The state of decentralization of the healthcare system and nutrition programs in the Lao People's Democratic Republic: an organizational study.

BACKGROUND: The Lao People's Democratic Republic (Lao PDR), a lower-middle income country, has a higher malnutrition rate than other Southeast Asian countries. The decentralization of healthcare is a determinant of the effectiveness of programs to reduce malnutrition, but no study has focused on this factor in this country. This organizational study explores the state of decentralization of the healthcare system in Lao PDR that underlies the nutrition programs in the country. METHODS: A qualitative study, which is based on a neo-institutional theory conceptual framework, explored factors related to dominant structure (laws, regulations, resources) and interpretative schemes (dominant ideas and beliefs) that characterize the nutrition services provided in the Lao healthcare system. Twenty-four semistructured interviews were performed with representatives of healthcare institutions involved in nutrition programs at different government levels, external donors and civil society organizations. The interviews were completed with relevant documents. The analysis focused on the convergence of interpretative schemes of the organizations concerned and the coherence between the structure underpinning the nutrition programs and the interpretative schemes. RESULTS: Services deployed to reduce malnutrition in the Lao PDR remain largely centralized, despite factors specific to the country that led it to promote decentralization of its services. The convergence of interpretive schemes and the coherence between the observed structure and the interpretative schemes of actors at all governance levels ensure the stability of this state of decentralization, which has persisted for almost 50 years. CONCLUSION: Nutrition programs in the Laos PDR are largely under the responsibility of the central government. The transformations in the healthcare system, notably with the use of new information technologies and the fact that the provinces are populated by a growing number of professionals trained in nutrition in addition to factors that push the system to be decentralized, such as ethnic diversity, the increasing availability of human resources in provinces, and the use of communication technologies, are not strong enough to change the balance of power between governance levels. The deconcentration that characterizes decentralization is therefore likely to continue for the foreseeable future.

Street-working children in Latin America: a critical perspective.

This article critically explores the complex realities faced by street-working children (SWC) in Latin America, highlighting historical and structural inequalities-such as coloniality, heteropatriarchy, and neoliberal capitalism-that perpetuate their marginalisation. Hegemonic public policies tend to focus narrowly on control, normalisation, and short-term relief, often neglecting the deeper systemic issues that sustain these vulnerabilities. This study calls for a shift towards alternative frameworks of public policy analysis that permit addressing the socio-political and cultural specificities of Latin America from a decolonial perspective. By incorporating affective, semiotic, and material dimensions, the Affective Interstice Theory provides analytical tools to understand how policy discourses not only shape the emotional and material experiences of those involved but also reinforce existing power structures. These insights reveal critical opportunities for resistance and transformative change, urging the development of policies that do more than address immediate needs-policies that actively dismantle the structural dynamics underpinning the marginalisation of SWC. The article underscores the need for contextualised approaches that engage with the complexity of local realities, offering a path towards more equitable and just policy outcomes across the region.

Obstetric care provider's knowledge about the use of low dose aspirin for preeclampsia prevention in low and middle income countries: a systematic review and meta-analysis.

