BackgroundLong-term exposure to particulate matter (PM) has essential and profound effects on human health, but most current studies focus on high-income countries. Evidence of the correlations between PM and health effects in low- and middle-income countries (LMICs), especially the risk factor PM1 (particles < 1 mu m in size), remains unclear. ObjectiveTo explore the effects of long-term exposure to particulate matter on the morbidity and mortality of cardiovascular and respiratory diseases in LMICs. MethodsA systematic search was conducted in the PubMed, Web of Science, and Embase databases from inception to May 1, 2022. Cohort studies and case-control studies that examine the effects of PM1, PM2.5, and PM10 on the morbidity and mortality of cardiovascular and respiratory diseases in LMICs were included. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Outcomes were analyzed via a random effects model and are reported as the relative risk (RR) with 95% CI. ResultsOf the 1,978 studies that were identified, 38 met all the eligibility criteria. The studies indicated that long-term exposure to PM2.5, PM10, and PM1 was associated with cardiovascular and respiratory diseases: (1) Long-term exposure to PM2.5 was associated with an increased risk of cardiovascular morbidity (RR per 1.11 mu g/m(3), 95% CI: 1.05, 1.17) and mortality (RR per 1.10 mu g/m(3), 95% CI: 1.06, 1.14) and was significantly associated with respiratory mortality (RR 1.31, 95% CI: 1.25, 1.38) and morbidity (RR 1.08, 95% CI: 1.02, 1.04); (2) An increased risk of respiratory mortality was observed in the elderly (65+ years) (RR 1.21, 95% CI: 1.00, 1.47) with long-term exposure to PM2.5; (3) Long-term exposure to PM10 was associated with cardiovascular morbidity (RR 1.07, 95% CI 1.01, 1.13), respiratory morbidity (RR 1.43, 95% CI: 1.21, 1.69) and respiratory mortality (RR 1.28, 95% CI 1.10, 1.49); (4) A significant association between long-term exposure to PM1 and cardiovascular disease was also observed. ConclusionsLong-term exposure to PM2.5, PM10 and PM1 was all related to cardiovascular and respiratory disease events. PM2.5 had a greater effect than PM10, especially on respiratory diseases, and the risk of respiratory mortality was significantly higher for LMICs than high-income countries. More studies are needed to confirm the effect of PM1 on cardiovascular and respiratory diseases.

Background: Gestational weight gain (GWG) below or above the Institute of Medicine (IOM) recommendations has been associated with adverse perinatal outcomes. Few studies have examined the effect of prenatal nutrient supplementations on GWG in low- and middle-income countries (LMICs). Objectives: We aimed to investigate the effects of multiple micronutrient supplements (MMSs) and small-quantity lipid-based nutrient supplements (LNSs) on GWG in LMICs. Methods: A 2-stage meta-analysis of individual participant data was conducted to examine the effects of MMSs (45,507 women from 14 trials) and small-quantity LNSs (6237 women from 4 trials) on GWG compared with iron and folic acid supplements only. Percentage adequacy of GWG and total weight gain at delivery were calculated according to the IOM 2009 guidelines. Binary outcomes included severely inadequate (percentage adequacy 125%) GWG. Results from individual trials were pooled using fixed-effects inverse-variance models. Heterogeneity was examined using I2, stratified analysis, and meta-regression. Results: MMSs resulted in a greater percentage adequacy of GWG [weighted mean difference (WMD): 0.86%; 95% CI: 0.28%, 1.44%; P < 0.01] and higher GWG at delivery (WMD: 209 g; 95% CI: 139, 280 g; P < 0.01) than among those in the control arm. Women who received MMSs had a 2.9% reduced risk of severely inadequate GWG (RR: 0.971; 95% CI: 0.956, 0.987; P < 0.01). No association was found between small-quantity LNSs and GWG percentage adequacy (WMD: 1.51%; 95% CI: -0.38%, 3.40%; P = 0.21). Neither MMSs nor small-quantity LNSs were associated with excessive GWG. Conclusions: Maternal MMSs were associated with greater GWG percentage adequacy and total GWG at delivery than was iron and folic acid only. This finding is consistent with previous results on birth outcomes and will inform policy development and local recommendations of switching routine prenatal iron and folic acid supplements to MMSs.

