Sample records for middle income groups

  1. Middle Income Students and the Cost of Postsecondary Education.

    ERIC Educational Resources Information Center

    Froomkin, Joseph; And Others

    Current proposals to assist middle-income groups with college costs and estimates of the burden to parents in different income groups are considered. Reasons for discontent by middle-income and upper-income groups regarding college costs are considered in relation to the following issues: the demographic squeeze, the temptation to choose high-cost…

  2. Comparing the Income Elasticity of Health Spending in Middle-Income and High-Income Countries: The Role of Financial Protection

    PubMed Central

    Vargas Bustamante, Arturo; Shimoga, Sandhya V.

    2018-01-01

    Background: As middle-income countries become more affluent, economically sophisticated and productive, health expenditure patterns are likely to change. Other socio-demographic and political changes that accompany rapid economic growth are also likely to influence health spending and financial protection. Methods: This study investigates the relationship between growth on per-capita healthcare expenditure and gross domestic product (GDP) in a group of 27 large middle-income economies and compares findings with those of 24 high-income economies from the Organization for Economic Cooperation and Development (OECD) group. This comparison uses national accounts data from 1995-2014. We hypothesize that the aggregated income elasticity of health expenditure in middle-income countries would be less than one (meaning healthcare is a normal good). An initial exploratory analysis tests between fixed-effects and random-effects model specifications. A fixed-effects model with time-fixed effects is implemented to assess the relationship between the two measures. Unit root, Hausman and serial correlation tests are conducted to determine model fit. Additional explanatory variables are introduced in different model specifications to test the robustness of our regression results. We include the out-of-pocket (OOP) share of health spending in each model to study the potential role of financial protection in our sample of high- and middle-income countries. The first-difference of study variables is implemented to address non-stationarity and cointegration properties. Results: The elasticity of per-capita health expenditure and GDP growth is positive and statistically significant among sampled middle-income countries (51 per unit-growth in GDP) and high-income countries (50 per unit-growth in GDP). In contrast with previous research that has found that income elasticity of health spending in middle-income countries is larger than in high-income countries, our findings show that

  3. Comparing the Income Elasticity of Health Spending in Middle-Income and High-Income Countries: The Role of Financial Protection.

    PubMed

    Vargas Bustamante, Arturo; V Shimoga, Sandhya

    2017-07-19

    As middle-income countries become more affluent, economically sophisticated and productive, health expenditure patterns are likely to change. Other socio-demographic and political changes that accompany rapid economic growth are also likely to influence health spending and financial protection. This study investigates the relationship between growth on per-capita healthcare expenditure and gross domestic product (GDP) in a group of 27 large middle-income economies and compares findings with those of 24 high-income economies from the Organization for Economic Cooperation and Development (OECD) group. This comparison uses national accounts data from 1995-2014. We hypothesize that the aggregated income elasticity of health expenditure in middle-income countries would be less than one (meaning healthcare is a normal good). An initial exploratory analysis tests between fixed-effects and random-effects model specifications. A fixed-effects model with time-fixed effects is implemented to assess the relationship between the two measures. Unit root, Hausman and serial correlation tests are conducted to determine model fit. Additional explanatory variables are introduced in different model specifications to test the robustness of our regression results. We include the out-of-pocket (OOP) share of health spending in each model to study the potential role of financial protection in our sample of high- and middle-income countries. The first-difference of study variables is implemented to address non-stationarity and cointegration properties. The elasticity of per-capita health expenditure and GDP growth is positive and statistically significant among sampled middle-income countries (51 per unit-growth in GDP) and high-income countries (50 per unit-growth in GDP). In contrast with previous research that has found that income elasticity of health spending in middle-income countries is larger than in high-income countries, our findings show that elasticity estimates can change if

  4. Impact of Housing and Community Conditions on Multidimensional Health among Middle- and Low-Income Groups in Hong Kong.

    PubMed

    Wang, Jionghua; Huang, Bo; Zhang, Ting; Wong, Hung; Huang, Yifan

    2018-05-31

    With decades of urbanization, housing and community problems (e.g., poor ventilation and lack of open public spaces) have become important social determinants of health that require increasing attention worldwide. Knowledge regarding the link between health and these problems can provide crucial evidence for building healthy communities. However, this link has heretofore not been identified in Hong Kong, and few studies have compared the health impact of housing and community conditions across different income groups. To overcome this gap, we hypothesize that the health impact of housing and community problems may vary across income groups and across health dimensions. We tested these hypotheses using cross-sectional survey data from Hong Kong. Several health outcomes, e.g., chronic diseases and the SF-12 v. 2 mental component summary scores, were correlated with a few types of housing and community problems, while other outcomes, such as the DASS-21⁻Stress scores, were sensitive to a broader range of problems. The middle- and low-income group was more severely affected by poor built environments. These results can be used to identify significant problems in the local built environment, especially amongst the middle- and low-income group.

  5. Effect of GNI on Infant Mortality Rate in Low Income, Lower Middle Income, Upper Middle Income and High Income Countries.

    PubMed

    Jalal, Sabeena; Khan, Najib Ullah; Younis, Mustafa Z

    2016-01-01

    Global disparities in health form a complex issue adversely affecting much of the world's population. What has been found is that national income and other general socio-economic factors are strong determinants of population health (Houweling, 2005 & Schell, 2007). In countries where resources are less, people are much less healthy than people living in rich countries. In wealthier countries that have made immense progress in health indicators, the resulting change in age structure and morbidity and mortality patterns portends even greater financial demands on the health sector. This study noted the trends in several health indicators versus economic indicators and related it to low income, lower middle income, upper middle income and high income countries. We noted that there is improvement in all health indicators along with an increasing GNI per Capita and GDP. In low income regions though, the rate of improvement is slower as opposed to high income countries. However, there is progress, which is leading to an increase in aging population.

  6. Income, income inequality and youth smoking in low- and middle-income countries.

    PubMed

    Li, David X; Guindon, G Emmanuel

    2013-04-01

    To examine the relationships between income, income inequality and current smoking among youth in low- and middle-income countries. Pooled cross-sectional data from the Global Youth Tobacco Surveys, conducted in low- and middle-income countries, were used to conduct multi-level logistic analyses that accounted for the nesting of students in schools and of schools in countries. A total of 169 283 students aged 13-15 from 63 low- and middle-income countries. Current smoking was defined as having smoked at least one cigarette in the past 30 days. Gross domestic product (GDP) per capita was our measure of absolute income. Contemporaneous and lagged (10-year) Gini coefficients, as well as the income share ratio of the top decile of incomes to the bottom decile, were our measures of income inequality. Our analyses reveal a significant positive association between levels of income and youth smoking. We find that a 10% increase in GDP per capita increases the odds of being a current smoker by at least 2.5%, and potentially considerably more. Our analyses also suggest a relationship between the distribution of incomes and youth smoking: youth from countries with more unequal distributions of income tend to have higher odds of currently smoking. There is a positive association between gross domestic product and the odds of a young person in a low- and middle-income country being a current smoker. Given the causal links between smoking and a wide range of youth morbidities, the association between smoking and income inequality may underlie a substantial portion of the health disparities observed that are currently experiencing rapid economic growth. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

