abid Malik ◽  
Ikhlaque Ahmed ◽  
Barbara Tomenson ◽  
...  
Keyword(s):  
Low Income ◽  
Perinatal Depression ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Behavioural Therapy ◽  
Low Income Countries ◽  
Household Debt ◽  
Low Income Country ◽  
Interaction Terms

BackgroundPoverty may moderate the effect of treatment of depression in low-income countries.AimsTo assess poverty and lack of empowerment as moderators of a cognitive-behavioural therapy (CBT)-based intervention for perinatal depression in rural Pakistan.MethodUsing secondary analysis of data from a randomised controlled trial (trial registration: ISRCTN65316374) we identified predictors of depression at 1-year follow-up and moderators of the intervention (n=791).ResultsPredictors of follow-up depression included household debt, the participant not being empowered to manage household finance and the interaction terms for these variables with the trial arm. Effect sizes for women with and without household debt were 0.80 and 0.55 respectively. The effect size for women in debt and not empowered financially was 0.94 compared with 0.50 for women with neither of these factors.ConclusionsOur findings demonstrate the importance of household debt and lack of financial empowerment of women as important maintaining factors of depression in low-income countries and our locally developed intervention tackled these problems successfully.

scholarly journals Tackling the global problem of traumatic stress in low-income countries: a pilot clinical trial comparing reconsolidation therapy to paroxetine in Nepal

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Alain Brunet ◽  
Ram P. Sapkota ◽  
Bhushan Guragain ◽  
Jacques Tremblay ◽  
Daniel Saumier ◽  
...  
Keyword(s):  
Low Income ◽  
Traumatic Stress ◽  
Treatment Effectiveness ◽  
Global Mental Health ◽  
Low Income Countries ◽  
Traumatic Memory ◽  
Low Income Country ◽  
Intent To Treat ◽  
Core Symptoms

Abstract Background Traumatic stress is a global mental health problem requiring novel, easily implemented treatment solutions. We compared the effectiveness and efficiency of Reconsolidation Therapy (RT) to the well-established antidepressant paroxetine, in reducing symptoms of traumatic stress among patients from Nepal, a low-income country. Methods Forty-six adults with posttraumatic stress disorder (PTSD) were randomized to one of two groups. The reconsolidation blocker propranolol was administered 90 min before briefly recalling a traumatic memory with a therapist, weekly for six consecutive weeks. This was compared to daily paroxetine for 26 weeks. Self-reported PTSD symptoms were assessed blindly at the 7th, 13th, and 26th weeks. Results An intent-to-treat analysis revealed a robust pre- to post-treatment main effect (β1 = − 4.83, 95% CI = [− 5.66, − 4.01], p < .001), whereby both groups improved, with Cohen’s effect sizes of d = 2.34 (95% CI = [1.57, 3.12]) for paroxetine, and of 2.82 (95% CI = [1.98, 3.66]) for RT after 7 weeks, suggesting treatment effectiveness for both groups in a real-world setting. Three and six-month follow-up yielded further significant improvement in both groups, which did not differ from each other. Conclusion RT also displayed promising efficiency, considering that it had been discontinued weeks earlier while the paroxetine treatment was continued, as recommended. RT could be taught in low-income countries as part of the local therapeutic resources to treat the core symptoms of PTSD, provided that such results are replicated on a broader scale. Trial registration ISRCTN34308454 (11/10/2017).

scholarly journals An individual randomised efficacy trial of autologous blood products, leukocyte and platelet-rich fibrin (L-PRF), to promote ulcer healing in leprosy in Nepal: the TABLE trial protocol

2021 ◽  
Author(s):  
Indra B Napit ◽  
Dilip Shrestha ◽  
Jon Bishop ◽  
Sopna Choudhury ◽  
Santosh Dulal ◽  
...  
Keyword(s):  
Low Income ◽  
Ulcer Healing ◽  
Controlled Trial ◽  
Autologous Blood ◽  
Foot Ulcer ◽  
Low Income Countries ◽  
Platelet Rich Fibrin ◽  
Single Centre Study

