LMICs

Whilst North to South knowledge transfer patterns have been extensively problematised by Southern and decolonial perspectives, there is very little reflection on the practice of research capacity development (RCD), still strongly focused on technoscientific solutionism, yet largely uncritical of its underlying normative directions and power asymmetries. Without making transparent these normative and epistemological dimensions, RCD practices will continue to perpetuate approaches that are likely to be narrow, technocratic and unreflexive of colonial legacies, thus failing to achieve the aims of RCD, namely, the equitable and development-oriented production of knowledge in low- and middle-income societies. Informed by the authors’ direct experience of RCD approaches and combining insights from decolonial works and other perspectives from the margins with Science and Technology Studies, the paper undertakes a normative and epistemological deconstruction of RCD mainstream practice. High...

Sanderson  et  al’s  realist  review  of  strategic  purchasing  identifies  insights  from  two  strands  of  theory:  the  economics of organisation and inter-organisational relationships. Our findings from a programme of research conducted  by  the  RESYST  (Resilient  and  Responsive  Health  Systems)  consortium  in  seven  countries  echo  these  results,  and  add  to  them  the  crucial  area  of  organisational  capacity  to  implement  complex  reforms.  We  identify  key  areas  for  policy  development.  These  are  the  need  for:  (1)  a  policy  design  with  clearly  delineated  responsibilities;  (2)  a  task  network  of  organisations  to  engage  in  the  broad  set  of  functions  needed;  (3)  more  effective means of engaging with populations; (4) a range of technical and management capacities; and (5) an awareness of the multiple agency relationships that are created by the broader financing environment and the provider incentives generated by multiple financing flows.

The Health Management Information System (HMIS) is an essential core component in framing the national health system. To operate six core components synchronically and to manage them successfully inside the health system, HMIS and communication are also placed centrally. However, the unworthy problems of HMIS data have been significantly affected by several characteristics. Among these characteristics, the organizational factors need to be considered as important issues. This systematic review aims to examine what organizational factors are determining the HMIS data quality in LMICs after 2005. Two independent reviewers selected 38 eligible primary published papers from 22 LMICs through three popular online sources: MEDLINE and PubMed, HINARI, and Google and Google Scholar. This finding mainly highlighted that weak organizational structuring and processing, less organizational learning development regarding HMIS, unavailability of HMIS resources, poor governance, and political issues impacted the HMIS data quality in LMICs.

We explore if there is potential to embed psychosocial wellbeing impact in global challenges research where the primary aims are not mental-health-related. We are interested in the use of material practices to deliver impact through routine project activities of working with concrete things together. The UKRI gateway-to-research was searched for information on Global Challenges Research Fund grants from 2015 to May 2020. Analysis shows that only 3% of projects self-categorise as engaging with mental health. Thirty-six non-mental-health GCRF grants were purposefully sampled for diversity and each coded independently by two researchers for relevant information. Findings suggest that: 50-70% of non-mental-health GCRF projects already engage implicitly, but non-strategically, with psychosocial wellbeing impact; opportunities for psychosocial wellbeing impact, from most to least frequent are community mobilisation, community-building, skills development, positive sense of self, positive emotions, and sociocultural identity; presence of material practice from most to least frequent are: (i) interactions between or enactments upon people, (ii) written materials or images, and (iii) objects; when a material practice was present, it was usually considered usable as a focus to enhance psychosocial wellbeing. Our study provides evidence that there are low hanging fruit opportunities to impact psychosocial wellbeing across SDG through routine project activities.

BACKGROUND:
Though road traffic injuries (RTIs) are a major cause of mortality in East Africa, few countries have emergency medical services. The aim was to create a sustainable and efficient prehospital lay first responder program, creating a system with lay first responders spread through the 53 motorcycle taxi stages of Iganga Municipality.
METHODS:
One hundred and fifty-four motorcycle taxi riders were taught a first aid curriculum in partnership with a local Red Cross first aid trainer and provided with a first aid kit following WHO guidelines for basic first aid. Pre- and post-survey tests measured first aid knowledge improvement over the course. Post-implementation incident report forms were collected from lay first responders after each patient encounter over 6 months. Follow-up interviews were conducted with 110 of 154 trainees, 9 months post-training.
RESULTS:
Improvement was measured across all five major first aid categories: bleeding control (56.9 vs. 79.7%), scene management (37.6 vs. 59.5%), airway and breathing (43.4 vs. 51.6%), recovery position (13.1 vs. 43.4%), and victim transport (88.2 vs. 94.3%). From the incident report findings, first responders treated 250 victims (82.8% RTI related) and encountered 24 deaths (9.6% of victims). Of the first aid skills, bleeding control and bandaging was used most often (55.2% of encounters). Lay first responders provided transport in 48.3% of encounters. Of 110 lay first responders surveyed, 70 of 76 who had used at least one skill felt "confident" in the care they provided.
CONCLUSION:
A prehospital care system composed of lay first responders can be developed leveraging existing transport organizations, offering a scalable alternative for LMICs, demonstrating usefulness in practice and measurable educational improvements in trauma skills for non-clinical lay responders.