Background: Nurses provide 90% of health care worldwide, yet little is known of the experiences of nurses and midwives in policy development in low- and middle-income countries (LMICs). Objective: To identify, appraise and synthesize the qualitative evidence on the experiences of nurses' and midwives' involvement in policy development LMICs. Design: A qualitative systematic review using modified Joanna Briggs Institute (JBI) methodology. Setting: Low and middle-income countries. Participants: Nurses' and midwives' involved in policy development, implementation, and/or evaluation. Methods: A systematic search was undertaken across nine databases to retrieve published studies in English between inception and April of 2021. Screening, critical appraisal, and data extraction was undertaken by two independent reviewers. Results: Ten articles met inclusion criteria. All studies were published between 2000 to 2021 from a variety of LMICs. The studies were medium to high quality (70-100% critical appraisal scores). Four major themes were identified related to policy development: 1) Marginal representation of nurses; 2) Determinants of nurses' involvement (including at the individual, organization, and systematic level); 3) Leadership as a pathway to involvement; 4) Promoting nurses' involvement. Conclusion: All studies demonstrated that nurses and nurse midwives continue to be minimally involved in policy development. Findings reveal reasons for nurses' limited involvement and strategies to foster sustained engagement of nurses in policy development in LMICs. To enhance their involvement in policy development in LMICs, change is needed at multiple levels. Systemic power relations need to be reconstructed to facilitate more collaborative interdisciplinary practices with nurses co-leading and co-developing health care policies.

Introduction: Information on immunization delivery costs (IDCs) is essential for better planning and budgeting for the sustainability and performance of national programs. However, delivery cost evidence is fragmented and of variable quality, making it difficult for policymakers, planners, and other stakeholders to understand and use. This study aimed to consolidate and summarize the evidence on delivery costs, answering the question: What are the unit costs of vaccine delivery across low- and middle-income countries (LMICs) and through a variety of delivery strategies? Methods: We conducted a systematic review of over 15,000 published and unpublished resources from 2005 to 2018 that included IDCs in LMICs. We quality-rated and extracted data from 61 resources that contained 410 immunization delivery unit costs (e.g., cost per dose, cost per fully immunized child). We converted cost findings to a common year (2016) and currency (U.S. dollars) to ensure comparability across studies and settings. We performed a descriptive and gap analysis and developed immunization delivery cost ranges using comparable unit costs for single vaccines and schedules of vaccines. Results: The majority of IDC evidence comes from low-income countries and Sub-Saharan Africa. Most unit costs are presented as cost per dose and represent health facility-based delivery. Discussion: The cost ranges may be higher than current estimates used in many LMICs for budgeting: $0.16-$2.54 incremental cost per dose (including economic, financial, and fiscal costs) for single, newly introduced vaccines, and $0.75-$9.45 full cost per dose (economic costs) for schedules of four to eight vaccines delivered to children under one. Conclusions: Despite increased attention on improving coverage and strengthening immunization delivery, evidence on the cost of delivery is nascent but growing. The cost ranges can inform planning and policymaking, but should be used with caution given their width and the few unit costs used in their development.

