Delivering water, sanitation and hygiene interventions to women and children in conflict settings: a systematic review

BackgroundAccess to safe water and sanitation facilities and the adoption of effective hygiene practices are fundamental to reducing maternal and child morbidity and mortality globally. In armed conflict settings, inadequate water, sanitation and hygiene (WASH) infrastructure poses major health risks for women and children. This review aimed to synthesise the existing information on WASH interventions being delivered to women and children in conflict settings in low-income and middle-income countries (LMICs) and to identify the personnel, sites and platforms being used to deliver such interventions.MethodsWe conducted a systematic search for publications indexed in four databases, and grey literature was searched through the websites of humanitarian agencies and organisations. Eligible publications reported WASH interventions delivered to conflict-affected women or children. We extracted and synthesised information on intervention delivery characteristics, as well as barriers and facilitators.ResultsWe identified 58 eligible publications reporting on the delivery of WASH interventions, mostly in Sub-Saharan Africa. Non-Governmental Organization (NGO)/United Nations (UN) agency staff were reported to be involved in delivering interventions in 62% of publications, with the most commonly reported delivery site being community spaces (50%). Only one publication reported quantitative data on intervention effectiveness among women or children.DiscussionThis review revealed gaps in the current evidence on WASH intervention delivery in conflict settings. Little information is available on the delivery of water treatment or environmental hygiene interventions, or about the sites and personnel used to deliver WASH interventions. Limited quantitative data on WASH intervention coverage or effectiveness with respect to women or children are important gaps, as multiple factors can affect how WASH services are accessed differently by women and men, and the hygiene needs of adolescent girls and boys differ; these factors must be taken into account when delivering interventions in conflict settings.PROSPERO registration numberCRD42019125221

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Delivering mental health and psychosocial support interventions to women and children in conflict settings: a systematic review

BMJ Global Health ◽

10.1136/bmjgh-2019-002014 ◽

2020 ◽

Vol 5 (3) ◽

pp. e002014

Author(s):

Mahdis Kamali ◽

Mariella Munyuzangabo ◽

Fahad J Siddiqui ◽

Michelle F Gaffey ◽

Sarah Meteke ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Low Income ◽

Psychosocial Support ◽

Grey Literature ◽

Sub Saharan Africa ◽

Observational Research ◽

Intervention Coverage ◽

Conflict Settings ◽

Women And Children

BackgroundOver 240 million children live in countries affected by conflict or fragility, and such settings are known to be linked to increased psychological distress and risk of mental disorders. While guidelines are in place, high-quality evidence to inform mental health and psychosocial support (MHPSS) interventions in conflict settings is lacking. This systematic review aimed to synthesise existing information on the delivery, coverage and effectiveness of MHPSS for conflict-affected women and children in low-income and middle-income countries (LMICs).MethodsWe searched Medline, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Psychological Information Database (PsycINFO)databases for indexed literature published from January 1990 to March 2018. Grey literature was searched on the websites of 10 major humanitarian organisations. Eligible publications reported on an MHPSS intervention delivered to conflict-affected women or children in LMICs. We extracted and synthesised information on intervention delivery characteristics, including delivery site and personnel involved, as well as delivery barriers and facilitators, and we tabulated reported intervention coverage and effectiveness data.ResultsThe search yielded 37 854 unique records, of which 157 were included in the review. Most publications were situated in Sub-Saharan Africa (n=65) and Middle East and North Africa (n=36), and many reported on observational research studies (n=57) or were non-research reports (n=53). Almost half described MHPSS interventions targeted at children and adolescents (n=68). Psychosocial support was the most frequently reported intervention delivered, followed by training interventions and screening for referral or treatment. Only 19 publications reported on MHPSS intervention coverage or effectiveness.DiscussionDespite the growing literature, more efforts are needed to further establish and better document MHPSS intervention research and practice in conflict settings. Multisectoral collaboration and better use of existing social support networks are encouraged to increase reach and sustainability of MHPSS interventions.PROSPERO registration numberCRD42019125221.

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Delivering nutrition interventions to women and children in conflict settings: a systematic review

BMJ Global Health ◽

10.1136/bmjgh-2020-004897 ◽

2021 ◽

Vol 6 (4) ◽

pp. e004897

Author(s):

Shailja Shah ◽

Zahra Ali Padhani ◽

Daina Als ◽

Mariella Munyuzangabo ◽

Michelle F Gaffey ◽

...