  7. Hospital payment systems based on diagnosis-related groups: experiences in low- and middle-income countries

    PubMed Central

    Wittenbecher, Friedrich

    2013-01-01

    Abstract Objective This paper provides a comprehensive overview of hospital payment systems based on diagnosis-related groups (DRGs) in low- and middle-income countries. It also explores design and implementation issues and the related challenges countries face. Methods A literature research for papers on DRG-based payment systems in low- and middle-income countries was conducted in English, French and Spanish through Pubmed, the Pan American Health Organization’s Regional Library of Medicine and Google. Findings Twelve low- and middle-income countries have DRG-based payment systems and another 17 are in the piloting or exploratory stage. Countries have chosen from a wide range of imported and self-developed DRG models and most have adapted such models to their specific contexts. All countries have set expenditure ceilings. In general, systems were piloted before being implemented. The need to meet certain requirements in terms of coding standardization, data availability and information technology made implementation difficult. Private sector providers have not been fully integrated, but most countries have managed to delink hospital financing from public finance budgeting. Conclusion Although more evidence on the impact of DRG-based payment systems is needed, our findings suggest that (i) the greater portion of health-care financing should be public rather than private; (ii) it is advisable to pilot systems first and to establish expenditure ceilings; (iii) countries that import an existing variant of a DRG-based system should be mindful of the need for adaptation; and (iv) countries should promote the cooperation of providers for appropriate data generation and claims management. PMID:24115798

  8. Meddling with middle modalities: a decomposition approach to mental health inequalities between intersectional gender and economic middle groups in northern Sweden

    PubMed Central

    Gustafsson, Per E.; Sebastián, Miguel San; Mosquera, Paola A.

    2016-01-01

    Background Intersectionality has received increased interest within population health research in recent years, as a concept and framework to understand entangled dimensions of health inequalities, such as gender and socioeconomic inequalities in health. However, little attention has been paid to the intersectional middle groups, referring to those occupying positions of mixed advantage and disadvantage. Objective This article aimed to 1) examine mental health inequalities between intersectional groups reflecting structural positions of gender and economic affluence and 2) decompose any observed health inequalities, among middle groups, into contributions from experiences and conditions representing processes of privilege and oppression. Design Participants (N=25,585) came from the cross-sectional ‘Health on Equal Terms’ survey covering 16- to 84-year-olds in the four northernmost counties of Sweden. Six intersectional positions were constructed from gender (woman vs. men) and tertiles (low vs. medium vs. high) of disposable income. Mental health was measured through the General Health Questionnaire-12. Explanatory variables covered areas of material conditions, job relations, violence, domestic burden, and healthcare contacts. Analysis of variance (Aim 1) and Blinder-Oaxaca decomposition analysis (Aim 2) were used. Results Significant mental health inequalities were found between dominant (high-income women and middle-income men) and subordinate (middle-income women and low-income men) middle groups. The health inequalities between adjacent middle groups were mostly explained by violence (mid-income women vs. men comparison); material conditions (mid- vs. low-income men comparison); and material needs, job relations, and unmet medical needs (high- vs. mid-income women comparison). Conclusions The study suggests complex processes whereby dominant middle groups in the intersectional space of economic affluence and gender can leverage strategic resources to gain

  9. Cigarette characteristic and emission variations across high-, middle- and low-income countries.

    PubMed

    O'Connor, R J; Wilkins, K J; Caruso, R V; Cummings, K M; Kozlowski, L T

    2010-12-01

    The public health burden of tobacco use is shifting to the developing world, and the tobacco industry may apply some of its successful marketing tactics, such as allaying health concerns with product modifications. This study used standard smoking machine tests to examine the extent to which the industry is introducing engineering features that reduce tar and nicotine to cigarettes sold in middle- and low-income countries. Multicountry observational study. Cigarettes from 10 different countries were purchased in 2005 and 2007 with low-, middle- and high-income countries identified using the World Bank's per capita gross national income metric. Physical measurements of each brand were tested, and tobacco moisture and weight, paper porosity, filter ventilation and pressure drop were analysed. Tar, nicotine and carbon monoxide emission levels were determined for each brand using International Organization for Standardization and Canadian Intensive methods. Statistical analyses were performed using Statistical Package for the Social Sciences. Among cigarette brands with filters, more brands were ventilated in high-income countries compared with middle- and low-income countries [χ(2)(4)=25.92, P<0.001]. Low-income brands differed from high- and middle-income brands in engineering features such as filter density, ventilation and paper porosity, while tobacco weight and density measures separated the middle- and high-income groups. Smoke emissions differed across income groups, but these differences were largely negated when one accounted for design features. This study showed that as a country's income level increases, cigarettes become more highly engineered and the emissions levels decrease. In order to reduce the burden of tobacco-related disease and further effective product regulation, health officials must understand cigarette design and function within and between countries. Copyright © 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All

  10. Cigarette characteristic and emission variations across high-, middle- and low-income countries

    PubMed Central

    O’Connor, R.J.; Wilkins, K.J.; Caruso, R.V.; Cummings, K.M.; Kozlowski, L.T.

    2010-01-01

    SUMMARY Objectives The public health burden of tobacco use is shifting to the developing world, and the tobacco industry may apply some of its successful marketing tactics, such as allaying health concerns with product modifications. This study used standard smoking machine tests to examine the extent to which the industry is introducing engineering features that reduce tar and nicotine to cigarettes sold in middle- and low-income countries. Study design Multicountry observational study. Methods Cigarettes from 10 different countries were purchased in 2005 and 2007 with low-, middle- and high-income countries identified using the World Bank’s per-capita gross national income metric. Physical measurements of each brand were tested, and tobacco moisture and weight, paper porosity, filter ventilation and pressure drop were analysed. Tar, nicotine and carbon monoxide emission levels were determined for each brand using International Organization for Standardization and Canadian Intensive methods. Statistical analyses were performed using Statistical Package for the Social Sciences. Results Among cigarette brands with filters, more brands were ventilated in high-income countries compared with middle- and low-income countries [χ2(4)=25.92, P<0.001]. Low-income brands differed from high- and middle-income brands in engineering features such as filter density, ventilation and paper porosity, while tobacco weight and density measures separated the middle- and high-income groups. Smoke emissions differed across income groups, but these differences were largely negated when one accounted for design features. Conclusions This study showed that as a country’s income level increases, cigarettes become more highly engineered and the emissions levels decrease. In order to reduce the burden of tobacco-related disease and further effective product regulation, health officials must understand cigarette design and function within and between countries. PMID:21030055

  11. National income inequality and ineffective health insurance in 35 low- and middle-income countries.

    PubMed

    Alvarez, Francisco N; El-Sayed, Abdulrahman M

    2017-05-01

    Global health policy efforts to improve health and reduce financial burden of disease in low- and middle-income countries (LMIC) has fuelled interest in expanding access to health insurance coverage to all, a movement known as Universal Health Coverage (UHC). Ineffective insurance is a measure of failure to achieve the intended outcomes of health insurance among those who nominally have insurance. This study aimed to evaluate the relation between national-level income inequality and the prevalence of ineffective insurance. We used Standardized World Income Inequality Database (SWIID) Gini coefficients for 35 LMICs and World Health Survey (WHS) data about insurance from 2002 to 2004 to fit multivariable regression models of the prevalence of ineffective insurance on national Gini coefficients, adjusting for GDP per capita. Greater inequality predicted higher prevalence of ineffective insurance. When stratifying by individual-level covariates, higher inequality was associated with greater ineffective insurance among sub-groups traditionally considered more privileged: youth, men, higher education, urban residence and the wealthiest quintile. Stratifying by World Bank country income classification, higher inequality was associated with ineffective insurance among upper-middle income countries but not low- or lower-middle income countries. We hypothesize that these associations may be due to the imprint of underlying social inequalities as countries approach decreasing marginal returns on improved health insurance by income. Our findings suggest that beyond national income, income inequality may predict differences in the quality of insurance, with implications for efforts to achieve UHC. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  12. Social Determinants of Smoking in Low- and Middle-Income Countries: Results from the World Health Survey