Prophylactic vaccines for human papillomavirus (HPV) are being introduced in many countries for the prevention of cervical cancer, the second most important cause of cancer-related death in women globally. This is likely to have a significant impact on the future burden of cervical cancer, particularly where screening is non-existent or limited in scale. Previous research on the challenges of vaccinating girls with the HPV vaccine has focused on evidence from developed countries. We conducted a systematic search of the literature in order to describe the barriers and challenges to implementation of HPV vaccine in low-and middle-income countries. We identified literature published post-2006 to September 2012 from five major databases. We validated the findings of the literature review with evidence from qualitative key informant interviews. Three key barriers to HPV vaccine implementation were identified: sociocultural, health systems and political. A linked theme, the sustainability of HPV vaccines programmes in low-and middle-income countries, cuts across these three barriers. Delivering HPV vaccine successfully will require multiple barriers to be addressed. Earlier research in developed countries emphasised sociocul-tural issues as the most significant barriers for vaccine roll-out. Our evidence suggests that the range of challenges for poorer countries is significantly greater, not least the challenge of reaching girls for three doses in settings where school attendance is low and/or irregular. Financial and political barriers to HPV vaccine roll-out continue to be significant for many poorer countries. Several demonstration and pilot projects have achieved high rates of acceptability and coverage and lessons learned should be documented and shared.

In their editorial, Tangcharoensathien et al1 describe the challenges of industry market promotion and policy interference  from  Big  Tobacco,  Alcohol,  and  Food  in  addressing  non-communicable  diseases  (NCDs).  They  provide an overview of the increasing influence of corporate interest in emerging economies and government attempts  to  implement  the  World  Health  Organization  (WHO)  ‘best  buy’  interventions.  The  authors  largely  draw on examples from Asia and a few selected countries, but provide little detail as to how aggressive marketing and  policy  interference  plays  out  in  a  context  of  poor  legislation  and  regulation    in  many  low-  and  middle-income countries (LMICs), where the burden of NCDs is increasing at an alarming rate and governments face a high burden of disease with a limited budget for countering industry interference. This commentary provides some poignant examples of the influence of Big Tobacco, Alcohol, and Food on market regulation and policy interference in LMICs and argues for more policy coherence and accountability in terms of multisectoral action and civil society activism. Securing funds for health promotion and establishing health promotion foundations could help achieve that goal.

Introduction Historical evidence, predominantly from high-income countries (HICs), shows that the tobacco industry uses a recurring set of arguments and techniques when opposing tobacco control policies. This data formed the basis of a model of tobacco industry political activity known as the policy dystopia model (PDM). The PDM has been widely used in tobacco control research and advocacy and has subsequently been shown relevant to other unhealthy commodities industries in both HICs and low-income and middle-income countries (LMICs). Before it can be validated as a generic tool for researching corporate influence on policy, one needs to determine whether the PDM successfully captures contemporary corporate political activities in LMICs.
Method We conducted semistructured interviews with 22 LMIC-based advocates and used the transcripts as the primary data source. The discursive and instrumental taxonomies constituting the PDM served as the starting point for the coding framework. Using thematic analysis, we combined deductive and inductive coding to ensure we captured all strategies from the PDM and the interviews.
Results This study found that the tobacco industry uses a set of discursive and instrumental strategies that is largely consistent across LMICs and with the PDM. We identified several minor contextual nuances absent from the PDM. Some of these nuances were characteristic to individual countries, while others to LMICs more broadly. They included the argument that tobacco control policies unfairly punish reputable tobacco industry actors, and an emphasis on instrumental strategies centred around maintaining a good image, rather than rehabilitating a tarnished image as emphasised in the PDM.
Conclusions Allowing for the nuances identified in this study, the PDM has been found to be fit for purpose. The revised model should now be tested through in-depth LMIC case studies and could be used to facilitate comparative studies of unhealthy commodity industries’ political activities.

