scholarly journals Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: A Systematic Review of Current Implementations and Gaps in Research (Preprint)

2020 ◽  
Author(s):  
Andrea H. Rossman ◽  
Hadley W. Reid ◽  
Michelle M. Pieters ◽  
Ceclia Mizelle ◽  
Megan von Isenberg ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Health Workers ◽  
Digital Health ◽  
Meta Analysis ◽  
Cancer Control ◽  
Risk Of Bias ◽  
Middle Income ◽  
High Burden ◽  
Middle Income Countries ◽  
Study Designs

BACKGROUND Eight-five percent of deaths due to cervical cancer occur in low- and middle-income countries (LMICs). In recent years, many digital health strategies have been implemented in LMICs to ameliorate patient-, provider-, and health system level challenges in cervical cancer control. Yet, there are limited efforts to systematically review the effectiveness and current landscape of digital health strategies for cervical cancer control in LMICs. OBJECTIVE We aimed to conduct a systematic review of digital health strategies for cervical cancer control in LMICs to assess their effectiveness, describe the range of strategies used, and summarize challenges to their implementation. METHODS A systematic search was conducted to identify publications describing digital health strategies for cervical cancer control in LMICs from five academic databases and Google Scholar. Titles and abstracts were screened and full texts were reviewed for eligibility. A structured data extraction template was used to summarize information from included studies. The risk of bias and data reporting guidelines for mobile health were assessed for each study. A meta-analysis of effectiveness was planned along with a narrative review of digital health strategies, implementation challenges, and opportunities for future research. RESULTS In the 24 included studies, digital health strategies for cervical cancer control focused predominantly on cervical image capture, remote expert review, training health workers, and, less frequently, patient education. Most included studies were implemented in sub-Saharan Africa, with fewer studies in other LMIC regions such as Asia or South America. One study had low risk of bias, and three studies had a moderate risk of bias while the remaining 20 studies had a high risk of bias. Due to insufficient studies with robust study designs, matched outcomes or interventions, a meta-analysis of effectiveness was not possible. Existing strategies used digital health for improving women’s knowledge and awareness about cervical cancer, increasing access to cervical cancer services, improving training of health workers and availability of data, and ensuring continuity of care. Key challenges in implementing digital health strategies for cervical cancer control were related to the high burden of training, technology-specific issues, infrastructure challenges, challenges with technology reach and inequitable access to technology among target users. CONCLUSIONS The current evidence on the effectiveness of digital health strategies for cervical cancer control is limited and, in most cases, is associated with a high risk of bias. Further studies are recommended to expand the investigation of digital health strategies for cervical cancer using robust study designs, explore other LMIC settings with high burden of cervical cancer (e.g., South America), and test a greater diversity of digital strategies. CLINICALTRIAL The review protocol is registered with the PROSPERO database for prospectively registered systematic reviews (Protocol # CRD42017071560).

Human Papillomavirus (HPV)

2021 ◽  
Author(s):  
Anne Schuind
Keyword(s):  
Cervical Cancer ◽  
Neutralizing Antibodies ◽  
Invasive Cervical Cancer ◽  
Cancer Control ◽  
Middle Income ◽  
Middle Income Countries ◽  
Common Cancer ◽  
Associated Lesions ◽  
Hpv Types ◽  
E6 And E7

HPV is extremely common worldwide and mainly transmitted through sexual contact; most people are infected with HPV shortly after onset of sexual activity. There are >200 types of HPV, of which at least 12 are cancer-causing (oncogenic or high-risk types). HPV is a causal factor for several anogenital and a subset of oropharyngeal cancers with 2 HPV types (16 and 18) causing 72% of all HPV-associated cancers. Cervical cancer is the fourth most common cancer among women globally with nearly 90% of the deaths occurring in low- and middle-income countries. Comprehensive cervical cancer control includes primary prevention (vaccination against HPV), secondary prevention (screening and treatment of pre-cancerous lesions) as well as treatment of invasive cervical cancer. The currently licensed vaccines are L1 VLP-based and prophylactic; they have been shown to be safe and highly effective in preventing HPV infections and HPV-associated lesions, precancer and cancer. Neutralizing antibodies are the mechanism of protection for prophylactic HPV VLP-based vaccines. Therapeutic HPV vaccines targeting the oncoproteins E6 and E7 are in clinical development.

scholarly journals Impact of maternal mental health interventions on child-related outcomes in low- and middle-income countries: a systematic review and meta-analysis

