Health System in Zimbabwe and Delay in Seeking Health Care of Breast Cancer Among Women

Breast cancer, the most prevailing and only cancer considered universal among women worldwide. The rate of breast cancer per 100,000 women is higher in high income countries than in low income countries. However, mortality rates are high in low income countries due to the delay in seeking health care. A systematic literature review was carried out to document the health system implemented in Zimbabwe and its challenges that could be contributing to the delay in seeking health care of breast cancer among women in Zimbabwe. A content analysis was used to analyze articles, searching was done using the Boolean search strategy, articles from 2005 to 2021, which met the inclusion criteria were considered. Factors such as centralized services due to shortage of cancer specialists, lack of financial allocations on breast cancer health programs, shortage of screening and surgical equipment, lack of accurate data due to weak registration system and health management information system as well as poor governance and leadership have also been found to be challenges in the health system of Zimbabwe that may contribute to delay in seeking health care of breast cancer among women in Zimbabwe. Keywords: breast cancer, health system, health care, Zimbabwe

A Bibliometric Analysis on Global Psychological and Behavioral Research Landscape on COVID-19 Pandemic

The COVID-19 pandemic outbreak in December 2019 has spread globally. The ongoing psychological and behavioral effects of the COVID-19 pandemic, which poses a major challenge to humanity, are of concern to researchers. To understand the academic community’s attention, focus and research collaboration on psychological and behavioral research during the COVID-19 pandemic, we conducted a macro analysis using a bibliometric approach. Using the topic selection strategy of TS = (“COVID-19” OR “coronavirus disease 2019” OR “SARS-CoV-2” OR “2019-nCoV”) AND TS = (“behavio*”) AND TS = (“psycholog*”), 2096 high-quality research articles and reviews were downloaded as data from the Web of Science core collection on 16 November 2021. Through analysis and visualization, the following conclusions are drawn in this study: (1) The popularity and importance of psychological and behavioral research under COVID-19 has increased significantly and needs further attention; (2). Related research focuses on eight hotspots, with quarantine, health care workers, the elderly, students, pregnant women, family, consumers, social media and emergency preparedness knowledge as the focus of the research object; and (3) Research collaboration is relatively high at the author, organizational and national levels. However, low-income countries need to get more attention. Furthermore, this article would help researchers make decisions for the research of psychological and behavioral issues under COVID-19 and planning for future prospects to contribute to academic development and applied methodology.

Changing Epidemiology of Acute Respiratory Infections in Under-Two Children in Dhaka, Bangladesh

Objectives: Risk factors for acute respiratory infections (ARIs) in community settings are not fully understood, especially in low-income countries. We examined the incidence and risk factors associated with ARIs in under-two children from the Microbiota and Health study.Methods: Children from a peri-urban area of Dhaka (Bangladesh) were followed from birth to 2 years of age by both active surveillance of ARIs and regular scheduled visits. Nasopharyngeal samples were collected during scheduled visits for detection of bacterial facultative respiratory pathogens. Information on socioeconomic, environmental, and household conditions, and mother and child characteristics were collected. A hierarchical modeling approach was used to identify proximate determinants of ARIs.Results: Of 267 infants, 87.3% experienced at least one ARI episode during the first 2 years of life. The peak incidence of ARIs was 330 infections per 100 infant-years and occurred between 2 and 4 months of age. Season was the main risk factor (rainy monsoon season, incidence rate ratio [IRR] 2.43 [1.92–3.07]; cool dry winter, IRR 2.10 [1.65–2.67] compared with hot dry summer) in the first 2 years of life. In addition, during the first 6 months of life, young maternal age (<22 years; IRR 1.34 [1.01–1.77]) and low birth weight (<2,500 g; IRR 1.39 [1.03–1.89]) were associated with higher ARI incidence.Conclusions: Reminiscent of industrialized settings, cool rainy season rather than socioeconomic and hygiene conditions was a major risk factor for ARIs in peri-urban Bangladesh. Understanding the causal links between seasonally variable factors such as temperature, humidity, crowding, diet, and ARIs will inform prevention measures.

Scoping Review of Oral Health-Related Birth Cohort Studies: Toward a Global Consortium

