Improving mental health among people living with HIV: a review of intervention trials in low- and middle-income countries Comparison of registered and published intervention fidelity assessment in cluster randomised trials of public health interventions in low- and middle-income countries: systematic review protocol A Systematic Review of The Impact of Improved Housing Interventions on Health In Low And Middle Income Tropical Settings. mHealth Interventions in Low and Middle-Income Countries: A Systematic Review Tackling inequalities in obesity: a protocol for a systematic review of the effectiveness of public health interventions at reducing socioeconomic inequalities in obesity amongst children Next steps for meeting the needs of people with severe mental illness in low- and middle-income countries. Adherence to a physical activity intervention among older adults in a post-transitional middle income country: A quantitative and qualitative analysis Community pharmacy services to optimise the use of medications for mental illness: a systematic review Interventions for domestic violence among pregnant women in low- and middle-income countries: a systematic review protocol A systematic review of online interventions for mental health in low and middle income countries: a neglected field Identifying the content of home-based health behaviour change interventions for frail older people: a systematic review protocol Defining and measuring health equity effects in research on task shifting interventions in high-income countries: a systematic review protocol Effects of school-based interventions on mental health stigmatization: a systematic review Value of a mobile information system to improve quality of care by community health workers. Social capital and health: Does egalitarianism matter? A literature review Reducing child conduct problems and promoting social skills in a middle-income country: cluster randomised controlled trial† The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study Cost-Effectiveness of School Support for Orphan Girls to Prevent HIV Infection in Zimbabwe Family-led rehabilitation after stroke in India: the ATTEND trial, study protocol for a randomized controlled trial Helping carers to care--the 10/66 dementia research group's randomized control trial of a caregiver intervention in Russia. Effectiveness of a brief community outreach tobacco cessation intervention in India: a cluster-randomised controlled trial (the BABEX Trial) Cluster-randomised controlled trials of individual and combined water, sanitation, hygiene and nutritional interventions in rural Bangladesh and Kenya: the WASH Benefits study design and rationale Understanding psychological distress among mothers in rural Nepal: a qualitative grounded theory exploration CONSORT-Equity 2017 extension and elaboration for better reporting of health equity in randomised trials Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial.
People living with HIV ( PLWH ) experience greater psychological distress than the general population . Evidence from high-incomes countries suggests that psychological interventions for PLWH can improve mental health symptoms , quality of life , and HIV care engagement . However , little is known about the effectiveness of mental health interventions for PLWH in low- and middle-income countries ( LMICs ) , where the large majority of PLWH reside . This systematized review aims to synthesize findings from mental health intervention trials with PLWH in LMICs to inform the delivery of mental health services in these setting s. A systematic search strategy was undertaken to identify peer- review ed published papers of intervention trials addressing negative psychological states or disorders ( e.g. depression , anxiety ) among PLWH in LMIC setting s. Search results were assessed against pre-established inclusion and exclusion criteria . Data from papers meeting criteria were extracted for synthesis . Twenty-six papers , published between 2000 and 2014 , describing 22 unique interventions were identified . Trials were implemented in sub-Saharan Africa ( n = 13 ) , Asia ( n = 7 ) , and the Middle East ( n = 2 ) , and addressed mental health using a variety of approaches , including cognitive-behavioral ( n = 18 ) , family-level ( n = 2 ) , and pharmacological ( n = 2 ) treatments . Four r and omized controlled trials reported significant intervention effects in mental health outcomes , and 11 preliminary studies demonstrated promising findings . Among the limited mental health intervention trials with PLWH in LMICs , few demonstrated efficacy .  Mental health interventions for PLWH in LMICs must be further developed and adapted for re source -limited setting s to improve effectiveness Background Cluster r and omised trials ( CRTs ) are a key instrument to evaluate public health interventions , particularly in low- and middle-income countries ( LMICs ) . Fidelity assessment examines study processes to gauge whether an intervention was delivered as initially planned . Evaluation of implementation fidelity ( IF ) is required to establish whether the measured effects of a trial are due to the intervention itself and may be particularly important for CRTs of complex interventions . Current CRT reporting guidelines offer no guidance on IF assessment . We will systematic ally review the scientific literature to study current practice s concerning the assessment of IF in CRTs of public health interventions in LMICs . Methods We will include  CRTs of public health interventions in LMICs that planned or assessed IF in either the trial protocol or the main trial report ( or an associated document ) . Search strategies use Medical Subject Headings ( MESH ) and text words related to CRTs , developing countries , and public health interventions . The electronic data base search was developed first for MEDLINE and adapted for the following data bases : EMBASE , CINAHL , PubMed , and EMB Review s , to identify CRT reports in English , Spanish , or French published on or after January 1 , 2012 . To ensure availability of a study protocol , we will include CRTs reporting a registration number in the abstract . For each included study , we will compare planned versus reported assessment of IF , and consider the dimensions of IF studied , and data collection methods used to evaluate each dimension . Data will be synthesis ed using quantitative and narrative techniques . Risk of bias for individual studies will be assessed using the Cochrane Collaboration Risk of Bias Tool criteria and additional criteria related to CRT methods . We will investigate possible sources of heterogeneity by performing subgroup analysis . This review was not eligible for inclusion in the PROSPERO registry . Discussion Fidelity assessment may be a key tool for making studies more reliable , internally valid , and externally generalizable . This review will provide a portrait of current practice s related to the assessment of intervention fidelity in CRTs and offer suggestions for improvement . Results