Screening for SARS-CoV-2: Health Policy Implications in Low- and Middle-Income Countries.
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ABSTRACT:
SUBMITTER: Hashmi SK
PROVIDER: S-EPMC7561345 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Low- and middle-income countries (LMICs) are significantly affected by SARS-CoV-2, partially due to their limited capacity for local production and implementation of molecular testing. Here, we provide detailed methods and validation of a molecular toolkit that can be readily produced and deployed using laboratory equipment available in LMICs. Our results show that lab-scale production of enzymes and nucleic acids can supply over 50,000 tests per production batch. The optimized one-step RT-PCR coupled to CRISPR-Cas12a-mediated detection showed a limit of detection of 102 ge/μL in a turnaround time of 2 h. The clinical validation indicated an overall sensitivity of 80%-88%, while for middle and high viral load samples (Cq ≤ 31) the sensitivity was 92%-100%. The specificity was 96%-100% regardless of viral load. Furthermore, we show that the toolkit can be used with the mobile laboratory Bento Lab, potentially enabling LMICs to implement detection services in unattended remote regions.
| S-EPMC8529268 | biostudies-literature
Project description:Background: Child and adolescent mental health (CAMH) policy is essential for the rational development of mental health systems for children and adolescents. However, there is a universal lack of CAMH policy, especially in low- and middle-income countries (LMICs). Therefore, this review aims to identify challenges and lessons for LMICs to develop and implement CAMH policy. Methods: PubMed (1781-), MEDLINE (1950-), EMBASE (1966-), and PsycINFO (1895-) were searched from inception to December 31, 2018, for publications on CAMH policy development and/or implementation. Abstracts and main texts of articles were double screened, and extracted data were analyzed through thematic synthesis. Results: A total of 31 publications were included through the systematic review. Six major challenges were identified for CAMH policy in LMICs: (i) poor public awareness and low political willingness; (ii) stigma against mental disorders; (iii) biased culture values toward children, adolescents and CAMH, from developmental nihilism to medicalization; (iv) the lack of CAMH data and evidence, from service statistics to program evaluation; (v) the shortage of CAMH resources, including human resources, service facilities, and funding; and (vi) unintended consequence of international support, including reducing local responsibilities, planning fragmentation, and unsustainability. Six lessons to overcome challenges were summarized: (i) rethinking the concept of CAMH, (ii) encouraging a stand-alone CAMH policy and budget, (iii) involving stakeholders, (iv) reinforcing the role of research and researchers in policy process, (v) innovating the usage of human and service resources, and (vi) maximizing the positive influence of international organizations and non-governmental organizations. Conclusion: Many LMICs are still facing various challenges for their CAMH policy development and implementation. To overcome the challenges, great and long-term efforts are needed, which include great determination of from domestic and global agents, multidisciplinary innovations, and collaboration and coordination from different sectors.
| S-EPMC7094177 | biostudies-literature
Project description:The burden of mental illness is excessive, but many countries lack evidence-based policies to improve practice. Mental health research evidence translation into policymaking is a 'wicked problem', often failing despite a robust evidence base. In a recent systematic review, we identified a gap in frameworks on agenda setting and actionability, and pragmatic, effective tools to guide action to link research and policy are needed. Responding to this gap, we developed the new EVITA 1.1 (EVIdence To Agenda setting) conceptual framework for mental health research-policy interrelationships in low- and middle-income countries (LMICs). We (1) drafted a provisional framework (EVITA 1.0); (2) validated it for specific applicability to mental health; (3) conducted expert in-depth interviews to (a) validate components and mechanisms and (b) assess intelligibility, functionality, relevance, applicability and effectiveness. To guide interview validation, we developed a simple evaluation framework. (4) Using deductive framework analysis, we coded and identified themes and finalized the framework (EVITA 1.1). Theoretical agenda-setting elements were added, as targeting the policy agenda-setting stage was found to lead to greater policy traction. The framework was validated through expert in-depth interviews (n?=?13) and revised. EVITA 1.1 consists of six core components [advocacy coalitions, (en)actors, evidence generators, external influences, intermediaries and political context] and four mechanisms (capacity, catalysts, communication/relationship/partnership building and framing). EVITA 1.1 is novel and unique because it very specifically addresses the mental health research-policy process in LMICs and includes policy agenda setting as a novel, effective mechanism. Based on a thorough methodology, and through its specific design and mechanisms, EVITA has the potential to improve the challenging process of research evidence translation into policy and practice in LMICs and to increase the engagement and capacity of mental health researchers, policy agencies/planners, think tanks, NGOs and others within the mental health research-policy interface. Next, EVITA 1.1 will be empirically tested in a case study.
