scholarly journals Challenges in the management of Wilms Tumor in a developing country: A twenty years experience from a single centre in Pakistan.

2021 ◽  
Author(s):  
Muhammad Khan ◽  
Ata Maaz ◽  
Muhammad Ashraf
Keyword(s):  
Wilms Tumor ◽  
Childhood Cancers ◽  
Single Centre ◽  
Middle Income ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Resource Poor ◽  
Prior Surgery ◽  
Cure Rates ◽  
Work Up

Background: Wilms Tumour (WT) is one of the most curable childhood cancers. High cure rates seen in the high-income countries are not duplicated in low and middle-income countries due to several constraints. We reviewed our data over the last 20 years in order to highlight some of these challenges. Methods: This is a retrospective review of medical notes of children with WT under the age of 18 years presenting to our institution between 1 November 1997 and 30 November 2017. Demographic, presentation and treatment details were recorded and factors associated with poor outcome were analysed. Results: Of the 211 children presenting with WT 117(55.5%) were males. Median age at presentation was 3 (Range 0-18) years. One hundred and twelve (53.7%) of these presented without any prior treatment, while 72 (34.1%) presented after tumour excision. Metastatic status was available for 178 patients; 117 (68%) had localised tumours, 36(21.8%) had metastatic disease and 25(11.9%) presented with recurrent mass. Thirty-nine (18.4%) patients refused treatment and 6(2.8%) died before starting treatment. During treatment, 23(13.4%) children died and 21(12.2%) abandoned. Only 99 patients finished treatment, 83 (83.8%) of whom are well off therapy and 15 (15.2%) have relapsed. Six (40%) of the 15 children who relapsed are alive after salvage therapy, while the remaining 9 (60%) have died. Conclusions: Our data highlights the challenges of managing WT in resource poor environments. Prior surgery, incomplete staging work-up and abandonment are some of the most frequently encountered barriers. A multipronged approach is required to overcome these challenges.

scholarly journals Hierarchical disentanglement of contextual from compositional risk factors of diarrhoea among under-five children in low- and middle-income countries

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Adeniyi Francis Fagbamigbe ◽  
A. Olalekan Uthman ◽  
Latifat Ibisomi
Keyword(s):  
Risk Factors ◽  
National Level ◽  
Cross Sectional ◽  
Middle Income ◽  
Contextual Risk ◽  
Under Five ◽  
Factors Associated ◽  
Under Five Children ◽  
Middle Income Countries ◽  
Low And Middle Income

AbstractSeveral studies have documented the burden and risk factors associated with diarrhoea in low and middle-income countries (LMIC). To the best of our knowledge, the contextual and compositional factors associated with diarrhoea across LMIC were poorly operationalized, explored and understood in these studies. We investigated multilevel risk factors associated with diarrhoea among under-five children in LMIC. We analysed diarrhoea-related information of 796,150 under-five children (Level 1) nested within 63,378 neighbourhoods (Level 2) from 57 LMIC (Level 3) using the latest data from cross-sectional and nationally representative Demographic Health Survey conducted between 2010 and 2018. We used multivariable hierarchical Bayesian logistic regression models for data analysis. The overall prevalence of diarrhoea was 14.4% (95% confidence interval 14.2–14.7) ranging from 3.8% in Armenia to 31.4% in Yemen. The odds of diarrhoea was highest among male children, infants, having small birth weights, households in poorer wealth quintiles, children whose mothers had only primary education, and children who had no access to media. Children from neighbourhoods with high illiteracy [adjusted odds ratio (aOR) = 1.07, 95% credible interval (CrI) 1.04–1.10] rates were more likely to have diarrhoea. At the country-level, the odds of diarrhoea nearly doubled (aOR = 1.88, 95% CrI 1.23–2.83) and tripled (aOR = 2.66, 95% CrI 1.65–3.89) among children from countries with middle and lowest human development index respectively. Diarrhoea remains a major health challenge among under-five children in most LMIC. We identified diverse individual-level, community-level and national-level factors associated with the development of diarrhoea among under-five children in these countries and disentangled the associated contextual risk factors from the compositional risk factors. Our findings underscore the need to revitalize existing policies on child and maternal health and implement interventions to prevent diarrhoea at the individual-, community- and societal-levels. The current study showed how the drive to the attainment of SDGs 1, 2, 4, 6 and 10 will enhance the attainment of SDG 3.

scholarly journals Assessing Factors Associated with TB Awareness in Nepal: A National and Subnational Study

