scholarly journals COVID-19 Vaccination in Lower-Middle Income Countries: National Stakeholder Views on Challenges, Barriers, and Potential Solutions

2021 ◽  
Vol 9 ◽  
Author(s):  
Eunice Twumwaa Tagoe ◽  
Nurnabi Sheikh ◽  
Alec Morton ◽  
Justice Nonvignon ◽  
Abdur Razzaque Sarker ◽  
...  
Keyword(s):  
National Level ◽  
Immunisation Programme ◽  
Health Providers ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Middle Income ◽  
Vaccination Programs ◽  
Middle Income Countries ◽  
Short Period ◽  
Barriers And Challenges

The development of COVID-19 vaccines does not imply the end of the global pandemic as now countries have to purchase enough COVID-19 vaccine doses and work towards their successful rollout. Vaccination across the world has progressed slowly in all, but a few high-income countries (HICs) as governments learn how to vaccinate their entire populations amidst a pandemic. Most low- and middle-income countries (LMICs) have been relying on the COVID-19 Vaccines Global Access (COVAX) Facility to obtain vaccines. COVAX aims to provide these countries with enough doses to vaccinate 20% of their populations. LMICs will likely encounter additional barriers and challenges rolling out vaccines compared HICs despite their significant experience from the Expanded Programme on Immunisation (EPI). This study explores potential barriers that will arise during the COVID-19 vaccine rollout in lower-middle-income countries and how to overcome them. We conducted sixteen semi-structured interviews with national-level stakeholders from Ghana and Bangladesh (eight in each country). Stakeholders included policymakers and immunisation programme experts. Data were analysed using a Framework Analysis technique. Stakeholders believed their country could use existing EPI structures for the COVID-19 vaccine rollout despite existing challenges with the EPI and despite its focus on childhood immunisation rather than vaccinating the entire population over a short period of time. Stakeholders suggested increasing confidence in the vaccine through community influencers and by utilising local government accredited institutions such as the Drug Authorities for vaccine approval. Additional strategies they discussed included training more health providers and recruiting volunteers to increase vaccination speed, expanding government budgets for COVID-19 vaccine purchase and delivery, and exploring other financing opportunities to address in-country vaccine shortages. Stakeholders also believed that LMICs may encounter challenges complying with priority lists. Our findings suggest that COVID-19 vaccination is different from previous vaccination programs, and therefore, policymakers have to expand the EPI structure and also take a systematic and collaborative approach to plan and effectively rollout the vaccines.

Collaboration Challenges of Non-Governmental Organizations in Healthcare System in Iran

2021 ◽  
Author(s):  
elahe Hooshmand ◽  
Esmat Pardasi ◽  
Jamshid jamali ◽  
Javad Javan-Noughabi ◽  
Ali vafaee-Najar
Keyword(s):  
Developing Countries ◽  
National Level ◽  
Issues Management ◽  
Cultural Issues ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Middle Income ◽  
Governmental Organizations ◽  
Data Framework ◽  
Non Governmental Organizations

Abstract Background: Despite the strong emphasize of government on collaboration and application of non-governmental organizations in healthcare, there can be seen a research gap in this area in developing countries. The present study aims to investigate collaboration challenges of non-governmental organizations in healthcare from the viewpoint of healthcare managers and active managers of non-governmental organizations of Iran as an example of low-middle income country. Methods: This study is carried out via 54 semi-structured interviews with the managers of governmental sector and the active managers of non-governmental organizations at the national level from 2019 to 2020. Data framework analysis method in Atlas.T software is used for analysis of the interviews. Results: The results of this study highlight five major concepts in collaboration challenges of non-governmental organizations in healthcare: political issues, operational issues, cultural issues, management issues, and communication issues. Conclusions: This study presents a clear framework for identification of collaboration challenges of non-governmental organizations in healthcare Especially for developing countries. This framework should be taken into consideration by authorities of Ministry of health in their policy makings.

Defining Preterm Birth and Stillbirth in the Western Pacific: A Systematic Review

2021 ◽  
pp. 101053952110260
Author(s):  
Mairead Connolly ◽  
Laura Phung ◽  
Elise Farrington ◽  
Michelle J. L. Scoullar ◽  
Alyce N. Wilson ◽  
...  
Keyword(s):  
Preterm Birth ◽  
National Level ◽  
Health Indicators ◽  
Western Pacific ◽  
World Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Definition Of ◽  
Health Organization ◽  
The Impact

Preterm birth and stillbirth are important global perinatal health indicators. Definitions of these indicators can differ between countries, affecting comparability of preterm birth and stillbirth rates across countries. This study aimed to document national-level adherence to World Health Organization (WHO) definitions of preterm birth and stillbirth in the WHO Western Pacific region. A systematic search of government health websites and 4 electronic databases was conducted. Any official report or published study describing the national definition of preterm birth or stillbirth published between 2000 and 2020 was eligible for inclusion. A total of 58 data sources from 21 countries were identified. There was considerable variation in how preterm birth and stillbirth was defined across the region. The most frequently used lower gestational age threshold for viability of preterm birth was 28 weeks gestation (range 20-28 weeks), and stillbirth was most frequently classified from 20 weeks gestation (range 12-28 weeks). High-income countries more frequently used earlier gestational ages for preterm birth and stillbirth compared with low- to middle-income countries. The findings highlight the importance of clear, standardized, internationally comparable definitions for perinatal indicators. Further research is needed to determine the impact on regional preterm birth and stillbirth rates.

