The Role of Neurosurgery in Worldwide Health Care and Its Disparities: An Overview

Neurosurgery is a relatively new branch of surgery that is increasingly important in global health. Neurosurgery has benefited from many recent technological improvements that have significantly increased the number of common conditions that can be effectively treated. Unfortunately, access to neurosurgeons is disproportionately concentrated in high-income countries, while many low- and middle-income countries have a drastic lack of neurosurgical workforce. This leads to extreme health disparities in the absence of urgently needed neurosurgical procedures. Access to current information can be improved by including LMICs in randomized clinical trials (RCTs) and by using the consensus conference method approach when RCT-derived evidence-based clinical guidelines are not applicable to LMICs. HICs must also contribute to meet the equipment needs of LMICs as well as share knowledge on how low-cost devices may be appropriately used in resource-constrained clinical environments. Finally, efforts to reduce disparities can benefit from the many new, more inclusive methods of communication we have learned to use effectively during the global SARS-CoV-2 pandemic. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

How can messaging apps, WhatsApp and SMS be used to support learning? A scoping review

In response to disruption to education during the COVID-19 pandemic, mobile phone-based messaging has emerged in some instances as an accessible, low-connectivity way of promoting interactivity. However, no recent reviews have been undertaken in relation to how social media and messaging apps can be used to effectively support education in low- and middle-income countries. In this scoping review, 43 documents were identified for inclusion, and three main thematic areas emerged: supporting student learning (including interacting with peers and other students, peer tutoring and collaborative learning;and interacting with teachers, through content delivery, teaching and assessment);teacher professional development (including structured support and prompts, and informal communities of practice);and supporting refugee education. The discussion and findings are both of practical use, to inform responses to the current pandemic and designing initiatives in the future, and will also be useful for advancing research in this expanding field. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Association between meteorological factors and COVID-19 transmission in low- and middle-income countries: A time-stratified case-crossover study.

BACKGROUND: Evidence is limited regarding the association between meteorological factors and COVID-19 transmission in low- and middle-income countries (LMICs). OBJECTIVE: To investigate the independent and interactive effects of temperature, relative humidity (RH), and ultraviolet (UV) radiation on the spread of COVID-19 in LMICs. METHODS: We collected daily data on COVID-19 confirmed cases, meteorological factors and non-pharmaceutical interventions (NPIs) in 2143 city- and district-level sites from 6 LMICs during 2020. We applied a time-stratified case-crossover design with distributed lag nonlinear model to evaluate the independent and interactive effects of meteorological factors on COVID-19 transmission after controlling NPIs. We generated an overall estimate through pooling site-specific relative risks (RR) using a multivariate meta-regression model. RESULTS: There was a positive, non-linear, association between temperature and COVID-19 confirmed cases in all study sites, while RH and UV showed negative non-linear associations. RR of the 90th percentile temperature (28.1 °C) was 1.14 [95% confidence interval (CI): 1.02, 1.28] compared with the 50th percentile temperature (24.4 °C). RR of the10th percentile UV was 1.41 (95% CI: 1.29, 1.54). High temperature and high RH were associated with increased risks in temperate climate but decreased risks in tropical climate, while UV exhibited a consistent, negative association across climate zones. Temperature, RH, and UV interacted to affect COVID-19 transmission. Temperature and RH also showed higher risks in low NPIs sites. CONCLUSION: Temperature, RH, and UV appeared to independently and interactively affect the transmission of COVID-19 in LMICs but such associations varied with climate zones. Our results suggest that more attention should be paid to meteorological variation when the transmission of COVID-19 is still rampant in LMICs.

Exploring the self-preparedness of frontline healthcare workers in a low- and middle-income country from a humanitarian context during the COVID-19 pandemic: A constructivist grounded theory study.

