The association between malnutrition and childhood disability in low- and middle- income countries: systematic review and meta-analysis of observational studies.

OBJECTIVE: The aim of this study was to evaluate the association between childhood disability and malnutrition in low- and middle- income countries (LMICs). METHODS: Articles were identified from 1990 to August 2017 by searching nine electronic databases. Epidemiological studies, undertaken in LMICs that compared the prevalence of malnutrition in children with disabilities to children without disabilities were eligible for inclusion. Titles, abstracts, and full texts were screened by two reviewers, and data were extracted using a structured table for eligible papers. Meta-analyses for the association between childhood disability and undernutrition were performed. RESULTS: The search generated 4678 results, from which 17 articles were eligible. Fifty-three per cent of these studies showed a positive association between childhood disability and undernutrition. Results varied when disaggregated by type of disability, with positive associations identified for 44% of studies focussed on neurodevelopmental disability, 60% of general disability studies and 67% of studies on hearing impairment. Only four studies were identified that considered overnutrition outcomes, and these showed variable results. Eighteen per cent of eligible studies were considered at low risk of bias, 53% had a medium risk, and 29% had a high risk of bias. Pooled ORs showed that children with disabilities were almost three times more likely to be underweight (OR 2.97, 95% CI 2.33, 3.79), and nearly twice as likely to experience stunting and wasting (Stunting: 1.82, 1.40, 2.36; Wasting: 1.90, 1.32-2.75), compared to controls. CONCLUSIONS: Children with disabilities may be a vulnerable group for undernutrition in LMICs, which should be reflected in disability and nutritional programming and policy-making.

Response of developing countries to biological threats: the case of the Republic of Haiti. / Les pays en développement face aux menaces biologiques : le cas de la République d'Haïti.

In spite of scientific progress, the world is still facing major biological threats. Not only are there epidemics caused by wildlife pathogens under natural conditions, there are also those caused accidently when researchers handle highly hazardous organisms stored in research laboratories, and those caused when countries use these organisms as biological weapons of war or when criminal groups use them for bioterrorism. Developing countries tend to be more vulnerable to such threats than developed countries owing to the poor resilience of their animal health systems, their advanced state of environmental degradation, their socio-economic fragility and their political instability. The occurrence of emerging and re-emerging diseases (avian influenza, Ebola virus disease) has caused deep concern around the world in recent years and has shown how important it is for countries to strengthen the organisation of their Veterinary Services. The Republic of Haiti is one of the developing countries with the most acute biophysical vulnerability. Over the years, it has experienced a large number of earthquakes, hurricanes, floods, droughts and epidemics that have further weakened a country with already scarce financial resources. However, Haiti is endeavouring to address biological threats by modernising its Veterinary Services and by implementing the animal health standards and guidelines of the World Organisation for Animal Health (OIE) for establishing resilient animal health systems.

Malgré les progrès scientifiques, le monde est aujourd'hui encore confronté à de grandes menaces biologiques. Outre les épidémies causées dans des conditions naturelles par des agents pathogènes issus de la faune sauvage, il faut mentionner également celles qui peuvent résulter d'accidents lors de la manipulation de certains germes très dangereux stockés dans les laboratoires de recherche, d'une part, ou de l'utilisation de ces germes par certains pays comme armes biologiques dans les guerres ou par des groupes criminels dans le bioterrorisme, d'autre part. Face à ces menaces, les pays en développement sont généralement plus vulnérables que les pays développés en raison du manque de résilience de leurs systèmes de santé animale, du niveau avancé de dégradation de leur environnement, de leur fragilité socio-économique et de leur instabilité politique. La survenue de maladies émergentes et ré-émergentes (grippe aviaire, maladie d'Ébola) a suscité au cours des dernières années un grand émoi dans le monde et montré combien il est important pour les pays de renforcer l'organisation de leurs Services vétérinaires. Parmi les pays en développement, la République d'Haïti présente une grande vulnérabilité biophysique. Elle a connu au fil du temps un grand nombre de séismes, cyclones, inondations, épisodes de sécheresse et épidémies qui ont encore plus fragilisé ce pays déjà peu pourvu en ressources financières. Toutefois, Haïti essaie de faire face aux menaces biologiques en modernisant ses Services vétérinaires et en appliquant les normes sanitaires et lignes directrices de l'Organisation mondiale de la santé animale (OIE) pour la mise en place de systèmes résilients de santé animale.