INTRODUCTION: Preeclampsia can elevate the likelihood of unfavorable consequences for a mother, such as severe morbidity and mortality. World Health Organization recommends low dose acetylsalicylic acid (aspirin, 75 mg per day) for the prevention of preeclampsia in women at moderate or high risk of developing the condition. The use of low dose aspirin is dependent on the knowledge of health care providers working in the antenatal care units. We found inconsistent figures regarding the knowledge level of health care providers on low dose aspirin for preeclampsia prevention around different low and middle income countries in the world. Thus, determining the pooled knowledge level of health care providers is very important. METHODS: This systematic review and meta-analysis (SRMA) was conducted on the knowledge level of among obstetric care providers towards preeclampsia prevention in low and middle income countries. We identified relevant literature in the English language only. A comprehensive search was conducted on databases such as PubMed, Google Scholar, HINARI, and Scopus. Subsequently, all datasets were exported to Mendeley reference manager and transferred to a Microsoft Excel spreadsheet to eliminate duplicate data during the review process. The extracted Microsoft Excel spreadsheet format data was imported to STATA software version 17 (STATA corporation, Texas, USA) for analysis. Then random effect model was used to estimate the pooled level of knowledge of health care providers on low dose aspirin for preeclampsia prevention in low income countries. Cochrane Q-test and I2 statistics were computed to assess heterogeneity among all the studies included in this SRMA. RESULT: A total of 1231 articles were identified through our search strategies, including Google Scholar, PubMed, Hinari and Scopus. Ultimately, six articles met the eligibility criteria for inclusion in the final SRMA. The pooled knowledge level of healthcare providers regarding the use of low-dose aspirin for preeclampsia prevention in low-income countries was found to be 16.38% (95% CI: 4.36-28.40). The Cochrane heterogeneity index, with a substantial I2 value of 98.89% and a significant P-value of 0.01, indicated significant heterogeneity among the primary studies included. CONCLUSION: the knowledge level of obstetric care providers in low and middle income countries is found very low and all the governmental and non-governmental organizations should strive to enhance the knowledge of obstetric care providers on the use of low dose aspirin for preeclampsia prevention in low and middle income countries.

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."

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.

Feasibility of increasing calcium content of drinking tap water following quality regulations to improve calcium intake at population level.

Background: Calcium intake is below recommendations in several parts of the world. Improving calcium intake has benefits not only for bone health but also helps to prevent pregnancy hypertension disorders. Calcium concentration of tap water is usually low The aim of the present study was to determine the maximum amount of calcium that can be added to tap water while complying with drinking water Argentine regulations. Methods: Tap water samples were collected from the Province of Buenos Aires (Argentina). Physicochemical properties and saturation index were measured. Different incremental concentrations of calcium chloride were added to the experimental aliquots. Results: Baseline water had a mean calcium concentration of 22.00 ± 2.54 mg/L, water hardness of 89.9 ± 6.4 mg/L CaCO 3, and a saturation index of -1.50 ± 0.11. After the addition of 0.4554 ± 0.0071 g of salt, water hard-ness reached 355.0 ± 7.1 mg/L CaCO 3, a calcium concentration of 140.50 ± 2.12 mg/L, and a saturation index -0.53 ± 0.02. Conclusions: This study shows that at laboratory level it is feasible to increase calcium concentration of drinking water by adding calcium chloride while complying with national standards. Calcium concentration of drinking tap water could be evaluated and minimum calcium concentration of tap water regulated so as to improve calcium intake in populations with low calcium intake.

The association between neighborhood socioeconomic deprivation and mental health in low- and middle-income countries: A scoping review.

BACKGROUND: Environmental research on mental health primarily originates from high-income countries, while information about the rest of the world remains limited. AIMS: This study examined: (1) the available published research evidence regarding the association between neighborhood-level deprivation and indicators of mental health and illness in low- and middle-income countries (LMICs), and (2) the gaps in the relevant research in LMIC settings that should be addressed in future studies. METHOD: First, we systematically searched for relevant primary studies in electronic databases (Ovid Medline, Scopus, Socindex, and PsycINFO) and citations in the reference lists. Then, a two-stage screening procedure was employed to select the relevant studies by screening the titles and abstracts and reviewing the selected full texts by independent researchers. After charting the data from the selected study reports, we collated, summarized, and discussed the results. RESULTS: We retrieved 51 studies across 19 LMICs, with only one study originating from a low-income country. Most studies focused on adult mental health topics and few explored children's mental health. Notably, a significant majority of these studies (N = 37) reported a positive association between neighborhood deprivation and mental health/disorder. However, the research methods used varied significantly, and there were several methodological limitations. CONCLUSIONS: This review highlights the need for more original studies in LMICs on the association between neighborhood deprivation and mental health, employing stronger methodologies.

