A new approach to the contextualization, content development, and delivery of LMIC guidelines is needed to improve outcomes.

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Objective To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and middle-income countries. Methods We systematically searched medical databases and websites of medical societies and contacted international organizations. Country-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation). We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of guidelines and plans for dissemination to target audiences. Findings We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries. Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development; breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines encompassed detailed implementation plans and socioeconomic considerations. Conclusion Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions.

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When flooded, seedlings of Gmelina arborea Roxb. produced more adventitious roots, had lower foliar Mn concentrations and lost fewer leaves than seedlings of Tectona grandis L.f. Severing the adventitious roots produced by flooded Gmelina seedlings increased leaf Mn concentration and leaf abscission and reduced whole-plant dry matter production. Flooded Gmelina cuttings, which do not produce adventitious roots, abscised few leaves until foliar concentrations of Mn and Fe had risen substantially above those of unflooded cuttings, at which time most leaves were shed. The results indicate that the development of adventitious roots in flooded seedlings of Gmelina suppressed uptake of Mn thereby minimizing leaf abscission.