Background: While research has been conducted on the availability, accessibility, and affordability of personal protective equipment for healthcare workers during the COVID-19 pandemic, little information is available on the ways in which health workers, especially those in humanitarian settings see themselves, and engage in self-preparedness for social, physical, and mental health and practical care in the pandemic. We sought to address this gap. Methods: We followed a constructivist grounded theory approach to guide in-depth interviews with 30 frontline doctors, nurses, and community healthcare workers recruited from the Rohingya refugee camps in Bangladesh using the purposive and snowball sampling methods. Analyses were carried out through the identification of codes in three phases: an initial line-by-line open coding, then focused axial coding, and finally selective coding. Findings: An emergent-grounded theory of "Navigating Self-Preparedness through Pandemics" was developed as we built a five-phased theoretical framework examining health worker responses with the following pillars: (a) pandemic shock; (b) pandemic awareness; (c) pandemic learning; (d) pandemic resilience, and (e) pandemic resurgence. Interpretation: The theory emerged as a realistic, socially, and culturally sensitive COVID-19 strategy to support healthcare workers. Self-preparedness was characterized by two interwoven processes: (1) the experiences of the daily life span of healthcare workers attempting to improve their own protection using all their potential while providing care for patients in a vulnerable setting and time and (2) the inseparable role of physical, psychological, social, and spiritual factors in each stage of learning during the pandemic to achieve better outcomes.

Resilience and vulnerabilities of urban food environments in the Asia-Pacific region.

Rapid urbanisation in the Asia-Pacific region is associated with complex changes to urban food environments. The impact of changing food environments on food purchasing and consumption and the diets and nutritional status of vulnerable groups, especially women and young children, is not well researched in low- and middle-income country cities. This paper aimed to examine: the risks and opportunities for healthy diets for low income populations offered by modernising urban centres; the concept of food deserts in relation to urban food environments in the Asia-Pacific region and how these could be mitigated; and measures to strengthen the resilience of food environments in the region using a case study of the impact of COVID-19 on informal food vendors. Our findings indicate that the dynamic changes in urban food environments in the Asia- Pacific region need to be understood by examining not only modern retail food outlets but also wet markets and informal food outlets, including street foods. Efforts should be made to ensure both modern and traditional outlets provide complementary platforms for convenient, affordable and accessible nutritious foods for urban populations. The resilience of urban food environments to environmental, physical and socio-economic shocks can be strengthened by shortening food supply chains and maximising food production in cities. Support mechanisms targeting urban informal food outlets and street vendors can also strengthen resilience and improve food security. Further research is needed on the impact of urbanising food environments on consumer choices, preferences, diets and health outcomes.

Impact of Magnetic Resonance Imaging on Healthcare in Low- and Middle-Income Countries.

Magnetic resonance imaging (MRI) played a significant role in the digital health platforms that influenced and supported modern medicine. However, there is a shortage of MRI in low- and middle-income countries (LMICs). The International Society of Radiology offers a detailed plan for LMICs to advance imaging quality in the global health agenda. The overarching objective of this scoping review was to determine the impact of MRI in healthcare in LMICs. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify available evidence. We systematically searched four academic databases for peer-reviewed literature published between 2018 and 2021, namely, Medline, PubMed, Web of Science, and Scopus, as well as Google Scholar as a source for gray literature. The search identified 54 articles. We identified a range of reasons for introducing MRI in LMICs. Nonetheless, some challenges to accepting MRI as a method of healthcare have been reported, including technological, regulatory, and economical challenges. To implement the proposed plan, the involvement of professional and international organizations is considered crucial. The establishment of an International Commission on Medical Imaging under the umbrella of international organizations is suggested and collaboration with other diagnostic disciplines is encouraged to raise awareness of the importance of upscale diagnostics at large and to foster its integration into the care pathway globally.

COVID-19 impact on the global neurosurgery resident training course and admission: A scoping review.