2020 ◽  
Vol 29 ◽  
Author(s):  
W. A. Tol ◽  
M. C. Greene ◽  
M. E. Lasater ◽  
K. Le Roch ◽  
C. Bizouerne ◽  
...  
Keyword(s):  
Mental Health ◽  
Exclusive Breastfeeding ◽  
Home Visiting ◽  
Health Workers ◽  
Maternal Mental Health ◽  
Meta Analysis ◽  
Middle Income ◽  
Middle Income Countries ◽  
Child Height ◽  
Low And Middle Income

Abstract Aims Observational studies have shown a relationship between maternal mental health (MMH) and child development, but few studies have evaluated whether MMH interventions improve child-related outcomes, particularly in low- and middle-income countries. The objective of this review is to synthesise findings on the effectiveness of MMH interventions to improve child-related outcomes in low- and middle-income countries (LMICs). Methods We searched for randomised controlled trials conducted in LMICs evaluating interventions with a MMH component and reporting children's outcomes. Meta-analysis was performed on outcomes included in at least two trials. Results We identified 21 trials with 28 284 mother–child dyads. Most trials were conducted in middle-income countries, evaluating home visiting interventions delivered by general health workers, starting in the third trimester of pregnancy. Only ten trials described acceptable methods for blinding outcome assessors. Four trials showed high risk of bias in at least two of the seven domains assessed in this review. Narrative synthesis showed promising but inconclusive findings for child-related outcomes. Meta-analysis identified a sizeable impact of interventions on exclusive breastfeeding (risk ratio = 1.39, 95% confidence interval (CI): 1.13–1.71, ten trials, N = 4749 mother–child dyads, I2 = 61%) and a small effect on child height-for-age at 6-months (std. mean difference = 0.13, 95% CI: 0.02–0.24, three trials, N = 1388, I2 = 0%). Meta-analyses did not identify intervention benefits for child cognitive and other growth outcomes; however, few trials measured these outcomes. Conclusions These findings support the importance of MMH to improve child-related outcomes in LMICs, particularly exclusive breastfeeding. Given, the small number of trials and methodological limitations, more rigorous trials should be conducted.

scholarly journals Efficacy of zinc as adjunctive pneumonia treatment in children aged 2 to 60 months in low-income and middle-income countries: a systematic review and meta-analysis

2020 ◽  
Vol 4 (1) ◽  
pp. e000662 ◽  
Author(s):  
Nick Brown ◽  
Antti Juhani Kukka ◽  
Andreas Mårtensson
Keyword(s):  
Systematic Review ◽  
Treatment Failure ◽  
Low Income ◽  
Meta Analysis ◽  
Severe Pneumonia ◽  
Risk Of Bias ◽  
Sensitivity Analyses ◽  
Cochrane Library ◽  
Middle Income ◽  
Middle Income Countries

BackgroundDespite advances in vaccination and case management, pneumonia remains the single largest contributor to early child mortality worldwide. Zinc has immune-enhancing properties, but its role in adjunctive treatment of pneumonia in low-income and middle-income countries (LMICs) is controversial and research still active.MethodsSystematic review and meta-analysis of randomised controlled trials of zinc and placebo in pneumonia in children aged 2 to 60 months in LMICs. Databases included MEDLINE, the Cochrane Library, EMBASE, LILACS, SciELO, the WHO portal, Scopus, Google Scholar and ClinicalTrials.gov. Inclusion criteria included accepted signs of pneumonia and clear measure of outcome. Risk of bias was independently assessed by two authors. ORs with 95% CI were used for calculating the pooled estimate of dichotomous outcomes including treatment failure and mortality. Time to recovery was expressed as HRs. Sensitivity analyses considering risk of bias and subgroup analyses for pneumonia severity were performed.ResultsWe identified 11 trials published between 2004 and 2019 fulfilling the a priori defined criteria, 7 from South Asia and 3 from Africa and 1 from South America. Proportional treatment failure was comparable in both zinc and placebo groups when analysed for all patients (OR 0.95 (95% CI 0.80 to 1.14)) and only for those with severe pneumonia (OR 0.93 (95% CI 0.75 to 1.14)). No difference was seen in mortality between zinc and placebo groups (OR 0.64 (95% CI 0.31 to 1.31)). Time to recovery from severe pneumonia did not differ between the treatment and control groups for patients with severe pneumonia (HR 1.01 (95% CI 0.89 to 1.14)). Removal of four studies with high risk of bias made no difference to the conclusions.ConclusionThere is no evidence that adjunctive zinc treatment improves recovery from pneumonia in children in LMICs.Trial registration numberCRD42019141602.

