Despite worldwide uptake, there has been little published evaluation of actually delivering the World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) in typical low- and middle-income countries (LMICs). This paper aims to evaluate the impact of a pilot study in which mhGAP guidelines for mental health sensitisation of community leaders were implemented in 1-day training events across 25 urban and rural health facilities (n = 1004 community leaders) in Uganda. A multiple choice mental health questionnaire was used to assess the community leaders’ mental health knowledge before and after completing the training. Training was evaluated across multiple sites and qualitative feedback comments were used to identify key themes on the impact of the training. The sensitisation training was found to be affordable, accessible and effective, and could be replicated in other LMICs and settings with local adaptations.

Hypertensive disorders of pregnancy (HDP) and postpartum depression (PPD) are significant global health challenges affecting maternal and child well-being. HDP, including pre-eclampsia, gestational hypertension, and chronic hypertension, complicate up to 10% of pregnancies worldwide, with profound implications for maternal mortality, particularly in low- to middle-income countries (LMICs) like Ghana. The incidence of HDP is rising globally, contributing substantially to maternal deaths and severe perinatal outcomes such as stillbirth and low birth weight. Concurrently, perinatal mental health issues, including PPD, affect a significant proportion of women globally, with higher prevalence rates observed in LMICs. Despite the known physiological impacts of HDP, their association with maternal mental health remains underexplored, especially in LMIC contexts. A systematic review and meta-analysis were conducted to explore the association between HDP and PPD in LMICs, focusing on available literature and studies from diverse global settings. Additionally, semi-structured qualitative interviews were conducted with healthcare professionals in Ghana to gather insights into local perspectives and experiences regarding this association. The systematic review revealed a consistent association between HDP and increased risk of PPD across various LMIC settings. Meta-analysis findings indicated a significant pooled odds ratio, highlighting a robust statistical linkage between HDP severity and subsequent PPD risk. Qualitative data underscored healthcare professionals’ observations of heightened psychological distress among women with HDP, emphasizing the complex interplay between physiological complications and maternal mental health outcomes in the Ghanaian context. The study findings underscore the critical need for integrated maternal health strategies that address both physical and psychological aspects of pregnancy complications like HDP. By elucidating these connections, the study contributes to advancing evidence-based interventions and support systems tailored to LMIC settings, aiming to mitigate adverse maternal mental health outcomes and improve overall perinatal care in Ghana and similar contexts worldwide. These insights are pivotal for informing policy decisions, guiding healthcare practices, and fostering targeted interventions that enhance maternal well-being during the vulnerable perinatal period.

Traditional faith healers (TFHs) are often consulted for serious mental illness (SMIs) in low- and middle-income countries (LMICs). Involvement of TFHs in mental healthcare could provide an opportunity for early identification and intervention to reduce the mental health treatment gap in LMICs. The aim of this study was to identify models of collaboration between TFHs and biomedical professionals, determine the outcomes of these collaborative models and identify any mechanisms (i.e., explanatory processes) or contextual moderators (i.e., barriers and facilitators) of these outcomes. A systematic scoping review of five electronic databases was performed from inception to March 2023 guided by consultation with local experts in Nigeria and Bangladesh. Data were extracted using a predefined data charting form and synthesised narratively. Six independent studies (eight articles) satisfied the inclusion criteria. Study locations included Ghana (n = 1), Nigeria (n = 1), Nigeria and Ghana (n = 1), India (n = 1), Hong Kong (n = 1) and South Africa (n = 1). We identified two main intervention typologies: (1) Western-based educational interventions for TFHs and (2) shared collaborative models between TFHs and biomedical professionals. Converging evidence from both typologies indicated that education for TFHs can help reduce harmful practices. Shared collaborative models led to significant improvements in psychiatric symptoms (in comparison to care as usual) and increases in referrals to biomedical care from TFHs. Proposed mechanisms underpinning outcomes included trust building and empowering TFHs by increasing awareness and knowledge of mental illness and human rights. Barriers to implementation were observed at the individual (e.g., suspicions of TFHs), relationship (e.g., reluctance of biomedical practitioners to equalise their status with TFHs) and service (e.g., lack of formal referral systems) levels. Research on collaborative models for mental healthcare is in its infancy. Preliminary findings are encouraging. To ensure effective collaboration, future programmes should incorporate active participation from community stakeholders (e.g., patients, caregivers, faith healers) and target barriers to implementation on multiple levels.