Keyword(s):

Meta Analysis ◽

Grey Literature ◽

Food Distribution ◽

Sub Saharan Africa ◽

Nutrition Interventions ◽

African Region ◽

Middle Income ◽

Conflict Settings ◽

Low Middle Income Countries ◽

Women And Children

BackgroundLow/middle-income countries (LMICs) face triple burden of malnutrition associated with infectious diseases, and non-communicable diseases. This review aims to synthesise the available data on the delivery, coverage, and effectiveness of the nutrition programmes for conflict affected women and children living in LMICs.MethodsWe searched MEDLINE, Embase, CINAHL, and PsycINFO databases and grey literature using terms related to conflict, population, and nutrition. We searched studies on women and children receiving nutrition-specific interventions during or within five years of a conflict in LMICs. We extracted information on population, intervention, and delivery characteristics, as well as delivery barriers and facilitators. Data on intervention coverage and effectiveness were tabulated, but no meta-analysis was conducted.ResultsNinety-one pubblications met our inclusion criteria. Nearly half of the publications (n=43) included population of sub-Saharan Africa (n=31) followed by Middle East and North African region. Most publications (n=58) reported on interventions targeting children under 5 years of age, and pregnant and lactating women (n=27). General food distribution (n=34), micronutrient supplementation (n=27) and nutrition assessment (n=26) were the most frequently reported interventions, with most reporting on intervention delivery to refugee populations in camp settings (n=63) and using community-based approaches. Only eight studies reported on coverage and effectiveness of intervention. Key delivery facilitators included community advocacy and social mobilisation, effective monitoring and the integration of nutrition, and other sectoral interventions and services, and barriers included insufficient resources, nutritional commodity shortages, security concerns, poor reporting, limited cooperation, and difficulty accessing and following-up of beneficiaries.DiscussionDespite the focus on nutrition in conflict settings, our review highlights important information gaps. Moreover, there is very little information on coverage or effectiveness of nutrition interventions; more rigorous evaluation of effectiveness and delivery approaches is needed, including outside of camps and for preventive as well as curative nutrition interventions.PROSPERO registration numberCRD42019125221.

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Delivering infectious disease interventions to women and children in conflict settings: a systematic review

BMJ Global Health ◽

10.1136/bmjgh-2019-001967 ◽

2020 ◽

Vol 5 (Suppl 1) ◽

pp. e001967

Author(s):

Sarah Meteke ◽

Marianne Stefopulos ◽

Daina Als ◽

Michelle F Gaffey ◽

Mahdis Kamali ◽

...

Keyword(s):

Infectious Disease ◽

Systematic Review ◽

Low Income ◽

Large Scale ◽

Malaria Treatment ◽

Sub Saharan Africa ◽

Intervention Coverage ◽

Middle Income ◽

Intervention Delivery ◽

Increased Risk

BackgroundConflict has played a role in the large-scale deterioration of health systems in low-income and middle-income countries (LMICs) and increased risk of infections and outbreaks. This systematic review aimed to synthesise the literature on mechanisms of delivery for a range of infectious disease-related interventions provided to conflict-affected women, children and adolescents.MethodsWe searched Medline, Embase, CINAHL and PsychINFO databases for literature published in English from January 1990 to March 2018. Eligible publications reported on conflict-affected neonates, children, adolescents or women in LMICs who received an infectious disease intervention. We extracted and synthesised information on delivery characteristics, including delivery site and personnel involved, as well as barriers and facilitators, and we tabulated reported intervention coverage and effectiveness data.ResultsA majority of the 194 eligible publications reported on intervention delivery in sub-Saharan Africa. Vaccines for measles and polio were the most commonly reported interventions, followed by malaria treatment. Over two-thirds of reported interventions were delivered in camp settings for displaced families. The use of clinics as a delivery site was reported across all intervention types, but outreach and community-based delivery were also reported for many interventions. Key barriers to service delivery included restricted access to target populations; conversely, adopting social mobilisation strategies and collaborating with community figures were reported as facilitating intervention delivery. Few publications reported on intervention coverage, mostly reporting variable coverage for vaccines, and fewer reported on intervention effectiveness, mostly for malaria treatment regimens.ConclusionsDespite an increased focus on health outcomes in humanitarian crises, our review highlights important gaps in the literature on intervention delivery among specific subpopulations and geographies. This indicates a need for more rigorous research and reporting on effective strategies for delivering infectious disease interventions in different conflict contexts.PROSPERO registration numberCRD42019125221.

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Delivering non-communicable disease interventions to women and children in conflict settings: a systematic review

BMJ Global Health ◽

10.1136/bmjgh-2019-002047 ◽

2020 ◽

Vol 5 (Suppl 1) ◽

pp. e002047

Author(s):

Shailja Shah ◽

Mariella Munyuzangabo ◽

Michelle F Gaffey ◽

Mahdis Kamali ◽

Reena P Jain ◽

...