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 Children against antibiotics misuse and antimicrobial resistance: assessing effectiveness of storytelling and picture drawing as public engagement approaches

2021 ◽  
Vol 6 ◽  
pp. 202
Author(s):  
Bernard Appiah ◽  
David Anum-Hagin ◽  
Martha Gyansa-Luterrodt ◽  
Elfreda Samman ◽  
Franklin Konadu Addo Agyeman ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Science Teachers ◽  
Public Engagement ◽  
Statistical Significance ◽  
Attitudes And Beliefs ◽  
Framework Analysis ◽  
Middle Income ◽  
Middle Income Countries ◽  
Negative Effect ◽  
Engagement Interventions

Background: Interventions delivered in schools have been found to be effective in improving knowledge of antibiotics and antimicrobial resistance (AMR) among school-aged children, particularly those in high-income countries, but the evidence is largely lacking in low- and middle-income countries. This study aimed to design, implement and assess storytelling in one school and picture drawing in another school as engagement approaches for improving knowledge, attitudes and beliefs about antibiotics and AMR among schoolchildren in Ghana.  Methods: Two schools with a total population of 375 schoolchildren ages 11-15 years in Tema, a city in Ghana, participated in public engagement interventions involving storytelling in one school and picture drawing in another school. The interventions included eight weeks of engagement led by science teachers and a competition held in each school. For quantitative outcome-based evaluation, schoolchildren were randomly sampled in each school (31 in the storytelling school and 32 in the picture-drawing school). Purposive sampling was also used to select 20 schoolchildren in each school for qualitative outcome-based evaluation. Respondents completed identical knowledge, attitudes and beliefs questionnaires and were interviewed at two time points (before and at most a week) after key interventions to assess changes in antibiotics and AMR knowledge, attitudes and beliefs. McNemar test was conducted to assess statistical significance between baseline and endline scores. Framework analysis was used for analysing the qualitative data. Results: Picture drawing had more significant effects (both positive and negative) on schoolchildren’s AMR knowledge, attitudes and beliefs, whereas storytelling had a negative effect on children’s AMR knowledge and no significant impact on beliefs and attitudes.  Conclusions: Our project’s findings suggest that public engagement interventions that use picture drawing and storytelling may influence the knowledge, attitudes and beliefs of schoolchildren regarding antibiotic misuse and AMR. However, modifications are required to make them much more effective.

scholarly journals What will it cost to prevent violence against women and girls in low- and middle-income countries? Evidence from Ghana, Kenya, Pakistan, Rwanda, South Africa and Zambia

2020 ◽  
Vol 35 (7) ◽  
pp. 855-866 ◽  
Author(s):  
Sergio Torres-Rueda ◽  
Giulia Ferrari ◽  
Stacey Orangi ◽  
Regis Hitimana ◽  
Emmanuelle Daviaud ◽  
...  
Keyword(s):  
South Africa ◽  
Violence Against Women ◽  
National Level ◽  
Cost Data ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Unit Costs ◽  
Prevention Interventions ◽  
Women And Girls

Abstract Violence against women and girls (VAWG) is a global problem with profound consequences. Although there is a growing body of evidence on the effectiveness of VAWG prevention interventions, economic data are scarce. We carried out a cross-country study to examine the costs of VAWG prevention interventions in low- and middle-income countries. We collected primary cost data on six different pilot VAWG prevention interventions in six countries: Ghana, Kenya, Pakistan, Rwanda, South Africa and Zambia. The interventions varied in their delivery platforms, target populations, settings and theories of change. We adopted a micro-costing methodology. We calculated total costs and a number of unit costs common across interventions (e.g. cost per beneficiary reached). We used the pilot-level cost data to model the expected total costs and unit costs of five interventions scaled up to the national level. Total costs of the pilots varied between ∼US $208 000 in a small group intervention in South Africa to US $2 788 000 in a couples and community-based intervention in Rwanda. Staff costs were the largest cost input across all interventions; consequently, total costs were sensitive to staff time use and salaries. The cost per beneficiary reached in the pilots ranged from ∼US $4 in a community-based intervention in Ghana to US $1324 for one-to-one counselling in Zambia. When scaled up to the national level, total costs ranged from US $32 million in Ghana to US $168 million in Pakistan. Cost per beneficiary reached at scale decreased for all interventions compared to the pilots, except for school-based interventions due to differences in student density per school between the pilot and the national average. The costs of delivering VAWG prevention vary greatly due to differences in the geographical reach, number of intervention components and the complexity of adapting the intervention to the country. Cost-effectiveness analyses are necessary to determine the value for money of interventions.

