Impact of COVID-19 containment measures on children with cancer in Indonesia

Introduction: Containment measures to limit COVID-19 spreading profoundly impact children around the globe, especially in low- and middle-income countries such as Indonesia. The aim of this case series study is to uncover the impact that COVID-19 measures have on Indonesian children with cancer and their families. Materials and Methods: A case series study was conducted in July 2021. Investigators identified three children diagnosed with cancer at an Indonesian referral hospital and studied their medical records. Caretakers were interviewed inside the hospital by an independent interviewer using a semi-structured questionnaire. Results: This study presents three children with cancer and their families. Access to proper healthcare was hindered during the COVID-19 pandemic due to mobility restrictions, medical staff shortage, limited chemotherapy and blood products availability, postponed medical procedures, and delayed or modified treatment administration. Financial hardships resulted because caretakers lost their jobs due to lockdowns and medication costs were no longer fully covered by health-insurance. Children and their relatives suffered from mental health issues. Anxiety, depression, stress, and loneliness were caused by the fear of receiving suboptimal cancer treatment, serious concerns about financial difficulties, and restricted social interactions. All families believed that COVID-19 measures worsened their children’s survival chances. Conclusion: COVID-19 measures adversely impact children with cancer and their families in Indonesia, and most likely in other low- and middle-income countries as well. Disruptions in timely and adequate childhood cancer treatment administration may importantly deteriorate survival chances. Governments and policymakers should take these indirect effects into account to protect vulnerable children and their families.

A global perspective on cervical cancer screening: a literature review

Cervical cancer is a significant health issue for women globally, with over 600,000 new cases and 342,000 deaths in 2020. Effective cervical screening programs, including primary screening methods such as Pap tests, human papillomaviruses (HPV) deoxyribonucleic acid (DNA) testing, and liquid-based cytology, can prevent and detect early cancer cases, improving morbidity and mortality rates. However, screening uptake varies widely across countries, with high-income countries have achieved over 70% uptake but low- and middle-income countries lagging due to a lack of recommendations and centralised screening systems. Even in high-income countries in the Middle East, uptake remains low, requiring further investigation. This review explores barriers to screening programme delivery and highlights centralised and multi-level interventions that have proven effective worldwide. Future research should focus on culturally sensitive approaches, healthcare infrastructure strengthening, and community education and outreach programs to address uptake disparities and barriers.

Early Identification of Autism Spectrum Disorder (ASD): Strategies for Use in Local Communities

Early diagnosis of autism spectrum disorder (ASD) is essential for improved outcomes. There is a paucity of data on the prevalence of ASD in low- and middle-income countries (LMIC), but early identifcation may be further delayed in those communities. In this paper, recent studies on strategies for the early detection of ASD, and the prevalence of ASD in LMIC are reviewed. The limitations that can arise in the early identifcation of ASD in LMIC communities are discussed, and screening tools and strategies that can be helpful are identifed. The goal is to recommend models that are culturally appropriate and scientifcally valid, easily integrated within community settings while strengthening community systems and reducing disparities in the early identifcation of ASD. Starting locally by simplifying and demystifying the ASD identifcation process and building community connections will inform global researchers and policymakers while making a diference in the lives of the children and families afected by ASD.

Barriers and Facilitators Factors to Uptake of Cervical Cancer Screening Among Women in Low- and Middle-income Countries: A Narrative Review

@#Cervical cancer is a worldwide health issue. Each year, it kills hundreds of thousands of women worldwide. Despite the availability of screening tests, the incidence of cervical cancer remains high in low and middle-income countries. In this review, we survey the current literature on factors affecting cervical cancer screening uptake among women in low and middle-income countries. It also highlights potential strategies for improving screening uptake and suggests directions for future research. Knowledge about cervical cancer and its screening, socio-demographic factors, personal and behavioural factors, cultural factors and beliefs, and health service factors are considered the main barriers and facilitators to cervical cancer screening uptake among women in low and middle-income countries. Understanding the facilitators and barriers to cervical cancer screening encountered by women in low and middle-income countries can improve screening uptake by overcoming inequalities in resource and information access. Culturally sensitive screening programs, improvement of the health system, and health education interventions to raise awareness of screening and its benefits can be effective strategies to improve screening uptake among women in low and middle-income countries.