Key points:

Technology can help mitigate the effects of the educational crisis and closures of schools, but ed-tech is not a silver bullet and governments need to have realistic expectations about what it can achieve
The digital divide means that internet and mobile network access varies greatly in middle- and low-income countries
Governments can provide immediate support by informing teachers about simple grassroots platforms where they can share their own ed-tech solutions
Educational TV and radio broadcasts in combination with SMS are effective communication channels between educators and students when the internet connectivity is poor or not available
It will be important for education authorities to begin planning how in 12-months’ time they will diagnose and treat the learning gaps that have emerged during the crisis.

Gene drive research is progressing towards future field evaluation of modified mosquitoes for malaria control in sub-Saharan Africa. While many literature sources and guidance point to the inadequacy of individual informed consent for any genetically modified mosquito release, including gene drive ones, (outside of epidemiological studies that might require blood samples) and at the need for a community-level decision, researchers often find themselves with no specific guidance on how that decision should be made, expressed and by whom. Target Malaria, the Kenya Medical Research Institute and the Pan African Mosquito Control Association co-organised a workshop with researchers and practitioners on this topic to question the model proposed by Target Malaria in its research so far that involved the release of genetically modified sterile male mosquitoes and how this could be adapted to future studies involving gene drive mosquito releases for them to offer reflections about potential ...

IntroductionDetermining whether antibiotic prescriptions are inappropriate requires knowledge of patients’ underlying conditions. In low-income and middle-income countries (LMICs), where misdiagnoses are frequent, this is challenging. Additionally, such details are often unavailable for prescription audits. Recent studies using standardised patients (SPs) offer a unique opportunity to generate unbiased prevalence estimates of antibiotic overuse, as the research design involves patients with predefined conditions.MethodsSecondary analyses of data from nine SP studies were performed to estimate the proportion of SP–provider interactions resulting in inappropriate antibiotic prescribing across primary care settings in three LMICs (China, India and Kenya). In all studies, SPs portrayed conditions for which antibiotics are unnecessary (watery diarrhoea, presumptive tuberculosis (TB), angina and asthma). We conducted descriptive analyses reporting overall prevalence of antibiotic overpres...

In contrast to a historical neglect of religious parameters, development studies and practice have increasingly acknowledged the need to integrate faith and religious beliefs in the context of development work in low- and middle-income societies (LMICs) with major development organisations collaborating with faith-based leaders to better-address issues ranging from conflict to HIV/AIDS and gender inequality. However, there is considerable work to be done in order to overcome Eurocentric conceptualisations of ‘religion’ and how the latter’s relationship to ‘culture’ has been theorised historically in order to engage substantively with religious idiom in diverse religio-cultural contexts. In this presentation, we will discuss some of the theoretical colonial underpinnings that hinder development practice from leveraging on the resourcefulness of religious parameters as embedded in wider cosmological, normative and socio-cultural systems. We will discuss the critical decolonial approach followed by project dldl/ድልድል, a project that works to strengthen and develop religio-culturally sensitive domestic violence systems in Ethiopia, Eritrea and the UK. The presentations will reveal the need for nuancing and contextualising the study of issues of international relevance such as domestic violence across diverse religio-cultural contexts and the need for cultivating reflexivity, humility and trust-based partnerships to reverse historical and on-going hierarchical and colonial North-South relationships in development research, knowledge transfer and practice.

CoIs: Professor Jane Plastow University of Leeds
Professor Paul Cooke University of Leeds
Dr Rebecca King University of Leeds
Dr Siobhan Hugh- Jones University of Leeds
Professor Tolib Mirzoev University of Leeds
Dr Erminia Colucci Middlesex University
Dr Rebecca Graber University of Brighton
Professor Stuart Taberner University of Leeds
Dr Karina Croucher University of Bradford
Dr Adrian Evans University of Bradford
Professor Raghu Raghavan De Montfort University
Professor Brian Brown De Montfort University

Our Partner Organisations and associated advisors are:
MIND India https://mindindia.org/ - Dr Sangeeta Goswami
National Institute of Mental Health and Neuroscience, Bangalore https://nimhans.ac.in/  - Professor Santosh Chaturvedi and Professor Poornima Bhola
Center for Public Mental Health, Universitas Gadjah Mada https://iup.psikologi.ugm.ac.id/center-for-puclic-mental-health/ - Dr Diana Setiyawati