    PubMed Central

    Hosseinpoor, Ahmad Reza; Parker, Lucy Anne; Tursan d'Espaignet, Edouard; Chatterji, Somnath

    2011-01-01

    Introduction Tobacco smoking is a leading cause of premature death and disability, and over 80% of the world's smokers live in low- or middle-income countries. The objective of this study is to assess demographic and socioeconomic determinants of current smoking in low- and middle-income countries. Methods We used data, from the World Health Survey in 48 low-income and middle-income countries, to explore the impact of demographic and socioeconomic factors on the current smoking status of respondents. The data from these surveys provided information on 213,807 respondents aged 18 years or above that were divided into 4 pooled datasets according to their sex and country income group. The overall proportion of current smokers, as well as the proportion by each relevant demographic and socioeconomic determinant, was calculated within each of the pooled datasets, and multivariable logistic regression was used to assess the association between current smoking and these determinants. Results The odds of smoking were not equal in all demographic or socioeconomic groups. Some factors were fairly stable across the four datasets studied: for example, individuals were more likely to smoke if they had little or no education, regardless of if they were male or female, or lived in a low or a middle income country. Nevertheless, other factors, notably age and wealth, showed a differential effect on smoking by sex or country income level. While women in the low-income country group were twice as likely to smoke if they were in the lowest wealth quintile compared with the highest, the association was absent in the middle-income country group. Conclusion Information on how smoking is distributed among low- or middle-income countries will allow policy makers to tailor future policies, and target the most vulnerable populations. PMID:21655299

  13. Social determinants of smoking in low- and middle-income countries: results from the World Health Survey.

    PubMed

    Hosseinpoor, Ahmad Reza; Parker, Lucy Anne; Tursan d'Espaignet, Edouard; Chatterji, Somnath

    2011-01-01

    Tobacco smoking is a leading cause of premature death and disability, and over 80% of the world's smokers live in low- or middle-income countries. The objective of this study is to assess demographic and socioeconomic determinants of current smoking in low- and middle-income countries. We used data, from the World Health Survey in 48 low-income and middle-income countries, to explore the impact of demographic and socioeconomic factors on the current smoking status of respondents. The data from these surveys provided information on 213,807 respondents aged 18 years or above that were divided into 4 pooled datasets according to their sex and country income group. The overall proportion of current smokers, as well as the proportion by each relevant demographic and socioeconomic determinant, was calculated within each of the pooled datasets, and multivariable logistic regression was used to assess the association between current smoking and these determinants. The odds of smoking were not equal in all demographic or socioeconomic groups. Some factors were fairly stable across the four datasets studied: for example, individuals were more likely to smoke if they had little or no education, regardless of if they were male or female, or lived in a low or a middle income country. Nevertheless, other factors, notably age and wealth, showed a differential effect on smoking by sex or country income level. While women in the low-income country group were twice as likely to smoke if they were in the lowest wealth quintile compared with the highest, the association was absent in the middle-income country group. Information on how smoking is distributed among low- or middle-income countries will allow policy makers to tailor future policies, and target the most vulnerable populations.

  14. Health Spending For Low-, Middle-, And High-Income Americans, 1963-2012.

    PubMed

    Dickman, Samuel L; Woolhandler, Steffie; Bor, Jacob; McCormick, Danny; Bor, David H; Himmelstein, David U

    2016-07-01

    US medical spending growth slowed between 2004 and 2013. At the same time, many Americans faced rising copayments and deductibles, which may have particularly affected lower-income people. To explore whether the health spending slowdown affected all income groups equally, we divided the population into income quintiles. We then assessed trends in health expenditures by and on behalf of people in each quintile using twenty-two national surveys carried out between 1963 and 2012. Before the 1965 passage of legislation creating Medicare and Medicaid, the lowest income quintile had the lowest expenditures, despite their worse health compared to other income groups. By 1977 the unadjusted expenditures for the lowest quintile exceeded those for all other income groups. This pattern persisted until 2004. Thereafter, expenditures fell for the lowest quintile, while rising more than 10 percent for the middle three quintiles and close to 20 percent for the highest income quintile, which had the highest expenditures in 2012. The post-2004 divergence of expenditure trends for the wealthy, middle class, and poor occurred only among the nonelderly. We conclude that the new pattern of spending post-2004, with the wealthiest quintile having the highest expenditures for health care, suggests that a redistribution of care toward wealthier Americans accompanied the health spending slowdown. Project HOPE—The People-to-People Health Foundation, Inc.

  15. Suicide and poverty in low-income and middle-income countries: a systematic review.

    PubMed

    Iemmi, Valentina; Bantjes, Jason; Coast, Ernestina; Channer, Kerrie; Leone, Tiziana; McDaid, David; Palfreyman, Alexis; Stephens, Bevan; Lund, Crick

    2016-08-01

    Suicide is the 15th leading cause of death worldwide, with over 75% of suicides occurring in low-income and middle-income countries. Nonetheless, evidence on the association between suicide and poverty in low-income and middle-income countries is scarce. We did a systematic review to understand the association between suicidal ideations and behaviours and economic poverty in low-income and middle-income countries. We included studies testing the association between suicidal ideations and behaviours and economic poverty in low-income and middle-income countries using bivariate or multivariate analysis and published in English between January, 2004, and April, 2014. We identified 37 studies meeting these inclusion criteria. In 18 studies reporting the association between completed suicide and poverty, 31 associations were explored. The majority reported a positive association. Of the 20 studies reporting on the relationship between non-fatal suicidal ideations and behaviours and poverty, 36 associations were explored. Again, almost all studies reported a positive association. However, when considering each poverty dimension separately, we found substantial variations. These findings show a consistent trend at the individual level indicating that poverty, particularly in the form of worse economic status, diminished wealth, and unemployment is associated with suicidal ideations and behaviours. At the country level, there are insufficient data to draw clear conclusions. Available data show a potential benefit in addressing economic poverty within suicide prevention strategies, with particular attention to both chronic poverty and acute economic events. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Factors influencing medical students' motivation to practise in rural areas in low-income and middle-income countries: a systematic review.

    PubMed

    Budhathoki, Shyam Sundar; Zwanikken, Prisca A C; Pokharel, Paras K; Scherpbier, Albert J

    2017-02-22

    There is a shortage of doctors working in rural areas all over the world, especially in low-income and middle-income countries. The choice to practise medicine in a rural area is influenced by many factors. Motivation developed as a medical student is one key determinant of this choice. This study explores influences on medical students' motivation to practise in rural areas of low-income and middle-income countries following graduation. A systematic review was conducted to identify influences on medical students' motivation to work in rural areas in low-income and middle-income countries. Papers reporting influences on motivation were included, and content analysis was conducted to select the articles. Articles not published in English were excluded from this review. A rural background (ie, being brought up in a rural area), training in rural areas with a community-based curriculum, early exposure to the community during medical training and rural location of medical school motivate medical students to work in rural areas. Perceived lack of infrastructure, high workload, poor hospital management and isolation are among the health facility factors that demotivate medical students for medical practice in rural areas. Medical school selection criteria focusing on a rural background factor and medical education curriculum focusing on rural area are more relevant factors in low-income and middle-income countries. The factors identified in this review may assist the planners, medical educators and policymakers in low-income and middle-income countries in designing relevant interventions to positively influence rural choices where the shortage of rural physicians is an ongoing and increasing concern. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  17. Socioeconomic inequality in the prevalence of noncommunicable diseases in low- and middle-income countries: results from the World Health Survey.