2021 ◽  
Vol 18 (10) ◽  
pp. 5124
Author(s):  
Yoko Iwaki ◽  
Santosh Kumar Rauniyar ◽  
Shuhei Nomura ◽  
Michael C. Huang
Keyword(s):  
Socioeconomic Factors ◽  
Influential Factors ◽  
Regional Level ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Middle Income ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Information And Communication ◽  
High Level

Tuberculosis (TB) has still remained a serious global health threat in low- and middle-income countries in recent years. As of 2021, Nepal is one of the high TB burden countries, with an increasing prevalence of cases. This study evaluates factors associated with TB awareness in Nepal. This study uses data from the Nepal Demographic and Health Survey, a cross-sectional survey carried out from June 2016 to January 2017. Multilevel logistic regression is performed to examine the association of demographic and socioeconomic factors with TB awareness. Our findings show a high level of TB awareness in all seven provinces of Nepal. Province 5 has the highest level of awareness (98.1%) among all provinces, followed by provinces 3 and 4, while province 6 has the lowest awareness level (93.2%) compared to others. Socioeconomic factors such as wealth, education and owning a mobile phone are significantly associated with TB awareness. Socioeconomic determinants are influential factors associated with TB awareness in Nepal. The wide variation in the proportion of awareness at a regional level emphasizes the importance of formulating tailored strategies to increase TB awareness. For instance, the use of mobile phones could be an effective strategy to promote TB awareness at a regional level. This study provides valuable evidence to support further research on the contribution of information and communication technology (ICT) usage to improving TB awareness in Nepal.

scholarly journals Prevalence and maternal socio-demographic factors associated with stillbirth in health facilities in Anambra, South-East Nigeria

1970 ◽  
Vol 19 (4) ◽  
pp. 3055-3062
Author(s):  
Nonye E Anyichie ◽  
Evelyn N Nwagu
Keyword(s):  
Rural Communities ◽  
Demographic Factors ◽  
Health Facilities ◽  
Women Empowerment ◽  
Middle Income ◽  
Anambra State ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Case Files ◽  
Socio Demographic Factors

Background: Stillbirth is a major adverse perinatal outcome especially in low and middle income countries across the globe. Certain factors relating to mothers from such countries may be associated with this adverse condition.Objectives: To determine the prevalence of stillbirth and also explore the maternal socio-demographic factors associated with stillbirth among mothers in rural communities in Anambra Central Senatorial District of Anambra State Nigeria who gave birth between January 2012 and December 2016.Methods: All case files of mothers who were delivered of their babies were accessed at the sampled health facilities in the district. Data were collected using a structured proforma. A total of 313 stillbirth cases were recorded across the health facilities from 2012-2016.Results: The highest prevalence of stillbirth was recorded in 2012 (38.07 per 1,000 total births). The prevalence of stillbirth was significantly associated with the maternal level of education, occupation, age and type of health facility the mother utilized (p<0.05).Conclusions: We recommend that women empowerment should be a priority at both family and community levels to enable women to seek and obtain necessary care during pregnancy and delivery.Keywords: Stillbirth; mothers; prevalence; health facilities.

scholarly journals Prevalence and factors associated with poor mental health among healthcare professionals in low- and lower-middle-income countries: a systematic review protocol

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Julia Lohmann ◽  
Denny John ◽  
Aso Dzay
Keyword(s):  
Mental Health ◽  
Healthcare Professionals ◽  
Health Workers ◽  
Poor Mental Health ◽  
Psychological Wellbeing ◽  
Health Issues ◽  
Middle Income ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Mental Health Issues

Abstract Background A healthy and productive health workforce is central to a well-functioning health system. However, health workers are at high risk of poor psychological wellbeing due to their particularly strenuous work demands. While mental health of health workers is a well-researched issue in high-income countries, research from low- and lower-middle-income countries (LLMIC) has begun to emerge only recently. The review aims to synthesize this body of research, specifically to assess the prevalence of mental health issues among health workers in LLMIC, to identify factors associated with good or poor mental health, and to highlight gaps in knowledge. Methods We will perform a systematic search of the published English and French language literature (from inception onwards) in MEDLINE, EMBASE, and PsycINFO. Eligible for inclusion are observational studies (e.g., cross-sectional, case-control, or cohort) and control arms of randomized controlled trials reporting investigations on the nature, prevalence, and factors associated with mental health or psychological wellbeing among formally trained health professionals and health associate professionals delivering health services in formal healthcare facilities in LLMIC. The primary outcomes will be burnout, depression, and general psychological wellbeing. Secondary outcomes include other specific mental health diagnoses, as well as general psychological stress, distress and/or trauma if work-related and explicitly framed as a mental health issue. Two authors will independently examine the studies against the eligibility criteria in the stages of title, abstract, and full-text study selection, as well as assess the risk of bias in included studies using standard checklists depending on study design. Disagreements will be resolved in discussion with the third author. Data will be extracted from included studies using a predefined and piloted coding framework. Given the anticipated heterogeneity of studies, we do not expect to be able to conduct meta-analysis and plan to summarize the extracted data in narrative form. The framework method will be used to organize narrative data by subthemes and explore patterns. Discussion In assessing the prevalence of mental health issues among healthcare professionals in LLMIC and identifying factors associated with positive or poor mental health, the review aims to synthesize all possible available information for policy makers and health system managers on a potentially highly important but not yet much-discussed issue and to highlight gaps in currently available knowledge. Systematic review registration International Prospective Register of Systematic Reviews PROSPERO (registration number CRD42019140036)