Worldwide, one billion people have a mental health disorder, placing these among the leading causes of ill-health and disability. Moreover, poor mental health disproportionately affects people in Low and Middle Income Countries (LMIC) where there exists also a huge mental health workforce gap. Arguably, mental health is a right and tackling poor mental health is also a means of facilitating sustainable socio-economic development. Global Mental Health aligns with Sustainable Development Goal 3: 'Good Health and Well-Being,' specifically 3.4: 'By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.'
Our ambition is to trigger a step-change in how the research community thinks about where, how and by whom mental health in LMICs can be impacted to benefit people experiencing poor mental health. Specifically, we believe there is untapped potential for global researchers to impact mental health whilst delivering their core (non-mental health) project aims, and that this can be done without significant resource implications. Therefore, to accelerate global action on mental health our long-term aim is to produce a Global Mental Health Impact Framework with potential for use in all research in developing countries. Our first stage project will establish a foundation and pathway towards this long-term aim by creating a beta version of the Impact Framework, based on arts and humanities methodologies first, ready for future testing and development across a broad range of GCRF projects in a second stage application. At this second stage, we will also develop an implementation plan to support funders, researchers and LMIC partners to understand and use the Framework.

The Challenge Cluster brings together 16 GCRF projects funded by the AHRC, ESRC and MRC, a University of Leeds (UoL) AHRC-GCRF Network Plus, and UoL AHRC-led GCRF Hub totaling over £6.5 million and collaborator from outside the academy who has worked on non-GCRF ODA-oriented projects. A huge advantage of the Cluster is that it builds on the activities and resources of Praxis: Arts and Humanities for Global Development: an AHRC-led GCRF Hub at the UoL. We will develop our own Praxis Nexus approach to bring together what has been found and engage with researchers, practitioners, and policy-makers to accelerate impact on a cross-national scale commensurate with the significance of the GCRF programme.

Measurable, realistic, achievable objectives for the first-stage 12-month project are to:-
1. Complete a scoping review of (i) material practices and (ii) implicit and explicit mental health activities in non-mental health focused GCRF projects funded to date;
2. Complete a report outlining the basis for a Global Mental Health Impact Framework around collaborative material practices;
3. Develop and strengthen equitable international academic, policy and practitioner partnerships and build capacity in LMIC and the UK; and,
4. Use this work to assist in developing the agenda and programmes of research to be undertaken in the second stage application.
In relation to potential applications and benefits we will:
1. Raise the awareness of UK and LMIC funders, researchers and organisations that they may be missing 'low hanging fruit' opportunities to impact mental health in their portfolios and projects;
2. Provide them with a basic understanding of how Global Mental Health challenges can be conceptualised and identified in non-mental health focused projects; and
3. Explain ways that diverse projects could achieve mental health impact at micro, meso and macro levels as part of their routine activities without overstretching project expertise or resources; and,
4. Stimulate LMIC organisations and government departments to think about how they might integrate mental health impact across their diverse agendas and projects.

Gene drive research is progressing towards future field evaluation of modified mosquitoes for malaria control in sub-Saharan Africa. While many literature sources and guidance point to the inadequacy of individual informed consent for any genetically modified mosquito release, including gene drive ones, (outside of epidemiological studies that might require blood samples) and at the need for a community-level decision, researchers often find themselves with no specific guidance on how that decision should be made, expressed and by whom. Target Malaria, the Kenya Medical Research Institute and the Pan African Mosquito Control Association co-organised a workshop with researchers and practitioners on this topic to question the model proposed by Target Malaria in its research so far that involved the release of genetically modified sterile male mosquitoes and how this could be adapted to future studies involving gene drive mosquito releases for them to offer reflections about potential ...

Gene drive research is progressing towards future field evaluation of modified mosquitoes for malaria control in sub-Saharan Africa. While many literature sources and guidance point to the inadequacy of individual informed consent for any genetically modified mosquito release, including gene drive ones, (outside of epidemiological studies that might require blood samples) and at the need for a community-level decision, researchers often find themselves with no specific guidance on how that decision should be made, expressed and by whom. Target Malaria, the Kenya Medical Research Institute and the Pan African Mosquito Control Association co-organised a workshop with researchers and practitioners on this topic to question the model proposed by Target Malaria in its research so far that involved the release of genetically modified sterile male mosquitoes and how this could be adapted to future studies involving gene drive mosquito releases for them to offer reflections about potential ...

