Prevalence and co-occurrence of symptoms of mental and substance use disorders among people with HIV age 40 and older in low- and middle-income countries: a cross-sectional study.

INTRODUCTION: Due to the increased effectiveness of and access to antiretroviral therapy (ART), people with HIV (PWH) are living longer. As a result, the population of older PWH has increased. Mental and substance use disorders (MSDs) are common and frequently co-occurring among PWH and are associated with poor HIV care outcomes. Research into the prevalence and co-occurrence of MSDs among ageing PWH remains limited, particularly in low- and middle-income countries (LMICs). METHODS: We analysed data collected between 2020 and 2022 from the International epidemiology Databases to Evaluate AIDS (IeDEA) Sentinel Research Network cohort of PWH aged 40 years or older on ART at 11 HIV clinics in Brazil, Côte d'Ivoire, India, Kenya, Mexico, Uganda, Rwanda, Togo, Vietnam, Zambia and Zimbabwe. We estimated the prevalence and co-occurrence of unhealthy alcohol use (AUDIT-C ≥3 for women, ≥4 for men), unhealthy drug use (ASSIST >3 for cannabis, cocaine, amphetamines, inhalants, sedatives, hallucinogens and/or opioids), and moderate to severe symptoms of depression (PHQ-9 ≥10), anxiety (GAD-7 ≥10) and post-traumatic stress disorder (PTSD) (PCL-5 ≥33). Psychiatric multimorbidity was defined as having symptoms of two or more disorders assessed. Log binomial models assessed the association between socio-demographic and HIV care characteristics and symptoms of anxiety, depression, PTSD or unhealthy substance use. RESULTS: Of 2821 participants, the prevalence of unhealthy alcohol and drug use was 21% and 5%, respectively. The prevalence of moderate to severe symptoms of depression, anxiety and PTSD was 14%, 9% and 6%, respectively. Overall, the prevalence of psychiatric multimorbidity was 11%. Among those with symptoms of at least one mental health or substance use outcome assessed (n = 1036), the prevalence of psychiatric multimorbidity was 31%. In binomial models, the prevalence of symptoms of depression and anxiety was higher, while the prevalence of unhealthy alcohol and drug use was lower among women than men. CONCLUSIONS: Unhealthy alcohol use and symptoms of depression were most commonly reported, among this cohort of PWH aged 40 or older across 11 LMICs. Integration of MSD screening and treatment into HIV care should be prioritized. The effectiveness and implementation of transdiagnostic or multi-focus mental health treatment approaches in HIV care settings should be examined.

Navigating HIV research among criminalized gender minority populations in Uganda: qualitative insights and lessons learned from novice researchers.

BACKGROUND: Transgender individuals often face stigma, discrimination, and various forms of abuse, which negatively impact their mental and physical health. They face a significantly greater risk of HIV, with a higher prevalence than the general population. Despite these challenges, transgender people have limited access to healthcare due to violence, legal barriers, and societal stigma, further exacerbated in countries like Uganda, where transgender identities are criminalized. Therefore, this study explored the lived experiences of HIV researchers working with gender minority populations in criminalizing contexts. METHODS: This was an interpretative phenomenological analysis (IPA) qualitative study. Twelve (12) research team members at all levels were involved in the study. Participants had less than five years of involvement in HIV research among gender minority populations. Data were collected using field notes, reflective journals, documentation from daily team debriefing sessions, and semi-structured interviews. The analysis used NVivo software. RESULTS: Positive experiences, barriers, and challenges were captured. The positive experiences were 'respecting cultural diversity', 'expanding networks', 'addressing misconceptions' and 'finding allies'. The barriers included 'experiencing stigma', 'lengthy research processes', 'feeling isolated', 'fearing for personal safety', 'unexpected logistical costs', and 'criminalization of sexual and gender minorities'. The key themes that emerged from the lessons learned were: 'dealing with gatekeepers', 'diversity and sensitivity training', 'leveraging networks', 'meaningful community engagement', 'reflexivity', 'ensuring safety', 'equal partnership', 'giving feedback' and 'awareness of legal implications'. CONCLUSIONS: This study highlights the importance of cultural sensitivity, community engagement, and reflexivity in research design and implementation. The findings emphasize the need for innovative strategies to navigate legal, social, and logistical barriers that researchers and participants face. Despite these challenges, the study demonstrates that meaningful collaboration with community members and building trust can significantly enhance the research process and outcomes. Future research should continue to explore these strategies while addressing ethical and safety concerns.

A Comparative Analysis of Otolaryngology Journal Characteristics and Metrics Across World Bank Income Groups.