Background: This study looks at how COVID-19 affected the admission and training of neurosurgical residents worldwide. Methods: From 2019 to 2021, we reviewed multiple databases (i.e., Google Scholar, Science Direct, PubMed, and Hinari) to evaluate the impact of the COVID-19 pandemic on neurosurgery resident training and admission in low middle-income countries (LMICs) and high-income countries (HICs). We then utilized a Wilcoxon signed-rank test to evaluate the difference between the two LMIC/HICs and employed Levene's test to assess the homogeneity of variances. Results: There were 58 studies that met our inclusion criteria; 48 (72.4%) were conducted in HIC and 16 (27.6%) in LMIC. The admission of new residents was mostly canceled in HIC (31.7%; n = 13) and in LMIC (25%; n = 4) from 2019 to 2021 due to COVID-19. Learning modalities changed to include predominantly video conferencing (i.e., 94.7% [n = 54] of cases). Further, neurosurgery was largely restricted to emergency cases alone (79.6% [n = 39]), with only 12.2% (n = 6) elective cases. The result was a marked reduction in resident surgical training (i.e., 66.7% [n = 10] in LMIC and 62.9% [n = 22] in HIC), despite increased workloads in (i.e., LMIC [37.4%; n = 6] and HIC [35.7%; n = 15]). This was attributed to the marked reduction in the number of surgical patients allotted to each resident (i.e., LMIC [87.5%; n = 14] than HIC [83.3%; n = 35]). Conclusion: The COVID-19 pandemic markedly disrupted neurosurgical education globally. Although differences have been found between LMICs and HICs training, the reduction of neurosurgical case-loads and surgical procedures has significantly impacted neurosurgical training. The question remains, how can this "loss of experience" be redressed in the future?

Epidemics, Lockdown Measures and Vulnerable Populations: A Mixed-Methods Systematic Review of the Evidence of Impacts on Mother and Child Health in Low-and Lower-Middle-Income Countries.

BACKGROUND: The aim of this research was to synthetise the existing evidence on the impact of epidemic-related lockdown measures on women and children's health in low- and lower-middle-income countries (LLMICs). METHODS: A mixed-methods systematic review was conducted of qualitative, quantitative and mixed-methods evidence. Between 1st and 10th of November 2021, seven scientific databases were searched. The inclusion criteria were that the paper provided evidence on the impact of lockdown and related measures, focused on LLMICs, addressed impacts on women and child's health, addressed epidemics from 2000-2020, was peer-reviewed, provided original evidence, and was published in English. The Joanne Briggs Institute's critical appraisal tools were used to assess the quality of the studies, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting. The evidence from the papers was grouped by type of lockdown measure and categories of impact, using a narrative data-based convergent synthesis design. RESULTS: The review process identified 46 papers meeting the inclusion criteria from 17 countries that focussed on the coronavirus disease 2019 (COVID-19) and Ebola epidemics. The evidence on the decrease of utilisation of health services showed plummeting immunisation rates and faltering use of maternal and perinatal services, which was linked to a growth of premature deaths. Impacts on the mental health of children and women were convincingly established, with lockdowns associated with surges in depression, anxiety and low life satisfaction. Vulnerability may be compounded by lockdowns, as livelihoods were disrupted, and poverty levels increased. CONCLUSION: Limitations included that searches were conducted in late-2020 as new research was being published, and that some evidence not published in English may have been excluded. Epidemic-related lockdown measures carry consequences for the health of women and children in lower-income settings. Governments will need to weigh the trade-offs of introducing such measures and consider policies to mitigate their impacts on the most vulnerable.

Utilization of telehealth to manage the Covid-19 pandemic in low- and middle-income countries: a scoping review.