A día de hoy, pese a los avances científicos, el mundo sigue afrontando amenazas biológicas de gran calado. Además de las epidemias causadas en condiciones naturales por agentes patógenos procedentes de la fauna salvaje, conviene mencionar las que puedan derivarse de accidentes acaecidos al manipular ciertos gérmenes muy peligrosos almacenados en laboratorios de investigación, por un lado, o del uso de esos gérmenes como arma de guerra biológica por parte de ciertos países o con fines de bioterrorismo por parte de grupos criminales, por el otro. Ante tales amenazas, los países en desarrollo suelen ser más vulnerables que los desarrollados porque sus sistemas de sanidad animal carecen de resiliencia, su medio ambiente está degradado y son socioeconómicamente frágiles y políticamente inestables. En los últimos años el advenimiento de enfermedades emergentes y reemergentes (influenza aviar, enfermedad por el virus del Ébola) ha generado gran desazón en todo el mundo y demostrado cuán importante es para los países reforzar la organización de sus Servicios Veterinarios. De entre los países en desarrollo, la República de Haití presenta una especial vulnerabilidad biofísica. A lo largo del tiempo ha sufrido un gran número de seísmos, ciclones, inundaciones, sequías y epidemias que han fragilizado aún más el país, que ya de entrada contaba con escasos recursos económicos. Pese a ello, Haití trata de hacer frente a las amenazas biológicas modernizando sus Servicios Veterinarios y aplicando las normas sanitarias y directrices de la Organización Mundial de Sanidad Animal (OIE) con el fin de instituir sistemas de sanidad animal dotados de resiliencia.

Animal pathogens and their impact on animal health, the economy, food security, food safety and public health.

Animal pathogens attract attention in both the livestock and public health sectors for their impacts on socio-economics, food safety and security, and human health. These impacts are felt at the household, national, regional and global levels. Whereas the World Organisation for Animal Health (OIE) has identified 118 animal diseases as notifiable, based on their potential for impact on trade, there is a selected subset that have been classified as posing a greater threat to countries due to unique characteristics, such as being highly transmissible, spreading rapidly within and between countries, and requiring cooperation between several countries to control their spread or exclude them. While these 'transboundary diseases' are endemic in much of the world, particularly the developing nations, many countries are classified as disease free. Following the terrorist events of 11 September 2001 in the United States, a small group of zoonotic pathogens and a group of animal-specific pathogens (those that cause what are referred to as `high-consequence foreign animal diseases'), were classified as high-risk, biothreat 'select agents'. Rather than providing a comprehensive review of all animal pathogens, the authors briefly review the impact of these high-risk biothreat agents on animal health, the economy, food security and safety, and public health, using highly pathogenic avian influenza, foot and mouth disease and brucellosis as examples. They focus on the impact of these diseases in the context of high-income countries and low- and middle-income countries, comparing and contrasting their impact at the national and individual household levels.