Keyword(s):

Technology Use ◽

Communicable Disease ◽

Grey Literature ◽

Multidisciplinary Care ◽

Observational Research ◽

Innovative Technology ◽

Intervention Delivery ◽

Effective Strategies ◽

Conflict Settings ◽

Women And Children

BackgroundNon-communicable diseases (NCDs) are the leading cause of death worldwide. In the context of conflict settings, population displacement, disrupted treatment, infrastructure damage and other factors impose serious NCD intervention delivery challenges, but relatively little attention has been paid to addressing these challenges. Here we synthesise the available indexed and grey literature reporting on the delivery of NCD interventions to conflict-affected women and children in low- and middle-income countries (LMICs).MethodsA systematic search in MEDLINE, Embase, CINAHL and PsycINFO databases for indexed articles published between 1 January 1990 and 31 March 2018 was conducted, and publications reporting on NCD intervention delivery to conflict-affected women or children in LMICs were included. A grey literature search of 10 major humanitarian organisation websites for publications dated between 1 January 2013 and 30 November 2018 was also conducted. We extracted and synthesised information on intervention delivery characteristics and delivery barriers and facilitators.ResultsOf 27 included publications, most reported on observational research studies, half reported on studies in the Middle East and North Africa region and 80% reported on interventions targeted to refugees. Screening and medication for cardiovascular disease and diabetes were the most commonly reported interventions, with most publications reporting facility-based delivery and very few reporting outreach or community approaches. Doctors were the most frequently reported delivery personnel. No publications reported on intervention coverage or on the effectiveness of interventions among women or children. Limited population access and logistical constraints were key delivery barriers reported, while innovative technology use, training of workforce and multidisciplinary care were reported to have facilitated NCD intervention delivery.ConclusionLarge and persistent gaps in information and evidence make it difficult to recommend effective strategies for improving the reach of quality NCD care among conflict-affected women and children. More rigorous research and reporting on effective strategies for delivering NCD care in conflict contexts is urgently needed.PROSPERO registration numberCRD42019125221

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Improving outcomes for neonates with gastroschisis in low-income and middle-income countries: a systematic review protocol

BMJ Paediatrics Open ◽

10.1136/bmjpo-2018-000392 ◽

2018 ◽

Vol 2 (1) ◽

pp. e000392 ◽

Cited By ~ 5

Author(s):

Naomi J Wright ◽

Monica Langer ◽

Irena CF Norman ◽

Melika Akhbari ◽

Q Eileen Wafford ◽

...

Keyword(s):

Systematic Review ◽

Low Income ◽

Grey Literature ◽

Surgical Care ◽

Length Of Hospital Stay ◽

Review Literature ◽

Sub Saharan Africa ◽

Cochrane Library ◽

Middle Income ◽

Middle Income Countries

IntroductionThere is a significant disparity in outcomes for neonates with gastroschisis in high-income countries (HICs) compared with low-income and middle-income countries (LMICs). Many LMICs report mortality rates between 75% and 100% compared with <4% in HICs.AimTo undertake a systematic review identifying postnatal interventions associated with improved outcomes for gastroschisis in LMICs.Methods and analysisThree search strings will be combined: (1) neonates; (2) gastroschisis and other gastrointestinal congenital anomalies requiring similar surgical care; (3) LMICs. Databases to be searched include MEDLINE, EMBASE, Scopus, Web of Science, ProQuest Dissertations and Thesis Global, and the Cochrane Library. Grey literature will be identified through Open-Grey, ClinicalTrials.gov, WHO International Clinical Trials Registry and ISRCTN registry (Springer Nature). Additional studies will be sought from reference lists of included studies. Study screening, selection, data extraction and assessment of methodological quality will be undertaken by two reviewers independently and team consensus sought on discrepancies. The primary outcome of interest is mortality. Secondary outcomes include complications, requirement for ventilation, parenteral nutrition duration and length of hospital stay. Tertiary outcomes include service delivery and implementation outcomes. The methodology of the studies will be appraised. Descriptive statistics and outcomes will be summarised and discussed.Ethics and disseminationEthical approval is not required since no new data are being collected. Dissemination will be via open access publication in a peer-reviewed medical journal and distribution among global health, global surgery and children’s surgical collaborations and international conferences.ConclusionThis study will systematically review literature focused on postnatal interventions to improve outcomes from gastroschisis in LMICs. Findings can be used to help inform quality improvement projects in low-resource settings for patients with gastroschisis. In the first instance, results will be used to inform a Wellcome Trust-funded multicentre clinical interventional study aimed at improving outcomes for gastroschisis across sub-Saharan Africa.PROSPERO registration numberCRD42018095349.