will be relevant to research ers , those who finance health interventions , and for decision-makers who seek the best evidence on public health interventions PHP289 A SyStemAtic Review of tHe imPAct of imPRoved HouSing inteRventionS on HeAltH in low And middle income tRoPicAl Setting S Butt T1 , Von Seidlein L2 1University College London , London , UK , 2Mahidol Oxford Tropical Medicine Research Unit , Bangkok , Thail and Objectives : Housing has a major impact on human health and wellbeing in the developing world directly ( e.g. through household accidents ) and indirectly ( e.g. through mediating contact between occupants and disease vectors ) . The objective of this review was to investigate the impact of improved housing on health in tropical zones of low and middle income countries . MethOds : A systematic review of major health and architecture data bases was conducted in order to identify records reporting the impact of housing features on the health of people living in tropical regions . Information was extracted and reported using a st and ardised form . Results were classified by study characteristics and qualitative trends explored . Results : We identified 120 studies that met the inclusion criteria . Studies covered vector-borne , gastrointestinal and respiratory diseases and household injuries . 76 were observational , 27 were trials ( including 11 r and omised controlled trials ) , 9 were models and 7 were studies considering economic aspects of  housing interventions . Of the economic studies identified , 3 were cost benefit analysis , 3 were cost per disability-adjusted life year ( DALY ) , while 1 measured burden of disease in DALYs . Outcomes were classified as economic ( 7 ) such as DALYs , direct health ( 57 ) such as incidence of diarrhoea , indirect health such as question naires ( 16 ) or surrogate ( 39 ) such as mosquito counts in a house . cOnclusiOns : There have been a considerable number of studies investigating the impact of housing features on health in tropical regions . Most focused on the impact of one or more housing feature on one or more health outcome . A smaller number of studies looked at whole house interventions and there have been few economic evaluations of improved housing interventions . A holistic approach to assessing health in the context of housing and consideration of issues of economics and implementation would be valuable topics for future research The purpose of this review was to determine whether mHealth interventions were effective in low- and middle-income countries in order to create a baseline for the evidence to support mHealth in developing countries . Studies were identified by search ing Medline on 02 October 2014 for articles published in the English language between January 2000 and September 2014 . Inclusion criteria were : 1 ) written in English , 2 ) completion of an mHealth intervention in a low or middle-income country , 3 ) measurement of patient outcomes , and 4 ) participants 18 years of age or older . 7,920 titles were review ed and 7 were determined eligible based on inclusion criteria . Interventions included a cluster r and omized trial , mixed methods study , retrospective comparison of an opt-in text message program , a two-arm proof of concept , single arm trial , a r and omized trial , and a single subject design . Five out of seven of the studies showed significant difference between the control and intervention . Currently there is little evidence on mHealth interventions in developing countries , and existing studies are very diverse ; however initial studies show changes in clinical outcomes , adherence , and health communication , including improved communication with providers , decrease in travel time , ability to receive expert advice , changes in clinical outcomes , and new forms of cost-effective education . While this initial review is promising , more evidence is needed to support and direct system-level re source investment Background There is growing evidence of the impact of overweight and obesity on short- and long-term functioning , health and well-being . Internationally , childhood obesity rates continue to rise in some countries ( for example , Mexico , India , China and Canada ) , although there is emerging evidence of a slowing of this increase or a plateauing in some age groups . In most European countries , the United States and Australia , however , socioeconomic inequalities in relation to obesity and risk factors for obesity are widening . Addressing inequalities in obesity , therefore , has a very high profile on the public health and health services agendas . However , there is a lack of accessible policy-ready evidence on what works in terms of interventions to reduce inequalities in obesity . Methods and design This article describes the protocol for a National Health Service Trust ( NHS ) National Institute for Health Research -funded systematic review of public health interventions at the individual , community and societal levels which might reduce socioeconomic inequalities in relation to obesity amongst children ages 0 to 18 years . The studies will be selected only if ( 1 ) they included a primary outcome that is a proxy for body fatness and ( 2 ) examined differential effects with regard to socioeconomic status ( education , income , occupation , social class , deprivation and poverty ) or the intervention was targeted specifically at disadvantaged groups ( for example , children of the unemployed , lone parents , low income and so on ) or at people who live in deprived areas . A rigorous and inclusive international literature search will be conducted for r and omised and nonr and omised controlled trials , prospect i ve and retrospective cohort studies ( with and /or without control groups ) and prospect i ve repeat cross-sectional studies ( with and /or without control groups ) . The following electronic data bases will be search ed : MEDLINE , Embase , CINAHL , PsycINFO , Social Science Citation Index , ASSIA , IBSS , Sociological Abstract s and the NHS Economic Evaluation Data base . Data base search es will be supplemented with website and grey literature search es . No studies will be excluded on the basis of language , country of origin or publication date . Study inclusion , data extraction and quality appraisal will be conducted by two review ers . Meta- analysis and narrative synthesis will be conducted . The main analysis will examine the effects of ( 1 ) individual , ( 2 ) community and ( 3 ) societal level public health interventions on socioeconomic inequalities in childhood obesity . Interventions will be characterised by their level of action and their approach to tackling inequalities . Context ual information on how such public health interventions are organised , implemented and delivered will also be examined . Discussion In this review , we consider public health strategies which reduce and prevent inequalities in the prevalence of childhood obesity , highlight any gaps in the evidence base and seek to establish