AIMS: To summarize evidence for the efficacy of smoking cessation interventions in low- and middle-income countries (LMICs). DESIGN: Systematic review and meta-analysis of randomized controlled trials SETTING: LMICs as defined by the World Bank PARTICIPANTS: Adult current cigarette smokers residing in LMICs INTERVENTIONS: Behavioral and/or pharmacotherapy smoking cessation interventions. MEASUREMENTS: PubMed MEDLINE, EMBASE (embase.com), Cochrane Central Register of Controlled Trials (Wiley), PsycINFO (Ebsco), SciELO, WHO Global Index Medicus and Scopus were searched from inception through 4/4/2018. Only studies with at least 6 months of follow-up were included. We used the most rigorous assessment of abstinence reported by each study. Effect sizes were computed from abstracted data. Where possible, a meta-analysis was done using Mantel-Haenzel random effect models reporting odds ratios (OR) and 95% confidence interval (CI). FINDINGS: Twenty-four randomized controlled trials were included. Six investigated the efficacy of pharmacologic agents. Four trials that compared nicotine replacement therapy (NRT) to placebo found NRT improved cessation rates (n=1230, OR 1.76, 95% CI 1.30-2.77, P<0.001, I(2) = 13%). Eight trials found that behavioral counseling was more effective than minimal interventions (e.g., brief advice); n=5,735, OR 6.87, 95% CI 4.18-11.29, P<0.001, I(2) = 67%). There was also evidence of the benefit of brief advice over usual care (n=728, OR 2.46, 95% CI 1.56-3.88, P< 0.001, I(2) =0%). CONCLUSION: Nicotine replacement therapy, behavioral counseling and brief advice appear to be effective in aiding smoking cessation in low- and middle-income countries. There is limited rigorous research on other smoking cessation interventions in these regions.

Adequate support for lactating mothers is crucial to improve the rates of early initiation, exclusive, and continued breastfeeding. Maternal breastfeeding intention and ongoing breastfeeding duration are strongly predicted by their partners' breastfeeding beliefs. Partner support has a significant effect on improving rates of any and exclusive breastfeeding, when compared with professional support, particularly in low-income populations. This systematic review investigates the effectiveness of breastfeeding interventions targeting fathers in low- and middle-income countries (LMIC). A systematic literature search was undertaken on Medline (EBSCOhost), PsycInfo, CINAHL, and Scopus databases and via manual searching. Inclusion criteria were experimental or quasiexperimental designs targeting fathers from LMIC, which measured either breastfeeding initiation, breastfeeding exclusivity, or duration of breastfeeding as the main outcomes. No time restriction was put in place, and all articles were published in English. The quality of selected papers was assessed using the Joanna Briggs Institute tool. A total of 8 articles were included from 6 interventions: 2 quasiexperimental and 4 randomized control trials. All interventions involved breastfeeding education targeting fathers; 2 were given only to fathers, and 4 delivered to both fathers and mothers. Among these interventions, 2 measured both early initiation and exclusive breastfeeding; one exclusive breastfeeding only; one exclusive breastfeeding, knowledge, and attitudes; one exclusive breastfeeding and knowledge; and one breastfeeding, continued breastfeeding, and awareness. Across all interventions, breastfeeding education showed significant improvement in breastfeeding outcomes in the intervention compared with the control groups. In summary, breastfeeding education interventions targeting fathers in LMIC are effective in improving early initiation of breastfeeding, exclusive breastfeeding, and continued breastfeeding. Thus, breastfeeding promotion should consider the education and involvement of fathers in the intervention.

BACKGROUND: Over 11.7 million people are currently receiving antiretroviral therapy in low- and middle-income countries and focused efforts are needed to ensure high levels of adherence and to minimize treatment failure. Recently, international targets have emphasized the importance of long-term virological suppression as a key measure of programme performance. METHODS: We systematically reviewed publications and conference abstracts published between January 2006 and May 2013 which reported virological outcomes among HIV-1 infected adults receiving first-line antiretroviral therapy for up to 5 years in low- and middle-income countries. Summary estimates of virological suppression after 6, 12, 24, 36, 48 and 60 months of antiretroviral therapy were analysed using random-effects meta-analysis. Intention-to-treat analysis assumed all participants who were lost-to-follow-up, deceased or stopped antiretroviral therapy as had virological failure. RESULTS: Summary estimates of virological suppression remained >80% up to 60 months of antiretroviral therapy for all 184 included cohorts. Intention-to-treat analysis yielded 74.7% (95%CI: 72.2-77.2) suppression after 6 months and to 61.8% (95%CI: 44.0-79.7) suppression after 48 months on antiretroviral therapy. Switches to second-line antiretroviral therapy were reported scarcely. CONCLUSIONS: Among individuals retained on antiretroviral therapy, virological suppression rates during the first 5 years of antiretroviral therapy were high (>80%) and stable. Suppression rates in intention-to-treat analysis declined during 4 years