At the start of the pandemic, the Philippines had to send swab samples to the Victorian Infectious Diseases Reference Laboratory in Melbourne, Australia for COVID-19 confirmation. With the increasing number of suspected cases needing confirmatory diagnostic testing, there was a demand to rapidly expand the capacity for widescale testing. Remarkably, within 200 days from announcement of the first confirmed COVID-19 case in the Philippines in January 30, 2020, the country has been able to expand its testing capacity from one national reference laboratory, the Research Institute for Tropical Medicine (RITM), to more than 100 licensed reverse transcription-polymerase chain reaction (RT-PCR) and cartridge-based PCR laboratories across the country. Due to the shortage of a trained clinical laboratory workforce, diagnostic centers are forced to hire additional personnel who have limited experience and technical knowledge and skills of molecular assays, especially in processing specimens, interpreting the results, identifying errors, and troubleshooting, in order to meet the demand of increased testing. Thus, the vulnerability to diagnostic errors, including cross-contamination, is increased and with the tendency for generating false-positive results that can compromise the health of the patient and disrupt the efficacy of public health policies and public health response, surveillance programs, and restrictive measures for containing the outbreak. Hence, this review article aims to present the different sources of contamination in the laboratory setting where RT-PCR assays are conducted, as well as provide efficient, effective and feasible solutions to address these issues, most especially in low-and middle-income countries (LMICs) like the Philippines.

Clinical leadership is recognised as a crucial element in health system strengthening and health policy globally yet it has received relatively little attention in low and middle income countries (LMICs). Moreover, analyses of clinical leadership tend to focus on senior-level individual leaders, overlooking a wider constellation of middle-level leaders delivering health care in practice in a way affected by their health care context. Using the theoretical lens of 'distributed leadership', this paper examines how middle-level leadership is practised and affected by context in Kenyan county hospitals, providing insights relevant to health care in other LMICs. The paper is based on empirical qualitative case studies of clinical departmental leadership in two Kenyan public hospitals, drawing on data gathered through ethnographic observation, interviews and focus groups. We inductively and iteratively coded, analysed and theorised our findings. We found the distributed leadership...

Gene drive research is progressing towards future field evaluation of modified mosquitoes for malaria control in sub-Saharan Africa. While many literature sources and guidance point to the inadequacy of individual informed consent for any genetically modified mosquito release, including gene drive ones, (outside of epidemiological studies that might require blood samples) and at the need for a community-level decision, researchers often find themselves with no specific guidance on how that decision should be made, expressed and by whom. Target Malaria, the Kenya Medical Research Institute and the Pan African Mosquito Control Association co-organised a workshop with researchers and practitioners on this topic to question the model proposed by Target Malaria in its research so far that involved the release of genetically modified sterile male mosquitoes and how this could be adapted to future studies involving gene drive mosquito releases for them to offer reflections about potential ...

IntroductionHistorical evidence, predominantly from high-income countries (HICs), shows that the tobacco industry uses a recurring set of arguments and techniques when opposing tobacco control policies. This data formed the basis of a model of tobacco industry political activity known as the policy dystopia model (PDM). The PDM has been widely used in tobacco control research and advocacy and has subsequently been shown relevant to other unhealthy commodities industries in both HICs and low-income and middle-income countries (LMICs). Before it can be validated as a generic tool for researching corporate influence on policy, one needs to determine whether the PDM successfully captures contemporary corporate political activities in LMICs.MethodWe conducted semistructured interviews with 22 LMIC-based advocates and used the transcripts as the primary data source. The discursive and instrumental taxonomies constituting the PDM served as the starting point for the coding framework. Using...

Whilst North to South knowledge transfer patterns have been extensively problematised by Southern and decolonial perspectives, there is very little reflection on the practice of research capacity development (RCD), still strongly focused on technoscientific solutionism, yet largely uncritical of its underlying normative directions and power asymmetries. Without making transparent these normative and epistemological dimensions, RCD practices will continue to perpetuate approaches that are likely to be narrow, technocratic and unreflexive of colonial legacies, thus failing to achieve the aims of RCD, namely, the equitable and developmentoriented production of knowledge in low-and middle-income societies. Informed by the authors' direct experience of RCD approaches and combining insights from decolonial works and other perspectives from the margins with Science and Technology Studies, the paper undertakes a normative and epistemological deconstruction of RCD mainstream practice. Hi...