scholarly journals Morbidity after surgical management of cervical cancer in low and middle income countries: A systematic review and meta-analysis

PLoS ONE ◽  
2019 ◽  
Vol 14 (7) ◽  
pp. e0217775
Author(s):  
Emma R. Allanson ◽  
Aime Powell ◽  
Max Bulsara ◽  
Hong Lim Lee ◽  
Lynette Denny ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Surgical Management ◽  
Meta Analysis ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Results of Cancer Control Education for Primary Care Providers in Low- and Middle-Income Countries

2017 ◽  
Vol 3 (2_suppl) ◽  
pp. 18s-18s
Author(s):  
Vanessa J. Eaton ◽  
Megan K. Kremzier ◽  
Doug Pyle
Keyword(s):  
Primary Care ◽  
Health Workers ◽  
Cancer Control ◽  
Primary Care Providers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Primary Health ◽  
Care Course ◽  
Low And Middle Income

Abstract 28 Background: The global burden of cancer is growing in low- and middle-income countries where availability of specialists to treat cancer is acutely low. To detect cancer earlier, patients must be educated about their risk for cancer and be screened when appropriate. In response to a growing need for cancer education in primary health care, ASCO International created the Cancer Control in Primary Care course, which was piloted in 2015. The purpose of the program is to increase the knowledge of primary health workers so as to recognize signs and symptoms of cancer, increase their ability to talk with patients about their risk, and to know how and when to refer patients for additional screening or diagnostic testing. Methods: ASCO collects data from participants in two stages: an on-site evaluation and a follow-up survey 12 months after the workshop. The survey instruments include questions about practice changes, learning objectives, and demographic information. Results: Follow-up surveys have been conducted for four courses. Ninety-three percent of respondents have reported that they made practice changes after the course. In addition, 90% reported that communication with patients about their risk for cancer had increased, 76% reported that they are screening patients for cancer more than before, and 74% reported that they have worked with specialists to plan treatment for their patients with cancer. Conclusion: Results of the Cancer Control in Primary Care course are positive, and ASCO will continue to collaborate with society and institutional partners to train primary health workers around the world to raise awareness of cancer. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

scholarly journals What interventions are effective in improving uptake and retention of HIV-positive pregnant and breastfeeding women and their infants in prevention of mother to child transmission care programmes in low-income and middle-income countries? A systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e024907 ◽  
Author(s):  
Lisa M Puchalski Ritchie ◽  
Monique van Lettow ◽  
Ba Pham ◽  
Sharon E Straus ◽  
Mina C Hosseinipour ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antenatal Care ◽  
Low Income ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Hiv Positive ◽  
Child Transmission ◽  
Middle Income ◽  
Middle Income Countries ◽  
Mother To Child

ObjectiveThis review was conducted to identify interventions effective in improving uptake and retention of HIV-positive mothers and their infants in prevention of mother to child transmission (PMTCT) services in low-income and middle-income countries (LMICs) in order to inform programme planning.MethodsWe conducted a systematic review of studies comparing usual care with any intervention to improve uptake and retention of HIV-positive pregnant or breastfeeding women and their children from birth to 2 years of age in PMTCT services in LMICs. Twenty-two electronic databases were searched from inception to 15 January 2018, for randomised, quasi-randomised and non-randomised controlled trials, and interrupted time series studies; reference lists of included articles were searched for relevant articles. Risk of bias was assessed using the Cochrane Effective Practice and Organisation of Care group criteria. Random-effects meta-analysis was conducted for studies reporting similar interventions and outcomes.ResultsWe identified 29 837 articles, of which 18 studies were included in our review. Because of heterogeneity in interventions and outcome measures, only one meta-analysis of two studies and one outcome was conducted; we found a statistically significant increase in antiretroviral therapy (ART) use during pregnancy for integration of HIV and antenatal care relative to standard non-integrated care (pooled AOR=2.69; 95% CI 1.25 to 5.78, p=0.0113). The remaining studies assessing other patient, provider or health system interventions were synthesised narratively, with small effects seen across intervention categories for both maternal and infant PMTCT outcomes based predominately on evidence with moderate to high risk of bias.ConclusionsEvidence on the effectiveness of interventions to improve uptake and retention of mothers and infants in PMTCT care is lacking. Our findings suggest that integration of HIV and antenatal care may improve ART use during pregnancy. Future studies to replicate promising approaches are needed. Improved reporting of key methodological criteria will facilitate interpretation of findings and improve the utility of evidence to PMTCT programme planners.PROSPERO registration numberCRD42015020829.