Les agents pathogènes d'origine animale revêtent une grande importance tant pour le secteur de l'élevage que pour celui de la santé publique, en raison de leurs conséquences sur la société et l'économie, sur la sécurité alimentaire, sur la sécurité sanitaire des aliments et sur la santé publique. Ces impacts sont perceptibles à l'échelle des ménages, des pays, des régions et du monde. L'Organisation mondiale de la santé animale (OIE) a établi une liste de 118 maladies animales à déclaration obligatoire en se basant principalement sur leurs conséquences potentielles pour le commerce ; néanmoins, un sous-ensemble de la liste concerne les maladies qui font peser un risque élevé sur les pays, de par leurs caractéristiques uniques, par exemple leur contagiosité, la rapidité de leur potentiel de propagation dans le territoire national ou d'un pays à l'autre, ou la nécessité de mettre en place une coopération internationale en vue de maîtriser leur propagation ou de les éliminer. Ces « maladies transfrontalières ¼ sont présentes à l'état endémique dans une grande partie du monde, en particulier dans les pays en développement, tandis que d'autres pays sont considérés comme « indemnes ¼. Suite aux attaques terroristes du 11 septembre 2001 aux États-Unis d'Amérique, les maladies animales dites « exotiques ¼ ainsi qu'un petit nombre d'agents pathogènes zoonotiques ont été classés dans la catégorie des « agents biologiques à haut risque ¼. Plutôt que de fournir un inventaire exhaustif des agents pathogènes d'origine animale, les auteurs résument l'impact de ces agents biologiques à haut risque sur la santé animale, l'économie, la sécurité alimentaire, la sécurité sanitaire des aliments et la santé publique, en illustrant leur propos avec les exemples de l'influenza aviaire hautement pathogène, la fièvre aphteuse et la brucellose. Ils examinent l'impact de ces maladies dans le contexte des pays à revenus élevés, mais aussi des pays à revenus faibles ou intermédiaires, en comparant et en détaillant les impacts respectifs à l'échelle nationale ainsi qu'à l'échelle des ménages.

Por su influencia en factores socioeconómicos y en temas como la higiene de los alimentos, la seguridad alimentaria o la salud humana, los patógenos animales atraen la atención de los sectores de la producción animal y la salud pública. Dicha influencia se deja sentir tanto a nivel de los hogares como a escala nacional, regional y mundial. Aunque la Organización Mundial de Sanidad Animal (OIE) tiene catalogadas 118 enfermedades animales como «de declaración obligatoria¼, atendiendo a sus posibles consecuencias para el comercio, hay un pequeño subconjunto de ellas que se consideran especialmente peligrosas para los países porque revisten características singulares, como el hecho de ser muy transmisibles, propagarse con gran rapidez entre los países y dentro de ellos o exigir cooperación entre varias naciones para combatir su propagación o atajarlas. Estas «enfermedades transfronterizas¼ son endémicas en gran parte del mundo, especialmente en las naciones en desarrollo, pero también hay muchos países que están considerados «libres¼ de ellas. Después de los atentados terroristas que sufrieron los Estados Unidos el 11 de septiembre de 2001, las llamadas enfermedades animales «extranjeras¼, junto con un pequeño grupo de patógenos zoonóticos, fueron catalogadas como «agentes selectos¼ de alto riesgo de amenaza biológica. En lugar de ofrecer una panorámica completa de todos los patógenos animales, los autores repasan brevemente el impacto de estos agentes calificados de alto riesgo y portadores de una amenaza biológica en la sanidad animal, la economía, la seguridad alimentaria, la higiene de los alimentos y la salud pública, valiéndose para ello de los ejemplos de la influenza aviar altamente patógena, la fiebre aftosa y la brucelosis. Centrándose en el impacto de estas enfermedades en el contexto de los países de renta alta y en el de los países de renta baja o media, comparan y contrastan tal impacto a escala nacional y en el ámbito de los hogares.

[Non-antiretroviral drugs uses among HIV-infected persons receiving antiretroviral therapy in Senegal: Costs and factors associated with prescription]. / Médicaments non antirétroviraux chez les personnes vivant avec le VIH sous traitement antirétroviral au Sénégal : coûts et facteurs associés à la prescription.