Quality and Accountability of ChatGPT in Health Care in Low- and Middle-Income Countries: Simulated Patient Study.

Using simulated patients to mimic 9 established noncommunicable and infectious diseases, we assessed ChatGPT's performance in treatment recommendations for common diseases in low- and middle-income countries. ChatGPT had a high level of accuracy in both correct diagnoses (20/27, 74%) and medication prescriptions (22/27, 82%) but a concerning level of unnecessary or harmful medications (23/27, 85%) even with correct diagnoses. ChatGPT performed better in managing noncommunicable diseases than infectious ones. These results highlight the need for cautious AI integration in health care systems to ensure quality and safety.

Factors Influencing the Use of Tobacco Among Youth in Low-Income, Lower-Middle-Income, and Upper-Middle-Income Countries: A Systematic Review.

BACKGROUND: The use of tobacco is a significant global public health issue. According to the World Health Organization, tobacco use is a considerable risk factor for many diseases and causes more than 8 million deaths per year, with a disproportionate impact on low- and middle-income countries. Therefore, this systematic review was conducted to identify the factors influencing tobacco use among youth in low-income, lower-middle-income, and upper-middle-income countries. Study Design: A system review. METHODS: The review followed the PRISMA guidelines, and the protocol was registered on PROSPERO (CRD42023430552). Several data sources were utilized, including PubMed, Scopus, ScienceDirect, MEDLINE, CINAHL, and ProQuest, and cross-sectional data from participants aged 15‒24 underwent investigation. Original full-text articles have been published between 2015 and 2023. Out of the 2892 studies, 20 were included in this review after two reviewers confirmed the eligibility criteria. RESULTS: The average age of the participants was (mean±standard deviation: 19.45±1.686). Most studies were conducted in lower-middle and upper-middle-income countries. Frequently reported influences were at the individual and social levels, including demographic, economic, and psychological parameters, attitude and knowledge, individual behavioral factors, parental education, family member tobacco use, stressful life events, and social networks. At the environmental level, factors included secondhand smoke exposure, community context, media channels, and access to tobacco. CONCLUSION: The findings demonstrated a significant association between youth tobacco use and individual-, social-, and environmental-level factors. Consequently, specific interventions targeting these factors should be deployed to mitigate youth tobacco use in various socioeconomic settings.

Association between sociodemographic variables and delayed patient presentation among surgical neuro-oncology patients in Mexico City: a single institution experience.

PURPOSE: Mexico has the second highest incidence of central and peripheral nervous system cancer cases in Latin America, but clinical and research resources to improve oncologic care are biased towards high-income countries. We carried out a retrospective study to identify sociodemographic factors associated with more severe clinical presentation among surgical neuro-oncology who underwent surgery at a major public referral hospital in Mexico City. METHODS: The hospital electronic medical record was reviewed to identify all surgical neuro-oncology patients who underwent surgery between January 1 and December 31, 2022. Descriptive statistics were used to characterize the patient population and outcomes; statistical analysis was performed to determine association between sociodemographic variables and advanced clinical presentation. RESULTS: A total of 366 neuro-oncology patients underwent surgery during the study period. The median patient age was 48 (IQR 17-83). The majority of patients were female (60.1, n = 220), single (51.4%, n = 188), and 29.2% (n = 107) endorsed being the primary provider for their family. The median number of dependents per patient was 4 (IQR 2-50), while the median monthly income was 10269 Mexican pesos (MXN) (IQR 2000-13500] and the median travel distance to INNN was 49 km (IQR 22-174). On multivariate analyses, having a higher number of dependents was associated with increased odds of presenting with longer symptom duration (p = 0.01). Divorced/separated status was associated with increased odds of presenting with tumors > 35mL in volume (p = 0.04). Primary provider (p = 0.01) and higher average monthly income (p = 0.03) was associated with decreased odds of presenting with tumors > 35mL. CONCLUSIONS: This is the first study to recognize that certain sociodemographic factors are associated with more severe clinical presentation among surgical neuro-oncology patients. Further studies are needed in order to decern specific causes for delayed presentation in this patient population in order to create targeted interventions and decrease delays in care.