Expected Benefits and Challenges of Using Economic Evaluations to Make Decisions About the Content of Newborn Screening Programs in Vietnam: A Scoping Review of the Literature

Abstract Screening newborns for genetic and other diseases is one of the most effective ways to improve health and reduce disease in a population. In developed countries, newborn screening has been a cornerstone of public health for decades. In many developing countries, however, newborn screening is still in its infancy. Many countries still lack screening programs. When a program is available, it generally lacks well-defined criteria on which decision-makers can justify the choice of diseases screened for and the methods used. One of the reasons put forward to understand this observation is the fact that little consideration is given by decision-makers to economic evaluations as a pillar of decision-making, as is the case in industrialized countries. This article provides a brief description of the challenges of using economic evaluation of newborn screening in developing countries. This will be illustrated by the example of the national newborn screening program in Vietnam.

Validity of the computerized version of the pediatric triage system CLARIPED for emergency care

Abstract Objective: To evaluate the validity of the computerized version of the pediatric triage system CLARIPED. Methods: Prospective, observational study in a tertiary emergency department (ED) from Jan-2018 to Jan-2019. A convenience sample of patients aged 0-18 years who had computerized triage and outcome variables registered. Construct validity was assessed through the association between urgency levels and patient outcomes. Sensitivity, specificity, positive and negative predictive values (PPVand NPV), undertriage, and overtriage rates were assessed. Results: 19,122 of 38,321 visits were analyzed. The urgency levels were: RED (emergency) 0.02%, ORANGE (high urgency) 3.21%, YELLOW (urgency) 35.69%, GREEN (low urgency) 58.46%, and BLUE (no urgency) 2.62%. The following outcomes increased according to the increase in the level of urgency: hospital admission (0.4%, 0.6%, 3.1%, 11.9% and 25%), stay in the ED observation room (2.8%, 4.7%, 15.9%, 40.4%, 50%), ≥ 2 diagnostic or therapeutic resources (7.8%, 16.5%, 33.7%, 60.6%, 75%), and ED length of stay in minutes (18, 24, 67,120, 260). The odds of using ≥ 2 resources or being hospitalized were significantly greater in the most urgent patients (Red, Orange, and Yellow) compared to the least urgent (Green and Blue): OR 7.88 (95%CI: 5.35-11.6) and OR 2.85 (95%CI: 2.63-3.09), respectively. The sensitivity to identify urgency was 0.82 (95%CI: 0.77-0.85); specificity, 0.62 (95%CI: 0.61-0.6; NPV, 0.99 (95%CI: 0.99-1.00); overtriage rate, 4.28% and undertriage, 18.41%. Conclusion: The computerized version of CLARIPED is a valid and safe pediatric triage system, with a significant correlation with clinical outcomes, good sensitivity, and low undertriage rate.

Neonatal Seizures—Perspective in Low-and Middle-Income Countries

Neonatal seizures are the commonest neurological emergency and are associated with poor neurodevelopmental outcome. While they are generally difcult to diagnose and treat, they pose a signifcant clinical challenge for physicians in low- and middle-income countries (LMIC). They are mostly provoked seizures caused by an acute brain insult such as hypoxic– ischemic encephalopathy (HIE), ischemic stroke, intracranial hemorrhage, infections of the central nervous system, or acute metabolic disturbances. Early onset epilepsy syndromes are less common. Clinical diagnosis of seizures in the neonatal period are frequently inaccurate, as clinical manifestations are difcult to distinguish from nonseizure behavior. Additionally, a high proportion of seizures are electrographic-only without any clinical manifestations, making diagnosis with EEG or aEEG a necessity. Only focal clonic and focal tonic seizures can be diagnosed clinically with adequate diagnostic certainty. Prompt diagnosis and timely treatment are important, with evidence suggesting that early treatment improves the response to antiseizure medication. The vast majority of published studies are from high-income countries, making extrapolation to LMIC impossible, thus highlighting the urgent need for a better understanding of the etiologies, comorbidities, and drug trials evaluating safety and efcacy in LMIC. In this review paper, the authors present the latest data on etiology, diagnosis, classifcation, and guidelines for the management of neonates with the emphasis on low-resource settings.