BACKGROUND: In addition to antiretroviral therapy, non-antiretroviral drugs are necessary for the appropriate care of people living with HIV. The costs of such drugs are totally or partially supported by the people living with HIV. We aimed to evaluate the overall costs, the costs supported by the people living with HIV and factors associated with the prescription of non-antiretroviral drugs in people living with HIV on antiretroviral therapy in Senegal. METHODS: We conducted a retrospective cohort study on 331 people living with HIV who initiated antiretroviral therapy between 2009 and 2011 and followed until March 2012. The costs of non-antiretroviral drugs were those of the national pharmacy for essential drugs; otherwise they were the lowest costs in the private pharmacies. Associated factors were identified through a logistic regression model. RESULTS: The study population was 61 % female. At baseline, 39 % of patients were classified at WHO clinical stage 3 and 40 % at WHO clinical stage 4. Median age, body mass index and CD4 cells count were 41 years, 18kg/m2 and 93 cells/µL, respectively. After a mean duration of 11.4 months of antiretroviral therapy, 85 % of patients received at least one prescription for a non-antiretroviral drug. Over the entire study period, the most frequently prescribed non-antiretroviral drugs were cotrimoxazole (78.9 % of patients), iron (33.2 %), vitamins (21.1 %) and antibiotics (19.6 %). The mean cost per patient was 34 Euros and the mean cost supported per patient was 14 Euros. The most expensive drugs per treated patient were antihypertensives (168 Euros), anti-ulcer agents (12 Euros), vitamins (8.5 Euros) and antihistamines (7 Euros). The prescription for a non-antiretroviral drug was associated with advanced clinical stage (WHO clinical stage 3/4 versus stage 1/2): OR=2.25; 95 % CI=1.11-4.57 and viral type (HIV-2 versus HIV-1/HIV-1+HIV-2): OR=0.36; 95 % CI=0.14-0.89. CONCLUSION: Non-antiretroviral drugs are frequently prescribed to people living with HIV in developing countries; mainly those infected with HIV-1 and those at an advanced clinical stage. Their costs can be a barrier to appropriate care and necessary efforts must made to make them available. However, early initiation of antiretroviral therapy and the registration of some non-antiretroviral drugs on the list of essential drugs, as well as social protection systems, should reduce their use and costs.

Seroepidemiology: an underused tool for designing and monitoring vaccination programmes in low- and middle-income countries.

Seroepidemiology, the use of data on the prevalence of bio-markers of infection or vaccination, is a potentially powerful tool to understand the epidemiology of infection before vaccination and to monitor the effectiveness of vaccination programmes. Global and national burden of disease estimates for hepatitis B and rubella are based almost exclusively on serological data. Seroepidemiology has helped in the design of measles, poliomyelitis and rubella elimination programmes, by informing estimates of the required population immunity thresholds for elimination. It contributes to monitoring of these programmes by identifying population immunity gaps and evaluating the effectiveness of vaccination campaigns. Seroepidemiological data have also helped to identify contributing factors to resurgences of diphtheria, Haemophilus Influenzae type B and pertussis. When there is no confounding by antibodies induced by natural infection (as is the case for tetanus and hepatitis B vaccines), seroprevalence data provide a composite picture of vaccination coverage and effectiveness, although they cannot reliably indicate the number of doses of vaccine received. Despite these potential uses, technological, time and cost constraints have limited the widespread application of this tool in low-income countries. The use of venous blood samples makes it difficult to obtain high participation rates in surveys, but the performance of assays based on less invasive samples such as dried blood spots or oral fluid has varied greatly. Waning antibody levels after vaccination may mean that seroprevalence underestimates immunity. This, together with variation in assay sensitivity and specificity and the common need to take account of antibody induced by natural infection, means that relatively sophisticated statistical analysis of data is required. Nonetheless, advances in assays on minimally invasive samples may enhance the feasibility of including serology in large survey programmes in low-income countries. In this paper, we review the potential uses of seroepidemiology to improve vaccination policymaking and programme monitoring and discuss what is needed to broaden the use of this tool in low- and middle-income countries.

Assessing the accuracy of a point-of-care analyzer for hyperlipidaemia in western Kenya.