Conventional benefit–cost analysis is well-established and widely used to assess interventions designed to improve public health and welfare. While it has many advantages, it has well-known limitations. Chief among these is its inattention to the distributional equity of the impacts. To measure individual well-being, the conventional approach relies on individuals’ willingness to exchange their own income for the outcomes they experience. To measure societal welfare, it relies on simple aggregation of these values across individuals. This approach reflects a relatively narrow conception of welfare and ignores how impacts are distributed across advantaged and disadvantaged individuals. Social welfare analysis has been proposed as an alternative approach to address these limitations, but real-world applications are rare due largely to the complexity of the calculations. This article provides a pragmatic approach for conducting equity-sensitive benefit–cost analysis globally that addresses data limitations and other challenges, illustrated with example applications. It formally develops and implements equity weights that adjust for the decreasing marginal value of money and for additional moral considerations, prioritizing increases in welfare for those who are worse off.

CHD includes a wide range of cardiac disorders present at birth. If appropriate care is delivered in time, the prognosis is relatively good. However, in many parts of the world, access to healthcare continues to be a problem for these patients, particularly in low- and middle-income countries. The aim of this study was to synthesise and analyse the available evidence to provide a deeper understanding of this problem. The literature search identified 1578 articles, and the final selection included 57 articles. Using the patient-centred healthcare access framework for identifying facilitators and barriers, issues were found at all levels of the health provision pathway, of which diagnosis, referral systems, lack of qualified institutions/health professionals, financing, inappropriate health insurance, and quality of care stand out. More evidence is needed to analyse the effect of potential barriers linked to acceptability. Given the nature of the barriers that this population faces, solutions depend on the health system and the local context.

Regulatory norms, rules, and arrangements enshrined in and established by EU pharmaceutical law travel internationally and influence foreign legal systems, regulatory practices, pharmaceutical company conduct, health systems’ functioning, and ultimately patient access to medicines and human health worldwide. This paper applies the mechanisms of Europeanisation (conditionality, socialisation, externalisation, and mimicry) to explain how these EU norms, rules and arrangements are diffused globally, with a focus on developing economies. Using the ongoing revision of the EU’s pharmaceutical legislation as a case study, this paper selects three innovative legislative proposals therein (i.e. environmental risk assessments for antimicrobials; reporting of public funding for medicines R&D; revised clinical test data and market protection, including a transferrable exclusivity voucher). Through the lens of Europeanisation, this paper postulates how these three legislative proposals, if adopted, would travel globally to developing economies, under which conditions, and with which likely impacts. This paper addresses several gaps in the literature, namely by introducing a global lens to the existing analyses of the EU’s revision of pharmaceutical law, by revealing the theory behind the emerging evidence of the EU’s influence over global pharmaceutical markets, and by positioning the case of pharmaceutical regulation in low- and middle-income countries among the scholarship on the global regulatory influence of EU internal market law.

In recent years the evidence base for psychological interventions in low- and -middle-income countries (LMIC) has rapidly accrued, demonstrating that task-shifting models result in desired outcomes. Next, it is important to look at how this evidence translates into practice. In doing so, this paper argues that the field of global mental health might benefit from applying a system theory or system science perspective. Systems thinking aims to understand how different components are connected and interdependent within a larger emergent entity. At present much of the research efforts into psychological interventions in LMIC are focusing on single interventions, with little focus on how these interventions sit in, or influence, a larger system. Adopting systems theory and system dynamics tools can help in; (i) better analyzing and understanding the key drivers of mental health problems and services, (ii) optimizing mental health services; and (iii) understanding the organization of people, institutions and resources required for rolling out and scaling-up mental health services. This paper reflects on some of these merits of a systems perspective, as well as provides some examples.