Environmental health perspectives for low-and middle-income countries / 《全球健康杂志（英文）》

In recent decades,the ecological environment has been increasingly challenged by the development of global industrialization and urbanization all over the world,even as global attention for health has raised dramatically.Common global environmental issues,such as air pollution and noise pollution,are associated with lasting im-pacts on health and contribute significantly to the overall burden of disease.Moreover,a global disparity exists between the burden of such environmental health issues and the global resources available to address this is-sue.To alleviate the environmental health impacts and ensure a sustainable future for human beings,China has made an important contribution to improving access to ecological protection,environmental governance,patri-otic health campaigns,smart city construction,and so on.Experiences gained in China may be useful for some other countries,particularly the low-and middle-income countries with limited sources.

Longitudinal measurement invariance of neuropsychological tests in a diverse sample from the ELSA-Brasil study

Objective: Longitudinal measurement invariance analyses are an important way to assess a test's ability to estimate the underlying construct over time, ensuring that cognitive scores across visits represent a similar underlying construct, and that changes in test performance are attributable to individual change in cognitive abilities. We aimed to evaluate longitudinal measurement invariance in a large, social and culturally diverse sample over time. Methods: A total of 5,949 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were included, whose cognition was reassessed after four years. Longitudinal measurement invariance analysis was performed by comparing a nested series of multiple-group confirmatory factor analysis models (for memory and executive function factors). Results: Configural, metric, scalar and strict invariance were tested and supported over time. Conclusion: Cognitive temporal changes in this sample are more likely to be due to normal and/or pathological aging. Testing longitudinal measurement invariance is essential for diverse samples at high risk of dementia, such as in low- and middle-income countries.

Lessons from the coronavirus disease 2019 (COVID-19) pandemic response in China, Italy, and the U.S.: a guide for Africa and low-and middle-income countries / 《全球健康杂志（英文）》

Africa can be "left behind" after other advanced continents recover from the coronavirus disease 2019 (COVID-19) pandemic as reflected by the global pandemic of HIV/MDS.In this paper,we summarize potentially adaptable,effective and innovative strategies from China,Italy,and the U.S.The purpose is to help African countries with weaker healthcare systems better respond to the COVID-19 pandemic.China,being the first to report COVID-19 infection swiftly swung into anti-epidemic actions by the use of innovative risk communication and epidemic containment strategies.Italy and U.S.,the next rapidly hit countries after China,however,experienced sustained infections and deaths due to delayed and ineffective response.Many African countries responded poorly to the COVID-19 pandemic as evidenced by the limited capacity for public health surveillance,poor leadership,low education and socioeconomic status,among others.Experience from China,Italy and U.S.suggests that a better response to the COVID-19 pandemic in Mrica needs a strong public health leadership,proactive strategies,innovative risk communication about the pandemic,massive tests and isolation,and scaling-up community engagement.Lastly,African countries must collaborate with other countries to facilitate real-time information and experience exchange with other countries to avoid being left behind.

