1
|
Gumede L, Nkosi PB, Sibiya MN. Allopathic Medicine Practitioners' perspectives on facilitating disclosure of traditional medicine use in Gauteng, South Africa: a qualitative study. BMC Complement Med Ther 2023; 23:451. [PMID: 38087333 PMCID: PMC10717688 DOI: 10.1186/s12906-023-04270-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Traditional medicine (TM) plays a key role in maintaining health in many societies. Given the requirement for TM disclosure, Allopathic Medicine Practitioners (AMPs) must encourage open communication with patients to persuade those who use TM to disclose. Addressing patient non-disclosure of TM requires this dialogue to be facilitated. We sought to understand and describe how South African AMPs facilitate disclosure of TM use during a consultation with patients who use both TM and allopathic medicine (AM) and how it influences the patients' willingness to disclose TM use. METHODS This qualitative exploratory descriptive study on AMPs at Gauteng district public hospitals in South Africa was conducted between 2021 and 2022. Non-probability purposive sampling was employed to select a sample of 14 AMPs. Individual participants were encouraged to share their unique experiences and interpretations of the phenomenon concerning TM use disclosure. The raw transcribed textual data were processed using ATLAS.ti, and inductive content analysis was undertaken following the coding of the content to identify categories. RESULTS The data revealed four major categories: 'providing a suitable atmosphere for disclosure,' 'encouraging patients to disclose TM usage to AMPs,' 'patient autonomy,' and 'AMP training'. During a consultation with patients who use both TM and AM, participants expressed their experiences and perceptions of TM nondisclosure. They also discussed several methods for encouraging patients to disclose their TM usage, particularly when TM is used concurrently with AM. CONCLUSION This study expands on previously reported findings by describing how South African AMPs facilitate the disclosure of TM use during consultation. Many AMPs struggle to initiate TM conversations with their patients which results in non-disclosure. This study revealed that integrating TM into AM training programmes, promoting cross-practice, and creating a safe environment is necessary for the development and application of the most appropriate approaches that would assist in facilitating disclosure.
Collapse
Affiliation(s)
- Lindiwe Gumede
- Department of Medical Imaging and Radiation Sciences, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa.
| | - Pauline B Nkosi
- Department of Radiography, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Maureen N Sibiya
- DVC of Research, Innovation and Engagement, Mangosuthu University of Technology, Durban, South Africa
| |
Collapse
|
2
|
Opuni KF, Kretchy JP, Agyabeng K, Boadu JA, Adanu T, Ankamah S, Appiah A, Amoah GB, Baidoo M, Kretchy IA. Contamination of herbal medicinal products in low-and-middle-income countries: A systematic review. Heliyon 2023; 9:e19370. [PMID: 37674839 PMCID: PMC10477504 DOI: 10.1016/j.heliyon.2023.e19370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023] Open
Abstract
The use of herbal medicinal products (HMPs) has grown significantly across low-and-middle-income countries (LMICs). Consequently, the safety of these products due to contamination is a significant public health concern. This systematic review aimed to determine the prevalence, types, and levels of contaminants in HMPs from LMICs. A search was performed in seven online databases, i.e., Africa journal online (AJOL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Directory of Open Access Journals (DOAJ), Health Inter-Network Access to Research Initiative (HINARI), World Health Organization Global Index Medicus (WHO GIM), Scopus, and PubMed using appropriate search queries and reported as per the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) guidelines. Ninety-one peer-reviewed articles published from 1982 to 2021 from 28 different countries across four continents were included in the study. Although metals, microbial, mycotoxins, pesticides, and residual solvents were the reported contaminants in the 91 articles, metals (56.0%, 51/91), microbial (27.5%, 25/91), and mycotoxins (18.7%, 17/91) were the most predominant. About 16.4% (1236/7518) of the samples had their contaminant levels above the regulatory limits. Samples tested for microbial contaminants had the highest proportion (46.4%, 482/1039) of contaminants exceeding the regulatory limit, followed by mycotoxins (25.8%, 109/423) and metals (14.3%, 591/4128). The proportion of samples that had their average non-essential metal contaminant levels above the regulatory limit was (57.6%, 377/655), 18.3% (88/480), 10.7% (24/225), and 11.3% (29/257) for Pb, Cd, Hg, and As, respectively. The commonest bacteria species found were Escherichia coli (52.3%, 10/19) and Salmonella species (42.1%, 8/19). This review reported that almost 90% of Candida albicans and more than 80% of moulds exceeded the required regulatory limits. HMP consumption poses profound health implications to consumers and patients. Therefore, designing and/or implementing policies that effectively regulate HMPs to minimize the health hazards related to their consumption while improving the quality of life of persons living in LMICs are urgently needed.