The clinicopathological landscape of thyroid cancer in South Africa-A multi-institutional review.

BACKGROUND: In South Africa (SA), data on the incidence of thyroid cancer is limited. Papillary thyroid carcinoma is by far the most common malignancy in developed countries; however, a preponderance of follicular thyroid cancer in developing countries, despite iodized salt, has been observed. The aim of this study was to describe the national landscape of thyroid cancer in SA with reference to pathological subtypes, surgical outcomes, and treatments offered. METHODS: A multi-institutional retrospective review of thyroid cancer patients operated on between January 2015 and December 2019 was performed. Public hospitals with associated academic institutions were included. Data were collected from theater registers, pathology, and radiology records. Statistical analysis was done to determine intergroup significance. RESULTS: A total of 464 thyroid cancer cases from 13 centers across five SA provinces were identified. Most patients presented with a mass (67%). Ultrasound was performed in 82% of patients, and 16.3% underwent surgery without pre-operative cytology. Of the histologically confirmed thyroid cancers, 61.8% were papillary and 22.1% follicular thyroid cancer. There was a significant association between subtype and geographical area, and T-stage and operation performed. Surgical complication rates included hematoma in 1.8%, post-operative hypocalcemia in 28.7%, and recurrent laryngeal nerve injury in 3.5%. CONCLUSION: This first national review describes the landscape of thyroid cancer in SA, revealing considerable differences compared to international studies. It provides valuable insight into the unique South African experience with this disease. In addition, this study serves as an impetus towards a prospective national registry with real-world data informing contextualized guidelines.

Motor development trajectories of children with cerebral palsy in a community-based early intervention program in rural South India.

BACKGROUND: Developmental trajectories are crucial for evidence-based prognostication, planning interventions, and monitoring progress in children with cerebral palsy (CP). AIMS: To describe gross motor development patterns of children with CP in rural South India for the five Gross Motor Function Classification System (GMFCS) levels. METHODS: Longitudinal cohort study of 302 children (176 males, 126 females) with CP aged 0 to 10 years, followed by a community-based early intervention program. GMFCS levels were 5.4 % level 1, 16.5 % level II, 22.8 % level III, 26.8 % level IV, and 28.5 % level V. Assessments were undertaken using the Gross Motor Function Measure (GMFM-66) at 6-month intervals between April 2017 and August 2020. Longitudinal analyses were performed using mixed-effects linear regression models. OUTCOMES AND RESULTS: Five distinct motor development curves were created for ages 0 to 10 years by GMFCS levels as a function of age and GMFM-66 with a stable limit model, variation in estimated limits and rates of development. CONCLUSIONS AND IMPLICATIONS: Motor development trajectories for CP in an LMIC differ from those reported in HICs. Consideration of how social determinants of health, environmental and personal factors impact motor development in low-resource contexts is crucial. Further work is needed to describe developmental trajectories of children for CP in LMICs.

Interventions to support the mental health of family carers of children with brain injury in low and middle income countries: a scoping review.

Aim: To review the international evidence base on interventions to support the mental health of family carers of children with brain injuries in low and middle income countries (LMIC). Methods: Searches were conducted with five electronic databases (Pubmed, Web of Science, Embase, PsycINFO, CINAHL) using search terms related to "family carers", "brain injury", "children" and "low and middle income countries". Studies were independently screened using predetermined eligibility criteria by two authors. Data were extracted from included studies using standardised data extraction and quality appraisal tools. These data were then subjected to narrative synthesis. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to govern the review process. Findings: One study met our inclusion criteria and described an acquired brain injury called nodding syndrome which occurs in Sub-Saharan Africa. The study was conducted in Ghana and provided group-based psychotherapy to carers and their children. As such we found no study which sought to solely support the mental health of family carers. Conclusions: There has been a lack of focus in the literature on the mental health of family carers of children with brain injuries in LMIC. Considering the vital importance of caregivers in supporting their children it is imperative that service providers and researchers devise programmes to better meet their needs. The mental health of family carers should be better supported to improve their overall wellbeing, which will in turn improve the wellbeing of their children.