    PubMed

    Hosseinpoor, Ahmad Reza; Bergen, Nicole; Mendis, Shanthi; Harper, Sam; Verdes, Emese; Kunst, Anton; Chatterji, Somnath

    2012-06-22

    Noncommunicable diseases are an increasing health concern worldwide, but particularly in low- and middle-income countries. This study quantified and compared education- and wealth-based inequalities in the prevalence of five noncommunicable diseases (angina, arthritis, asthma, depression and diabetes) and comorbidity in low- and middle-income country groups. Using 2002-04 World Health Survey data from 41 low- and middle-income countries, the prevalence estimates of angina, arthritis, asthma, depression, diabetes and comorbidity in adults aged 18 years or above are presented for wealth quintiles and five education levels, by sex and country income group. Symptom-based classification was used to determine angina, arthritis, asthma and depression rates, and diabetes diagnoses were self-reported. Socioeconomic inequalities according to wealth and education were measured absolutely, using the slope index of inequality, and relatively, using the relative index of inequality. Wealth and education inequalities were more pronounced in the low-income country group than the middle-income country group. Both wealth and education were inversely associated with angina, arthritis, asthma, depression and comorbidity prevalence, with strongest inequalities reported for angina, asthma and comorbidity. Diabetes prevalence was positively associated with wealth and, to a lesser extent, education. Adjustments for confounding variables tended to decrease the magnitude of the inequality. Noncommunicable diseases are not necessarily diseases of the wealthy, and showed unequal distribution across socioeconomic groups in low- and middle-income country groups. Disaggregated research is warranted to assess the impact of individual noncommunicable diseases according to socioeconomic indicators.

  18. The Middle Income Squeeze

    ERIC Educational Resources Information Center

    Glover, Steve

    1978-01-01

    Complaints about a middle income family's hardships in sending their children to private colleges and universities are examined. The difficulty may be attributable to a progressive College Scholarship Service (CSS) taxation rate schedule that causes larger proportionate reductions in the standard of living for some families than others.…

  19. The impact of income inequality and national wealth on child and adolescent mortality in low and middle-income countries.

    PubMed

    Ward, Joseph L; Viner, Russell M

    2017-05-11

    Income inequality and national wealth are strong determinants for health, but few studies have systematically investigated their influence on mortality across the early life-course, particularly outside the high-income world. We performed cross-sectional regression analyses of the relationship between income inequality (national Gini coefficient) and national wealth (Gross Domestic Product (GDP) averaged over previous decade), and all-cause and grouped cause national mortality rate amongst infants, 1-4, 5-9, 10-14, 15-19 and 20-24 year olds in low and middle-income countries (LMIC) in 2012. Gini models were adjusted for GDP. Data were available for 103 (79%) countries. Gini was positively associated with increased all-cause and communicable disease mortality in both sexes across all age groups, after adjusting for national wealth. Gini was only positively associated with increased injury mortality amongst infants and 20-24 year olds, and increased non-communicable disease mortality amongst 20-24 year old females. The strength of these associations tended to increase during adolescence. Increasing GDP was negatively associated with all-cause, communicable and non-communicable disease mortality in males and females across all age groups. GDP was also associated with decreased injury mortality in all age groups except 15-19 year old females, and 15-24 year old males. GDP became a weaker predictor of mortality during adolescence. Policies to reduce income inequality, rather than prioritising economic growth at all costs, may be needed to improve adolescent mortality in low and middle-income countries, a key development priority.

  20. Relations among Emergent Literacy Skills, Behavior Problems, and Social Competence in Preschool Children from Low- and Middle-Income Backgrounds.

    ERIC Educational Resources Information Center

    Lonigan, Christopher J.; Bloomfield, Brenlee G.; Anthony, Jason L.; Bacon, Kimberly D.; Samwel, Corine S.; Phillips, Beth M.

    1999-01-01

    A study examined the overlap between behaviors associated with attention-deficit hyperactivity disorders and emergent literacy skills in 44 children from middle-income families and 41 Head Start children. Attention problems were associated with literacy skills in both groups, however, the effect was strongest for the middle-income group.…

  1. Socioeconomic inequality in the prevalence of noncommunicable diseases in low- and middle-income countries: Results from the World Health Survey

    PubMed Central

    2012-01-01

    Background Noncommunicable diseases are an increasing health concern worldwide, but particularly in low- and middle-income countries. This study quantified and compared education- and wealth-based inequalities in the prevalence of five noncommunicable diseases (angina, arthritis, asthma, depression and diabetes) and comorbidity in low- and middle-income country groups. Methods Using 2002–04 World Health Survey data from 41 low- and middle-income countries, the prevalence estimates of angina, arthritis, asthma, depression, diabetes and comorbidity in adults aged 18 years or above are presented for wealth quintiles and five education levels, by sex and country income group. Symptom-based classification was used to determine angina, arthritis, asthma and depression rates, and diabetes diagnoses were self-reported. Socioeconomic inequalities according to wealth and education were measured absolutely, using the slope index of inequality, and relatively, using the relative index of inequality. Results Wealth and education inequalities were more pronounced in the low-income country group than the middle-income country group. Both wealth and education were inversely associated with angina, arthritis, asthma, depression and comorbidity prevalence, with strongest inequalities reported for angina, asthma and comorbidity. Diabetes prevalence was positively associated with wealth and, to a lesser extent, education. Adjustments for confounding variables tended to decrease the magnitude of the inequality. Conclusions Noncommunicable diseases are not necessarily diseases of the wealthy, and showed unequal distribution across socioeconomic groups in low- and middle-income country groups. Disaggregated research is warranted to assess the impact of individual noncommunicable diseases according to socioeconomic indicators. PMID:22726343

  2. Prevalence of Hypertension in Low- and Middle-Income Countries

    PubMed Central

    Sarki, Ahmed M.; Nduka, Chidozie U.; Stranges, Saverio; Kandala, Ngianga-Bakwin; Uthman, Olalekan A.

    2015-01-01

    Abstract We aimed to obtain overall and regional estimates of hypertension prevalence, and to examine the pattern of this disease condition across different socio-demographic characteristics in low-and middle-income countries. We searched electronic databases from inception to August 2015. We included population-based studies that reported hypertension prevalence using the current definition of blood pressure ≥140/90 mm Hg or self-reported use of antihypertensive medication. We used random-effects meta-analyses to pool prevalence estimates of hypertension, overall, by World Bank region and country income group. Meta-regression analyses were performed to explore sources of heterogeneity across the included studies. A total of 242 studies, comprising data on 1,494,609 adults from 45 countries, met our inclusion criteria. The overall prevalence of hypertension was 32.3% (95% confidence interval [CI] 29.4–35.3), with the Latin America and Caribbean region reporting the highest estimates (39.1%, 95% CI 33.1–45.2). Pooled prevalence estimate was also highest across upper middle income countries (37.8%, 95% CI 35.0–40.6) and lowest across low-income countries (23.1%, 95% CI 20.1–26.2). Prevalence estimates were significantly higher in the elderly (≥65 years) compared with younger adults (<65 years) overall and across the geographical regions; however, there was no significant sex-difference in hypertension prevalence (31.9% vs 30.8%, P = 0.6). Persons without formal education (49.0% vs 24.9%, P < 0.00001), overweight/obese (46.4% vs 26.3%, P < 0.00001), and urban settlers (32.7% vs 25.2%, P = 0.0005) were also more likely to be hypertensive, compared with those who were educated, normal weight, and rural settlers respectively. This study provides contemporary and up-to-date estimates that reflect the significant burden of hypertension in low- and middle-income countries, as well as evidence that hypertension remains a major public health issue

  3. Competing Forces of Socioeconomic Development and Environmental Degradation on Health and Happiness for Different Income Groups in China.