OBJECTIVE: Recently, the coronavirus disease 2019 (Covid-19) pandemic has led to an increase in the use of telehealth technology. It seems that the application of this technology in low- and middle-income countries (LMICs) has been limited, and few studies have been undertaken to review the current state of knowledge in this area. The aim of the present study was to explore the utilization of telehealth to manage the Covid-19 pandemic in LMICs. MATERIALS AND METHODS: This scoping review was conducted in 2022. PubMed, Web of Science, Scopus, the Cochrane Library, IEEE Xplore, and ProQuest were searched, and all quantitative research, qualitative studies, case reports, and case studies related to the use of telehealth to manage Covid-19 in LMICs and published since 2020 were included in the study. The findings were analyzed and reported narratively. RESULTS: In total, 18 articles were included in the research. These studies were conducted in South Asia, sub-Saharan Africa, the Middle East and North Africa, and East Asia and Oceania. Telehealth interventions included teleconsultation, telecoaching, teledermatology, televisit, mhealth applications, telerehabilitation, telepharmacy, and telepsychiatry. WhatsApp was the most common way for service delivery and in most studies, patients and health care providers were satisfied with services. CONCLUSION: Although the use of telehealth interventions was limited in LMICs during the Covid-19 pandemic, in most cases, it was an effective solution to combat the outbreak of Covid-19 and had positive outcomes. A comparison between the characteristics and clinical effectiveness of similar interventions in different countries including LMICs are worth investigation in the future studies.

A leap towards enforcing medicines prescribing by generic names in low- and middle-income countries (LMICs): pitfalls, limitations, and recommendations for local drug regulatory agencies.

The Drug Regulatory Authority of Pakistan (DRAP) in response to the public outcry on increasing medicines prices in the country issued notifications to direct healthcare professionals to prescribe medicines with their generic names. Like DRAP, many regulators in the low- and middle-income countries (LMICs) are also inspiring from the west to legally enforce generic prescribing in a bid to reduce the out-of-pocket public expenditures. However, there are pitfalls in the LMICs drug regulatory framework, which if left unaddressed can severely jeopardise the foreseen benefits of medicines prescribing by generic names. This article critically appraises the impact of prescribing by generic names regulations in LMICs and highlights the key considerations that are vital to address before legally enforcing generic prescribing. The ethics, regulatory compliance, and good governance are the key to success; better generics for a better tomorrow.

A tale of two applications: lessons learned from national LMIC COVID applications.

Mobile health (mHealth) technologies in low- and middle-income countries (LMICs) have received increased attention for the significant potential benefits they can bring to underserved populations. As smartphones are becoming increasingly accessible, many stakeholders in the mHealth space have begun exploring smartphone applications as a means to impact individuals living within LMICs. With the COVID-19 pandemic straining healthcare systems around the world, many governments in LMICs turned to use smartphone applications to help support and manage their pandemic responses. By analyzing national COVID-19 applications created and launched by the Indian and Vietnamese governments, we highlight effective application functions and strategies, summarizing best practices for future LMIC application development.

The impact of delayed access to COVID-19 vaccines in low- and lower-middle-income countries.

Introduction: A majority of low-income (LIC) and lower-middle-income countries (LMIC) were unable to achieve at least 10% population coverage during initial vaccine rollouts, despite the rapid development of the coronavirus disease 2019 (COVID-19) vaccines. Nearly three years into this pandemic, evaluating the impact of inequities in vaccine access, uptake, and availability is long overdue. We hypothesized that a delay in receiving COVID-19 vaccines was associated with an increased toll on cumulative cases and mortality. Furthermore, this relationship was modified by the size of a country's economy. Methods: We performed an ecological study assessing these relationships, in which a country's economic standing was assessed by world bank income classification, gross domestic product based on the purchasing power parity (GDP PPP) per capita category, and crude GDP PPP. Results: Countries with the smallest economies reported first vaccination much later than larger economies on all three rankings, as much as 100 days longer. Among low-income countries, a one-day increase until the first vaccination was associated with a 1.92% (95% CI: 0.100, 3.87) increase in cumulative cases when compared to high-income countries (p = 0.0395) when adjusting for population size, median age, and testing data availability. Similarly, among the lowest GDP PPP countries a one-day increase until the first vaccination was associated with a 2.73% (95% CI: 0.100, 5.44) increase in cumulative cases when compared to the highest GDP PPP countries (p = 0.0415). When modeling cumulative mortality, effects in the same direction and magnitude were observed, albeit statistically non-significant. Conclusion: Economic standing modified the effects of delayed access to COVID-19 vaccination on cumulative cases and mortality, in which LMICs tended to fare worse in outcomes than high-income countries despite the eventual rollout of vaccines. These findings highlight the importance of prioritizing equitable and timely access to COVID-19 vaccines across all countries, irrespective of economic size. Future studies should examine the impacts that vaccine inequities had on local transmission dynamics.