Study Background and Aims: There are marked barriers to research and publishing for low- and middle- income country (LMIC) ENT researchers. This could be reflected in LMIC journal characteristics and research, which has never been investigated. We aim to characterize differences in the number, geographic distribution, publishing costs, reach, number of articles, citations, and impact factors of high-income country (HIC) journals compared to LMIC journals. Methods: We included journals listed under the category "Otorhinolaryngology' in three major journal databases. From journal websites, we collected data related to financial model, waiver policy, access, and distribution. Additionally, from the Clarivate Journal Citation Reports 2022, we collected the following journal metrics: total articles, total citations, journal citation indicator, journal impact factor (JIF), 5-year JIF, and JIF without self cites. Results: 79.7% HIC journals offered English editing services, compared with 25.0% of LMIC journals. Additionally, 40.0% of HIC journals are solely open access compared with 92.0% in LMICs. Lower journal metrics were seen in LMIC journals, including 2022 mean total articles (107 HICs vs. 60 LMICs), total citations (4296 vs. 751), journal citation indicator (0.88 vs. 0.35), and journal impact factor (12.68 vs. 0.82). Conclusion: We have identified substantial differences in the distribution, English editing services, and journal metrics of HIC journals compared to LMIC journals. These may point to potential barriers to publishing and research access for those in LMICs. To support LMIC research, future work should evaluate opportunities to increase the number of ENT journals in LMICs, expand open access publishing, improve access to language services, and increase LMIC research impact.

Prevalence data on chicken diseases in low-resource settings.

The presence of transmissible disease in livestock has a major impact on welfare and economics in animal and public health. A lack of data enables the spread of diseases due to misinformed decision-making on prevention and control. Low-resource settings face challenges in providing data, turning data availability into a development issue. For this study, a large dataset (n = 997) was collected on prevalence and seroprevalence estimates on viral (n = 224), bacterial (n = 83) and parasitic (n = 690) diseases in backyard chickens in low- and middle-income countries (LMICs). These estimates originate from 306 studies identified during the screening phase of a systematic literature review. An attempt was made to classify the studies according to the Food and Agriculture Organization of the United Nations'classification system for family poultry production systems. Of the studies, 98.7% (302/306) focused on a single poultry production system, while 1.3% (4/306) targeted two different production systems. Within the group of studies that covered one production system, 85.4% (258/302) were classified as â€Ëœsmall extensive scavenging or extensive scavenging,'â€Ëœsmall extensive scavenging'and/or â€Ëœextensive scavenging'. In addition, 52% (159/306) of the studies did not report information on chicken breed type. No data were found on any relevant disease for 56.9% (78/137) of LMICs, signifying a potential data gap. Of the estimates on viral and bacterial diseases, 71.0% (218/307) corresponded to diseases notifiable to the World Organisation for Animal Health, highlighting a tendency to measure disease occurrence for diseases relevant to trade. The latter might not necessarily be priority diseases for the producers, however. Furthermore, 72.3% (222/307) of the estimates originate from random samples and could be used to estimate prevalence in backyard chickens using imputation methods, thus bridging the data gap.

Les maladies transmissibles affectant les animaux d'élevage ont un impact majeur sur la santé animale et la santé publique, avec des effets sur le bien-être et sur l'économie. L'absence de données favorise la propagation des maladies puisque les mesures de prévention et de contrôle reposent sur des décisions mal informées. Les contextes faiblement dotés en ressources se heurtent à la difficulté de produire des données, ce qui fait de la disponibilité des données un enjeu de développement. Pour les besoins de la présente étude, un vaste jeu de données (n = 997) a été constitué, regroupant les taux de prévalence et de séroprévalence estimés d'un certain nombre de maladies virales (n = 224), bactériennes (n = 83) et parasitaires (n = 690) affectant les poulets de basse-cour dans les pays à revenu faible et intermédiaire. Ces estimations sont extraites des 306 études retenues lors de la phase de sélection initiale d'un examen systématique de la littérature. Une tentative de classement de ces études a été réalisée en se basant sur la classification des systèmes d'aviculture familiale élaborée par l'Organisation des Nations Unies pour l'alimentation et l'agriculture. Au total, 98,7 % (302/306) des études portaient sur un système unique de production de volailles, les 1,3 % restantes (4/306) portant sur deux systèmes de production différents. Dans le groupe des études couvrant un seul système de production, 85,4 % des élevages étudiés (258/302) relevaient des catégories " petits systèmes extensifs en liberté ou systèmes extensifs en liberté ", " petits systèmes extensifs en liberté " et/ou " systèmes extensifs en liberté ". En outre, dans 52 % des études (159/306), la race des poulets n'était pas précisée. Aucune donnée n'a pu être trouvée concernant les maladies importantes des volailles dans 56,9 % (78/137) des pays à revenu faible ou intermédiaire, ce qui indique un déficit potentiel de données. S'agissant des maladies virales et bactériennes, 71,0 % des estimations (218/307) correspondaient à des maladies à déclaration obligatoire à l'Organisation mondiale de la santé animale, ce qui souligne la tendance à signaler la survenue des maladies ayant une incidence sur les échanges internationaux. Toutefois, ce ne sont pas nécessairement ces maladies qui sont prioritaires pour les éleveurs. D'autre part, 72,3 % (222/307) des estimations provenaient d'échantillons aléatoires et pourraient donc servir à estimer la prévalence chez les poulets de basse-cour en appliquant des méthodes d'imputation, ce qui permettrait de combler les écarts.