| S-EPMC7195852 | biostudies-literature
Project description: Not available
| S-EPMC8654432 | biostudies-literature
Project description: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.
| S-EPMC9727964 | biostudies-literature
Project description:For 20 years, substantial effort has been devoted to catalyse health policy and systems research (HPSR) to support vulnerable populations and resource-constrained regions through increased funding, institutional capacity-building and knowledge production; yet, participation from low- and middle-income countries (LMICs) is underrepresented in HPSR knowledge production.A bibliometric analysis of HPSR literature was conducted using a high-level keyword search. Health policy and/or health systems literature with a topic relevant to LMICs and whose lead author's affiliation is in an LMIC were included for analysis. The trends in knowledge production from 1990 to 2015 were examined to understand how investment in HPSR benefits those it means to serve.The total number of papers published in PubMed increases each year. HPSR publications represent approximately 10% of these publications, but this percentage is increasing at a greater rate than PubMed publications overall and the discipline is holding this momentum. HPSR publications with topics relevant to LMICs and an LMIC-affiliated lead authors (specifically from low-income countries) are increasing at a greater rate than any other category within the scope of this analysis.While the absolute number of publications remains low, lead authors from an LMIC have participated exponentially in the life and biomedical sciences (PubMed) since the early 2000s. HPSR publications with a topic relevant to LMICs and an LMIC lead author continue to increase at a greater rate than the life and biomedical science topics in general. This correlation is likely due to increased capacity for research within LMICs and the support for publications surrounding large HPSR initiatives. These findings provide strong evidence that continued support is key to the longevity and enhancement of HPSR toward its mandate.
| S-EPMC5534120 | biostudies-literature
Project description:An influential policy idea states that reducing inequality is beneficial for improving health in the low and middle income countries (LMICs). Our study provides an empirical test of this idea: we utilized data collected by the Demographic and Health Surveys between 2000 and 2011 in as much as 52 LMICs, and we examined the relationship between household wealth inequality and two health outcomes: anemia status (of the children and their mothers) and the women' experience of child mortality. Based on multi-level analyses, we found that higher levels of household wealth inequality related to worse health, but this effect was strongly reduced when we took into account the level of individuals' wealth. However, even after accounting for the differences between individuals in terms of household wealth and other characteristics, in those LMICs with higher household wealth inequality more women experienced child mortality and more children were tested with anemia. This effect was partially mediated by the country's level and coverage of the health services and infrastructure. Furthermore, we found higher inequality to be related to a larger health gap between the poor and the rich in only one of the three examined samples. We conclude that an effective way to improve the health in the LMICs is to increase the wealth among the poor, which in turn also would lead to lower overall inequality and potential investments in public health infrastructure and services.