OBJECTIVES: The prevalence of hyperlipidaemia, along with other non-communicable diseases, is on the rise in low- and middle-income countries. CardioChek PA is a point-of-care lipid measuring device, which seeks to overcome laboratory-based diagnostic barriers by providing immediate results without dependency on significant laboratory infrastructure. However, it has not been validated in Kenya. In this study, we assess the accuracy of CardioChek PA with respect to the gold standard laboratory-based testing. METHODS: In Webuye, Kenya, two blood samples were collected from 246 subjects to simultaneously measure the lipid levels via both CardioChek PA and the gold standard. All subjects were adults, and geographic stratified sampling methods were applied. Statistical analysis of the device's accuracy was based on per cent bias parameters, as established by the United States National Institutes of Health (NIH). The NIH recommends that per cent bias be ≤±3% for low-density lipoprotein (LDL) cholesterol, ≤±5% for high-density lipoprotein (HDL) cholesterol, ≤±5% for total cholesterol (TC) and ≤±4% for triglycerides (TG). Risk group misclassification rates were also analysed. RESULTS: The CardioChek PA analyzer was substantially inaccurate for LDL cholesterol (-25.9% bias), HDL cholesterol (-8.2% bias) and TC (-15.9% bias). Moreover, those patients at higher risk of complications from hyperlipidaemia were most likely to be misclassified into a lower risk category. CONCLUSION: CardioChek PA is inaccurate and not suitable for our clinical setting. Furthermore, our findings highlight the need to validate new diagnostic tools in the appropriate setting prior to scale up regardless of their potential for novel utility.

Non-clinical interventions for acute respiratory infections and diarrhoeal diseases among young children in developing countries.

OBJECTIVE: To assess the effectiveness of non-clinical interventions against acute respiratory infections and diarrhoeal diseases among young children in developing countries. METHODS: Experimental and observational impact studies of non-clinical interventions aimed at reducing the incidence of mortality and/or morbidity among children due to acute respiratory infections and/or diarrhoeal diseases were reviewed, following the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. RESULTS: Enhancing resources and/or infrastructure, and promoting behavioural changes, are effective policy strategies to reduce child morbidity and mortality due to diarrhoeal disease and acute respiratory infections in developing countries. Interventions targeting diarrhoeal incidence generally demonstrated a reduction, ranging from 18.3% to 61%. The wide range of impact size reflects the diverse design features of policies and the heterogeneity of socio-economic environments in which these policies were implemented. Sanitation promotion at household level seems to have a greater protective effect for small children. CONCLUSION: Public investment in sanitation and hygiene, water supply and quality and the provision of medical equipment that detect symptoms of childhood diseases, in combination of training and education for medical workers, are effective policy strategies to reduce diarrhoeal diseases and acute respiratory infections. More research is needed in the countries that are most affected by childhood diseases. There is a need for disaggregation of analysis by age cohorts, as impact effectiveness of policies depends on children's age.

Use of a bibliometric literature review to assess medical research capacity in post-conflict and developing countries: Somaliland 1991-2013.

OBJECTIVES: Effective healthcare systems require high-quality research to guide evidence-based interventions and strategic planning. In low- and middle-income countries, especially those emerging from violent conflict, research capacity often lags behind other aspects of health system development. Here, we sought to bibliometrically review health-related research output in Somaliland, a post-conflict self-declared, autonomous nation on the Horn of Africa, as a means of assessing research capacity. METHODS: We reviewed articles on health-related research conducted in Somaliland between 1991 and 2013 that included a description of the experimental design, and articles were published in either a peer-reviewed journal or as part of a scholarly programme receiving formal review. We did not include policy or social science research that did not enrol or interact with subjects from Somaliland. Using online databases, all studies meeting minimum eligibility criteria were reviewed in regard to Somaliland-based co-authorship, topic of research and specific measures of quality. RESULTS: A total of 37 studies were included in this review. Of these, only 19 (51%) included co-authorship by Somaliland-based researchers. Of the 21 studies reporting ethical approval, 16 (64%) received approval from the Somalia or Somaliland Ministry of Health, while five received approval from a university or national commission. More than two-thirds of published research was limited to a few areas of investigation with most (19, 51%) following basic cross-sectional study designs. The number of articles published per year increased from 0 to 1 in the years 1991-2007 to a maximum of 8 in 2013. CONCLUSIONS: Research activity in Somaliland is extremely limited. Investigators from high-income countries have largely directed the research agenda in Somaliland; only half of the included studies list co-authors from institutions in Somaliland. Leadership and governance of health research in Somaliland is required to define national priorities, promote scholarly activity and guide the responsible conduct of research. The methods used here to assess research capacity may be generalisable to other low- and middle-income countries and post-conflict settings to measure the impact of research capacity-building efforts.