Abstract BackgroundLeprosy is curable with multidrug therapy and treatment in the early stages can prevent disability. However, local nerve damage can lead to injury and consequently recurring and disfiguring ulcers. The aim of this study is to evaluate the treatment of leprosy ulcers using an autologous blood product; leukocyte and platelet-rich fibrin (L-PRF) to promote healing.MethodsThis is a single centre study in the Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal. Consenting patients (n = 130) will be individually randomised in a single-blinded, controlled trial. Participants will be 18 years of age or older, admitted to hospital with a clean, dry and infection free chronic plantar foot ulcer between 2 and 20 cm2 in size. If the ulcer is infected, it will be treated before enrolment into the study. The intervention involves the application of leukocyte and platelet-rich fibrin (L-PRF) matrix on the ulcer beds during twice-weekly dressing changes. Controls receive usual care in the form of saline dressings only during their twice-weekly dressing changes. Primary outcomes are rate of healing assessed using standardised photographs by observers blind to allocated treatment, and time to complete re-epithelialization. Follow up is at six months from randomisation.DiscussionThis research will provide valuable information on the clinical and cost-effectiveness of L-PRF in the treatment of leprosy ulcers. An additional benefit is the evaluation of the effects of treatment on quality of life for people living with leprosy ulcers. The results will improve our understanding of the scalability of this treatment across low-income countries for ulcer healing in leprosy and potentially other conditions such as diabetic ulcers.Trial registrationISRCTN14933421. Date of trial registration: 16 June 2020

A Cross-sectional Study of the Clinical Profile of Children With Cerebral Palsy in Benin, a West African Low-Income Country

2019 ◽  
Vol 34 (13) ◽  
pp. 842-850
Author(s):  
Emmanuel Segnon Sogbossi ◽  
Damienne Houekpetodji ◽  
Toussaint G. Kpadonou ◽  
Yannick Bleyenheuft
Keyword(s):  
Risk Factors ◽  
Cerebral Palsy ◽  
Low Income ◽  
Classification System ◽  
West African ◽  
Low Income Countries ◽  
Cross Sectional ◽  
Common Cause ◽  
Low Income Country ◽  
Children With Cerebral Palsy

Cerebral palsy is a common cause of pediatric motor disability. Although there are increasing amounts of data on the clinical profile of children with cerebral palsy in high-income countries, corresponding information about low-income countries and developing countries is lacking. Therefore, we aimed to describe the clinical spectrum of cerebral palsy in children in Benin, a representative West African low-income country. Our cross-sectional observational study included 114 children with cerebral palsy recruited from community-based rehabilitation centers and teaching hospitals (median age: 7 years, range 2-17; sex: 66% male). Data were collected through review of medical records and interviews with children’s mothers. Assessment included risk factors, clinical subtypes according to the Surveillance of CP in Europe criteria, severity of motor outcome scored by the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System, comorbidities, and school attendance. We recorded a high prevalence of intrapartum adverse events. Seventeen percent of children had postneonatal cerebral palsy, with cerebral malaria being the most common cause. Most children were severely affected (67.5% as bilateral spastic; 54.4% as GMFCS IV or V), but severity declined substantially with age. Only 23% of the children with cerebral palsy had attended school. Poor motor outcomes and comorbidities were associated with school nonattendance. These results suggest that intrapartum risk factors and postnatal cerebral malaria in infants are opportune targets for prevention of cerebral palsy in Sub-Saharan low-income countries.

scholarly journals Computerised cognitive–behavioural therapy for adults with intellectual disability: randomised controlled trial

2017 ◽  
Vol 211 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Patricia Cooney ◽  
Catherine Jackman ◽  
David Coyle ◽  
Gary O'Reilly
Keyword(s):  
Intellectual Disability ◽  
Randomised Controlled Trial ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Primary Outcome Measure ◽  
Cognitive Behavioural ◽  
Randomised Controlled