The risk of SARS-CoV-2 Omicron variant emergence in low and middle-income countries (LMICs).

We estimated the probability of undetected emergence of the SARS-CoV-2 Omicron variant in 25 low and middle-income countries (LMICs) prior to December 5, 2021. In nine countries, the risk exceeds 50 %; in Turkey, Pakistan and the Philippines, it exceeds 99 %. Risks are generally lower in the Americas than Europe or Asia.

Sociodemographic, economic, physical, and mental health status of previously hospitalised patients with COVID-19 symptoms in Bangladesh: Protocol for a mixed-method study.

Introduction: Not much is known about the long-term consequences of COVID-19, popularly known as long COVID. This is particularly so in terms of patterns and clusters of symptoms over time, sociodemographic and economic characteristics of patients, and related clinical history. This is crucial for resource-constrained health systems such as Bangladesh to address long COVID as a forthcoming challenge. This protocol aims to investigate the consequences of COVID-19 over time for physical and mental health and how these are associated with demographic and socio-economic factors. Methods and analysis: This mixed-method study collected information on all patients with symptoms of COVID-19 admitted to and discharged after recovery from a COVID-19-dedicated hospital in Bangladesh (N = 942), from April to December 2020. The sources of data were admission records and discharge certificates from the hospital for clinical history, cross-sectional survey on physical and mental health (assessed by DASS21 scale)-related symptoms and socioeconomic changes after recovery, and qualitative in-depth interviews on experiences of COVID-19. Interviews were conducted over the phone. Quantitative analysis was done to estimate the prevalence of physical and mental health consequences of COVID-19 after recovery and the association with socio-economic and demographic information. The qualitative analysis was performed using a thematic analysis approach. Discussion: It is imperative to understand the post-COVID consequences and related health and non-health aspects to inform evidence-based policymaking, especially for resource-poor contexts such as Bangladesh. Given the dearth of evidence in this regard, the proposed study will contribute to bridging this knowledge gap. It is important to note that this study is one of the few which presents information on post-COVID-19 consequences in the context of low- and middle-income countries and the first in Bangladesh.

Barriers against and strategies for malaria control during the COVID-19 pandemic in low- and middle-income countries: a systematic review.

BACKGROUND: The COVID-19 pandemic has disrupted malaria control activities globally. Notably, high levels of excess malaria morbidity and mortality in low- and middle-income countries (LMICs) were reported. Although it is crucial to systematically understand the main causes of the disruption to malaria control and synthesize strategies to prepare for future pandemics, such studies are scarce. Therefore, this study aims to better identify barriers against and strategies for malaria control. METHODS: Following the PRISMA guidelines and through searches of electronic databases and Google Scholar, a systematic literature review was conducted to identify studies pertaining to malaria control published between January 2020 and December 2021. Only studies that discussed reported barriers and/or strategies related to malaria were included for the review. The Mixed Methods Quality Appraisal Tool (MMAT) and the Authority, Accuracy, Coverage, Objectivity, Date and Significance (AACODS) checklist were used for quality appraisal. Key information such as literature type, study design, setting and population, interventions, outcomes, barriers, and strategies were extracted. With an existing framework of four dimensions (accessibility, affordability, availability, and acceptability) further subdivided by the supply and demand sides, this study synthesized information on barriers and strategies related to malaria control and further categorized the strategies based on the time frame. RESULTS: From the 30 selected studies, 27 barriers and 39 strategies were identified. The lockdown measures, which mainly threatened geographic accessibility and availability of malaria control services, were identified to be the main barrier hindering effective mobilization of community health workers and resources. Among the identified strategies, clear risk communication strategies would alleviate psychosocial barriers, which challenged acceptability. Some strategies that cross-cut points across all four dimensions would, require systems-level integration to enhance availability and affordability of malaria control. The strategies were distinguished between short-term, for instant response, and mid to long-term for future readiness. CONCLUSIONS: The pandemic resulted in complex barriers to malaria control, particularly imposing a double burden on LMICs. Identifying strategies to overcome said barriers provides useful insights in the decision-making processes for the current and future pandemic. Cross-cutting strategies that integrate all dimensions need to be considered. Health system strengthening and resilience strategy appropriate for country-specific context is fundamental.