Klebsiella pneumoniae with carbapenemases: high prevalence of sequence type 307 with blaOXA181 in South African community hospitals.

This study investigated the molecular characteristics of urinary carbapenemase-producing Klebsiella pneumoniae isolates (n = 194) in Gauteng, South Africa, using simple, cost-effective PCR methodologies. Extensively drug resistant (XDR) ST307 with blaOXA-181 on IncX3 plasmids was endemic in Gauteng community hospitals leaving limited options for treating in- and outpatient urinary tract infections. High-level ceftazidime/avibactam resistance was detected among isolates harbouring blaOXA-48-like including blaOXA-181. These findings highlighted the need for genomic methodologies suitable for lower- and middle-income countries to track XDR clones and plasmids in community hospitals. Such results will aid with treatment and stewardship strategies.

The Influence of Vision Impairment on the Measurement of Cognition in Older Adults in India: Findings From LASI-DAD.

Background and Objectives: Prior investigations have not considered whether poor vision biases cognitive testing. However, such research is vital given increasing evidence that vision impairment (VI) may be an important modifiable risk factor for dementia, particularly in low- and middle-income settings where the prevalence of VI is high. Research Design and Methods: This study employed data from 3 784 participants in Wave 1 of the Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) who underwent both visual acuity and cognitive function testing. We used multiple indicators and multiple causes models to assess differential item functioning (DIF; eg, bias) in cognitive testing by objectively measured distance and near VI. Multivariable linear regression was used to model the association between VI and cognitive factor scores before and after DIF adjustment. Analyses were performed for general cognition and separate cognitive domains, corresponding to memory, language/fluency, executive functioning, and visuospatial performance. Models were adjusted for demographic, health, and socioeconomic covariates. Results: Participants in our sample were 60 and older. Most participants with VI were 60-69 years old (59.6%) and 50.8% were female. Individuals experiencing both distance and near VI tended to be older, have lower educational attainment, be married, reside in rural settings, and belong to lower consumption and BMI categories. Both distance and near VI were associated with poorer cognition before and after DIF-adjustment. Differences between DIF-unadjusted and -adjusted scores were small compared to the standard error of measurement, indicating no evidence of meaningful measurement differences by VI. Discussion and Implications: In well-conducted large-scale surveys, bias in cognitive testing due to VI is likely minimal. Findings strengthen previous evidence on the association between VI and dementia by showing that such associations are unlikely to be attributable to vision-related measurement error in the assessment of cognitive functioning.

Dilation and evacuation versus medication abortion at 15-24 weeks of gestation in low-middle income country: A retrospective cohort study.

Objective: To compare the effectiveness and safety of dilation and evacuation (D&E) to that of medication abortion at 15-24 weeks in a low-middle income country. Study design: We conducted a retrospective cohort on effectiveness and safety of D&E vs medication abortion at 15-24 weeks in an Ethiopian setting over a year (January 1-December 31, 2023). We looked at success (need for additional procedure) of both abortion procedures and their complication rates. Hemorrhage, infection, uterine perforation/rupture, and cervical tear were the complications we compared between the groups (D&E group vs medication abortion group). P-value less than 0.05 and Adjusted odds ratio (AOR) with 95% CI were used to present results significance. Results: A total of 225 abortion cases (162 medication abortion cases and 63 D&E cases) at gestational age of 15-24 weeks were included in the final analysis. The mean gestational age was 18 ± 2.8 weeks in the D&E group compared to 21 ± 3 weeks in the medication abortion group (p-value < 0.001). The overall procedure effectiveness between the abortion procedures was similar (95.2% vs 96.9% in the D&E group and medication abortion groups, p-value = 0.542). D&E (AOR = 2.92 [95% CI = 0.62-13.69]) was not associated with increased overall complications compared to medication abortion, after controlling for parity, gestational age, and history of prior uterine scar. Conclusion: We found both abortion methods (D&E and medication abortion) are effective with comparable complication rates. Implications: D&E and medication abortion are safe and effective methods of abortion for gestations up to 24 weeks even in a low-middle income country (LMIC) setting; as such, greater resources are needed to ensure to increase availability of D&E in order for women to have a choice in their treatment options.