Collapse
Affiliation(s)
- Kwabena F.M. Opuni
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - James-Paul Kretchy
- Department of Public Health, School of Medicine and Health Sciences, Central University, P. O. Box 2305, Miotso, Accra, Ghana
| | - Kofi Agyabeng
- Department of Biostatistics, School of Public Health, University of Ghana, P. O. Box LG13, Legon, Accra, Ghana
| | - Joseph A. Boadu
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - Theodosia Adanu
- Balme Library, University of Ghana, P.O. Box LG24, Legon, Accra, Ghana
| | - Samuel Ankamah
- Balme Library, University of Ghana, P.O. Box LG24, Legon, Accra, Ghana
| | - Alexander Appiah
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - Geralda B. Amoah
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - Mariam Baidoo
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| | - Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, P.O. Box LG43, Legon, Accra, Ghana
| |
Collapse
|
3
|
Senes-Lopes TFD, Luz JRDD, Guterres ZDR, Barbosa EA, Batista D, Galdino OA, Ururahy MAG, Gomes Dos Santos EC, López JA, Araujo-Silva G, Almeida MDG. Pseudobombax parvifolium Hydroalcoholic Bark Extract: Chemical Characterisation and Cytotoxic, Mutagenic, and Preclinical Aspects Associated with a Protective Effect on Oxidative Stress. Metabolites 2023; 13:748. [PMID: 37367906 DOI: 10.3390/metabo13060748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/04/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
Plants have long been used in traditional medicine to treat illnesses. Nevertheless, their chemical diversity requires studies to establish the extract dosage and its safe use. Pseudobombax parvifolium, an endemic species of the Brazilian Caatinga biome, is commonly used in folk medicine, due to its anti-inflammatory properties related to cellular oxidative stress; however, its biological properties have scarcely been studied. In this study, we chemically characterized the P. parvifolium hydroalcoholic bark extract (EBHE) and evaluated its cytotoxic, mutagenic, and preclinical aspects, as well as its antioxidant effect. Our phytochemical analysis revealed a significative total polyphenol content and identified loliolide for the first time in this species. Cytotoxicity, mutagenicity, and acute oral and repeated dose indicated no toxic effects on cell culture, Drosophila melanogaster, and Wistar rat exposure to different EBHE concentrations, respectively. Furthermore, we observed a significant decrease in lipid peroxidation and a mild hypoglycemic and hypolipidemic effect with repeated oral dosing of EBHE. Although there were no significant changes in glutathione content, we did observe a significant increase in superoxide dismutase at a dose of 400 mg/kg and in glutathione peroxidase at doses of 100, 200, and 400 mg/kg. These findings suggest that EBHE has potential as a source of bioactive molecules, and it can be used safely in traditional medicine and in the development of herbal medicines for application in the public health system.