Youth living in low- and middle-income countries (LMICs) have an increased vulnerability to mental illnesses, with many lacking access to adequate treatment. There has been a growing body of interventions using task sharing with trained peer leaders to address this mental health gap. This scoping review examines the characteristics, effectiveness, components of peer delivery and challenges of peer-led mental health interventions for youth aged 10–24 in LMICs. A key term search strategy was employed across MEDLINE, Embase, Web of Science, Global Health and Global Index Medicus. Eligibility criteria included young people aged 10–24 and a peer-led component delivered in any setting in an LMIC. Study selection and extraction were conducted independently by the first and second authors, with discrepancies resolved by the senior author. Study characteristics were summarised and presented descriptively. The search identified 5,358 citations, and 19 studies were included. There were 14 quantitative, four qualitative and one mixed methods study reporting mental health outcomes. Types of interventions were heterogenous but fell within three broad categories: (1) peer education and psychoeducation, (2) peer-led psychotherapy and counselling and (3) peer support. All studies reported improved mental health outcomes as a result of the peer-led interventions. Peer-led interventions are versatile in terms of both the types of interventions and mode of delivery. Lived experience, mutual respect and reduced stigma make this method a highly unique and effective way to engage this age group. However, implementing peer-led youth interventions is not without challenges. Adequate training, supervision, cultural appropriateness and support from established institutions are critical to safeguarding and ensuring the sustainability of such programs. Our findings suggest that peer-led models are a valuable intervention strategy that policymakers can leverage in current and future efforts to address youth mental health in LMICs. Future areas of research should expand to include the perspectives of other key stakeholders involved in the implementation of peer-led mental health interventions, focusing on factors including fidelity, feasibility and acceptability to enhance implementation insights.

In the aftermath of the 2022 Pakistan flooding, disaster management faced critical challenges, particularly in mental health support. This study analyzed an incident where eighteen internally displaced individuals lost their lives in a bus fire. The current approach involves a comprehensive analysis of the incident, exploring the difficulties encountered in managing relief efforts, and providing mental health support. The study aims were to evaluate existing mental health support mechanisms, to identify challenges in disaster management, and to propose recommendations for future preparedness. Recommendations include enhancing disaster response training, integrating mental health services into primary health care, and prioritizing community resilience. These insights contribute to a deeper understanding of disaster management in resource-constrained regions.

Soil-transmitted helminth (STH) infections afflict people worldwide, especially in tropical and subtropical regions. Strongyloides stercoralis is distinctive from other STH nematodes by its complex life cycle features of autoinfection, parthenogenesis, and environmental reproduction. This scoping review aims to identify the structures, features, and techniques employed in existing STH models, emphasizing their potential application in describing S. stercoralis infection dynamics. A comprehensive search was conducted in the Medline, Embase, and Scopus databases for studies published until 14 June 2024. A total of 47 studies presenting a new model or novel adaptation of an existing model to human STH infection transmission were identified: only one described S. stercoralis transmission in humans. The identified models were predominantly deterministic and focused on the dynamics of mean worm load within hosts and the infectiousness of the environmental reservoir. One model addressed transmission in multi-host scenarios, as not all STH transmission cycles involve multiple hosts. Models were frequently used to simulate the effectiveness of mass drug administration, including drug efficacy and treatment coverage, while water, sanitation, and hygiene (WASH), health education, and vaccination were less explored. Given the limitation of individual-level data, compartmental models may be a reasonable starting point for S. stercoralis transmission. For a comprehensive understanding, incorporating parasite life cycle features into the model, exploring multi-host dynamics, including a diverse range of host heterogeneities, and assessing the impact of climatic factors like rainfall and land surface temperature on parasite survival in the environment may be beneficial, especially in settings where their importance is notable.

Young people (YP) (between 10 and 24 years) are disproportionally vulnerable to developing and being affected by mental health conditions due to physical, social and emotional risk factors. YP in low-and middle-income countries (LMICs) have poorer access to, and quality of, mental health services compared to those in high-income countries. Digital mental health interventions (DMHIs) have been proposed as tools to address this burden of disease and reduce the global treatment gap in youth mental health outcomes. This study aimed to examine the evidence for DMHIs for treating mental disorders in YP based in LMICs. To do this, the author searched academic databases (MEDLINE, PsycINFO, Embase and Web of Science) for primary studies on DMHIs targeting YP in LMICs. Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria were followed. The quality of the studies was assessed using the Critical Appraisal Skills Programme) framework. A narrative synthesis methodology was used to summarise and explain the findings. The authors identified 287 studies of which 7 were eligible in the final review. The authors found evidence of the effectiveness of multiple forms of DMHI (especially internet-based cognitive behavioural therapy) on anxiety and depression outcomes. Studies reported a lack of long-term benefits of treatment, high dropout rates, and did not include key geographical settings or data on cost-effectiveness. No studies were judged to be of high quality. This review highlights the available evidence showing that DMHIs can improve mental health outcomes for YP in LMICs, but due to the limited number of studies and lack of high-quality data, increased adoption and scaling up of digital interventions require more rigorous studies showing clinical effectiveness and ability to provide return on investment.