how such public health interventions are organised , implemented and delivered . PROSPERO registration number : The explicit inclusion of mental health within the Sustainable Development Goals is a welcome development , borne out of powerful advocacy using public health , economic and human rights arguments . As funding comes on line for scale-up of evidence -based mental health care by task-sharing with primary care , it is time to take stock about care for people affected by severe mental illness ( SMI ) . The existing evidence base for task shared care for SMI provides an imperative to get started , but is skewed towards relatively more affluent and urban population s in middle-income countries where specialist mental health professionals provide most of the care . R and omised , controlled trials and rigorous implementation research on task shared service models are underway which will go some way to improving underst and ing of the quality , safety , effectiveness and acceptability of more widely generalisable care for people with SMI . A sub-group of people with SMI have more complex and long-term needs for care , with a high risk of homelessness , imprisonment and human rights violations as family and social supports become overwhelmed . Case studies from non-governmental organisations provide examples of holistic approaches to rehabilitation , recovery and empowerment of people with SMI , but rigorous comparative studies are needed to identify the most efficient , effective and scalable approaches to care . Health system constraints are emerging as the over-riding barriers to successful task-sharing , highlighting a need to develop and evaluate chronic care models for people with SMI that succeed in reducing premature mortality , improving wellbeing and achieving better social outcomes . Addressing these evidence gaps is essential if task-sharing mental health care is going to deliver on its promise of promoting recovery for the full range of people affected by SMI Objectives The effectiveness of community level interventions depends to a great extent on adherence . Currently , information on factors related to adherence in older adults from developing countries is scarce . Our aim was to identify factors associated to adherence to a physical activity intervention in older adults from a post-transitional middle income country . Design , setting and participants Using a combination of quantitative and qualitative methods we studied 996 older Chilean subjects ( 65–67.9 years at baseline ) with low to medium socioeconomic status from 10 health centers r and omized to receive a physical activity intervention as part of the CENEX cluster trial ( IS RCT N48153354 ) . Measurements Using a multilevel regression model , the relationship between adherence ( defined a priori as attendance at a minimum of 24 physical activity classes spread over at least 12 months ) and individual , intervention-related and context ual factors was evaluated . We also conducted 40 semi-structured interviews with older adults ( n=36 ) and instructors ( n=4 ) . Transcripts of the interviews were analyzed using content analysis to identify barriers and facilitators to adherence . Results Adherence to physical activity intervention was 42.6 % ( CI 95 % 39.5 to 45.6 ) . Depression , diabetes mellitus , percentage of impoverished households and rate of arrests for violent crimes in the neighborhood predicted less adherence ( p<0.05 ) while being retired , participation in physical activity prior to the intervention , and green areas per habitant were positively associated with adherence ( p<0.05 ) . The qualitative interviews identified three primary barriers to adherence : current health problems , lack of time due to commitments for caring for family members , and being employed , and two primary facilitators to adherence : the health benefits attributed to the intervention and the opportunity the classes provided for social interaction with others . Conclusion In order to enhance effectiveness of community exercise interventions , strategies to improve participation should be targeted to older adults from deprived areas and those with psychological and medical conditions The objective of this systematic review was to evaluate the impact of pharmacist delivered community-based services to optimise the use of medications for mental illness . Twenty-two controlled ( r and omised and non-r and omised ) studies of  pharmacists ' interventions in community and residential aged care setting s identified in international scientific literature were included for review . Papers were assessed for study design , service recipient , country of origin , intervention type , number of participating pharmacists , method ological quality and outcome measurement . Three studies showed that pharmacists ' medication counselling and treatment monitoring can improve adherence to antidepressant medications among those commencing treatment when calculated using an intention-to-treat analysis . Four trials demonstrated that pharmacist conducted medication review s may reduce the number of potentially inappropriate medications prescribed to those at high risk of medication misadventure . The results of this review provide some evidence that pharmacists can contribute to optimising the use of medications for mental illness in the community setting . However , more well design ed studies are needed to assess the impact of pharmacists as members of community mental health teams and as providers of comprehensive medicines information to people with schizophrenia and bipolar Background Violence during pregnancy is a global problem , associated with serious health risks for both the mother and baby . Evaluation of interventions targeted for reducing or controlling domestic violence ( DV ) is still in its infancy , and the majority of findings are primarily from high-income countries ( HICs ) . Therefore , there is an urgent need for generating evidence of DV interventions among pregnant women in low- and middle-income countries ( LMICs ) . Methods Preferred Reporting Items for Systematic Review s and Meta-Analyses ( PRISMA ) guidelines will be employed to structure the review . A comprehensive search will be carried out via electronic data bases including MEDLINE , CINAHL , Scopus , Embase , Web of Science , PsycINFO , and The Cochrane library . Gray literature will also be scrutinized for potential articles . An optimal search strategy has been developed following consultations with subject-matter experts and librarians . This search strategy will be adapted to the different data bases . Experimental studies evaluating DV interventions among pregnant women from LMICs will be included in the review . The review will only include literature written in English . Two review ers will independently screen and assess studies for inclusion in the review . A third author will resolve any discrepancies between the review ers . Risk of bias will be assessed based on the Cochrane risk of bias assessment tool , and overall