La presencia de enfermedades transmisibles en los animales de granja tiene importantes repercusiones en el bienestar y la economía tanto en el ámbito de la sanidad animal como en el de la salud pública. La falta de datos favorece la propagación de enfermedades debido a la toma de decisiones en materia de prevención y control basada en información mal fundada. En los entornos de bajos recursos existen dificultades para el suministro de información, lo que convierte la disponibilidad de datos en un problema de desarrollo. Para este estudio, se recopiló un amplio conjunto de datos (n = 997) sobre estimaciones de prevalencia y seroprevalencia de enfermedades víricas (n = 224), bacterianas (n = 83) y parasitarias (n = 690) en pollos de traspatio en países de ingresos medios y bajos (PIMB). Estas estimaciones provienen de 306 estudios encontrados durante la fase de selección de una revisión bibliográfica sistemática. Se intentó clasificar los estudios según la clasificación de sistemas de producción avícola familiar de la Organización de las Naciones Unidas para la Alimentación y la Agricultura. El 98,7 % de los estudios (302/306) se centraron en un único sistema de producción avícola, mientras que el 1,3 % (4/306) se centraron en dos sistemas de producción diferentes. Dentro del grupo de estudios que abarcaban un solo sistema de producción, el 85,4 % (258/302) se clasificaron como sistema "extensivo de escarbado pequeño o extensivo de escarbado", "extensivo de escarbado pequeño" o "extensivo de escarbado". Además, en el 52 % (159/306) de los estudios no se proporcionó información sobre el tipo de raza de los pollos. No se encontraron datos sobre ninguna enfermedad pertinente para el 56,9 % (78/137) de los PIMB, lo que indica una posible carencia de datos. De las estimaciones sobre enfermedades víricas y bacterianas, el 71,0 % (218/307) correspondían a enfermedades de declaración obligatoria a la Organización Mundial de Sanidad Animal, lo que evidencia una tendencia a medir la aparición de enfermedades pertinentes para el comercio. Sin embargo, estas podrían no ser necesariamente enfermedades prioritarias para los productores. Por otro lado, el 72,3 % (222/307) de las estimaciones proceden de muestras aleatorias y podrían utilizarse para estimar la prevalencia en los pollos de traspatio utilizando métodos de imputación, lo que permitiría subsanar la carencia de datos.

A global overview of health system financing and available infrastructure and oversight for kidney care.

BACKGROUND: Governance, health financing, and service delivery are critical elements of health systems for provision of robust and sustainable chronic disease care. We leveraged the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to evaluate oversight and financing for kidney care worldwide. METHODS: A survey was administered to stakeholders from countries affiliated with the ISN from July to September 2022. We evaluated funding models utilized for reimbursement of medications, services for the management of chronic kidney disease, and provision of kidney replacement therapy (KRT). We also assessed oversight structures for the delivery of kidney care. RESULTS: Overall, 167 of the 192 countries and territories contacted responded to the survey, representing 97.4% of the global population. High-income countries tended to use public funding to reimburse all categories of kidney care in comparison with low-income countries (LICs) and lower-middle income countries (LMICs). In countries where public funding for KRT was available, 78% provided universal health coverage. The proportion of countries that used public funding to fully reimburse care varied for non-dialysis chronic kidney disease (27%), dialysis for acute kidney injury (either hemodialysis or peritoneal dialysis) (44%), chronic hemodialysis (45%), chronic peritoneal dialysis (42%), and kidney transplant medications (36%). Oversight for kidney care was provided at a national level in 63% of countries, and at a state/provincial level in 28% of countries. CONCLUSION: This study demonstrated significant gaps in universal care coverage, and in oversight and financing structures for kidney care, particularly in in LICs and LMICs.

Exploring the impact of early exposure and mentorship on the neurosurgery career aspirations of medical students in low- and middle-income countries.

Early exposure to neurosurgery has been shown to have a positive influence on students' perceptions and attitudes towards the field of neurosurgery. This review delves into the problems faced by the neurosurgery workforce in LMICs, highlighting the necessity for local and international collaborative strategies and plans to enhance the medical education curriculum, training, and retention of neurosurgeons in their home countries. Mentorship also emerges as a crucial factor in neurosurgical career progress, narrowing the gap between theoretical knowledge and real-world practical skills, and providing guidelines in career pathways. Despite numerous benefits of early exposure and mentorship, limitations such as limited resources, inadequate elective opportunities, and negative cultural influences, hinder students' interest in neurosurgery. However, initiatives such as global outreach programs and collaborations between HICs and LMICs aim to address these challenges and improve access to mentorship and training opportunities and programs. This review recommends the integration of mentorship into career development strategies, establishing well-structured mentorship programs, and strengthening neurosurgery exposure in medical education. By implementing these recommendations, the next generation of neurosurgeons can be better equipped to address the complex challenges in LMICs, ultimately, enhancing easy access to neurosurgical care and strengthening healthcare systems.