Does a phone text message improve focused antenatal care visit and skill birth attendance in low and middle income countries? A systematic review and meta-analysis of randomized clinical trials (Preprint)

2018 ◽  
Author(s):  
Fasil Wagnew ◽  
Getenet Ayalew Dessie1 ◽  
Animut Ayalew Alebel ◽  
Henok Teshome Mulugeta ◽  
Amanuel Abajobir Alemu
Keyword(s):  
Systematic Review ◽  
Text Messaging ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Skilled Birth Attendance ◽  
Risk Of Bias ◽  
Middle Income ◽  
Middle Income Countries ◽  
Birth Attendance ◽  
Focused Antenatal Care

BACKGROUND Background: Missed appointments are a major cause of inefficiency in healthcare delivery. MHealth has been projected as a possible solution to support women during pregnancy, birth and puerperium period, to increase the uptake of essential maternal services. OBJECTIVE This systematic review and meta-analysis study was aimed to determine the effectiveness of phone text messaging on Focused Antenatal Care (FANC) visits and skilled birth attendance in Low and Middle Income Countries (LMICs). METHODS We searched a broad body of literature from electronic databases–Cochrane review, PsycINFO, PubMed and Google Scholar to offer comprehensive evidence on the role of phone text messaging on FANC visits and skilled birth attendance. We extracted data from only randomized clinical trials (RCTs). Meta-analyses were conducted using random-effects models with inverse variance method in Review Manager (RevMan) computer software. Qualities of the included studies were determined by GRADEpro, and risk of bias was assessed using Cochrane Collaboration risk of bias tool. RESULTS Result: Of the 1,224 non-duplicated articles screened, only 7 RCT studies met eligibility criteria and included in this synthesis. On aggregate, there were statistically significant associations in experimental group in that pregnant mothers who received text messaging had a 74% increase in FANC visits (OR = 2.74 (95% CI: 1.41, 5.32) and 82% in skilled birth attendance (OR = 1.82 (95% CI: 1.33, 2.49). The overall qualities of included studies were moderate, and had low risk of bias. CONCLUSIONS Conclusion: Phone text messaging has positive effects for the uptake of FANC visits and skill birth attendance in LMICs. A short messaging service targeting pregnant woman is an invaluable, affordable intervention to improve maternal healthcare seeking behaviors. CLINICALTRIAL Not applicable

scholarly journals Human Papilloma Virus self-sampling performance in low- and middle-income countries

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ashwini Kamath Mulki ◽  
Mellissa Withers
Keyword(s):  
Cervical Cancer ◽  
Health Workers ◽  
Sub Saharan Africa ◽  
Screening Methods ◽  
Middle Income ◽  
Middle Income Countries ◽  
Novel Approach ◽  
Very High ◽  
Low And Middle Income

Abstract Background Screening for HPV has led to significant reductions in cervical cancer deaths in high-income countries. However, the same results have not been achieved in low- and middle-income countries (LMICs). HPV self-sampling is a novel approach that could improve screening rates. Methods This study’s objective is to summarize the recent literature on HPV self-sampling in LMICs, focusing on sensitivity/specificity, and feasibility/acceptability of self-sampling compared to traditional screening methods. We conducted a PubMed search for articles published in English within the last 10 years on self-sampling in LMICs. Results Fifty eligible articles from 26 countries were included, 19 of which came from sub-Saharan Africa and 18 from Latin America/Caribbean. Seven studies examined sensitivity, with five reporting rates higher than 91%. Six reported on specificity, which was also very high at 86–97.8%. Six studies examined self-sampling concordance with provider-collected sampling, with concordance rates ranging from 87 to 97.5%. A total of 38 studies examined the feasibility/acceptability of HPV self-sampling. Participation rates were very high in all studies, even when self-sampling was done at participants’ homes (over 89% participation). Overall, participants reported that HPV self-sampling was easy to perform (75–97%, 18 studies), painless (60–90%, nine studies), and preferred over provider-collected sampling (57–100%, 14 studies). Eight studies reported follow-up rates for participants who completed self-sampling; however, these rates varied widely-from 13.7 to 90%. The major benefits of self-sampling include convenience of screening from home, less embarrassment, and less travel. Improved education and awareness of self-sampling, combined with support from community health workers, could reduce perceptions of self-sampling being inferior to provider-collected sampling. Improving follow-up of abnormal results and improving linkages to treatment are also essential. Conclusion Our literature review highlights HPV self-sampling is a well-performing test that shows promise in terms of expanding screening efforts for the prevention of cervical cancer-related deaths in LMICs.

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