Evolving practice in global healthcare: Remote physics support for low- and middle-income countries.

The COVID-19 pandemic has disrupted traditional onsite support for radiotherapy clinics in low- and middle-income countries (LMIC). Clinics there have struggled to commission new techniques and receive onsite training for their staff. We sought to evaluate whether an offsite approach could fill this gap at a clinic in Jordan by requesting a clinical audit and attempting to commission volumetric modulated arc therapy (VMAT). Over 13 months, a consultant provided remote support for a radiotherapy center that had already obtained treatment equipment and licenses. The consultant began by conducting a virtual audit, using a remote login to the center's R&V and TPS, to identify any gaps in the clinical workflow. Suggestions for improving the clinical workflow were proposed, and change implementation was tracked through emails, social media apps, and video conferencing. An extensive table outlined the commissioning process, including all measurements to be done. Social media apps and shared documents were used to track measurements and analysis. The lack of person-to-person interaction in this new remote-support ecosystem created conflicts; we have highlighted some of these, as well as their resolution and the lessons learned from them. The virtual audit identified gaps categorized as machine QA, treatment plan review, and treatment delivery processes. Following the implementation of the proposals, motion management was added, and machine QA became more comprehensive. VMAT was commissioned using the reports of the AAPM and the IAEA. The main challenges for remote support were time difference, establishing an appropriate form and frequency of communication, tone of voice used in messages, and buy-in from local staff. This evolving practice will enable medical physicists to use modern, multimodal remote communication pathways to effectively transfer knowledge to centers in LMICs. The audit-proposal-improvement pathway for remote support can be incorporated to help others while avoiding the pitfalls we faced.

Use of provider-to-provider telemedicine in Kenya during the COVID-19 pandemic.

Introduction: According to the World Health Organization (WHO), about 90 percent of countries continue to report COVID-related disruptions to their health systems. The use of telemedicine has been especially common among high-income countries to safely deliver and access health services where enabling infrastructure like broadband connectivity is more widely available than low- and middle-income countries (LMICs). The Addis Clinic implements a provider-to-provider (P2P) asynchronous telemedicine model in Kenya. We sought to examine the use of the P2P telemedicine platform during the second year of COVID-19. Methods: To assess sustainability, we compared the data for two 12-month calendar periods (period A = year 2020, and period B = year 2021). To examine performance, we compared the data for two different 12-month periods (period C = pandemic period of February 2021 to January 2022, and period D = baseline period of February 2019 to January 2020). Results: Sustainability of the P2P telemedicine platform was maintained during the pandemic with increased activity levels from 2,604 cases in 2020 to 3,525 cases in 2021. There was an average of 82 specialists and 5.9 coordinators during 2020, and an average of 81 specialists and 6.0 coordinators during 2021. During 2020, there were 444 cases per coordinator, and 587 cases per coordinator in 2021(P = 0.078). During 2020, there were 32 cases per specialist, and 43 cases per specialist in 2021(P = 0.068). Performance decreased with 99 percent of cases flagged as "answered" during the baseline period (period D), and 75 percent of cases flagged as "answered" during the pandemic period (period C). Conclusion: Results suggest that despite a decline in certain sustainability and performance indicators, The Addis Clinic was able to sustain a very high level of activity during the second year of the pandemic, as shown by the continued use of the system. Furthermore, despite some of the infrastructure challenges present in LMICs, the P2P telemedicine platform was a viable option for receiving clinical recommendations from medical experts located remotely. As health systems in LMICs grapple with the effects of the pandemic, it is worthwhile to consider the use of telemedicine to deliver essential health services.