Establishing human microbial observatory programs in low- and middle-income countries.

Studies of the human microbiome are progressing rapidly but have largely focused on populations living in high-income countries. With increasing evidence that the microbiome contributes to the pathogenesis of diseases that affect infants, children, and adults in low- and middle-income countries (LMICs), and with profound and rapid ongoing changes occurring in our lifestyles and biosphere, understanding the origins of and developing microbiome-directed therapeutics for treating a number of global health challenges requires the development of programs for studying human microbial ecology in LMICs. Here, we discuss how the establishment of long-term human microbial observatory programs in selected LMICs could provide one timely approach.

Identifying Gaps and Barriers in Alzheimer's Disease and Related Dementia Research and Management in Low- and Middle-Income Countries: A Survey of Health Professionals and Researchers.

Background: The significant increase in Alzheimer's disease and related dementia prevalence is a global health crisis, acutely impacting low- and lower-middle and upper-middle-income countries (LLMICs/UMICs). Objective: The objective of this study is to identify key barriers and gaps in dementia care and research in LLMICs and UMICs. Methods: We conducted an international, cross-sectional survey among clinicians and healthcare professionals (n = 249 in 34 countries) across LLMICs and UMICs, exploring patient demographics, use of clinical diagnosis, dementia evaluation, screening/evaluation tools, and care and treatment. Results: Significant disparities were found in diagnostic practices, access to assessments, and access to care. On average, clinicians in LLMICs saw more patients, had less time for evaluations, lower use of formal screening and tools, and less access to biomarkers. They were also under-resourced compared to UMICs. Conclusions: The findings provide insights for policymakers, healthcare organizations, and researchers to address the complex challenges associated with dementia care in diverse settings. Addressing these challenges requires a multipronged approach involving local, national, and international stakeholders.

Research, education and practice of tele-neurorehabilitation in low and middle-income countries: A Scoping Review.

BACKGROUND: Tele-neurorehabilitation (TNR) allows for remote delivery of rehabilitation services for those with neurological disabilities. Despite growing global interest and uptake, its adoption remains challenging in Low-and-Middle-Income-Countries (LMICs). OBJECTIVE: To explore available literature on the nature of training and education, research and practice of TNR in LMICs. METHODS: Following PRISMA-ScR guidelines and predefined selection criteria, four databases were screened. Quality assessment was performed using the Joanna Briggs Institute tools. Relevant data was extracted to using a data extraction form in Microsoft Excel and were narratively synthesised under Education/training, Research and Clinical Practice of TNR. RESULTS: We identified no formal structured training courses/programs for TNR users/providers. Sessions were mainly delivered as part of a research project. The included studies highlighted the need to engage stakeholders in TNR research and improve digital-literacy among healthcare providers/users. Development and use of clinical decision-making-tools, models of TNR suitable for varied populations and prior area-mapping were a few suggestions for clinical/research practice. CONCLUSION: There is an immense need to develop academic/structured programs for TNR to build capacity among providers/users in LMICs. Practice must adhere to principles of safety, effectiveness, and based on high quality clinical-guidelines suitable to the context to ensure optimal uptake and practice of TNR in LMICs.