The multidisciplinary nature and long duration of birth cohort studies allow investigation of the relationship between general and oral health and indicate the most appropriate stages in life to intervene. To date, the worldwide distribution of oral health-related birth cohort studies (OHRBCSs) has not been mapped, and a synthesis of information on methodological characteristics and outcomes is not available. We mapped published literature on OHRBCSs, describing their oral health-related data and methodological aspects. A 3-step search strategy was adopted to identify published studies using PubMed, Embase, Web of Science, and OVID databases. Studies with baseline data collection during pregnancy or within the first year of life or linked future oral health data to exposures during either of these 2 life stages were included. Studies examining only mothers' oral health and specific populations were excluded. In total, 1,721 articles were suitable for initial screening of titles and abstracts, and 528 articles were included in the review, identifying 120 unique OHRBCSs from 34 countries in all continents. The review comprised literature from the mid-1940s to the 21st century. Fifty-four percent of the OHRBCSs started from 2000 onward, and 75% of the cohorts were from high-income and only 2 from low-income countries. The participation rate between the baseline and the last oral health follow-up varied between 7% and 93%. Ten cohorts that included interventions were mostly from 2000 and with fewer than 1,000 participants. Seven data-linkage cohorts focused mostly on upstream characteristics and biological aspects. The most frequent clinical assessment was dental caries, widely presented as decayed, missing, and filled teeth (DMFT/dmft). Periodontal conditions were primarily applied as isolated outcomes or as part of a classification system. Socioeconomic classification, ethnicity, and country- or language-specific assessment tools varied across countries. Harmonizing definitions will allow combining data from different studies, adding considerable strength to data analyses; this will be facilitated by forming a global consortium.

Integrating ultrasound education and resources within undergraduate medical education in order to Bring Ultrasound Internationally for Long-term Development (BUILD)

Aims: At the Ohio State University College of Medicine, medical students have the option to train in ultrasound and take part in global electives where they can utilize clinical ultrasound. This presents the opportunity for medical students to engage in bidirectional sharing of medical and ultrasound knowledge in geographic regions with limited resources. We developedBringing Ultrasound Internationally for Long-term development (BUILD), a longitudinal course, to provide standardized ultrasound education to students planning to enroll in global health electives.Material and methods: This was a pilot study of the BUILD curriculum. Third-year medical students planning to complete a global health elective were invited to participate. Enrolled students completed an online curriculum, hands-on scanning, and pathology sessions, which augmented the predeparture Global Health course work. Students received two resource assessments: one to be completed by the student, and one to be completed by the on-site preceptor. Main outcomes measured were number of enrolled students, primary indications for imaging, and number of scans per-day.Results: In total, 152 students participated in the study and traveled to 22 different global sites in Low-Income Countries (LIC’s). All enrolled students completed the curriculum. Between 3 and 25 scans were performed per day and the leading indication for ultrasound imaging was obstetric and abdominal pain evaluation.Conclusions: The BUILD curriculum is a feasible construct to prepare students for using ultrasound during global electives. Students successfully performed proctored scans in a variety of settings. This format can be adopted by other institutions to further support student and global ultrasound programs.

Effects of Host Genetic Polymorphisms on the Efficacy of the Radical Cure Malaria Drug Primaquine

Malaria is a major cause of death in low-income countries. Malaria relapses are caused by Plasmodium vivax–induced latent liver stage hypnozoites, and relapses contribute significantly to the total disease burden. The goal of malaria elimination is threatened in countries where P. vivax is endemic and relapses remain a key aspect of concern. Targeting of the hypnozoites is crucial for radical cure and this is achieved by primaquine (PQ). In addition to its anti-hypnozoite effects, PQ also possesses gametocidal activity against all malaria causing Plasmodium species and is hence a useful tool to curtail malaria transmission. It is well known that host glucose-6-phosphate dehydrogenase (G6PD) deficiency is associated with hemolysis after treatment with PQ. Multiple other host polymorphisms impact on PQ metabolism, potentially affecting drug efficacy. Being a prodrug, PQ requires host factors cytochrome P450 2D6 (CYP2D6), cytochrome P450 NADPH: oxidoreductase (CPR) and monoamine oxidase (MAO) for its metabolism and conversion to active form. The efficacy of PQ in the host is therefore dependent on genetic polymorphisms of these three host genes. The efficacy of PQ is important for clearing reservoirs of P. vivax infection. Here, we have analyzed the known spectrum of genetic polymorphisms for host genes that enable PQ metabolism. It is vital to delineate the polymorphisms that determine the ultimate efficacy of PQ for formulating better malaria elimination strategies in countries with severe malaria burden. Thus population-based studies of these gene variants will provide new insights into the role of host genetics on PQ treatment outcomes.

Growing Inequality in the Coffee Global Value Chain: A Complex Network Assessment

Following the liberalization of the coffee sector, governance and power balance in the international coffee trade has changed, with associated impacts on livelihoods in producing countries, most of which are middle- and low-income countries. Drawing on trade data for the period 1995–2018, we examine the dynamics and evolution of the international green coffee market to shed light on the re-distribution of value in the coffee supply chain. Data analysis shows that, over the studied period, the green coffee trade has increased considerably while the number of countries with a relevant role in trade has decreased, so that large exporting countries cover a higher share of trade, to the detriment of small exporting countries. We analyzed various properties of the global coffee trade network to provide insight on the relative contribution of countries not only in terms of their export value but also in terms of other selected features. The green coffee trade has gone from being distributed in many traditionally coffee-producing countries to concentrating mainly on the major coffee producers, as well as in some non-producing countries. These changes in the structure of the international green coffee market have led to greater inequality between producing and importing countries.