Collapse
Affiliation(s)
- Tiago Felipe de Senes-Lopes
- Postgraduate Program in Health Sciences, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal 59012-570, RN, Brazil
- Multidisciplinary Research Laboratory, Department of Clinical and Toxicological Analysis, Health Sciences Center, Federal University of Rio Grande do Norte, Natal 59012-570, RN, Brazil
- Laboratory of Cytogenetics and Mutagenesis, State University of Mato Grosso do Sul, Mundo Novo 79980-000, MS, Brazil
| | - Jefferson Romáryo Duarte da Luz
- Multidisciplinary Research Laboratory, Department of Clinical and Toxicological Analysis, Health Sciences Center, Federal University of Rio Grande do Norte, Natal 59012-570, RN, Brazil
- Organic Chemistry and Biochemistry Laboratory, State University of Amapá, Macapá 68900-070, AP, Brazil
| | - Zaira da Rosa Guterres
- Laboratory of Cytogenetics and Mutagenesis, State University of Mato Grosso do Sul, Mundo Novo 79980-000, MS, Brazil
| | - Eder A Barbosa
- Laboratory of Synthesis and Analysis of Biomolecules, Institute of Chemistry, University Campus Darcy Ribeiro, University of Brasília, Brasília 70910-900, DF, Brazil
| | - Débora Batista
- Multidisciplinary Research Laboratory, Department of Clinical and Toxicological Analysis, Health Sciences Center, Federal University of Rio Grande do Norte, Natal 59012-570, RN, Brazil
| | - Ony Araújo Galdino
- Postgraduate Program in Health Sciences, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal 59012-570, RN, Brazil
| | - Marcela Abbott Galvão Ururahy
- Postgraduate Program in Pharmaceutical Sciences, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal 59012-570, RN, Brazil
| | - Elizabeth Cristina Gomes Dos Santos
- Multidisciplinary Research Laboratory, Department of Clinical and Toxicological Analysis, Health Sciences Center, Federal University of Rio Grande do Norte, Natal 59012-570, RN, Brazil
| | - Jorge A López
- Multidisciplinary Research Laboratory, Department of Clinical and Toxicological Analysis, Health Sciences Center, Federal University of Rio Grande do Norte, Natal 59012-570, RN, Brazil
| | - Gabriel Araujo-Silva
- Organic Chemistry and Biochemistry Laboratory, State University of Amapá, Macapá 68900-070, AP, Brazil
| | - Maria das Graças Almeida
- Postgraduate Program in Health Sciences, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal 59012-570, RN, Brazil
- Multidisciplinary Research Laboratory, Department of Clinical and Toxicological Analysis, Health Sciences Center, Federal University of Rio Grande do Norte, Natal 59012-570, RN, Brazil
- Postgraduate Program in Pharmaceutical Sciences, Center for Health Sciences, Federal University of Rio Grande do Norte, Natal 59012-570, RN, Brazil
| |
Collapse
|
4
|
Hagen EH, Blackwell AD, Lightner AD, Sullivan RJ. Homo medicus: The transition to meat eating increased pathogen pressure and the use of pharmacological plants in Homo. Am J Biol Anthropol 2023; 180:589-617. [PMID: 36815505 DOI: 10.1002/ajpa.24718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
The human lineage transitioned to a more carnivorous niche 2.6 mya and evolved a large body size and slower life history, which likely increased zoonotic pathogen pressure. Evidence for this increase includes increased zoonotic infections in modern hunter-gatherers and bushmeat hunters, exceptionally low stomach pH compared to other primates, and divergence in immune-related genes. These all point to change, and probably intensification, in the infectious disease environment of Homo compared to earlier hominins and other apes. At the same time, the brain, an organ in which immune responses are constrained, began to triple in size. We propose that the combination of increased zoonotic pathogen pressure and the challenges of defending a large brain and body from pathogens in a long-lived mammal, selected for intensification of the plant-based self-medication strategies already in place in apes and other primates. In support, there is evidence of medicinal plant use by hominins in the middle Paleolithic, and all cultures today have sophisticated, plant-based medical systems, add spices to food, and regularly consume psychoactive plant substances that are harmful to helminths and other pathogens. We propose that the computational challenges of discovering effective plant-based treatments, the consequent ability to consume more energy-rich animal foods, and the reduced reliance on energetically-costly immune responses helped select for increased cognitive abilities and unique exchange relationships in Homo. In the story of human evolution, which has long emphasized hunting skills, medical skills had an equal role to play.