BackgroundDespite the evidence base for computer-assisted cognitive–behavioural therapy (CBT) in the general population, it has not yet been adapted for use with adults who have an intellectual disability.AimsTo evaluate the utility of a CBT computer game for adults who have an intellectual disability.MethodA 2 × 3 (group × time) randomised controlled trial design was used. Fifty-two adults with mild to moderate intellectual disability and anxiety or depression were randomly allocated to two groups: computerised CBT (cCBT) or psychiatric treatment as usual (TAU), and assessed at pre-treatment, post-treatment and 3-month follow-up. Forty-nine participants were included in the final analysis.ResultsA significant group x time interaction was observed on the primary outcome measure of anxiety (Glasgow Anxiety Scale for people with an Intellectual Disability), favouring cCBT over TAU, but not on the primary outcome measure of depression (Glasgow Depression Scale for people with a Learning Disability). A medium effect size for anxiety symptoms was observed at post-treatment and a large effect size was observed after follow-up. Reliability of Change Indices indicated that the intervention produced clinically significant change in the cCBT group in comparison with TAU.ConclusionsAs the first application of cCBT for adults with intellectual disability, this intervention appears to be a useful treatment option to reduce anxiety symptoms in this population.

scholarly journals Impact of refugee population on development: A comparative analysis for the case of host economies

2018 ◽  
Vol 18 (1) ◽  
pp. 77-96
Author(s):  
Mohamed Kouni
Keyword(s):  
Labor Force ◽  
Direct Effect ◽  
Low Income ◽  
Indirect Effect ◽  
Point Of View ◽  
Low Income Countries ◽  
Middle Income ◽  
Refugee Population ◽  
Low Income Country ◽  
Middle Income Countries

Abstract This study was carried out to investigate the relationship between refugees and development in host economies from a macroeconomic point of view. The results obtained show that this relationship is non-linear. The empirical results demonstrate that refugees have a positive and significant direct effect in high and lower-middle-income countries. A positive and significant indirect effect of refugees through labor force and RD channels is also present in the same groups. In upper-middle-income and low-income countries, the direct effect of refugees is negative and significant. Similarly, the indirect effect of the refugee population on development through labor force channel is also negative and statistically significant. However, the indirect effect of refugees through RD channel is statistically significant only for the low-income country group.

scholarly journals Mean Corpuscular Volume as a Marker for Adherence to Zidovudine-Containing Therapy in HIV-Infected Adults

2012 ◽  
Vol 6 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Joseph O Mugisha ◽  
Katherine Donegan ◽  
Sarah Fidler ◽  
Gita Ramjee ◽  
Andrew Hodson ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Low Income ◽  
Mean Corpuscular Volume ◽  
Controlled Trial ◽  
Low Income Countries ◽  
Corpuscular Volume ◽  
Hiv Rna ◽  
Cart Initiation ◽  
Short Course ◽  
Randomised Controlled

Objectives: To assess whether mean corpuscular volume (MCV) is useful in detecting non-adherence to AZTcontaining therapy. Design: Observational study within randomised controlled trial. Methods: We combined data from two treatment arms in SPARTAC, an RCT of short-course cART in primary HIV infection, classifying participants as responders (HIV-RNA decrease ≥1 log10 or reaching <400copies/ml) or nonresponders following cART initiation. We assessed the sensitivity and specificity of using different percentage increases in MCV for accurately differentiating between responders and non-responders. We further examined changes in MCV levels up to 24 weeks after protocol-indicated cART cessation. Results: Of 119 participants included in this analysis, 73 (61%) were women, 71 of whom were randomised in Africa. Ninety-eight (88%) and 84 (85%) were classified as responders at 4 and 12 weeks respectively following cART initiation. MCV increased by a mean 3% and 1% at week 4, and 14% and <1% at 12 weeks for responders and non-responders. A 2% MCV increase at 4 weeks had 62% sensitivity and specificity for identifying virological response. At 12 weeks, an 8% increase had 89% sensitivity and specificity. In responders, MCV remained lower for individuals in African compared to non-African sites throughout and rose from 85 vs 90 fL at cART start to 96 vs 103 fL at 12 weeks post-initiation then fell to 88 vs 93 fL and 86 vs 89 fL at 12 and 48 weeks post-cessation. Conclusion: In low-income countries, where HIV RNA may be unavailable, 12-weekly MCV measurements may be useful in monitoring adherence to AZT-containing regimens.

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