Challenges faced in managing cervical cancer patients who present post-operatively with more advanced disease in LMICs: Case studies from Cameroon.

Cameroon is a low-and-middle income country (LMIC) with one of the highest incidence and mortality from cervical cancer in Africa. In this Central African country where the prevalence of human immunodeficiency virus (HIV) is high and the screening coverage is low, cervical cancer is the most deadly and the second most common cancer among women. Notwithstanding the growing burden of cervical cancer in Cameroon, most patients - often of lower socioeconomic status - continue to encounter multi-level barriers to timely and adequate care. These include the lack of physical and financial access to healthcare facilities, limited quality pathology, imaging and treatment services, ignorance of disease by the population, shortage of a well-trained oncology workfroce, which result in significant delays in gaining access to screening, diagnosis, treatment and care. This paper presents 3 cases of patients with advanced cervical cancer who had surgery (hysterectomy) as primary treatment, without appropriate post-surgical investigation to further specify disease stage, persistence of residual disease, and need for adjuvant chemoradiation. Pathology services and diagnostic imaging procedures remain scarce and underused in LMIC countries like Cameroon. Healthcare professionals involved in patient care lack adequate knowledge, skills and collaborative strategy to properly navigate these patients. To address these challenges, the health system should be reinforced with adequate infrastructures, sustainable funding should be secured to enhance universal health coverage and promote cancer prevention and control programs, multidisciplinary teams and coordination of care among providers should be improved, and relevant health indicators should be put in place to better monitor the quality of care delivered to patients who are mostly vulnerable and uninformed.

Increasing trends of antibiotic resistance in Uganda: analysis of the national antimicrobial resistance surveillance data, 2018-2021.

BACKGROUND: Continuous monitoring of antimicrobial resistance (AMR) in Uganda involves testing bacterial isolates from clinical samples at national and regional hospitals. Although the National Microbiology Reference Laboratory (NMRL) analyzes these isolates for official AMR surveillance data, there's limited integration into public health planning. To enhance the utilization of NMRL data to better inform drug selection and public health strategies in combating antibiotic resistance, we evaluated the trends and spatial distribution of AMR to common antibiotics used in Uganda. METHODS: We analyzed data from pathogenic bacterial isolates from blood, cerebrospinal, peritoneal, and pleural fluid from AMR surveillance data for 2018-2021. We calculated the proportions of isolates that were resistant to common antimicrobial classes. We used the chi-square test for trends to evaluate changes in AMR resistance over the study period. RESULTS: Out of 537 isolates with 15 pathogenic bacteria, 478 (89%) were from blood, 34 (6.3%) were from pleural fluid, 21 (4%) were from cerebrospinal fluid, and 4 (0.7%) were from peritoneal fluid. The most common pathogen was Staphylococcus aureus (20.1%), followed by Salmonella species (18.8%). The overall change in resistance over the four years was 63-84% for sulfonamides, fluoroquinolones macrolides (46-76%), phenicols (48-71%), penicillins (42-97%), ß-lactamase inhibitors (20-92%), aminoglycosides (17-53%), cephalosporins (8.3-90%), carbapenems (5.3-26%), and glycopeptides (0-20%). There was a fluctuation in resistance of Staphylococcus aureus to methicillin (60%-45%) (using cefoxitin resistance as a surrogate for oxacillin resistance) Among gram-negative organisms, there were increases in resistance to tetracycline (29-78% p < 0.001), ciprofloxacin (17-43%, p = 0.004), ceftriaxone (8-72%, p = 0.003), imipenem (6-26%, p = 0.004), and meropenem (7-18%, p = 0.03). CONCLUSION: The study highlights a concerning increase in antibiotic resistance rates over four years, with significant increase in resistance observed across different classes of antibiotics for both gram-positive and gram-negative organisms. This increased antibiotic resistance, particularly to commonly used antibiotics like ceftriaxone and ciprofloxacin, makes adhering to the WHO's Access, Watch, and Reserve (AWaRe) category even more critical. It also emphasizes how important it is to guard against the growing threat of antibiotic resistance by appropriately using medicines, especially those that are marked for "Watch" or "Reserve."

Evaluation of Pathology Resources for Cervical Cancer Detection Between 2018 & 2022: a Retrospective Study at Moi Teaching and Referral Hospital, Western Kenya.