    PubMed

    Gu, Lijuan; Rosenberg, Mark W; Zeng, Juxin

    2017-10-01

    China's rapid socioeconomic growth in recent years and the simultaneous increase in many forms of pollution are generating contradictory pictures of residents' well-being. This paper applies multilevel analysis to the 2013 China General Social Survey data on social development and health to understand this twofold phenomenon. Multilevel models are developed to investigate the impact of socioeconomic development and environmental degradation on self-reported health (SRH) and self-reported happiness (SRHP), differentiating among lower, middle, and higher income groups. The results of the logit multilevel analysis demonstrate that income, jobs, and education increased the likelihood of rating SRH and SRHP positively for the lower and middle groups but had little or no effect on the higher income group. Having basic health insurance had an insignificant effect on health but increased the likelihood of happiness among the lower income group. Provincial-level pollutants were associated with a higher likelihood of good health for all income groups, and community-level industrial pollutants increased the likelihood of good health for the lower and middle income groups. Measures of community-level pollution were robust predictors of the likelihood of unhappiness among the lower and middle income groups. Environmental hazards had a mediating effect on the relationship between socioeconomic development and health, and socioeconomic development strengthened the association between environmental hazards and happiness. These outcomes indicate that the complex interconnections among socioeconomic development and environmental degradation have differential effects on well-being among different income groups in China.

  4. The HIV-1 Epidemic: Low- to Middle-Income Countries

    PubMed Central

    Shao, Yiming; Williamson, Carolyn

    2012-01-01

    Low- to middle-income countries bear the overwhelming burden of the human immunodeficiency virus type 1 (HIV-1) epidemic in terms of the numbers of their citizens living with HIV/AIDS (acquired immunodeficiency syndrome), the high degrees of viral diversity often involving multiple HIV-1 clades circulating within their populations, and the social and economic factors that compromise current control measures. Distinct epidemics have emerged in different geographical areas. These epidemics differ in their severity, the population groups they affect, their associated risk behaviors, and the viral strains that drive them. In addition to inflicting great human cost, the high burden of HIV infection has a major impact on the social and economic development of many low- to middle-income countries. Furthermore, the high degrees of viral diversity associated with multiclade HIV epidemics impacts viral diagnosis and pathogenicity and treatment and poses daunting challenges for effective vaccine development. PMID:22393534

  5. Influenza vaccines in low and middle income countries

    PubMed Central

    Ott, Jördis J.; Klein Breteler, Janna; Tam, John S.; Hutubessy, Raymond C.W.; Jit, Mark; de Boer, Michiel R.

    2013-01-01

    Objectives: Economic evaluations on influenza vaccination from low resource settings are scarce and have not been evaluated using a systematic approach. Our objective was to conduct a systematic review on the value for money of influenza vaccination in low- and middle-income countries. Methods: PubMed and EMBASE were searched for economic evaluations published in any language between 1960 and 2011. Main outcome measures were costs per influenza outcome averted, costs per quality-adjusted life years gained or disability-adjusted life years averted, costs per benefit in monetary units or cost-benefit ratios. Results: Nine economic evaluations on seasonal influenza vaccine met the inclusion criteria. These were model- or randomized-controlled-trial (RCT)-based economic evaluations from middle-income countries. Influenza vaccination provided value for money for elderly, infants, adults and children with high-risk conditions. Vaccination was cost-effective and cost-saving for chronic obstructive pulmonary disease patients and in elderly above 65 y from model-based evaluations, but conclusions from RCTs on elderly varied. Conclusion: Economic evaluations from middle income regions differed in population studied, outcomes and definitions used. Most findings are in line with evidence from high-income countries highlighting that influenza vaccine is likely to provide value for money. However, serious methodological limitations do not allow drawing conclusions on cost-effectiveness of influenza vaccination in middle income countries. Evidence on cost-effectiveness from low-income countries is lacking altogether, and more information is needed from full economic evaluations that are conducted in a standardized manner. PMID:23732900

  6. Treatment and disease outcomes of migrants from low- and middle-income countries in the Australian HIV Observational Database cohort.

    PubMed

    Tilley, Donna M; Griggs, Elizabeth; Hoy, Jennifer; Wright, Stephen T; Woolley, Ian; Burke, Michael; O'Connor, Catherine C

    2015-01-01

    People from culturally and linguistically diverse backgrounds, including low- and middle-income countries, account for a third of new HIV diagnoses in Australia and are a priority for HIV prevention and treatment programs. We describe the demographic and clinical characteristics of participants in the Australian HIV Observational Database (AHOD) and compare disease outcomes, progression to AIDS and treatment outcomes of those born in low- and middle-income countries, with those born in high-income countries and Australia. All participants enrolled in AHOD sites where country of birth is routinely collected were included in the study. Age, CD4 count, HIV viral load, antiretroviral therapy, hepatitis co-infection, all-cause mortality and AIDS illness were analysed. Of 2403 eligible participants, 77.3% were Australian born, 13.7% born in high-income countries and 9.0% born in middle- or low-income countries. Those born in Australia or high-income countries were more likely to be male (96%) than those from middle- or low-income countries (76%), p < .0001 and more likely to have acquired HIV via male to male sexual contact (77%; 79%) compared with those from middle- or low-income countries (50%), p < .0001. At enrolment, mean CD4 cell count was higher in Australian born (528 cells/µL) than both those born in high-income countries (468 cells/µL) and those born in middle- and low-income countries (451 cells/µL), p < .0001; whereas the mean HIV RNA level (log10 copies/mL) was similar in all three groups (4.44, 4.76 and 4.26, respectively), p = .19.There was no difference in adjusted incidence risk ratios for all-cause mortality and AIDS incidence in all three groups, p = .39. These findings reflect successful outcomes of people born in low- and middle-income countries once engaged in HIV care.

  7. Treatment and disease outcomes of migrants from low- and middle-income countries in the Australian HIV Observational Database cohort

    PubMed Central

    Tilley, Donna M.; Griggs, Elizabeth; Hoy, Jennifer; Wright, Stephen T.; Woolley, Ian; Burke, Michael; O’Connor, Catherine C.