quality of the evidence will be judged using Grading of Recommendations , Assessment , Development , and Evaluation ( GRADE ) criteria . Findings will be presented with the narrative synthesis , and if applicable , they will be further quantified using r and om-effects meta- analysis . Effect size , risk ratio for dichotomous variables , and st and ardized mean differences for continuous variables will be calculated for each outcome using Review Manager 5.3 . Discussion Systematic review s to evaluate the efficacy of interventions to address DV within the perinatal context have been limited . Hence , no one intervention has emerged as substantially effective towards addressing perinatal DV and associated health consequences . The evidence generated from this systematic review will inform research ers and policy makers about the effectiveness of existing DV interventions among pregnant women in LMICs and provide recommendations for future research in this area . This in turn will contribute towards violence prevention in LMICs . Systematic review registration PROSPERO Background . Low and middle income countries ( LMICs ) are facing an increase of the impact of mental health problems while confronted with limited re sources and limited access to mental health care , known as the ‘ mental health gap ’ . One strategy to reduce the mental health gap would be to utilize the internet to provide more widely-distributed and low cost mental health care . We undertook this systematic review to investigate the effectiveness and efficacy of online interventions in LMICs . Methods . We systematic ally search ed the data -bases PubMed , PsycINFO , JMIR , and additional sources . MeSH terms , Thesaurus , and free text keywords were used . We included all r and omized controlled trials ( RCTs ) of online interventions in LMICs . Results . We found only three articles reported results of RCTs on  online interventions for mental health conditions in LMICs , but none of these interventions was compared with an active control condition . Also , the mental health conditions were diverse across the three studies . Conclusions . There is a dearth of studies examining the effect of online interventions  in LMICs , so we can not draw a firm conclusion on its effectiveness . However , given the effectiveness of  online interventions in high income countries and sharp increase of internet access in LMICs , online interventions may offer a potential to help reduce the ‘ mental health gap ’ . More studies are urgently needed in LMICs Background Meeting the needs of the growing number of older people is a challenge for health and social care services . Home-based interventions aim ing to modify health-related behaviours of frail older people have the potential to improve functioning and well-being . Previous review s have focused on whether such interventions are effective , rather than what might make them effective . Recent advances in behavioural science make possible the identification of potential ‘ active ingredients ’ of effective interventions , such as component behaviour change techniques ( BCTs ) , and intended intervention functions ( IFs ; e.g. to educate , to impart skills ) . This paper reports a protocol for a systematic review that seeks to ( a ) identify health behaviour change interventions for older frail people , ( b ) describe the content of these interventions , and ( c ) explore links between intervention content and effectiveness . The protocol is reported in accordance with Preferred Reporting Items for Systematic Review s and Meta-Analyses Protocol s ( PRISMA -P ) 2015 guidelines . Methods / design Studies will be identified through a systematic search of 15 electronic data bases , supplemented by citation tracking . Studies will be retained for review where they report r and omised controlled trials focusing on home-based health promotion delivered by a health professional for frail older people in community setting s , written in English , and either published from 1980 onwards , or , for registered trials only , unpublished but completed with results obtainable from authors . Interventions will be coded for their content ( BCTs , IFs ) and for evidence of effectiveness ( outcome data relating to behavioural and health outcomes ) . Analyses will describe characteristics of all interventions . Interventions for which effectiveness data are available will be categorised into those showing evidence of effectiveness versus those showing no such evidence . The potential for each intervention characteristic to contribute to change in behaviour or health outcomes will be estimated by calculating the percentage of all interventions featuring those characteristics that have shown effectiveness . Discussion Results will reveal the strategies that have been drawn on within home-based interventions to modify the health behaviours of frail older people , and highlight those more associated with positive changes in behaviour and health . Findings from this review will provide a useful basis for underst and ing , developing , and implementing behaviour change interventions in this field . Systematic review registration PROSPERO Introduction Task shifting interventions are intended to both deliver clinical ly effective treatments to reduce disease burden and address health inequities or population vulnerability . Little is known about how health equity and population vulnerability are defined and measured in research focused on task shifting . This systematic review will address the following questions : Among  task shifting interventions in high-income setting s that have been studied using r and omised controlled trials or variants , how are health inequity or population vulnerability identified and defined ? What methods and indicators are used to describe , characterise and measure the population ’s baseline status and the intervention ’s impacts on inequity and vulnerability ? Methods and analysis Studies were identified through data base search es ( MEDLINE , Embase , CINAHL , PsycINFO and Web of Science ) . Eligible studies will be r and omised controlled trials published since 2004 , conducted in high-income countries , concerning task shifting interventions to treat any disease , in any population that may face health disadvantage as defined by the PROGRESS-Plus framework ( place of residence , race/ethnicity/culture/ language , occupation , gender/sex , religion , social capital , socioeconomic position , age , disability , sexual orientation , other vulnerable groups ) . We will conduct independent and duplicate title and abstract screening , then identify related papers from the same programme of research through further data base and manual search ing . From each programme of research , we will extract study details , and definitions and measures of health equity or population vulnerability based on the PROGRESS-Plus framework . Two investigators will assess the quality of reporting and measurement related to health equity and vulnerability using a scale developed