Gene drive research is progressing towards future field evaluation of modified mosquitoes for malaria control in sub-Saharan Africa. While many literature sources and guidance point to the inadequacy of individual informed consent for any genetically modified mosquito release, including gene drive ones, (outside of epidemiological studies that might require blood samples) and at the need for a community-level decision, researchers often find themselves with no specific guidance on how that decision should be made, expressed and by whom. Target Malaria, the Kenya Medical Research Institute and the Pan African Mosquito Control Association co-organised a workshop with researchers and practitioners on this topic to question the model proposed by Target Malaria in its research so far that involved the release of genetically modified sterile male mosquitoes and how this could be adapted to future studies involving gene drive mosquito releases for them to offer reflections about potential ...

Whilst North to South knowledge transfer patterns have been extensively problematised by Southern and decolonial perspectives, there is very little reflection on the practice of research capacity development (RCD), still strongly focused on technoscientific solutionism, yet largely uncritical of its underlying normative directions and power asymmetries. Without making transparent these normative and epistemological dimensions, RCD practices will continue to perpetuate approaches that are likely to be narrow, technocratic and unreflexive of colonial legacies, thus failing to achieve the aims of RCD, namely, the equitable and developmentoriented production of knowledge in low-and middle-income societies. Informed by the authors' direct experience of RCD approaches and combining insights from decolonial works and other perspectives from the margins with Science and Technology Studies, the paper undertakes a normative and epistemological deconstruction of RCD mainstream practice. Highlighting asymmetries of power and material resources in knowledge production, the paper's decolonial lens seeks to aid the planning, implementation and evaluation of RCD interventions. Principles of cognitive justice and epistemic pluralism, accessibility enabled by systems thinking and sustainability grounded on localisation are suggested as the building blocks for more reflexive and equitable policies that promote research capacity for the purpose of creating social value and not solely for the sake of perpetuating technoscience. Open Peer Review Reviewer Status AWAITING PEER REVIEW Any reports and responses or comments on the article can be found at the end of the article.

Gene drive research is progressing towards future field evaluation of modified mosquitoes for malaria control in sub-Saharan Africa. While many literature sources and guidance point to the inadequacy of individual informed consent for any genetically modified mosquito release, including gene drive ones, (outside of epidemiological studies that might require blood samples) and at the need for a community-level decision, researchers often find themselves with no specific guidance on how that decision should be made, expressed and by whom. Target Malaria, the Kenya Medical Research Institute and the Pan African Mosquito Control Association co-organised a workshop with researchers and practitioners on this topic to question the model proposed by Target Malaria in its research so far that involved the release of genetically modified sterile male mosquitoes and how this could be adapted to future studies involving gene drive mosquito releases for them to offer reflections about potential ...

In their editorial, Tangcharoensathien et al1 describe the challenges of industry market promotion and policy interference from Big Tobacco, Alcohol, and Food in addressing non-communicable diseases (NCDs). They provide an overview of the increasing influence of corporate interest in emerging economies and government attempts to implement the World Health Organization (WHO) ‘best buy’ interventions. The authors largely draw on examples from Asia and a few selected countries, but provide little detail as to how aggressive marketing and policy interference plays out in a context of poor legislation and regulation in many low- and middleincome countries (LMICs), where the burden of NCDs is increasing at an alarming rate and governments face a high burden of disease with a limited budget for countering industry interference. This commentary provides some poignant examples of the influence of Big Tobacco, Alcohol, and Food on market regulation and policy interference in LMICs and argues ...

AIM: To systematically review the literature on health-related quality of life (HRQoL) of children and adolescents (≤18yo) with cerebral palsy (CP) from low- and middle-income countries(LMICs) to identify trends in HRQoL and areas for future research.
METHOD: We systematically reviewed six key bibliographic databases and two reviewers independently screened results. Peer-reviewed original articles examining HRQoL of children from LMICs were eligible.
RESULTS: A total of 22 524 papers were identified, of which 16, from eight LMICs, were included. Four measures of HRQoL were used; Child Health Questionnaire Parent Form 50(n=5); Paediatric Quality of Life Inventory 3.0 and 4.0 (n=4); CP Quality of Life Questionnaire for Children (n=4); Lifestyle Assessment Questionnaire CP (n=3). Children with CP from LMICs(n=1579; 2–18y) had significantly poorer HRQoL on all instrument dimensions when compared to age-matched controls (p<0.003) and on all except two dimensions when compared to peers in high-income countries (p<0.001). Physical well-being dimensions ofHRQoL were poorest overall and associated with impaired motor function.
INTERPRETATION: Research to improve HRQoL in LMICs is required and should address all aspects of HRQoL. Future research is recommended to incorporate multi-respondent assessment, utilize both general and CP-specific measures of HRQoL, and delineate adolescents as an unique cohort.