Where There Is No Paediatric Intensivist: Building Critical Care Capacity and Implementing a Pandemic Response Team in Guyana

BACKGROUND AND AIM: Building formal Paediatric Critical Care Medicine (PCCM)capacity provides a significant opportunity for meaningful impact on quality of life and mortality rates in Low Middle Income Countries (LMICs). In a global pandemic, it becomes even more essential to provide critical care to this vulnerable population.To meet the challenges of developing PCCM in Guyana, we utilized a student centered, Micro-Modular Fellowship (MMF) strategy which utilized standardised curricula (PFCCS, PALS, NRP, etc.), bespoke courses (Ventilation, POCUS, etc.), open source simulation, and teleconferenced lectures from PICUs around the world. Training the Trainer, Psychological Safety and High Yield Pedagogy, were key components in optimising both PCCM program sustainability and clinical outcomes in Guyana. METHOD(S): Didactics were immediately reinforced by student driven, case based simulations which often drew from grand rounds and were conducted in an environment in which psychological safety, continuous feedback dynamic process improvement, and High Performance Teamwork were constantly emphasized. RESULT(S): Our multidisciplinary team was able to build and sustain the first paediatric critical care unit in Guyana. Since 2018, over five hundred children have benefited from the establishment of this unit. In addition, our established strategy also resulted in rapid capacity building and mobilisation of a Paediatric COVID 19 response team to the 2020 pandemic surge in Guyana. CONCLUSION(S): Our High Yield Pedagogy approach optimised rapid knowledge acquisition and lasting translation into paediatric critical care medicine practiceacross multiple practice milieus in Guyana.It may provide a useful model for building sustainable PCCM capacity in other LMICs.

Tobacco industry influence in low- and middle-income countries in the ASEAN region: Qualitative interviews with tobacco control experts during the COVID-19 pandemic.

INTRODUCTION: While most Association of Southeast Asian Nations (ASEAN) countries have adopted the Framework Convention on Tobacco Control (FCTC), implementation and enforcement of measures are lacking in some low- and middle-income countries (LMICs) in the region. This study aimed to describe: 1) how the tobacco industry has undermined tobacco control efforts and adapted its tactics in response to the COVID-19 pandemic and other external factors, 2) the political factors that hinder progress, and 3) the expert recommendations to overcome challenges of tobacco control in the ASEAN region. METHODS: During the COVID-19 pandemic, qualitative interviews were conducted with tobacco control experts to explore their perspectives and recommendations to address the barriers and challenges of tobacco control in ASEAN LMICs. RESULTS: Eleven tobacco control experts participated in interviews. Five themes emerged from the data: 1) a shift to below-the-line marketing and digital technologies to target youth; 2) industry develops new tactics to undermine tobacco control; 3) cigarette packet branding - the last remaining marketing channel; 4) political factors hindering tobacco control; and 5) broader involvement and collaboration in tobacco control. CONCLUSIONS: The tobacco industry continues to undermine tobacco control in ASEAN LMICs, shifting its marketing, corporate social responsibility (CSR) and lobbying tactics in response to changing regulations, digital technologies, and the COVID-19 pandemic. While lack of government leadership also hinders progress, full adoption of the FCTC and increased collaboration in tobacco control are recommended to overcome these issues.