    2018-01-01

    People from culturally and linguistically diverse backgrounds, including low- and middle-income countries, account for a third of new HIV diagnoses in Australia and are a priority for HIV prevention and treatment programs. We describe the demographic and clinical characteristics of participants in the Australian HIV Observational Database (AHOD) and compare disease outcomes, progression to AIDS and treatment outcomes of those born in low- and middle-income countries, with those born in high-income countries and Australia. All participants enrolled in AHOD sites where country of birth is routinely collected were included in the study. Age, CD4 count, HIV viral load, antiretroviral therapy, hepatitis co-infection, all-cause mortality and AIDS illness were analysed. Of 2403 eligible participants, 77.3% were Australian born, 13.7% born in high-income countries and 9.0% born in middle- or low-income countries. Those born in Australia or high-income countries were more likely to be male (96%) than those from middle- or low-income countries (76%), p < .0001 and more likely to have acquired HIV via male to male sexual contact (77%; 79%) compared with those from middle- or low-income countries (50%), p < .0001. At enrolment, mean CD4 cell count was higher in Australian born (528 cells/µL) than both those born in high-income countries (468 cells/µL) and those born in middle- and low-income countries (451 cells/µL), p < .0001; whereas the mean HIV RNA level (log10 copies/mL) was similar in all three groups (4.44, 4.76 and 4.26, respectively), p = .19. There was no difference in adjusted incidence risk ratios for all-cause mortality and AIDS incidence in all three groups, p = .39. These findings reflect successful outcomes of people born in low- and middle-income countries once engaged in HIV care. PMID:26679270

  8. Economic Disparities in Middle Childhood Development: Does Income Matter?

    ERIC Educational Resources Information Center

    Votruba-Drzal, Elizabeth

    2006-01-01

    A large literature has documented the influence of family economic resources on child development, yet income's effects in middle childhood have been understudied. Using data from the National Longitudinal Survey of Youth (N = 3,551), the author examined the influence of family income in early and middle childhood on academic skills and…

  9. Efficacy and safety of bubble CPAP in neonatal care in low and middle income countries: a systematic review.

    PubMed

    Martin, Simone; Duke, Trevor; Davis, Peter

    2014-11-01

    Forty per cent of global child deaths occur in the neonatal period. Low and middle income countries need effective and simple methods to improve hospital-based neonatal care. Bubble continuous positive airway pressure (CPAP) may have a role in improving the quality of respiratory support in hospitals in low and middle income countries. To examine the evidence for the efficacy and safety of bubble CPAP in neonates with respiratory distress in low and middle income settings. A systematic search (1946-March 2014) was performed of Pubmed, Ovid MEDLINE, Web of Science, Google Scholar and the references of relevant articles. Articles meeting inclusion criteria (CPAP for respiratory distress in infants <28 days of age in hospitals in low and middle income countries) were assessed using Grading of Recommendations, Assessment, Development and Evaluation and Newcastle-Ottawa Quality Assessment Scale methodology. Outcomes included need for mechanical ventilation, complications and mortality. In three studies, the initial use of bubble CPAP compared with oxygen therapy, followed by mechanical ventilation if required, reduced the need for mechanical ventilation by 30%-50%. In another three trials comparing bubble CPAP with ventilator CPAP, mortality and complication rates were similar, while meta-analysis of CPAP failure in these same trials showed a lower failure rate in the bubble CPAP groups (p <0.003). There is evidence that bubble CPAP is safe and reduces the need for mechanical ventilation. Further research into the efficacy of bubble CPAP in low-income and middle-income countries is needed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  10. Management of severe acute malnutrition in low-income and middle-income countries

    USDA-ARS?s Scientific Manuscript database

    Kwashiorkor and marasmus, collectively termed severe acute malnutrition (SAM), account for at least 10% of all deaths among children under 5 years of age worldwide, virtually all of them in low-income and middle-income countries. A number of risk factors, including seasonal food insecurity, environm...

  11. Health outcomes of unpaid care workers in low-income and middle-income countries: a protocol for a systematic review

    PubMed Central

    Magaña, Irene; Martínez, Pablo; Loyola, María-Soledad

    2018-01-01

    Introduction The literature on health outcomes of unpaid care work has included studies coming from high-income countries, and has reported gender inequalities that make caregiving women more vulnerable to physical and mental health problems. The impact of unpaid care work on the health of those living in low-income and middle-income countries, where women’s autonomy is more limited, is unknown. Methods and analysis We will conduct a systematic review of observational studies on health outcomes according to unpaid caregiving status and sex of people living in low-income and middle-income countries. Cumulative Index to Nursing and Allied Health Literature, PubMed and Scientific Electronic Library Online Citation Index will be searched for reports in English or Spanish with published results from inception to 1 June 2017. We expect the studies to have recruited individuals in low-income and middle-income countries, including exposed and non-exposed groups to participation in unpaid care to members if their households or community reporting either physical and/or mental health problems, self-reported health-related quality of life, self-care skills/behaviours or use of any healthcare services in the participants. Data extraction, the assessment of risk of bias and confounding, and qualitative synthesis will be carried out by two independent reviewers with the assistance of a third party. Dissemination Results are expected to be published in peer-reviewed journals from the field of health and gender, or health and inequality. PROSPERO registration number CRD42017071785. PMID:29362257

  12. Sectoral output, energy use, and CO2 emission in middle-income countries.

    PubMed

    Sohag, Kazi; Al Mamun, Md; Uddin, Gazi Salah; Ahmed, Ali M

    2017-04-01

    Middle-income countries are currently undergoing massive structural changes towards more industrialized economies. In this paper, we carefully examine the impact of these transformations on the environmental quality of middle-income countries. Specifically, we examine the role of sector value addition to GDP on CO 2 emission nexus for middle-income economies controlling for the effects of population growth, energy use, and trade openness. Using recently developed panel methods that consider cross-sectional dependence and allow for heterogeneous slope coefficients, we show that energy use and growth of industrial and service sectors positively explain CO 2 emissions in middle-income economies. We also find that population growth is insignificantly associated with CO 2 emission. Hence, our paper provides a solid ground for developing a sustainable and pro-growth policy for middle-income countries.

  13. Parenting Practices and Tobacco Use in Middle School Students in Low- and Middle-Income Countries

    ERIC Educational Resources Information Center

    Poms, Laura W.; Fleming, Lila C.; Jacobsen, Kathryn H.

    2012-01-01

    Background: Parenting practices have been shown to have a strong influence on adolescent tobacco use in high-income countries. This study examined whether parenting practices also were associated with tobacco use by middle school students (approximately ages 13-15) in low- and middle-income countries. Methods: A secondary analysis was performed on…

  14. Socioeconomic inequality in smoking in low-income and middle-income countries: results from the World Health Survey.

    PubMed

    Hosseinpoor, Ahmad Reza; Parker, Lucy Anne; Tursan d'Espaignet, Edouard; Chatterji, Somnath

    2012-01-01

    To assess the magnitude and pattern of socioeconomic inequality in current smoking in low and middle income countries. We used data from the World Health Survey [WHS] in 48 low-income and middle-income countries to estimate the crude prevalence of current smoking according to household wealth quintile. A Poisson regression model with a robust variance was used to generate the Relative Index of Inequality [RII] according to wealth within each of the countries studied. In males, smoking was disproportionately prevalent in the poor in the majority of countries. In numerous countries the poorest men were over 2.5 times more likely to smoke than the richest men. Socioeconomic inequality in women was more varied showing patterns of both pro-rich and pro-poor inequality. In 20 countries pro-rich relative socioeconomic inequality was statistically significant: the poorest women had a higher prevalence of smoking compared to the richest women. Conversely, in 9 countries women in the richest population groups had a statistically significant greater risk of smoking compared to the poorest groups. Both the pattern and magnitude of relative inequality may vary greatly between countries. Prevention measures should address the specific pattern of smoking inequality observed within a population.