for this study . A narrative synthesis will highlight similarities and differences between the gathered studies and offer critical analyses and implication s. Ethics and dissemination This review does not involve primary data collection , does not constitute research on human subjects and is not subject to additional institutional ethics review or informed consent procedures . Dissemination will include open-access peer- review ed publication and academic conference presentations . PROSPERO Registration Number CRD42017049959 Stigmatizing , or discriminatory , perspectives and behaviour , which target individuals on the basis of their mental health , are observed in even the youngest school children . We conducted a systematic review of the published and unpublished , scientific literature concerning the benefits and harms of school-based interventions , which were directed at students 18 years of age or younger to prevent or eliminate such stigmatization . Forty relevant studies were identified , yet only a qualitative synthesis was deemed appropriate . Five limitations within the evidence base constituted barriers to drawing conclusive inferences about the effectiveness and harms of school-based interventions : poor reporting quality , a dearth of r and omized controlled trial evidence , poor methods quality for all research design s , considerable clinical heterogeneity , and inconsistent or null results . Nevertheless , certain suggestive evidence derived both from within and beyond our evidence base has allowed us to recommend the development , implementation and evaluation of a curriculum , which fosters the development of empathy and , in turn , an orientation toward social inclusion and inclusiveness . These effects may be achieved largely by bringing especially but not exclusively the youngest children into direct , structured contact with an infant , and likely only the oldest children and youth into direct contact with individuals experiencing mental health difficulties . The possible value of using educational activities , material s and contents to enhance hypothesized benefits accruing to direct contact also requires investigation . Overall , the curriculum might serve as primary prevention for some students and as secondary prevention for others INTRODUCTION We will be unable to achieve sustained impact on health outcomes with community health worker (CHW)-based interventions unless we bridge the gap between small scale efficacy studies and large scale interventions . Effective strategies to support the management of CHWs are central to bridging the gap . Mobile phones are broadly available , particularly in low and middle income countries ( LAMIC 's ) , where the penetration rate approaches 100 % . In this article we describe how mobile phones may be combined with mobile web-based technology to assist in the management of CHWs in two projects in South Africa . METHODS This paper is a descriptive one , drawing lessons from two R and omised Controlled Trials ( RCT ' s ) , outlining how a mobile phone information system can be utilized to enhance the quality of health interventions . We organized our comprehensive management and supervision system around a previously published management framework . The system is composed of mobile phones utilized by CHWs and a web-based interface utilized by CHW supervisors  . Computerized algorithms were design ed with intervention and assessment protocol s to aid in the real-time supervision and management of CHWs . RESULTS CHWs used mobile phones to initiate intervention visits and trigger content to be delivered during the course of intervention visits . Supervisors used the web-based interface for real-time monitoring of the location , timing , and content of intervention visits . Additional real-time support was provided through direct support calls in the event of crises in the field . CONCLUSION Mobile phone-based information system platforms offer significant opportunities to improve CHW-delivered interventions . The extent to which these efficiency gains can be translated into realized health gains for communities is yet to be tested The aim of the paper is to critically review the notion of  social capital  and review empirical literature on the association between social capital and health across countries . The methodology used for the review includes a systematic search on electronic data bases for peer- review ed published literature . We categorize studies according to level of analysis ( single and multilevel ) and examine whether studies reveal a significant health impact of individual and area level social capital . We compare the study conclusions according to the country 's degrees of economic egalitarianism . Regardless of study design , our findings indicate that a positive association ( fixed effect ) exists between social capital and better health irrespective of countries degree of egalitarianism . However , we find that the between-area variance ( r and om effect ) in health tends to be lower in more egalitarian countries than in less egalitarian countries . Our tentative conclusion is that an association between social capital and health at the individual level is robust with respect to the degree of egalitarianism within a country . Area level or context ual social capital may be less salient in egalitarian countries in explaining health differences across places Background There is an urgent need for effective , affordable interventions to prevent child mental health problems in low- and middle-income countries . Aims To determine the effects of a universal pre-school-based intervention on child conduct problems and social skills at school and at home . Method In a cluster r and omised design , 24 community pre-schools in inner-city areas of Kingston , Jamaica , were r and omly assigned to receive the Incredible Years Teacher Training intervention ( n = 12 ) or to a control group ( n = 12 ) . Three children from each class with the highest levels of teacher-reported conduct problems were selected for evaluation , giving 225 children aged 3–6 years . The primary outcome was observed child behaviour at school . Secondary outcomes were child behaviour by parent and teacher report , child attendance and parents ’ attitude to school . The study is registered as IS RCT N35476268 . Results Children in intervention schools showed significantly reduced conduct problems ( effect size ( ES ) = 0.42 ) and increased friendship skills ( ES = 0.74 ) through observation , significant reductions to teacher-reported ( ES = 0.47 ) and parent-reported ( ES = 0.22 ) behaviour difficulties and increases in teacher-reported social skills ( ES = 0.59 ) and child attendance ( ES = 0.30 ) . Benefits to parents ’ attitude to school were not significant . Conclusions A low-cost , school-based intervention in a middle-income country substantially reduces child conduct problems and increases child social skills at home and at school BACKGROUND Physical activity has a protective effect against  cardiovascular disease ( CVD )  in high-income countries , where physical activity is mainly recreational , but it is not known if this is also observed in lower-income countries , where physical activity is mainly non-recreational . We examined whether different amounts and types of physical activity are associated with lower mortality and CVD  in countries at different economic levels . METHODS In this prospect i ve cohort study , we recruited participants from 17 countries ( Canada , Sweden , United Arab Emirates , Argentina , Brazil , Chile , Pol and , Turkey , Malaysia , South Africa , China , Colombia , Iran , Bangladesh , India , Pakistan , and Zimbabwe ) . Within each country , urban and rural areas in and around selected cities and towns were identified to reflect the geographical diversity . Within these communities , we invited individuals aged between 35 and 70 years who intended to live at their current address for at least another 4 years .  