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Potentials and challenges of using co-design in health services research in low-and middle-income countries

Global Health Research and Policy 2023年第1期8卷 514-521页

作者： Devendra Raj Singh Rajeeb Kumar Sah Bibha Simkhada Zoe Darwin School of Human and Health Sciences University of HuddersfieldHuddersfieldUK

Co-design with people having poor access to health services and fragile health systems in low-and middle-income countries can be momentous in bringing service users and other stakeholders together to improve the delivery and utilisation of health *** is ample of evidence from high-income countries regarding how co-design can translate available evidence into developing acceptable,feasible,and adaptable health solutions in different ***,there is limited literature on co-design in health research in the context of low-and middle-income ***,it is crucial to understand how knowledge about collaborative working can be translated into policy and practice in the context of low-and middle-income ***,this paper discusses the concept of co-design,co-production,and co-creation in health and the potentiality and challenges of using co-design in health services research in low-and middle-income *** the challenges,the co-design research has considerable potential to encourage the meaningful engagement of service users and other stakeholders in developing,implementing,and evaluating real-world solutions in low-and middle-income *** is essential to balance power dynamics in a co-design process through mutual recognition and respect,participant diversity,and reciprocity and flexibility in *** inclusive and collaborative approach to working is complex due to existing rigid hierarchical structures,socio-cultural beliefs,political interference and working ***,this could be minimised by developing transparent terms of reference that reflect the value and benefits of equal partnership in particular co-design work.

关键词： Co-design Potentials Challenges Health services research low-middle-income countries

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Typhoid intestinal perforation in developing countries: Still unavoidable deaths?

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World Journal of Gastroenterology 2017年第11期23卷 1925-1931页

作者： Sandro Contini Department of Surgical Sciences University of Parma43123 ParmaItaly

Typhoid fever is a public health challenge mostly concentrated in impoverished, overcrowded areas of the developing world, with lack of safe drinking and sanitation. The most serious complication is typhoid intestinal perforation(TIP), observed in 0.8% to 39%, with a striking rate difference between high-income and low-middle-income countries. Although the mortality rate consequent to TIP in resource-poor countries is improved in the last decades, it is still fluctuating from 5% to 80%, due to surgical-and not surgical-related constraints. Huge economic costs and long timelines are required to provide a short-to middle-term solution to the lack of safe water and sanitation. Inherent limitations of the currently available diagnostic tools may lead to under-evaluation as well as over-evaluation of the disease, with consequent delayed treatment or inappropriate, excessive antibiotic use, hence increasing the likelihood of bacterial resistance. There is a need for immunization programs in populations at greatest risk, especially in sub-Saharan Africa. Uniform surgical strategies and guidelines, on the basis of sound or prospective surgical studies and adapted to the local realities, are still lacking. Major drawbacks of the surgical treatment are the frequent delays to surgery, either for late diagnosis or for difficult transports, and the unavailable appropriate intensive care units in most peripheral facilities. As a consequence, poor patient's conditions at presentation, severe peritoneal contamination and unsuitable postoperative care are the foremost determinant of surgical morbidity and mortality.

关键词： Typhoid bacterial resistance Typhoid fever Typhoid intestinal perforation Developing countries low-middle-income countries Postoperative care Typhoid vaccination

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