  15. Socioeconomic Inequality in Smoking in Low-Income and Middle-Income Countries: Results from the World Health Survey

    PubMed Central

    Hosseinpoor, Ahmad Reza; Parker, Lucy Anne; Tursan d'Espaignet, Edouard; Chatterji, Somnath

    2012-01-01

    Objectives To assess the magnitude and pattern of socioeconomic inequality in current smoking in low and middle income countries. Methods We used data from the World Health Survey [WHS] in 48 low-income and middle-income countries to estimate the crude prevalence of current smoking according to household wealth quintile. A Poisson regression model with a robust variance was used to generate the Relative Index of Inequality [RII] according to wealth within each of the countries studied. Results In males, smoking was disproportionately prevalent in the poor in the majority of countries. In numerous countries the poorest men were over 2.5 times more likely to smoke than the richest men. Socioeconomic inequality in women was more varied showing patterns of both pro-rich and pro-poor inequality. In 20 countries pro-rich relative socioeconomic inequality was statistically significant: the poorest women had a higher prevalence of smoking compared to the richest women. Conversely, in 9 countries women in the richest population groups had a statistically significant greater risk of smoking compared to the poorest groups. Conclusion Both the pattern and magnitude of relative inequality may vary greatly between countries. Prevention measures should address the specific pattern of smoking inequality observed within a population. PMID:22952617

  16. Cardiovascular risk and events in 17 low-, middle-, and high-income countries.

    PubMed

    Yusuf, Salim; Rangarajan, Sumathy; Teo, Koon; Islam, Shofiqul; Li, Wei; Liu, Lisheng; Bo, Jian; Lou, Qinglin; Lu, Fanghong; Liu, Tianlu; Yu, Liu; Zhang, Shiying; Mony, Prem; Swaminathan, Sumathi; Mohan, Viswanathan; Gupta, Rajeev; Kumar, Rajesh; Vijayakumar, Krishnapillai; Lear, Scott; Anand, Sonia; Wielgosz, Andreas; Diaz, Rafael; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Lanas, Fernando; Yusoff, Khalid; Ismail, Noorhassim; Iqbal, Romaina; Rahman, Omar; Rosengren, Annika; Yusufali, Afzalhussein; Kelishadi, Roya; Kruger, Annamarie; Puoane, Thandi; Szuba, Andrzej; Chifamba, Jephat; Oguz, Aytekin; McQueen, Matthew; McKee, Martin; Dagenais, Gilles

    2014-08-28

    More than 80% of deaths from cardiovascular disease are estimated to occur in low-income and middle-income countries, but the reasons are unknown. We enrolled 156,424 persons from 628 urban and rural communities in 17 countries (3 high-income, 10 middle-income, and 4 low-income countries) and assessed their cardiovascular risk using the INTERHEART Risk Score, a validated score for quantifying risk-factor burden without the use of laboratory testing (with higher scores indicating greater risk-factor burden). Participants were followed for incident cardiovascular disease and death for a mean of 4.1 years. The mean INTERHEART Risk Score was highest in high-income countries, intermediate in middle-income countries, and lowest in low-income countries (P<0.001). However, the rates of major cardiovascular events (death from cardiovascular causes, myocardial infarction, stroke, or heart failure) were lower in high-income countries than in middle- and low-income countries (3.99 events per 1000 person-years vs. 5.38 and 6.43 events per 1000 person-years, respectively; P<0.001). Case fatality rates were also lowest in high-income countries (6.5%, 15.9%, and 17.3% in high-, middle-, and low-income countries, respectively; P=0.01). Urban communities had a higher risk-factor burden than rural communities but lower rates of cardiovascular events (4.83 vs. 6.25 events per 1000 person-years, P<0.001) and case fatality rates (13.52% vs. 17.25%, P<0.001). The use of preventive medications and revascularization procedures was significantly more common in high-income countries than in middle- or low-income countries (P<0.001). Although the risk-factor burden was lowest in low-income countries, the rates of major cardiovascular disease and death were substantially higher in low-income countries than in high-income countries. The high burden of risk factors in high-income countries may have been mitigated by better control of risk factors and more frequent use of proven pharmacologic

  17. Health outcomes of unpaid care workers in low-income and middle-income countries: a protocol for a systematic review.

    PubMed

    Magaña, Irene; Martínez, Pablo; Loyola, María-Soledad

    2018-01-23

    The literature on health outcomes of unpaid care work has included studies coming from high-income countries, and has reported gender inequalities that make caregiving women more vulnerable to physical and mental health problems. The impact of unpaid care work on the health of those living in low-income and middle-income countries, where women's autonomy is more limited, is unknown. We will conduct a systematic review of observational studies on health outcomes according to unpaid caregiving status and sex of people living in low-income and middle-income countries. Cumulative Index to Nursing and Allied Health Literature, PubMed and Scientific Electronic Library Online Citation Index will be searched for reports in English or Spanish with published results from inception to 1 June 2017. We expect the studies to have recruited individuals in low-income and middle-income countries, including exposed and non-exposed groups to participation in unpaid care to members if their households or community reporting either physical and/or mental health problems, self-reported health-related quality of life, self-care skills/behaviours or use of any healthcare services in the participants. Data extraction, the assessment of risk of bias and confounding, and qualitative synthesis will be carried out by two independent reviewers with the assistance of a third party. Results are expected to be published in peer-reviewed journals from the field of health and gender, or health and inequality. CRD42017071785. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. Socioeconomic Inequalities Persist Despite Declining Stunting Prevalence in Low- and Middle-Income Countries.

    PubMed

    da Silva, Inácio Crochemore M; França, Giovanny V; Barros, Aluisio J D; Amouzou, Agbessi; Krasevec, Julia; Victora, Cesar G

    2018-02-01

    Global stunting prevalence has been nearly halved between 1990 and 2016, but it remains unclear whether this decline has benefited poor and rural populations within low- and middle-income countries (LMICs). We assessed time trends in stunting among children <5 y of age (under-5) according to household wealth and place of residence in 67 LMICs. Stunting prevalence was analyzed in 217 nationally representative Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 67 countries with ≥2 surveys between 1993 and 2014. National estimates were stratified by wealth and area of residence, comparing the poorest 40% with the wealthiest 60%, and those residing in urban and rural areas. Time trends were calculated for LMICs by using multilevel regression models weighted by under-5 population, with stratification by wealth and by residence. Trends in absolute (slope index of inequality; SII) and relative (concentration index; CIX) inequalities were calculated. Mean prevalences in 1993 were 53.7% in low-income and 48.2% in middle-income countries, with annual average linear declines of 0.76 and 0.72 percentage points (pp), respectively. Although similar slopes of declines were observed for the poorest 40% and wealthiest 60% groups in all countries (0.78 and 0.74 pp, respectively), absolute and relative inequalities increased over time in low-income countries (SII increased from -19.3% in 1993 to -23.7% in 2014 and CIX increased from -6.2% to -10.8% in the same period). In middle-income countries, socioeconomic inequalities remained stable. Overall, stunting prevalence decreased more rapidly among rural than for urban children (0.78 and 0.55 pp, respectively). The prevalence of stunting is decreasing. Poor-rich gaps are stable in middle-income countries and slightly increasing in low-income countries. Rural-urban inequalities are decreasing over time.