Total physical activity  was assessed using the  International Physical Activity Question naire ( IPQA ) . Participants with pre-existing CVD were excluded from the analyses . Mortality and CVD were recorded during a mean of 6·9 years of follow-up . Primary clinical outcomes during follow-up were mortality plus major CVD ( CVD mortality , incident myocardial infa rct ion , stroke , or heart failure ) , either as a composite or separately . The effects of physical activity on mortality and CVD were adjusted for sociodemographic factors and other risk factors taking into account household , community , and country clustering . FINDINGS Between Jan 1 , 2003 , and Dec 31 , 2010 , 168 916 participants were enrolled , of whom 141 945 completed the IPAQ . Analyses were limited to the 130 843 participants without pre-existing CVD . Compared with low physical activity ( < 600 metabolic equivalents [ MET ] × minutes per week or < 150 minutes per week of moderate intensity physical activity ) , moderate ( 600 - 3000 MET × minutes or 150 - 750 minutes per week ) and high physical activity ( > 3000 MET × minutes or > 750 minutes per week ) were associated with grade d reduction in mortality ( hazard ratio 0·80 , 95 % CI 0·74 - 0·87 and 0·65 , 0·60 - 0·71 ; p<0·0001 for trend ) , and major CVD ( 0·86 , 0·78 - 0·93 ; p<0·001 for trend  ) . Higher physical activity was associated with lower risk of CVD and mortality  in high-income , middle-income , and low-income countries . The adjusted population attributable fraction for not meeting the physical activity guidelines was 8·0 % for mortality and 4·6 % for major CVD , and for not meeting high physical activity was 13·0 % for mortality and 9·5 % for major CVD . Both recreational and non-recreational physical activity were associated with benefits . INTERPRETATION Higher recreational and non-recreational physical activity was associated with a lower risk of mortality and CVD events in individuals from low-income , middle-income , and high-income countries . Increasing physical activity is a simple , widely applicable , low cost global strategy that could reduce deaths and CVD in middle age . FUNDING Population Health Research Institute , the Canadian Institutes of Health Research , Heart and Stroke Foundation of Ontario , Ontario SPOR Support Unit , Ontario Ministry of Health and Long-Term Care , AstraZeneca , Sanofi-Aventis , Boehringer Ingelheim , Servier , GSK , Novartis , King Pharma , and national and local organisations in participating countries that are listed at the end of the Article This cost-effectiveness study analyzes the cost per quality -adjusted life year ( QALY ) gained in a r and omized controlled trial that tested school support as a structural intervention to prevent HIV risk factors among Zimbabwe orphan girl adolescents . The intervention significantly reduced early marriage , increased years of schooling completed , and increased health-related quality of life . By reducing early marriage , the literature suggests the intervention reduced HIV infection . The intervention yielded an estimated US$ 1,472 in societal benefits and an estimated gain of 0.36 QALYs per orphan supported . It cost an estimated US$ 6/QALY gained , about 1 % of annual per capita income in Zimbabwe . That is well below the maximum price that the World Health Organization ( WHO ) Commission on Macroeconomics and Health recommends paying for health gains in low and middle income countries . About half the girls in the intervention condition were boarded when they reached high school . For non-boarders , the intervention ’s financial benefits exceeded its costs , yielding an estimated net cost savings of $ 502 per pupil . Without boarding , the intervention would yield net savings even if it were 34 % less effective in replication . Boarding was not cost-effective . It cost an additional $ 1,234 per girl boarded ( over the 3 years of the study , discounted to present value at a 3 % discount rate ) but had no effect on any of the outcome measures relative to girls in the treatment group who did not board . For girls who did not board , the average cost of approximately 3 years of school support was US$ 973 Background Globally , most strokes occur in low- and middle-income countries , such as India , with many affected people having no or limited access to rehabilitation services . Western models of stroke rehabilitation are often unaffordable in many population s but evidence from systematic review s of stroke unit care and early supported discharge rehabilitation trials suggest that some components might form the basis of affordable interventions in low-re source setting s. We describe the background , history and design of the ATTEND trial , a complex intervention centred on family-led stroke rehabilitation in India . Methods / design The ATTEND trial aims to test the hypothesis that a family-led caregiver-delivered home-based rehabilitation intervention , design ed for the Indian context , will reduce the composite poor outcome of death or dependency at 6 months after stroke , in a multicentre , individually r and omized controlled trial with blinded outcome assessment , involving 1200 patients across 14 hospital sites in India . Discussion The ATTEND trial is testing the effectiveness of a low-cost rehabilitation intervention that could be widely generalizable to other low- and middle-income countries . Trial registration Clinical Trials Registry-India CTRI/2013/04/003557 . Australian New Zeal and Clinical Trials Registry ACTRN12613000078752 . Universal Trial Number U1111 - 1138 - 6707 OBJECTIVES Dementia is a rapidly growing public health problem in low and middle income countries . There is an urgent need , in the absence of formal services , to develop interventions design ed to improve the lives of people with dementia , and their families . This study tests the effectiveness of the 10/66 caregiver intervention among people with dementia , and their carers . DESIGN A single blind parallel group r and omized controlled trial ( IS RCT N41039907 ) . SETTING Moscow . PARTICIPANTS Sixty