Collapse
Affiliation(s)
- Edward H Hagen
- Department of Anthropology, Washington State University, Pullman, Washington, USA
| | - Aaron D Blackwell
- Department of Anthropology, Washington State University, Pullman, Washington, USA
| | - Aaron D Lightner
- Department of Anthropology, Washington State University, Pullman, Washington, USA
- Department of the Study of Religion, Aarhus University, Aarhus, Denmark
| | - Roger J Sullivan
- Department of Anthropology, California State University, Sacramento, California, USA
| |
Collapse
|
5
|
Yanful B, Kirubarajan A, Bhatia D, Mishra S, Allin S, Di Ruggiero E. Quality of care in the context of universal health coverage: a scoping review. Health Res Policy Syst 2023; 21:21. [PMID: 36959608 PMCID: PMC10035485 DOI: 10.1186/s12961-022-00957-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/28/2022] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION Universal health coverage (UHC) is an emerging priority of health systems worldwide and central to Sustainable Development Goal 3 (target 3.8). Critical to the achievement of UHC, is quality of care. However, current evidence suggests that quality of care is suboptimal, particularly in low- and middle-income countries. The primary objective of this scoping review was to summarize the existing conceptual and empirical literature on quality of care within the context of UHC and identify knowledge gaps. METHODS We conducted a scoping review using the Arksey and O'Malley framework and further elaborated by Levac et al. and applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews reporting guidelines. We systematically searched MEDLINE, EMBASE, CINAHL-Plus, PAIS Index, ProQuest and PsycINFO for reviews published between 1 January 1995 and 27 September 2021. Reviews were eligible for inclusion if the article had a central focus on UHC and discussed quality of care. We did not apply any country-based restrictions. All screening, data extraction and analyses were completed by two reviewers. RESULTS Of the 4128 database results, we included 45 studies that met the eligibility criteria, spanning multiple geographic regions. We synthesized and analysed our findings according to Kruk et al.'s conceptual framework for high-quality systems, including foundations, processes of care and quality impacts. Discussions of governance in relation to quality of care were discussed in a high number of studies. Studies that explored the efficiency of health systems and services were also highly represented in the included reviews. In contrast, we found that limited information was reported on health outcomes in relation to quality of care within the context of UHC. In addition, there was a global lack of evidence on measures of quality of care related to UHC, particularly country-specific measures and measures related to equity. CONCLUSION There is growing evidence on the relationship between quality of care and UHC, especially related to the governance and efficiency of healthcare services and systems. However, several knowledge gaps remain, particularly related to monitoring and evaluation, including of equity. Further research, evaluation and monitoring frameworks are required to strengthen the existing evidence base to improve UHC.
Collapse
Affiliation(s)
- Bernice Yanful
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Abirami Kirubarajan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Dominika Bhatia
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sujata Mishra
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Erica Di Ruggiero
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| |
Collapse
|
6
|
Sundararajan R, Alakiu R, Ponticiello M, Birch G, Kisigo G, Okello E, Peck RN. Understanding traditional healer utilisation for hypertension care using the Andersen model: A qualitative study in Mwanza, Tanzania. Glob Public Health 2023; 18:2191687. [PMID: 36973183 PMCID: PMC10065353 DOI: 10.1080/17441692.2023.2191687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 03/08/2023] [Indexed: 03/29/2023]
Abstract
ABSTRACTHypertension disproportionately affects people living in African countries, where there are many challenges to appropriate diagnosis and treatment, and many people with hypertension utilise traditional healers as their primary source of healthcare. In this study, we sought to understand factors driving healer utilisation among people with hypertension. We conducted 52 semi-structured interviews with traditional healers, patients and healthcare providers in the Mwanza region of Tanzania. We used the Andersen model of healthcare utilisation to organise our findings on factors driving utilisation of traditional healers for hypertension care. Traditional healers routinely provide care to hypertensive patients and are a critical component of the healthcare landscape. However, healers also operate independently of the biomedical healthcare system, and biomedical providers may hold negative perceptions of healers. Further, healers were described as preferential by patients due to the convenient locations of their practices and perceived improvement of hypertension symptoms with traditional treatment. Finally, healers expressed a desire for more formal collaboration with biomedicine to improve patient care. Our findings may guide future interventions in Tanzanian communities and elsewhere where traditional healers may act as partners to allopathic providers and patients in the continuum of hypertension care.