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Gestational weight gain in low-income and middle-income countries: a modelling analysis using nationally representative data

BMJ Global Health ◽

10.1136/bmjgh-2020-003423 ◽

2020 ◽

Vol 5 (11) ◽

pp. e003423

Author(s):

Dongqing Wang ◽

Molin Wang ◽

Anne Marie Darling ◽

Nandita Perumal ◽

Enju Liu ◽

...

Keyword(s):

Weight Gain ◽

North Africa ◽

Low Income ◽

Sub Saharan Africa ◽

Middle Income ◽

Middle Income Countries ◽

Gestational Weight ◽

Latin America And Caribbean ◽

Nationally Representative ◽

Sub Saharan

IntroductionGestational weight gain (GWG) has important implications for maternal and child health and is an ideal modifiable factor for preconceptional and antenatal care. However, the average levels of GWG across all low-income and middle-income countries of the world have not been characterised using nationally representative data.MethodsGWG estimates across time were computed using data from the Demographic and Health Surveys Program. A hierarchical model was developed to estimate the mean total GWG in the year 2015 for all countries to facilitate cross-country comparison. Year and country-level covariates were used as predictors, and variable selection was guided by the model fit. The final model included year (restricted cubic splines), geographical super-region (as defined by the Global Burden of Disease Study), mean adult female body mass index, gross domestic product per capita and total fertility rate. Uncertainty ranges (URs) were generated using non-parametric bootstrapping and a multiple imputation approach. Estimates were also computed for each super-region and region.ResultsLatin America and Caribbean (11.80 kg (95% UR: 6.18, 17.41)) and Central Europe, Eastern Europe and Central Asia (11.19 kg (95% UR: 6.16, 16.21)) were the super-regions with the highest GWG estimates in 2015. Sub-Saharan Africa (6.64 kg (95% UR: 3.39, 9.88)) and North Africa and Middle East (6.80 kg (95% UR: 3.17, 10.43)) were the super-regions with the lowest estimates in 2015. With the exception of Latin America and Caribbean, all super-regions were below the minimum GWG recommendation for normal-weight women, with Sub-Saharan Africa and North Africa and Middle East estimated to meet less than 60% of the minimum recommendation.ConclusionThe levels of GWG are inadequate in most low-income and middle-income countries and regions. Longitudinal monitoring systems and population-based interventions are crucial to combat inadequate GWG in low-income and middle-income countries.

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Impact of COVID-19 on FDIs, Remittances and Foreign Aids: A Case Study of Nepal

Millennial Asia ◽

10.1177/0976399620974202 ◽

2021 ◽

pp. 097639962097420

Author(s):

Gaurav Bhattarai ◽

Binita Subedi

Keyword(s):

United Nations ◽

Low Income ◽

Global Economy ◽

Grey Literature ◽

Foreign Assistance ◽

Foreign Direct Investments ◽

Middle Income ◽

Low Income Country ◽

The Government ◽

The Impact

The global economy has been severely paralysed, owing to the unprecedented crisis triggered by the COVID-19 pandemic, and different studies have indicated that the crisis is relatively more maleficent to the lower-income and middle-income economies. Methodologically, this study relied on the review and analysis of the grey literature, media reporting and data published by the Asian Development Bank, United Nations Conference on Trade and Development (UNCTAD), United Nations (UN), World Bank, International Monetary Fund (IMF) among others. The article begins by describing the impact of the pandemic on low-income and middle-income countries, and it discusses how they have responded to the crisis. While discussions have surfaced regarding whether COVID-19 will reverse the process of globalization, what will be its impact on the low-income country like Nepal? The study also highlights that with foreign direct investments speculated to shrink and foreign assistance and remittance taking a hit, how is Nepal struggling to keep its economy afloat? Analysing the new budget that the government unveiled in 2020, this study concludes with a note that instead of effectively implementing the plans and policies directed by the budget, Nepal is unnecessarily engaged in political mess and is needlessly being dragged into the geopolitical complications.

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P1586Research network in Africa (RNA): antihypertensive drugs strategies in 12 African countries

European Heart Journal ◽

10.1093/eurheartj/ehz748.0346 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Kane ◽

P Cavagna ◽

I B Diop ◽

B Gaye ◽

J B Mipinda ◽

...