family caregivers of people aged 65 and over with dementia were r and omized to receive the intervention and medical care as usual ( n = 30 ) or medical care as usual only ( n = 30 ) . Caregiver and person with dementia outcomes were assessed at baseline and after 6 months . INTERVENTION The caregiver education and training intervention was delivered over five , weekly , half-hour sessions and was made up of three modules : ( i ) assessment ( one session ) ; ( ii ) basic education about dementia ( two sessions ) ; and ( iii ) training regarding specific problem behaviors ( two sessions ) . MEASUREMENTS Dementia was diagnosed using DSM-IV criteria . Caregiver : Zarit Carer Burden Interview ; carer psychological distress ( SRQ 20 ) ; and carer Quality of Life ( WHOQOL-BREF ) . Person with dementia : Behavioural and Psychological symptoms ( NPI-Q ) ; quality of life ( DEMQOL ) . RESULTS Caregivers in the intervention group reported large and statistically significant net improvements at 6-month follow-up in burden compared to controls . No group differences were found on caregiver psychological distress and patient and caregiver quality of life . CONCLUSIONS The low-level intervention seems to be as , if not more , effective than similar interventions applied in high income countries Background Tobacco use kills half a million people every month , most in low – middle income countries ( LMICs ) . There is an urgent need to identify potentially low-cost , scalable tobacco cessation interventions for these countries . Objective To evaluate a brief community outreach intervention delivered by health workers to promote tobacco cessation in India . Design Cluster-r and omised controlled trial . Setting 32 low-income administrative blocks in Delhi , half government authorised ( ‘ resettlement colony ’ ) and half unauthorised ( ‘ J.J. cluster ’ ) communities . Participants 1213 adult tobacco users . Interventions Administrative blocks were computer r and omised in a 1:1 ratio , to the intervention ( 16 clusters ; n=611 ) or control treatment ( 16 clusters ; n=602 ) , delivered and assessed at individual level between 07/2012 and 11/2013 . The intervention was single session quit advice ( 15 min ) plus a single training session in yogic breathing exercises ; the control condition comprised very brief quit advice ( 1 min ) alone . Both were delivered via outreach , with contact made though household visits . Measurements The primary outcome was 6-month sustained abstinence from all tobacco , assessed 7 months post intervention delivery , biochemically verified with salivary cotinine . Results The smoking cessation rate was higher in the intervention group ( 2.6 % ( 16/611 ) ) than in the control group ( 0.5 % ( 3/602 ) ) ( relative risk=5.32 , 95 % CI 1.43 to 19.74 , p=0.013 ) . There was no interaction with type of tobacco use ( smoked vs smokeless ) . Results did not change material ly in adjusted analyses , controlling for participant characteristics . Conclusions A single session community outreach intervention can increase tobacco cessation in LMIC . The effect size , while small , could impact public health if scaled up with high coverage . Trial registration number IS RCT CN23362894 Introduction Enteric infections are common during the first years of life in low-income countries and contribute to growth faltering with long-term impairment of health and development . Water quality , sanitation , h and washing and nutritional interventions can independently reduce enteric infections and growth faltering . There is little evidence that directly compares the effects of these individual and combined interventions on diarrhoea and growth when delivered to infants and young children . The objective of the WASH Benefits study is to help fill this knowledge gap . Methods and analysis WASH Benefits includes two cluster-r and omised trials to assess improvements in water quality , sanitation , h and washing and child nutrition — alone and in combination — to rural households with pregnant women in Kenya and Bangladesh . Geographically matched clusters ( groups of household compounds in Bangladesh and villages in Kenya ) will be r and omised to one of six intervention arms or control . Intervention arms include water quality , sanitation , h and washing , nutrition , combined water+sanitation+h and washing ( WSH ) and WSH+nutrition . The studies will enrol newborn children ( N=5760 in Bangladesh and N=8000 in Kenya ) and measure outcomes at 12 and 24 months after intervention delivery . Primary outcomes include child length-for-age Z-scores and caregiver-reported diarrhoea . Secondary outcomes include stunting prevalence , markers of environmental enteropathy and child development scores ( verbal , motor and personal/social ) . We will estimate unadjusted and adjusted intention-to-treat effects using semiparametric estimators and permutation tests . Ethics and dissemination Study protocol s have been review ed and approved by human subjects review boards at the University of California , Berkeley , Stanford University , the International Centre for Diarrheal Disease Research , Bangladesh , the Kenya Medical Research Institute , and Innovations for Poverty Action . Independent data safety monitoring boards in each country oversee the trials . This study is funded by a grant from the Bill & Melinda Gates Foundation to the University of California , Berkeley . Registration Trial registration identifiers ( http://www . clinical trials.gov ) : NCT01590095 ( Bangladesh ) , NCT01704105 ( Kenya ) Background There is a large burden of psychological distress in low and middle-income countries , and culturally relevant interventions must be developed to address it . This requires an underst and ing of how distress is experienced . We conducted a qualitative grounded theory study to underst and how mothers experience and manage distress in Dhanusha , a low-re source setting in rural Nepal . We also explored how distressed mothers interact with their families and the wider community . Methods Participants were identified during a cluster-r and omised controlled trial in which mothers were screened for psychological distress using the 12-item General Health Question naire ( GHQ-12 ) . We conducted 22 semi-structured interviews with distressed mothers ( GHQ-12 score ≥5 ) and one with a traditional healer ( dhami ) , as well as 12 focus group discussion s with community members . Data were analysed using grounded theory methods and a model was developed to explain psychological distress in this setting . Results We found that distress was termed tension by participants and mainly described in terms of physical symptoms . Key perceived causes of distress were poor health , lack of sons , and fertility problems . Tension developed in a context of limited autonomy for women and perceived duty towards the family . Distressed mothers discussed several strategies to alleviate tension , including seeking treatment for perceived physical health problems and tension from doctors or dhamis , having