Can health technology assessments assist the global campaign against poverty? / 《全球健康杂志（英文）》

Although a key tenant of the Sustainable Development Goals is to achieve universal health coverage,the global drug gap persists—over a third of the global population lack access to essential medicines.Without access to affordable drugs,people have worse health outcomes,higher medical expenses,and productivity loss,pushing them into poverty.Health technology assessments (HTAs) offer an opportunity to decrease the global drug gap and increase access to essential medicines by overcoming barriers to medicine access.These barriers include drug procurement,drug affordability for payers and patients,a patient's ability to obtain essential medicines,and health system capacity.Using HTAs can therefore close the global drug gap by increasing access to affordable essential medicines.In turn,people have better health outcomes,spend less money on medical care,and can have better productivity.Ultimately,use of HTAs can lift the population out of poverty and force fewer people into poverty by creating better health outcomes at affordable prices.

Patient needs four years after first psychiatric hospitalization in a Brazilian cohort

Knowledge about the needs of psychiatric patients is essential for mental health care planning. However, research on met and unmet needs is still scarce, particularly in low- and middle-income countries. This study aimed to describe the patients' needs (met and unmet) at least four years after their first psychiatric hospitalization and to verify the role of demographic and clinical features as possible predictors of these needs. Patients who had their first psychiatric admission between January 1, 2006 and December 31, 2007 at an inpatient unit in the city of Ribeirão Preto, Brazil, were eligible to participate in the study. Patients were contacted and face-to-face interviews were conducted by psychologists using the Camberwell Assessment of Need. Data were analyzed using zero-inflated negative binomial regression model. Of 933 eligible patients, 333 were interviewed. The highest level of needs was related to welfare benefits (32.4%, unmet=25.5%), followed by household skills (30.3%, unmet=3.0%), psychotic symptoms (29.4%, unmet=9.0%), psychological distress (27.6%, unmet=8.4%), physical health (24.3%, unmet=5.4%), daytime activities (19.5%, unmet=16.5%), and money (16.8%, unmet=9.0%). Fewer years of schooling, living with relatives, and unemployment at the moment of the first admission were significantly associated with a higher number of both met and unmet needs in the follow-up. Unmet needs were also more often reported by patients living alone. In conclusion, socioeconomic indicators were the best predictors of needs. The unmet needs related to welfare benefits point to the need for specific social and health policies.

Population neuroscience: challenges and opportunities for psychiatric research in low- and middle-income countries

Objective: Population neuroscience is an emerging field that combines epidemiology and neuroscience to study how genes and the environment shape typical and atypical brain functioning. The objective of this study was to review key studies on population neuroscience from low- and middle-income countries (LMICs) and to identify potential gaps vis-à-vis studies conducted in high-income countries. Methods: We conducted a systematic review to search for longitudinal cohort studies investigating the development of psychiatric disorders in children and adolescents in LMICs. We performed an electronic search in the EMBASE and MEDLINE databases from inception to July 5th, 2019. Results: We found six cohorts from four countries that met our search criteria: three cohorts from Brazil, one from China, one from South Africa, and one from Mauritius. Relevant examples of findings from these studies are reported. Conclusion: Our results demonstrate the impact of the valuable science output these cohort designs promote, allowing LMICs to have a share in frontline global psychiatry research. National and international funding agencies should invest in LMIC population neuroscience in order to promote replication and generalization of research from high-income countries.

Hospitals' responsibility in response to the threat of infectious disease outbreak in the context of the coronavirus disease 2019 (COVID-19) pandemic: implications for low- and middle-income countries / 《全球健康杂志（英文）》