scholarly journals Factors associated with the uptake of cataract surgery and interventions to improve uptake in low- and middle-income countries: A systematic review

PLoS ONE ◽  
2020 ◽  
Vol 15 (7) ◽  
pp. e0235699
Author(s):  
Eunice Wandia Mailu ◽  
Bhavisha Virendrakumar ◽  
Stevens Bechange ◽  
Emma Jolley ◽  
Elena Schmidt
Keyword(s):  
Systematic Review ◽  
Cataract Surgery ◽  
Middle Income ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Low And Middle Income

An Analysis of Factors Associated with Burn Injury Outcomes in Low- and Middle-Income Countries

2021 ◽  
Vol 257 ◽  
pp. 442-448
Author(s):  
Caitlin Jacobs ◽  
Jonathan Vacek ◽  
Benjamin Many ◽  
Megan Bouchard ◽  
Fizan Abdullah
Keyword(s):  
Burn Injury ◽  
Middle Income ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Injury Outcomes ◽  
Low And Middle Income

scholarly journals Organizational factors associated with health worker protection during the COVID-19 pandemic in four provinces of South Africa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Muzimkhulu Zungu ◽  
Kuku Voyi ◽  
Nosimilo Mlangeni ◽  
Saiendhra Vasudevan Moodley ◽  
Jonathan Ramodike ◽  
...  
Keyword(s):  
South Africa ◽  
Occupational Health ◽  
Health Worker ◽  
Personal Protective Equipment ◽  
Health Workers ◽  
Health Facilities ◽  
Protective Equipment ◽  
Middle Income ◽  
Factors Associated ◽  
Middle Income Countries

Abstract Background Health workers, in short supply in many low-and-middle-income countries, are at increased risk of SARS-CoV-2 infection. This study aimed to assess how South Africa, prepared to protect its health workers from SARS-CoV-2 infection. Methods This was a cross-sectional study design applying participatory action research in four provinces of South Africa. A semi-structured questionnaire and a qualitative observational HealthWISE walkthrough risk assessment was carried out to collect data on occupational safety and health (OSH) systems in 45 hospitals across four provinces to identify factors associated with health worker protection. Adapting the International Labour Organization (ILO) and World Health Organization (WHO) HealthWISE tool, we compiled compliance scores through walkthrough surveys. We used logistic regression to analyze the relationship between readiness indicators and the actual implementation of protective measures. Results We found that health facilities in all four provinces had SARS-CoV-2 plans for the general population but no comprehensive OHS plan for health workers. Provincial Departments of Health (PDoH) varied in how they were organized to respond: Provinces A and D had an OSH SARS-CoV-2 provincial coordinating team and a dedicated budget for occupational health; Province A had an occupational health doctor and nurse; while Province B had an occupational health nurse; Province A and D PDoHs had functional OSH committees; and Province D had conducted some health risk assessments specific to SARS-CoV-2. However, none of the assessed health facilities had an acceptable HealthWISE compliance score (≥ 75%) due to poor ventilation and inadequate administrative control measures. While the supply of personal protective equipment was adequate, it was often not worn properly. Our study found that having an OSH SARS-CoV-2 policy was significantly associated with higher personal protective equipment and ventilation scores. In addition, our analysis showed that hospitals with higher compliance scores had significantly lower infection rates (IRR 0.98; 95% CI: 0.97, 0.98). Conclusions Despite some initial preparedness, greater effort to protect health workers is still warranted. Low-and-middle-income countries may need to pay more attention to OSH systems and consider using tools, such as ILO/WHO HealthWISE tool, to protect health workers’ health.

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