The role of the private sector in the provision of antenatal care: a study of Demographic and Health Surveys from 46 low- and middle-income countries.

OBJECTIVE: To examine the role of the private sector in the provision of antenatal care (ANC) across low- and middle-income countries. METHODS: Demographic and Health Survey (DHS) data from 46 countries (representing 2.6 billion people) on components of ANC given to 303 908 women aged 15-49 years for most recent birth were used. We identified 79 unique sources of care which were re-coded into home, public, private (commercial) and private (not-for-profit). Use of ANC and a quality of care index (scaled 0-1) were stratified by type of provider, region and wealth quintile. Linear regressions were used to examine the association between provider type and antenatal quality of care score. RESULTS: Across all countries, the main source of ANC was public (54%), followed by private commercial (36%) and home (5%), but there were large variations by region. Home-based ANC was associated with worse quality of care (0.2; 95% CI -0.2 to -0.19) relative to the public sector, while the private not-for-profit sector (0.03; 95% CI 0.02 to 0.04) was better. There were no differences in quality of care between public and private commercial providers. CONCLUSIONS: The market for ANC varies considerably between regions. The two largest sectors - public and private commercial - perform similarly in terms of quality of care. Future research should examine the role of the private sector in other health service domains across multiple countries and test what policies and programmes can encourage private providers to contribute to increased coverage, quality and equity of maternal care.

Participation in medical research as a resource-seeking strategy in socio-economically vulnerable communities: call for research and action.

The freedom to consent to participate in medical research is a complex subject, particularly in socio-economically vulnerable communities, where numerous factors may limit the efficacy of the informed consent process. Informal consultation among members of the Switching the Poles Clinical Research Network coming from various sub-Saharan African countries, that is Burkina Faso, The Gambia, Rwanda, Ethiopia, the Democratic Republic of Congo (DRC) and Benin, seems to support the hypothesis that in socio-economical vulnerable communities with inadequate access to health care, the decision to participate in research is often taken irrespectively of the contents of the informed consent interview, and it is largely driven by the opportunity to access free or better quality care and other indirect benefits. Populations' vulnerability due to poverty and/or social exclusion should obviously not lead to exclusion from medical research, which is most often crucially needed to address their health problems. Nonetheless, to reduce the possibility of exploitation, there is the need to further investigate the complex links between socio-economical vulnerability, access to health care and individual freedom to decide on participation in medical research. This needs bringing together clinical researchers, social scientists and bioethicists in transdisciplinary collaborative research efforts that require the collective input from researchers, research sponsors and funders.

Need for certification of household water treatment products: examples from Haiti.

OBJECTIVE: To evaluate four household water treatment (HWT) products currently seeking approval for distribution in Haiti, through the application of a recently-developed national HWT product certification process. METHODS: Four chemical treatment products were evaluated against the certification process validation stage by verifying international product certifications confirming treatment efficacy and reviewing laboratory efficacy data against WHO HWT microbiological performance targets; and against the approval stage by confirming product composition, evaluating treated water chemical content against national and international drinking water quality guidelines and reviewing packaging for dosing ability and usage directions in Creole. RESULTS: None of the four evaluated products fulfilled validation or approval stage requirements. None was certified by an international agency as efficacious for drinking water treatment, and none had data demonstrating its ability to meet WHO HWT performance targets. All product sample compositions differed from labelled composition by >20%, and no packaging included complete usage directions in Creole. CONCLUSIONS: Product manufacturers provided information that was inapplicable, did not demonstrate product efficacy, and was insufficient to ensure safe product use. Capacity building is needed with country regulatory agencies to objectively evaluate HWT products. Products should be internationally assessed against WHO performance targets and also locally approved, considering language, culture and usability, to ensure effective HWT.

Are French general practitioners consulted before travel to developing countries? A cross-sectional study conducted in a French airport.