Background: Cervical cancer cases are increasing in sub-Saharan Africa, particularly in Kenya, exacerbated by inadequate histopathology resources, posing a significant barrier to timely diagnosis and treatment. There has been little research on the availability and evolution of histopathology resources for diagnosing cervical cancer over the years. This retrospective study evaluated this evolution at Moi Teaching and Referral Hospital in Kenya between 2018 and 2022. Methods: We used a mixed-methods approach. An in-depth interview was conducted with one of MTRH's pathology laboratory staff to assess the equipment, personnel, and quality control trends between 2018 and 2022. A thematic analysis was conducted in NVivo. We also retrospectively conducted a comprehensive inventory review of laboratory resources from 2018-2022 via purposive sampling. Microsoft Excel and Stata version 17 were utilized for descriptive statistical analysis. Turnaround time (TAT) was assessed against the UK's National Health Service Cervical Screening Program guidelines. Results: The number of histopathology laboratory personnel at MTRH increased from 2018 to 2022, during which the facility included two pathologists, one records person, and one office administrator. Patient annual visits increased from approximately 350,000 in 2018 to approximately 500,000 in 2022. However, the histopathology personnel-to-population ratio decreased from 1.5 pathologists and 2.7 histo-technicians per 100,000 in 2018 to 1.4 pathologists and 1.8 histo-technicians per 100,000 in 2022. Despite this decrease, lab equipment, automatic tissue processors and embedding machines were added, and an average 14-day turnaround time was maintained for pathology reports. Conclusions: Despite a decreased personnel-to-patient ratio, the addition of crucial histopathology equipment mirrors the operational commitment of the Moi Teaching and Referral Hospital. The 14-day TAT is commendable, contributes to operational effectiveness and significantly contributes to timely detection. The hospital's dedication to upgrading its infrastructure underscores a proactive approach to addressing growing healthcare demands and improving patient outcomes, even with limited human resources. The decline in the personnel-to-patient ratio underscores challenges in diagnosis, emphasizing the need to address workforce and infrastructure gaps to improve patient care within similar low-resource settings.

Addressing the critical gap: conscious sedation for pediatric oncology patients in LMICs.

Most newly diagnosed pediatric cancer patients reside in LMICs. These countries face challenges in providing quality treatment, particularly with procedures requiring stillness or causing pain. Conscious sedation (CS) is underutilized in LMICs due, causing treatment delays and adverse outcomes. Advocacy for CS teams, training, and policy support is essential to improve outcomes.

Development of an online authentic radiology viewing and reporting platform to test the skills of radiology trainees in Low- and Middle-Income Countries.

BACKGROUND: Diagnostic radiology residents in low- and middle-income countries (LMICs) may have to provide significant contributions to the clinical workload before the completion of their residency training. Because of time constraints inherent to the delivery of acute care, some of the most clinically impactful diagnostic radiology errors arise from the use of Computed Tomography (CT) in the management of acutely ill patients. As a result, it is paramount to ensure that radiology trainees reach adequate skill levels prior to assuming independent on-call responsibilities. We partnered with the radiology residency program at the Aga Khan University Hospital in Nairobi (Kenya) to evaluate a novel cloud-based testing method that provides an authentic radiology viewing and interpretation environment. It is based on Lifetrack, a unique Google Chrome-based Picture Archiving and Communication System, that enables a complete viewing environment for any scan, and provides a novel report generation tool based on Active Templates which are a patented structured reporting method. We applied it to evaluate the skills of AKUHN trainees on entire CT scans representing the spectrum of acute non-trauma abdominal pathology encountered in a typical on-call setting. We aimed to demonstrate the feasibility of remotely testing the authentic practice of radiology and to show that important observations can be made from such a Lifetrack-based testing approach regarding the radiology skills of an individual practitioner or of a cohort of trainees. METHODS: A total of 13 anonymized trainees with experience from 12 months to over 4 years took part in the study. Individually accessing the Lifetrack tool they were tested on 37 abdominal CT scans (including one normal scan) over six 2-hour sessions on consecutive days. All cases carried the same clinical history of acute abdominal pain. During each session the trainees accessed the corresponding Lifetrack test set using clinical workstations, reviewed the CT scans, and formulated an opinion for the acute diagnosis, any secondary pathology, and incidental findings on the scan. Their scan interpretations were composed using the Lifetrack report generation system based on active templates in which segments of text can be selected to assemble a detailed report. All reports generated by the trainees were scored on four different interpretive components: (a) acute diagnosis, (b) unrelated secondary diagnosis, (c) number of missed incidental findings, and (d) number of overcalls. A 3-score aggregate was defined from the first three interpretive elements. A cumulative score modified the 3-score aggregate for the negative effect of interpretive overcalls. RESULTS: A total of 436 scan interpretations and scores were available from 13 trainees tested on 37 cases. The acute diagnosis score ranged from 0 to 1 with a mean of 0.68 ± 0.36 and median of 0.78 (IQR: 0.5-1), and there were 436 scores. An unrelated secondary diagnosis was present in 11 cases, resulting in 130 secondary diagnosis scores. The unrelated secondary diagnosis score ranged from 0 to 1, with mean score of 0.48 ± 0.46 and median of 0.5 (IQR: 0-1). There were 32 cases with incidental findings, yielding 390 scores for incidental findings. The number of missed incidental findings ranged from 0 to 5 with a median at 1 (IQR: 1-2). The incidental findings score ranged from 0 to 1 with a mean of 0.4 ± 0.38 and median of 0.33 (IQR: 0- 0.66). The number of overcalls ranged from 0 to 3 with a median at 0 (IQR: 0-1) and a mean of 0.36 ± 0.63. The 3-score aggregate ranged from 0 to 100 with a mean of 65.5 ± 32.5 and median of 77.3 (IQR: 45.0, 92.5). The cumulative score ranged from - 30 to 100 with a mean of 61.9 ± 35.5 and median of 71.4 (IQR: 37.4, 92.0). The mean acute diagnosis scores and SD by training period were 0.62 ± 0.03, 0.80 ± 0.05, 0.71 ± 0.05, 0.58 ± 0.07, and 0.66 ± 0.05 for trainees with ≤ 12 months, 12-24 months, 24-36 months, 36-48 months and > 48 months respectively. The mean acute diagnosis score of 12-24 months training was the only statistically significant greater score when compared to ≤ 12 months by the ANOVA with Tukey testing (p = 0.0002). We found a similar trend with distribution of 3-score aggregates and cumulative scores. There were no significant associations when the training period was categorized as less than and more than 2 years. We looked at the distribution of the 3-score aggregate versus the number of overcalls by trainee, and we found that the 3-score aggregate was inversely related to the number of overcalls. Heatmaps and raincloud plots provided an illustrative means to visualize the relative performance of trainees across cases. CONCLUSION: We demonstrated the feasibility of remotely testing the authentic practice of radiology and showed that important observations can be made from our Lifetrack-based testing approach regarding radiology skills of an individual or a cohort. From observed weaknesses areas for targeted teaching can be implemented, and retesting could reveal their impact. This methodology can be customized to different LMIC environments and expanded to board certification examinations.