The WHO declared the coronavirus disease 2019 (COVID-19) outbreak as a public health emergency of international concern on January 30, 2020, and then a pandemic on March 11, 2020. COVID-19 affected over 200 countries and territories worldwide, with 25,541,380 confirmed cases and 852,000 deaths associated with COVID-19 globally, as of September 1, 2020. 1While facing such a public health emergency, hospitals were on the front line to deliver health care and psychological services. The early detection, diagnosis, reporting, isolation, and clinical management of patients during a public health emergency required the extensive involvement of hospitals in all aspects. The response capacity of hospitals directly determined the outcomes of the prevention and control of an outbreak. The COVID-19 pandemic has affected almost all nations and territories regardless of their development level or geographic location, although suitable risk mitigation measures differ between developing and developed countries. In low- and middle-income countries (LMICs), the consequences of the pandemic could be more complicated because incidence and mortality might be associated more with a fragile health care system and shortage of related resources. 2-3 As evidenced by the situation in Bangladesh, India, Kenya, South Africa, and other LMICs, socioeconomic status (SES) disparity was a major factor in the spread of disease, potentially leading to alarmingly insufficient preparedness and responses in dealing with the COVID-19 pandemic. 4 Conversely, the pandemic might also bring more unpredictable socioeconomic and long-term impacts in LMICs, and those with lower SES fare worse in these situations. This review aimed to summarize the responsibilities of and measures taken by hospitals in combatting the COVID-19 outbreak. Our findings are hoped to provide experiences, as well as lessons and potential implications for LMICs.

Establishment of trauma registry at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi and mapping of high risk geographic areas for trauma / 世界急诊医学杂志（英文）

BACKGROUND@# Less attention is directed toward gaining a better understanding of the burden and prevention of injuries, in low and middle income countries (LMICs). We report the establishment of a trauma registry at the Adult Emergency and Trauma Centre (AETC) at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi and identify high risk geographic areas.@*METHODS@# We devised a paper based two-page trauma registry form. Ten data clerks and all AETC clinicians were trained to complete demographic and clinical details respectively. Descriptive data, regression and hotspot analyses were done using STATA 15 statistical package and ArcGIS (16) software respectively.@*RESULTS@#There were 3,747 patients from May 2013 to May 2015. The most common mechanisms of injury were assault (38.2%), and road traffic injuries (31.6%). The majority had soft tissue injury (53.1%), while 23.8% had no diagnosis indicated. Fractures (OR 19.94 [15.34–25.93]), head injury and internal organ injury (OR 29.5 [16.29–53.4]), and use of ambulance (OR 1.57 [1.06– 2.33]) were found to be predictive of increased odds of being admitted to hospital while assault (OR 0.69 [0.52–0.91]) was found to be associated with less odds of being admitted to hospital. Hot spot analysis showed that at 99% confidence interval, Ndirande, Mbayani and Limbe were the top hot spots for injury occurrence.@*CONCLUSION@# We have described the process of establishing an integrated and potentially sustainable trauma registry. Significant data were captured to provide details on the epidemiology of trauma and insight on how care could be improved at AETC and surrounding health facilities. This approach may be relevant in similar poor resource settings.

Tuberculosis Contact Tracing In Low- And Middle- Income Countries: A Systematic Review

Introduction Tuberculosis (TB) a major global health challenge especially in low- and middle-income countries reflects improper, delayed or missed diagnosis. Contact screening should be utilized both as an efficient and effective targeted approach to intensify TB case finding.Methods Through a comprehensive systematic literature review of online database, this paper aims at providing an insight into the current practice of TB contact screening and to provide evidence based practice for formulation of appropriate policies in low- and middle-income countries. There are 24 articles included in this review from studies published from 2005 to 2014.Results Findings in literature varies substantially. Generally, contact screening is better intensified with clear operational guidelines, adequate training, include close contact outside household as appropriate and follow up at least for 1 year. Prioritizing high risk close contacts is helpful in resource limited setting. Tuberculin skin test is still of value as screening tool and intensified case finding must be accompanied with effective management protocol. Prophylaxis treatment is recommended especially for children especially less than 5 years old, unvaccinated, malnourished, living with person having HIV and close contact with MDR-TB.Conclusion Policy recommendations in improving TB management must incorporate complementary strategies to enhance case finding, effective management protocol for follow up or prophylaxis treatment, training for public health capacity and concerted dedication from various stakeholders.