BACKGROUND: General practitioners (GPs) could play a central role in preventing travel-related health issues. The aim of this study was to assess, in travellers departing to developing countries from a French airport, the proportion of individuals having sought GP counseling before departure and to identify determinants for having consulted a GP. METHODS: Cross-sectional study conducted between November 2012 and July 2013, in all adults living in France. Sociodemographic, health characteristics, type of travel and resources consulted before departure were collected. A descriptive analysis was performed. Determinants for having consulted a GP before departure were investigated using a logistic regression analysis. RESULTS: Of the 360 travellers included, 230 (64%) sought health counseling before departure. GPs were the main source of information for 134 (58%) travellers having sought health information and the only one for 49 (21%). Almost half of the travellers (48%) departing to sub-Saharan countries did not seek health counseling from a medical doctor (GP, non-GP specialist, specialist consulted in an international vaccination center or occupational physician). Individuals significantly more likely to travel without having consulted a GP were young and male, held foreign nationality, had travelled more than five times before, rarely consulted their GP and were travelling to a non-malarious area. CONCLUSION: GPs were the main but not the only source of information and counseling before traveling to a developing country. This study helps identify the characteristics of individuals likely to travel without having consulted a GP before departure.

Scarcity of protective items against HIV and other bloodborne infections in 13 low- and middle-income countries.

OBJECTIVE: To assess protection of surgical healthcare workers against HIV and other bloodborne infections in low- and middle-income countries (LMICs). METHODS: Literature review based on recent studies assessing baseline surgical capacity in LMICs using the WHO Situational Analysis of Access to Emergency and Essential Surgical Care, the Surgeons OverSeas (SOS) Personnel, Infrastructure, Procedures, Equipment and Supplies (PIPES) survey and the Harvard Humanitarian Initiative survey tools. The availability of protective eyewear, sterile gloves and sterilisers was assessed. RESULTS: Thirteen individual country studies with relevant data were identified documenting items from 399 hospitals. The countries included Afghanistan, Bolivia, Gambia, Ghana, Liberia, Mongolia, Nigeria, Sierra Leone, Solomon Islands, Somalia, Sri Lanka, Tanzania and Zambia. Overall, only 29% (79/270) of hospitals always had eye protection. Sterilisers were only available at 64% (244/383) of facilities. Sterile gloves were the most available item, available at 75% of facilities (256/340). CONCLUSION: Surgical healthcare worker protection for bloodborne infections continues to be deficient in LMICs. Improved documentation of these items should be incorporated into future surgical capacity studies. Policy makers and clinicians should work together to secure resources and interventions that will protect this vital workforce.

Socioeconomic and psychological impact of treatment for unilateral intraocular retinoblastoma.

PURPOSE: To identify the socioeconomic and psychosocial impacts of clinical treatment decisions for advanced unilateral intraocular retinoblastoma. DESIGN: Retrospective observational case series. SETTING: institutional study at Alexandria Main University Hospital. STUDY POPULATION: records of 66 unilateral retinoblastoma cases treated from May 2005 to May 2013 were retrospectively reviewed. Sixty cases were eligible (International Intraocular Retinoblastoma Classification [IIRC] group C, D or E). PROCEDURES: two treatment groups were compared: enucleation vs. salvage treatment. Salvage treatment eyes were further subdivided based on IIRC group. Six socioeconomic parameters (financial burden, financial impact, psychological, social, medical and tumor impacts) were scored. Parameter scores ranged from 0 to 3, for overall score range 0 (no adverse impact) to 18 (severe adverse impact). MAIN OUTCOME MEASURES: derived Socioeconomic scores were correlated with treatment and outcomes. RESULTS: The enucleation group (28 eyes) had a median overall Socioeconomic score of 4/18, significantly lower than the salvage treatment group (32 eyes), median score 11/18 (P<0.01). Socioeconomic score varied with IIRC group. Attempted eye salvage failed in 25 children, due to uncontrolled tumor (44%) and socioeconomic impact of cumulative therapies (56%). Treatment duration and Socioeconomic score were higher for the 5 children in the salvage treatment group who developed metastatic disease compared to those without metastasis (P<0.01). CONCLUSIONS: The socioeconomic and psychosocial impacts of attempted ocular salvage for unilateral intraocular retinoblastoma are severe, in comparison to primary enucleation. Primary enucleation is a good treatment for unilateral retinoblastoma.

Causes of childhood blindness in a developing country and an underdeveloped country.