Collapse
Affiliation(s)
- Radhika Sundararajan
- Weill Cornell Medicine, Center for Global Health, New York NY USA
- Weill Cornell Medicine, Department of Emergency Medicine, New York NY USA
| | - Rinu Alakiu
- Weill Cornell Medical College, New York, NY USA
| | | | | | - Godfrey Kisigo
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Bugando Medical Center, Mwanza, Tanzania
| | | | - Robert N. Peck
- Weill Cornell Medicine, Center for Global Health, New York NY USA
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- Bugando Medical Center, Mwanza, Tanzania
| |
Collapse
|
7
|
Palileo-Villanueva LM, Palafox B, Amit AML, Pepito VCF, Ab-Majid F, Ariffin F, Balabanova D, Isa MR, Mat-Nasir N, My M, Renedo A, Seguin ML, Yusoff K, Dans AL, Mckee M. Prevalence, determinants and outcomes of traditional, complementary and alternative medicine use for hypertension among low-income households in Malaysia and the Philippines. BMC Complement Med Ther 2022; 22:252. [PMID: 36180884 PMCID: PMC9526286 DOI: 10.1186/s12906-022-03730-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 09/19/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Traditional, complementary and alternative medicine (TCAM) is used to treat a broad range of conditions. In low- and middle-income countries (LMICs), TCAM use is particularly common among those with low socio-economic status. To better understand the patterns and impact of TCAM use on the management of non-communicable diseases in these populations, this study examines the prevalence and characteristics of TCAM use for hypertension, its determinants, and its association with hypertension management outcomes and wellbeing among low-income adults in two Southeast Asian countries at different levels of economic and health system development, Malaysia and the Philippines. METHODS We analysed cross-sectional data from 946 randomly selected adults diagnosed with hypertension from low-income rural and urban communities in Malaysia (n = 495) and the Philippines (n = 451). We compared the prevalence, characteristics and household expenditure on TCAM use between countries and used multi-level, mixed-effects regression to estimate associations between TCAM use and its determinants, and five hypertension management outcomes and wellbeing. RESULTS The prevalence of TCAM use to manage hypertension was higher in the Philippines than in Malaysia (18.8% vs 8.8%, p < 0.001). Biologically-based modalities, e.g. herbal remedies, were the most common type of TCAM used in both countries, mainly as a complement, rather than an alternative to conventional treatment. Households allocated around 10% of health spending to TCAM in both countries. Belief that TCAM is effective for hypertension was a positive predictor of TCAM use, while belief in conventional medicine was a negative predictor. TCAM use was not strongly associated with current use of medications for hypertension, self-reported medication adherence, blood pressure level and control, or wellbeing in either country. CONCLUSIONS A small, but significant, proportion of individuals living in low-income communities in Malaysia and the Philippines use TCAM to manage their hypertension, despite a general lack of evidence on efficacy and safety of commonly used TCAM modalities. Recognising that their patients may be using TCAM to manage hypertension will enable health care providers to deliver safer, more patient-centred care.
Collapse
Affiliation(s)
| | - Benjamin Palafox
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Arianna Maever L Amit
- College of Medicine, University of the Philippines Manila, Manila, Philippines.,School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | - Veincent Christian F Pepito
- College of Medicine, University of the Philippines Manila, Manila, Philippines.,School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
| | - Fadhlina Ab-Majid
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Farnaza Ariffin
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Dina Balabanova
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Mohamad-Rodi Isa
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Nafiza Mat-Nasir
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Mazapuspavina My
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Alicia Renedo
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Maureen L Seguin
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Khalid Yusoff
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia.,Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Antonio L Dans
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Martin Mckee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Centre for Global Chronic Conditions, 15-17 Tavistock Place, London, WC1H 9SH, UK
| |
Collapse
|