scholarly journals ‘I Waited for It until Forever’: Community Barriers to Accessing Intellectual Disability Services for Children and Their Families in Cape Town, South Africa

2020 ◽  
Vol 17 (22) ◽  
pp. 8504
Author(s):  
Siyabulela Mkabile ◽  
Leslie Swartz
Keyword(s):  
South Africa ◽  
Intellectual Disability ◽  
Cape Town ◽  
Disability Services ◽  
Structured Interviews ◽  
Middle Income ◽  
Middle Income Countries ◽  
Qualitative Research Design ◽  
Interview Guide ◽  
Children With Intellectual Disability

Background: Intellectual disability is more common in low- and middle-income countries than in high-income countries. Stigma and discrimination have contributed to barriers to people with intellectual disability accessing healthcare. As part of a larger study on caregiving of children with intellectual disability in urban Cape Town, South Africa, we interviewed a sub-group of families who had never used the intellectual disability services available to them, or who had stopped using them. Methods: We employed a qualitative research design and conducted semi-structured interviews to explore the views and perspectives of parents and caregivers of children with intellectual disability who are not using specialised hospital services. We developed an interview guide to help explore caregivers’ and parents’ views. Results: Results revealed that caregivers and parents of children with intellectual disability did not use the intellectual disability service due to financial difficulties, fragile care networks and opportunity costs, community stigma and lack of safety, lack of faith in services and powerlessness at effecting changes and self-stigmatisation. Conclusion: Current findings highlight a need for increased intervention at community level and collaboration with community-based projects to facilitate access to services, and engagement with broader issues of social exclusion.

scholarly journals Impact of national interventions to promote responsible antibiotic use: a systematic review

2019 ◽  
Vol 75 (1) ◽  
pp. 14-29 ◽  
Author(s):  
Jane Mingjie Lim ◽  
Shweta Rajkumar Singh ◽  
Minh Cam Duong ◽  
Helena Legido-Quigley ◽  
Li Yang Hsu ◽  
...  
Keyword(s):  
Systematic Review ◽  
National Level ◽  
Public Health Problem ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Middle Income ◽  
Middle Income Countries ◽  
Policy Interventions ◽  
The Impact

Abstract Background Global recognition of antimicrobial resistance (AMR) as an urgent public health problem has galvanized national and international efforts. Chief among these are interventions to curb the overuse and misuse of antibiotics. However, the impact of these initiatives is not fully understood, making it difficult to assess the expected effectiveness and sustainability of further policy interventions. We conducted a systematic review to summarize existing evidence for the impact of nationally enforced interventions to reduce inappropriate antibiotic use in humans. Methods We searched seven databases and examined reference lists of retrieved articles. To be included, articles had to evaluate the impact of national responsible use initiatives. We excluded studies that only described policy implementations. Results We identified 34 articles detailing interventions in 21 high- and upper-middle-income countries. Interventions addressing inappropriate antibiotic access included antibiotic committees, clinical guidelines and prescribing restrictions. There was consistent evidence that these were effective at reducing antibiotic consumption and prescription. Interventions targeting inappropriate antibiotic demand consisted of education campaigns for healthcare professionals and the general public. Evidence for this was mixed, with several studies showing no impact on overall antibiotic consumption. Conclusions National-level interventions to reduce inappropriate access to antibiotics can be effective. However, evidence is limited to high- and upper-middle-income countries, and more evidence is needed on the long-term sustained impact of interventions. There should also be a simultaneous push towards standardized outcome measures to enable comparisons of interventions in different settings.

scholarly journals Medical Education and Training: Building In-Country Capacity at All Levels

2016 ◽  
Vol 34 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Fredrick Chite Asirwa ◽  
Anne Greist ◽  
Naftali Busakhala ◽  
Barry Rosen ◽  
Patrick J. Loehrer
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
National Level ◽  
Cancer Control ◽  
Tertiary Hospital ◽  
Middle Income ◽  
Middle Income Countries ◽  
High Resource ◽  
Medical Education And Training ◽  
Representative Model

Poorly trained workers and limited workforce capacity contribute immensely to barriers in cancer control in low- and middle-income countries (LMICs). Because of an increasing disease burden and the gap in trained personnel, it is critical that LMICs must develop appropriate in-country training programs at all levels to adequately address their cancer-related outcomes. The training in LMICs of cancer health personnel should address priority cancer diseases in the specific country by developing caregivers, trainers, researchers, and administrators at all levels of health care and all cadres of staff, from the community level to the national level. The Academic Model of Providing Access to Health care is a representative model of how a public tertiary hospital like the Moi Teaching and Referral Hospital in an LMIC setting can leverage its resources, collaborate with partners from high-resource countries, and assist in the development of a training center to spearhead a sustainable education program.

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