A qualitative study on apparent and latent contributing factors to driving errors in Iran.

Road traffic crashes (RTCs) disproportionately impact low and middle-income countries (LMICs). Current interventions in LMICs primarily target road user behavior, neglecting systemic issues and casting drivers as mere contributors. Given Iran's unique cultural, financial, and social intricacies, this study aims to explore the latent causes of RTCs, prioritizing drivers' experiences and encompassing insights from various traffic system components. Applying a qualitative approach, data were collected through 46 semi-structured interviews with 38 participants, including drivers and experts from traffic-related organizations. Content analysis identified ten themes as contributing to driving errors. Direct factors included fatigue influenced by economic and occupational conditions, distraction from internal and external sources, reckless behaviors influenced by traffic culture and environment, and Inadequate driving skills due to training. Macro-scale challenges in road infrastructure, vehicle quality, education, and accident investigations were highlighted. The lack of a centralized traffic safety authority and a predominant focus on penalizing drivers overshadowed systemic issues. The study offers valuable insights into the complex interplay of factors contributing to driving errors in LMICs, advocating for a paradigm shift towards holistic, systemic interventions beyond individual driver behavior and challenging the conventional blame-centric view associated with driving errors.

The safety impacts of paved shoulder width in Indian four-lane rural highways.

The shoulder width, as a geometric element, plays a crucial role in enhancing highway safety. Research from high-income countries indicates that improving shoulders on highways leads to substantial safety benefits. However, the safety effectiveness of paved shoulders for low- and middle-income countries (LMICs) highway contexts has limited evidence. This study evaluated the safety effectiveness of the paved shoulder width on 61 km, four-lane, divided rural intercity highways in India. The first objective was to evaluate highway crash patterns using data from 2016 to 2019. The second objective was to evaluate the safety effectiveness of paved shoulder width using the case-control approach. The findings of this study demonstrate a consistent decline in the likelihood of crashes as the shoulder's width increases within the range of zero to 2.5 m for the 100 m segment length and zero to 1.7 m for the 500 m segment length. Nevertheless, model estimates indicate an increased crash risk for shoulders wider than 2.5 m. The results also suggested that the odds ratio for paved shoulder widths ranging from no shoulder to 2.5 m is likely to follow the crash modification factor from the highway safety manual. The findings of this study hold significant implications for the design policy of shoulder width on rural highways in LMICs.

Individual- and community-level predictors of healthcare-seeking behaviour for acute respiratory tract infections among children under five in 29 low-and middle-income countries: a multilevel analysis.