Keyword(s):

Blood Pressure ◽

Low Income ◽

Democratic Republic ◽

Antihypertensive Drugs ◽

Sub Saharan Africa ◽

Low Income Countries ◽

African Countries ◽

Middle Income ◽

Middle Income Countries ◽

Sub Saharan

Abstract Background High Blood Pressure is the worldwide leading global burden of disease risk factor. In Sub-Saharan Africa, the number of adults with raised blood pressure has alarmingly increased from 0.59 to 1.13 billion between 1975 and 2015. Blood pressure-lowering medicines are cornerstone of cardiovascular risk reduction. Data on management of anti-hypertensive drugs in sub-Saharan Africa are squarce. Purpose Our study aims to describe antihypertensive drugs strategies in Africa. Methods We conducted a cross-sectional survey in urban clinics during outpatient consultation specialized in hypertension cardiology departments of 29 medical centers from 17 cities across 12 African countries (Benin, Cameroon, Congo, Democratic Republic of Congo, Gabon, Guinea, Ivory Coast, Mauritania, Mozambic, Niger, Senegal, Togo). Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. Country income was retrieved from the World Bank database. All analyses were performed through scripts developed in the R software (3.4.1 (2017–06–30)). Results A total of 2198 hypertensive patients (58.4±11.8 years; 39.9% male) were included. Among whom 2123 (96.6%) had at least one antihypertensive drug. Overall, 30.8% (n=653) received monotherapy and calcium-channel blockers (49.6%) were the most common monotherapy prescribed follow by diuretics (18.7%). Two-drug strategies were prescribed for 927 patients (43.6%). Diuretics and Angiotensin-converting enzyme inhibitors was the combination most frequently prescribed (33.7%). Combination of three drugs or more was used in 25.6% (n=543) of patients. The proportion of drugs strategies differed significantly according to countries (p<0.001), monotherapy ranged from 12.7% in Niger to 47.1% in Democratic Republic of the Congo (figure). Furthermore we observed a significantly difference of strategies between low and middle income countries (55.3% and 44.7% of monotherapy respectively) (p<0.001). According to hypertension grades 1, 2 and 3, the proportion of three-drugs or more combination was 25%, 28% and 34% in middle-income and lower in low-income countries (18%, 19% and 25%). Furthermore, Grade 3 hypertension in low income countries was still treated with monotherapy (36%) instead of 19% in middle income countries (p<0.01). Antihypertensive strategies by country Conclusion Our study described antihypertensive drugs use across 12 sub-Saharan countries, and identified disparities specific to the income context. Inequity in access to drugs combination is a serious barrier to tackle the burden of hypertension in Africa.

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Strategies used to establish palliative care in rural low- and middle-income countries: an integrative review

Health Policy and Planning ◽

10.1093/heapol/czaa051 ◽

2020 ◽

Vol 35 (8) ◽

pp. 1110-1129

Author(s):

Atsede Aregay ◽

Margaret O’Connor ◽

Jill Stow ◽

Nicola Ayers ◽

Susan Lee

Keyword(s):

Palliative Care ◽

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Care Home ◽

Sub Saharan Africa ◽

Integrative Review ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

Abstract Globally, 40 million people need palliative care; about 69% are people over 60 years of age. The highest proportion (78%) of adults are from low- and middle-income countries (LMICs), where palliative care still developing and is primarily limited to urban areas. This integrative review describes strategies used by LMICs to establish palliative care in rural areas. A rigorous integrative review methodology was utilized using four electronic databases (Ovid MEDLINE, Ovid Emcare, Embase classic+Embase and CINAHL). The search terms were: ‘palliative care’, ‘hospice care’, ‘end of life care’, ‘home-based care’, ‘volunteer’, ‘rural’, ‘regional’, ‘remote’ and ‘developing countries’ identified by the United Nations (UN) as ‘Africa’, ‘Sub-Saharan Africa’, ‘low-income’ and ‘middle- income countries’. Thirty papers published in English from 1990 to 2019 were included. Papers were appraised for quality and extracted data subjected to analysis using a public health model (policy, drug availability, education and implementation) as a framework to describe strategies for establishing palliative care in rural areas. The methodological quality of the reviewed papers was low, with 7 of the 30 being simple programme descriptions. Despite the inclusion of palliative care in national health policy in some countries, implementation in the community was often reliant on advocacy and financial support from non-government organizations. Networking to coordinate care and medication availability near-patient homes were essential features of implementation. Training, role play, education and mentorship were strategies used to support health providers and volunteers. Home- and community-based palliative care services for rural LMICs communities may best be delivered using a networked service among health professionals, community volunteers, religious leaders and technology.

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