repeated pregnancies until a son was delivered , manipulating social circumstances in the household , and deciding to accept their fate . Their ability to implement these strategies depended on whether they were able to negotiate with their in-laws or husb and s for re sources . Conclusions Vulnerability , as a consequence of gender and social disadvantage , manifests as psychological distress among mothers in Dhanusha . Screening tools incorporating physical symptoms of tension should be envisaged , along with interventions to address gender inequity , support marital relationships , and improve access to perinatal healthcare We outline CONSORT-Equity 2017 reporting st and ards , an extension to the CONSORT ( Consoli date d St and ards of Reporting Trials ) statement that aims to improve the reporting of intervention effects in r and omised trials where health equity is relevant . Health inequities are unfair differences in health that can be avoided by reasonable action . We defined a r and omised trial where health equity is relevant as one that assesses effects on health equity by evaluating an intervention focused on people experiencing social disadvantage or by exploring the difference in the effect of the intervention between two groups ( or as a gradient across more than two groups ) experiencing different levels of social disadvantage , or both . We held a consensus meeting with diverse potential users from high , middle , and low income countries , including knowledge users such as patients and method ologists . We discussed evidence for each proposed extension item from empirical studies , review s , key informant interviews , and an online survey , aim ing to improve clarity of reporting without imposing undue burden on authors . The new guidance contains equity extensions to 16 items from CONSORT 2010 plus one new item on research ethics reporting , with examples of good practice and a brief explanation and elaboration for each . Widespread uptake of this guidance for the reporting of trials where health equity is relevant will make it easier for decision makers to find and use evidence from r and omised trials to reduce unfair inequalities in health BACKGROUND Group cognitive stimulation therapy programmes can benefit cognition and quality of life for people with dementia . Evidence for home-based , carer-led cognitive stimulation interventions is limited . OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of carer-delivered individual cognitive stimulation therapy ( iCST ) for people with dementia and their family carers , compared with treatment as usual ( TAU ) . DESIGN A multicentre , single-blind , r and omised controlled trial assessing clinical effectiveness and cost-effectiveness . Assessment s were at baseline , 13 weeks and 26 weeks ( primary end point ) . SETTING Participants were recruited through Memory Clinics and Community Mental Health Teams for older people . PARTICIPANTS A total of 356 caregiving dyads were recruited and 273 completed the trial . INTERVENTION iCST consisted of structured cognitive stimulation sessions for people with dementia  , completed up to three times weekly over 25 weeks . Family carers were supported to deliver the sessions at home . MAIN OUTCOME MEASURES Primary outcomes for the person with dementia were cognition and quality of life . Secondary outcomes included behavioural and psychological symptoms , activities of daily living , depressive symptoms and relationship quality . The primary outcome for the family carers was mental/physical health ( Short Form question naire-12 items ) . Health-related quality of life ( European Quality of Life-5 Dimensions ) , mood symptoms , resilience and relationship quality comprised the secondary outcomes . Costs were estimated from health and social care and societal perspectives . RESULTS There were no differences in any of the primary outcomes for people with dementia between intervention and TAU [ cognition : mean difference -0.55 , 95 % confidence interval ( CI ) -2.00 to 0.90 ; p-value = 0.45 ; self-reported quality of life : mean difference -0.02 , 95 % CI -1.22 to 0.82 ; p-value = 0.97 at the 6-month follow-up ] . iCST did not improve mental/physical health for carers . People with dementia in the iCST group experienced better relationship quality with their carer , but there was no evidence that iCST improved their activities of daily living , depression or behavioural and psychological symptoms . iCST seemed to improve health-related quality of life for carers but did not benefit carers ' resilience or their relationship quality with their relative . Carers conducting more sessions had fewer depressive symptoms . Qualitative data suggested that people with dementia and their carers experienced better communication owing to iCST . Adjusted mean costs were not significantly different between the groups . From the societal perspective , both health gains and cost savings were observed . CONCLUSIONS iCST did not improve cognition or quality of life for people with dementia , or carers ' physical and mental health . Costs of the intervention were offset by some reductions in social care and other services . Although there was some evidence of improvement in terms of the caregiving relationship and carers ' health-related quality of life , iCST does not appear to deliver clinical benefits for cognition and quality of life for people with dementia . Most people received fewer than the recommended number of iCST sessions . Further research is needed to ascertain the clinical effectiveness of carer-led cognitive stimulation interventions for people with dementia . TRIAL REGISTRATION Current Controlled Trials IS RCT N65945963 . FUNDING This project was funded by the National Institute of Health Research ( NIHR ) Health Technology Assessment ( HTA ) programme and will be published in full in Health Technology Assessment ; Vol . 19 , No. 64 . See the NIHR Journals Library website for further information
We identified three primary mechanisms of spillovers : reduced disease transmission , social proximity and substitution of re sources within households .
We found the strongest evidence for spillovers through reduced disease transmission , particularly vaccines and mass drug administration .
In general , the proportion of a population receiving an intervention was associated with improved health .
We found evidence of publication bias for certain spillover estimates but not for total or direct effects .
Conclusions We found the strongest evidence for spillovers from vaccines and mass drug administration to control infectious disease .
There was little high quality evidence of spillovers for other interventions
Background Many interventions delivered to improve health may benefit not only direct recipients but also people in close physical or social proximity .
Our objective was to review all published literature about the spillover effects of interventions on health outcomes in low-middle income countries and to identify methods used in estimating these effects .