OBJECTIVES: This study aimed to identify the individual- and community-level determinants of mothers' healthcare-seeking behaviour for children under the age of 5 years with acute respiratory infection (ARI) symptoms in low-and middle-income countries (LMICs). STUDY DESIGN: Nationally representative Demographic and Health Survey datasets from 29 LMICs were used. METHODS: The study included 16,893 children aged under 5 years with ARI symptoms in the 2 weeks prior to the survey. A multilevel logistic regression model was used to examine associations between individual- and community-level factors with health-seeking behaviour for ARIs. The adjusted odds ratio (AOR) along with 95% confidence intervals (CIs) were reported as a measure of association. RESULTS: The overall prevalence of healthcare-seeking behaviour for ARIs among children under 5 years in LMICs was 58.83% (95% CI: 58.08, 59.57). Findings showed that mothers with primary or higher education (AOR = 1.20; 95% CI: 1.08, 1.33), and those residing in rich households (AOR = 1.32; 95% CI: 1.18, 1.48), attending antenatal care (ANC) visits (AOR = 1.53; 95% CI: 1.31, 1.79) and delivering at a healthcare facility (AOR = 1.28; 95% CI: 1.16, 1.41) were more likely to seek healthcare for ARIs. A higher level of community maternal education (AOR = 1.44; 95% CI: 1.24, 1.68) was positively associated with seeking healthcare for ARIs, while a higher level of community poverty (AOR = 0.83; 95% CI: 0.72, 0.96) was negatively associated with healthcare seeking for ARIs. CONCLUSIONS: This study revealed that mothers' healthcare-seeking behaviour for ARIs was closely linked to modifiable risk factors, including maternal education, household wealth, use of maternal health services (e.g., ANC), as well as community poverty and literacy levels. Future interventions should consider these modifiable risk factors when developing strategies to improve child health outcomes in LMICs.

Ten-year follow-up of outcomes, patterns of care, and psychosocial burden in adolescent and young adult (AYA) patients with bone sarcomas from a large cohort in a low-income and middle-income country (LMIC).

BACKGROUND: The care of adolescents and young adults (AYAs) with bone sarcomas involves unique challenges. The objectives of this study were to identify challenges and evaluate long-term outcomes of these patients from India who received treatment with novel protocols. METHODS: This prospective cohort study included AYA patients (aged 15-39 years) with osteosarcoma and Ewing sarcoma (ES), who were treated uniformly at the authors' institute using unique protocols (OGS-12 and EFT-2001) from 2011 to 2021 and from 2013 to 2018, respectively. RESULTS: The cohorts included 688 of 748 (91.9%) treatment-naive AYA patients with osteosarcoma and 126 of 142 (88.7%) treatment-naive AYA patients with ES. Among 481 of 561 patients (85.7%) who had nonmetastatic osteosarcoma treated according to protocol, at a median follow-up of 59.7 months, the 5-year event-free survival (5-EFS) rate was 58.6% (95% confidence interval, 54.1%-63.5%) and for 142 patients (20.6%) who had metastatic osteosarcoma, the 5-EFS rate was 18.7%. The 5-EFS rate was 66.4% and 21.9% for 104 patients (73%) with nonmetastatic ES and 38 patients (27%) with metastatic ES, respectively. Treatment-naive patients had better outcomes, similar to compliance in the form of protocol completion (hazard ratio, 1.93 [p = .0043] and 2.66 [p < .0001], respectively. Only 230 of 377 (61.0%) male patients and 10 of 134 (7.4%) female patients reached out to fertility specialists. In addition, 17 of 161 (10.6%) eligible male survivors and 14 of 61 (22.9%) eligible female survivors got married posttreatment. Furthermore, 14 of 17 (82.4%) males and 14 of 14 (100%) females conceived. Among 311 patients who were working or attending school during diagnosis, greater than 90% had interruptions. CONCLUSIONS: Homogenous treatment with the OGS-12 and EFT-2001 protocols resulted in internationally comparable long-term outcomes in the cohorts with nonmetastatic and metastatic AYA bone sarcomas. Treatment compliance, timely referral to sarcoma reference centers (avoiding prior inadvertent treatment), and streamlining fertility-preservation practices constitute unmet needs that demand prioritization.

An unusual case of crusted scabies in an immunocompetent adult: A case report.

Key Clinical Message: Although rare, crusted scabies can affect immunocompetent individuals with no identifiable risk factors. A high index of suspicion, regardless of an individual's immunological status or absence of traditional risk factors, should be maintained by health professionals to facilitate prompt referral to a dermatologist. Abstract: Crusted scabies is an uncommon variant of human scabies characterized by extensive crusted and scaly hyperkeratotic papules, and plaques resulting from profound proliferation of mites in the skin. It is highly contagious and typically occurs in immunocompromised individuals. Reports of cases in healthy adults are rare. It is often resistant to routine treatment. We report a case of a 30-year-old immunocompetent male who presented to us with an extensive pruritic papular rash that started in the inter-digital web spaces of his hands. Within 3 months from onset, the lesions progressed, and became hyperkeratotic, scaly, non-pruritic, spreading to involve his entire body (sparing his face only). Crusty scabies was eventually diagnosed and treated by a dermatologist after months of misdiagnosis at peripheral facilities. Although rare, crusted scabies can affect immunocompetent individuals. A high index of suspicion is required, regardless of immunological status. Among immunocompetent individuals, a thorough search for traditional risk factors is imperative.