Barriers to early identification of autism in Brazil

Objective: Parents of children with autism spectrum disorders (ASD) seem to perceive that their child's development is not following the normal pattern as early as the first year of life. However, ASD children may not receive a diagnosis until they are of preschool age, especially in low- and middle-income countries. The objective of this study was to evaluate the pathway between initial parental concerns about atypical child development and ASD diagnosis in Brazil. Methods: Nineteen mothers whose children had been diagnosed with ASD participated and were interviewed. The ASD group consisted of two girls and 17 boys, with a mean age of 93.0 months (SD 48.4 months; range 39-197 months). Results: Mothers had their first concerns regarding ASD when children were 23.6±11.6 months old, but formal diagnosis occurred at a mean ± SD age of 59.6±40.5 months, corresponding to a 3-year delay. Most mothers felt discouraged to address their concerns due to negative experiences with health professionals. Conclusion: In Brazil, mothers perceived the first signs of ASD in their children at an age similar to that reported in other countries, but the diagnosis of ASD seemed to be delayed. Consistent with the literature, mothers reported negative experiences with health professionals during the pathway to achieving ASD diagnosis.

Partnership of the Sociedade Brasileira de Oncologia Pediátrica and International Society of Pediatric Oncology to improve nutritional care for children with cancer in Brazil

Abstract The authors present a proposal of a partnership between the Sociedade Brasileira de Oncologia Pediátrica (SOBOPE) and the International Society of Pediatric Oncology (SIOP) to promote the standardization and improvement of nutritional care of kids under cancer treatment in Brazil. The results of the first meeting in Brazil as well as plans for future meetings are described.

Common mental disorders and sociodemographic characteristics: baseline findings of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Objective: To assess the prevalence of common mental disorders (CMD) and the association of CMD with sociodemographic characteristics in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. Methods: We analyzed data from the cross-sectional baseline assessment of the ELSA-Brasil, a cohort study of 15,105 civil servants from six Brazilian cities. The Clinical Interview Schedule-Revised (CIS-R) was used to investigate the presence of CMD, with a score ≥ 12 indicating a current CMD (last week). Specific diagnostic algorithms for each disorder were based on the ICD-10 diagnostic criteria. Prevalence ratios (PR) of the association between CMD and sociodemographic characteristics were estimated by Poisson regression. Results: CMD (CIS-R score ≥ 12) was found in 26.8% (95% confidence intervals [95%CI] 26.1-27.5). The highest burden occurred among women (PR 1.9; 95%CI 1.8-2.0), the youngest (PR 1.7; 95%CI 1.5-1.9), non-white individuals, and those without a university degree. The most frequent diagnostic category was anxiety disorders (16.2%), followed by depressive episodes (4.2%). Conclusion: The burden of CMD was high, particularly among the more socially vulnerable groups. These findings highlight the need to strengthen public policies aimed to address health inequities related to mental disorders.

Accelerating the development of a group A Streptococcus vaccine: an urgent public health need

Group A Streptococcus (GAS) infections cause substantial worldwide morbidity and mortality, mostly associated with suppurative complications such as pharyngitis, impetigo, and non-suppurative immune syndromes such as acute rheumatic fever, rheumatic heart disease, and acute post-streptococcal glomerulonephritis. Deaths occur mostly in children, adolescents, and young adults in particular pregnant women in low- and middle-income countries. GAS strains are highly variable, and a GAS vaccine would need to overcome the issue of multiple strains. Several approaches have been used multivalent vaccines using N-terminal polypeptides of different M protein; conserved M protein vaccines with antigens from the conserved C-repeat portion of the M protein; incorporation selected T- and B-cell epitopes from the C-repeat region in a synthetic polypeptide or shorter single minimal B-cell epitopes from this same region; and non-M protein approaches utilizing highly conserved motives of streptococcal C5a peptidase, GAS carbohydrate and streptococcal fibronectin-binding proteins. A GAS vaccine represents urgent need for this neglected disease and should therefore deserve the greatest attention of international organizations, donors, and vaccine manufacturers.