INTRODUCTION: The causes of childhood blindness depend on factors such as geographic location or the human development index of the populations under study. The main causes in developed countries are genetic and hereditary diseases, while infectious and contagious diseases, together with nutritional and vitamin deficiencies, are the main causes in underdeveloped countries (UDCs). METHODS: Study of the causes of blindness among children admitted to a regional centre in Nador, Morocco, and among children in Mekele, Ethiopia. The study was carried out in collaboration with two non-governmental organizations based in Madrid, Spain. First, we worked with Fudación Adelias in June 2010, and with Proyecto Visión in October 2012. RESULTS: The study comprised a total of 27 children in Morocco and 85 in Ethiopia. The average age of the children was 10.92 and 6.94 years, respectively. The main causes of blindness in Morocco were hereditary pathologies (25.92%) and refractive errors (14.82%), although trauma (7.40%) and corneal disease (7.40%) are relevant. Among the children from Ethiopia, corneal disease (27.05%) and trauma (20%) were the main causes of blindness, while congenital and hereditary diseases had a lower prevalence (4.70%). CONCLUSIONS: The causes of blindness depend on the human development index of the populations under study. While corneal disease and trauma are the main causes observed in UDCs like Ethiopia, hereditary pathologies and refractive errors are the main causes within the Moroccan population studied. A mixed form can be observed in this country, as the cause of blindness found in developed countries, such as congenital and hereditary pathologies which are present alongside the causes normally found in LDCs.

Evaluation of blood donors questionnaire in a developing country: The case of Gabon.

BACKGROUND: Blood transfusion is a life-saving therapeutic act without alternative. Each blood transfusion carries the risk of blood-borne pathogens transmission. The present study, is the first establishing the usefulness of blood donors screening questionnaire in the setting of the Gabonese National Blood Transfusion Center. STUDY DESIGN: Nine hundred and thirty-four blood donors aged between 18 and 48 years old were initially enrolled and submitted to physical examination (body-mass index and blood pressure). After physical examination 854 donors were judged fit for blood donation and were randomly distributed in two groups. The first group of donors did not take the screening questionnaire; whereas the second group went through the screening questionnaire. Both groups were then tested for human immunodeficiency virus, hepatitis B, hepatitis C and syphilis. RESULTS: Data revealed a seroprevalence among the donors of 2.5%, 2.5%, 1.1%, and 3.3% for the human immunodeficiency virus, hepatitis B, hepatitis C and syphilis markers respectively. In the Gabonese setting, blood donors' screening questionnaire reduced respectively by 0.6%, 0.35% and 1.3% the proportion of hepatitis B, hepatitis C and treponema pallidum seroreactive donors being selected for donation. The questionnaire had no positive effect on discriminating human immunodeficiency virus positive donors. CONCLUSION: Blood donors' seroprevalence of blood-borne pathogens is relatively important in our setting. Blood donors' screening questionnaire reduced the proportion of hepatitis B, hepatitis C and syphilis seropositive blood donors. The questionnaire did not effectively discriminate human immunodeficiency virus-infected donor candidates.

[Evaluation of tuberculous patients' management when re-treated in Cotonou, Benin]. / Évaluation de la prise en charge des patients admis au régime de retraitement à Cotonou, Bénin.

Retreatment of tuberculosis is the leading risk factor for drug resistance if the management is not adequate and complete. The objective of this study was to evaluate the management of cases of retreatment in Cotonou. This was a retrospective, descriptive cross type which covered a period of 5 years. Outcomes of retreatment cases were compared against those for new cases that were registered during the same period. We analyzed the cases of 389 retreatment patients and 4542 new cases. The success rates of treatment were generally satisfactory (80% vs. 86%, P=0.0001). Of adverse outcomes, the rate of loss of sight of was 12% versus 7%, P=0.26, the rate was 23% for cases of occasions. The failure rate was low and similar in both populations (2%). The retreatment regimen for patients with TB in Cotonou appears to give generally satisfactory results. The high loss to follow-up in case of retreatment means that a personalized therapeutic approach for such patients is needed in general and in particular in the case of defaulters.