Water, sanitation and hygiene (WASH) index for primary healthcare facilities: Towards achieving WASH security.

This study focused on designing a WASH Index for assessing the status of WASH in Primary Healthcare Facilities (PHCs) especially for low- and middle-income countries. To assess the effectiveness of the WASH Index in evaluating the WASH in PHCs, PHCs were selected from 70 Local Government Areas (LGA) across 3 Southwestern States in Nigeria. The WASH index comprises of the five Joint Monitoring Programme service ladders as outlined in the World Health Organization Global Baseline Report for monitoring basic WASH services in health care facilities: water, sanitation, hygiene, waste management and environmental cleaning. The 5 service elements (termed as components) assessed were based on 10 indicators and 30 sub-indicators. The results of the WASH Index of the PHCs were compared statistically on LGA and State basis with emphasis on the status of WASH facilities. The study concludes that the result would further provide baseline information on the status of WASH in PHCs in the selected States in the quest to achieve the Sustainable Development Goals (SDGs). This study recommends that the WASH Index could be adopted an assessment tool for evaluating WASH in PHCs in other to ensure communication of results to policy makers and other relevant stakeholders, for effective monitoring healthcare facilities.

Improving HPV Vaccination Uptake Among Adolescents in Low Resource Settings: Sociocultural and Socioeconomic Barriers and Facilitators.

Background: Lower- and middle-income countries (LMICs) are disproportionately impacted by human papillomavirus (HPV) and would benefit from implementing the HPV vaccine. In the context of competing health priorities, utilizing scarce domestic infrastructure and human resources for HPV vaccination remains challenging for many LMICs. Given the high benefits of the HPV vaccine, the World Health Organization (WHO) is now encouraging for all countries, particularly LMICs, to introduce HPV vaccines into their routine immunization programs. Understanding the barriers and facilitators to HPV adolescent vaccine programs in LMICs may help strengthen how LMICs implement HPV vaccine programs, in turn, increasing HPV vaccine acceptance, uptake, and coverage. Objective: To identify and assess barriers and facilitators to implementing adolescent HPV vaccination programs in LMICs. Methods: This study comprised a review of literature assessing adolescent HPV vaccination in LMICs published after 2020 from a sociocultural perspective. Results: Overall, the findings showed that LMICs should prioritize increasing HPV vaccine availability and HPV vaccine knowledge, particularly focusing on cancer prevention, as knowledge reduces misinformation and increases vaccine acceptance. Evidence suggests that factors promoting HPV vaccine uptake include fostering low vaccine hesitancy, integrating HPV vaccination as a primary school routine vaccination, and vaccinating both genders. A one-dose HPV vaccine may enable many LMICs to increase vaccine acceptance, uptake, and coverage while controlling financial, infrastructure, and human resource costs. Conclusion: As HPV is one of the leading causes of death in many LMICs, implementing the HPV vaccine may be highly beneficial. Cohesive national HPV vaccine buy-in and understanding the success and challenges of prior LMIC HPV vaccine implementation is crucial to developing effective, efficient, and sustainable HPV vaccination programs.

The Economic Burden of Childhood Ocular Morbidity in Bangladesh.

INTRODUCTION: Childhood eye morbidity is a great public health problem, especially in low-income countries. This study aimed to determine the economic burden of childhood ocular morbidity on attending tertiary hospitals in Bangladesh. This study also assessed the catastrophic health expenditure (CHE) for childhood ocular morbidity in Bangladesh. METHODS: A cross-sectional mixed method was used for this study from April to October 2023 at two tertiary hospitals in Bangladesh, one government-funded and one private. Face-to-face interviews using a semi-structured quantitative questionnaire with the caregivers/parents and in-depth interviews (IDIs) were conducted among the same respondents of these two hospitals, and a workshop was conducted with the stakeholders during the study period. RESULTS: This was the first study in Bangladesh to determine the cost of pediatric ocular morbidity. Among 335 patients, the total median direct cost at a single time was 3740 ± 18,285 BDT (34 ± 166.2 USD) at the government hospital and 7300 ± 40,630 BDT (66.36 ± 369.36 USD) at the private hospital. The disease-specific median overall cost from diagnosis of the disease was 65,000 BDT (591 USD) for squint, 50,000 BDT (454.54 USD) for cataract, and 30,000 BDT (272.72 USD) for eye injury. Almost 90% of the caregivers/parents faced CHE due to different pediatric ocular morbidity. CONCLUSIONS: These cost estimates can be used as an initial basis for financial decisions that aim to enhance access to care, management, and follow-up of children with ocular morbidity. These cost estimates also offer helpful information for organizational and financial sustainability initiatives. Policymakers can consider serious immediate interventions for securing ocular health services in Bangladesh and prevent families from CHE.