| S-EPMC4263747 | biostudies-literature
Project description:ObjectivesTo identify priority policy issues in access to medicines (ATM) relevant for low- and middle-income countries, to identify research questions that would help address these policy issues, and to prioritize these research questions in a health policy and systems research (HPSR) agenda.MethodsThe study involved i) country- and regional-level priority-setting exercises performed in 17 countries across five regions, with a desk review of relevant grey and published literature combined with mapping and interviews of national and regional stakeholders; ii) interviews with global-level stakeholders; iii) a scoping of published literature; and iv) a consensus building exercise with global stakeholders which resulted in the formulation and ranking of HPSR questions in the field of ATM.ResultsA list of 18 priority policy issues was established following analysis of country-, regional-, and global-level exercises. Eighteen research questions were formulated during the global stakeholders' meeting and ranked according to four ranking criteria (innovation, impact on health and health systems, equity, and lack of research). The top three research questions were: i) In risk protection schemes, which innovations and policies improve equitable access to and appropriate use of medicines, sustainability of the insurance system, and financial impact on the insured? ii) How can stakeholders use the information available in the system, e.g., price, availability, quality, utilization, registration, procurement, in a transparent way towards improving access and use of medicines? and iii) How do policies and other interventions into private markets, such as information, subsidies, price controls, donation, regulatory mechanisms, promotion practices, etc., impact on access to and appropriate use of medicines?ConclusionsOur HPSR agenda adopts a health systems perspective and will guide relevant, innovative research, likely to bear an impact on health, health systems and equity.
| S-EPMC3854087 | biostudies-literature
Project description:BackgroundThe deployment of Community Health Workers (CHWs) is widely promoted as a strategy for reducing health inequities in low- and middle-income countries (LMIC). Yet there is limited evidence on whether and how CHW programmes achieve this. This systematic review aimed to synthesise research findings on the following questions: (1) How effective are CHW interventions at reaching the most disadvantaged groups in LMIC contexts? and (2) What evidence exists on whether and how these programmes reduce health inequities in the populations they serve?MethodsWe searched six academic databases for recent (2014-2020) studies reporting on CHW programme access, utilisation, quality, and effects on health outcomes/behaviours in relation to potential stratifiers of health opportunities and outcomes (e.g., gender, socioeconomic status, place of residence). Quantitative data were extracted, tabulated, and subjected to meta-analysis where appropriate. Qualitative findings were synthesised using thematic analysis.ResultsOne hundred sixty-seven studies met the search criteria, reporting on CHW interventions in 33 LMIC. Quantitative synthesis showed that CHW programmes successfully reach many (although not all) marginalized groups, but that health inequalities often persist in the populations they serve. Qualitative findings suggest that disadvantaged groups experienced barriers to taking up CHW health advice and referrals and point to a range of strategies for improving the reach and impact of CHW programmes in these groups. Ensuring fair working conditions for CHWs and expanding opportunities for advocacy were also revealed as being important for bridging health equity gaps.ConclusionIn order to optimise the equity impacts of CHW programmes, we need to move beyond seeing CHWs as a temporary sticking plaster, and instead build meaningful partnerships between CHWs, communities and policy-makers to confront and address the underlying structures of inequity.Trial registrationPROSPERO registration number CRD42020177333 .
| S-EPMC8996551 | biostudies-literature
Project description:There is growing interest in how different forms of knowledge can strengthen policy-making in low- and middle-income country (LMIC) health systems. Additionally, health policy and systems researchers are increasingly aware of the need to design effective institutions for supporting knowledge utilisation in LMICs. To address these interwoven agendas, this scoping review uses the Arskey and O'Malley framework to review the literature on knowledge utilisation in LMIC health systems, using eight public health and social science databases. Articles that described the process for how knowledge was used in policy-making, specified the type of knowledge used, identified actors involved (individual, organisation or professional), and were set in specific LMICs were included. A total of 53 articles, from 1999 to 2016 and representing 56 countries, were identified. The majority of articles in this review presented knowledge utilisation as utilisation of research findings, and to a lesser extent routine health system data, survey data and technical advice. Most of the articles centered on domestic public sector employees and their interactions with civil society representatives, international stakeholders or academics in utilising epistemic knowledge for policy-making in LMICs. Furthermore, nearly all of the articles identified normative dimensions of institutionalisation. While there is some evidence of how different uses and institutionalisation of knowledge can strengthen health systems, the evidence on how these processes can ultimately improve health outcomes remains unclear. Further research on the ways in which knowledge can be effectively utilised and institutionalised is needed to advance the collective understanding of health systems strengthening and enhance evidence-informed policy formulation.
| S-EPMC6971874 | biostudies-literature