  19. Socioeconomic inequalities in risk factors for non communicable diseases in low-income and middle-income countries: results from the World Health Survey

    PubMed Central

    2012-01-01

    Background Monitoring inequalities in non communicable disease risk factor prevalence can help to inform and target effective interventions. The prevalence of current daily smoking, low fruit and vegetable consumption, physical inactivity, and heavy episodic alcohol drinking were quantified and compared across wealth and education levels in low- and middle-income country groups. Methods This study included self-reported data from 232,056 adult participants in 48 countries, derived from the 2002–2004 World Health Survey. Data were stratified by sex and low- or middle-income country status. The main outcome measurements were risk factor prevalence rates reported by wealth quintile and five levels of educational attainment. Socioeconomic inequalities were measured using the slope index of inequality, reflecting differences in prevalence rates, and the relative index of inequality, reflecting the prevalence ratio between the two extremes of wealth or education accounting for the entire distribution. Data were adjusted for confounding factors: sex, age, marital status, area of residence, and country of residence. Results Smoking and low fruit and vegetable consumption were significantly higher among lower socioeconomic groups. The highest wealth-related absolute inequality was seen in smoking among men of low- income country group (slope index of inequality 23.0 percentage points; 95% confidence interval 19.6, 26.4). The slope index of inequality for low fruit and vegetable consumption across the entire distribution of education was around 8 percentage points in both sexes and both country income groups. Physical inactivity was less prevalent in populations of low socioeconomic status, especially in low-income countries (relative index of inequality: (men) 0.46, 95% confidence interval 0.33, 0.64; (women) 0.52, 95% confidence interval 0.42, 0.65). Mixed patterns were found for heavy drinking. Conclusions Disaggregated analysis of the prevalence of non

  20. Global Health Equity: Cancer Care Outcome Disparities in High-, Middle-, and Low-Income Countries

    PubMed Central

    de Souza, Jonas A.; Hunt, Bijou; Asirwa, Fredrick Chite; Adebamowo, Clement

    2016-01-01

    Breakthroughs in our global fight against cancer have been achieved. However, this progress has been unequal. In low- and middle-income countries and for specific populations in high-income settings, many of these advancements are but an aspiration and hope for the future. This review will focus on health disparities in cancer within and across countries, drawing from examples in Kenya, Brazil, and the United States. Placed in context with these examples, the authors also draw basic recommendations from several initiatives and groups that are working on the issue of global cancer disparities, including the US Institute of Medicine, the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, and the Union for International Cancer Control. From increasing initiatives in basic resources in low-income countries to rapid learning systems in high-income countries, the authors argue that beyond ethics and equity issues, it makes economic sense to invest in global cancer control, especially in low- and middle-income countries. PMID:26578608

  1. Pharmaceutical quality assurance of local private distributors: a secondary analysis in 13 low-income and middle-income countries.

    PubMed

    Van Assche, Kerlijn; Nebot Giralt, Ariadna; Caudron, Jean Michel; Schiavetti, Benedetta; Pouget, Corinne; Tsoumanis, Achilleas; Meessen, Bruno; Ravinetto, Raffaella

    2018-01-01

    The rapid globalisation of the pharmaceutical production and distribution has not been supported by harmonisation of regulatory systems worldwide. Thus, the supply systems in low-income and middle-income countries (LMICs) remain exposed to the risk of poor-quality medicines. To contribute to estimating this risk in the private sector in LMICs, we assessed the quality assurance system of a convenient sample of local private pharmaceutical distributors. This descriptive study uses secondary data derived from the audits conducted by the QUAMED group at 60 local private pharmaceutical distributors in 13 LMICs. We assessed the distributors' compliance with good distribution practices (GDP), general quality requirements (GQR) and cold chain management (CCM), based on an evaluation tool inspired by the WHO guidelines 'Model Quality Assurance System (MQAS) for procurement agencies'. Descriptive statistics describe the compliance for the whole sample, for distributors in sub-Saharan Africa (SSA) versus those in non-SSA, and for those in low-income countries (LICs) versus middle-income countries (MICs). Local private pharmaceutical distributors in our sample were non-compliant, very low-compliant or low-compliant for GQR (70%), GDP (60%) and CCM (41%). Only 7/60 showed good to full compliance for at least two criteria. Observed compliance varies by geographical region and by income group: maximum values are higher in non-SSA versus SSA and in MICs versus LICs, while minimum values are the same across different groups. The poor compliance with WHO quality standards observed in our sample indicates a concrete risk that patients in LMICs are exposed to poor-quality or degraded medicines. Significant investments are needed to strengthen the regulatory supervision, including on private pharmaceutical distributors. An adapted standardised evaluation tool inspired by the WHO MQAS would be helpful for self-evaluation, audit and inspection purposes.

  2. Pharmaceutical quality assurance of local private distributors: a secondary analysis in 13 low-income and middle-income countries

    PubMed Central

    Caudron, Jean Michel; Schiavetti, Benedetta; Pouget, Corinne; Tsoumanis, Achilleas; Meessen, Bruno; Ravinetto, Raffaella

    2018-01-01

    Introduction The rapid globalisation of the pharmaceutical production and distribution has not been supported by harmonisation of regulatory systems worldwide. Thus, the supply systems in low-income and middle-income countries (LMICs) remain exposed to the risk of poor-quality medicines. To contribute to estimating this risk in the private sector in LMICs, we assessed the quality assurance system of a convenient sample of local private pharmaceutical distributors. Methods This descriptive study uses secondary data derived from the audits conducted by the QUAMED group at 60 local private pharmaceutical distributors in 13 LMICs. We assessed the distributors’ compliance with good distribution practices (GDP), general quality requirements (GQR) and cold chain management (CCM), based on an evaluation tool inspired by the WHO guidelines ’Model Quality Assurance System (MQAS) for procurement agencies'. Descriptive statistics describe the compliance for the whole sample, for distributors in sub-Saharan Africa (SSA) versus those in non-SSA, and for those in low-income countries (LICs) versus middle-income countries (MICs). Results Local private pharmaceutical distributors in our sample were non-compliant, very low-compliant or low-compliant for GQR (70%), GDP (60%) and CCM (41%). Only 7/60 showed good to full compliance for at least two criteria. Observed compliance varies by geographical region and by income group: maximum values are higher in non-SSA versus SSA and in MICs versus LICs, while minimum values are the same across different groups. Conclusion The poor compliance with WHO quality standards observed in our sample indicates a concrete risk that patients in LMICs are exposed to poor-quality or degraded medicines. Significant investments are needed to strengthen the regulatory supervision, including on private pharmaceutical distributors. An adapted standardised evaluation tool inspired by the WHO MQAS would be helpful for self-evaluation, audit and inspection

  3. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries

    PubMed Central

    Gelaye, Bizu; Rondon, Marta; Araya, Ricardo; Williams, Michelle A.

    2016-01-01

    Maternal depression, a non-psychotic depressive episode of mild to major severity, is one of the major contributors of pregnancy-related morbidity and mortality. Maternal depression (antepartum or post partum) has been linked to negative health-related behaviours and adverse outcomes, including psychological and developmental disturbances in infants, children, and adolescents. Despite its enormous burden, maternal depression in low-income and middle-income countries remains under-recognised and undertreated. In this Series paper, we systematically review studies that focus on the epidemiology of perinatal depression (ie, during antepartum and post-partum periods) among women residing in low-income and middle-income countries. We also summarise evidence for the association of perinatal depression with infant and childhood outcomes. This review is intended to summarise fi ndings from the existing literature, identify important knowledge gaps, and set the research agenda for creating new generalisable knowledge pertinent to increasing our understanding of the prevalence, determinants, and infant and childhood health outcomes associated with perinatal depression. This review is also intended to set the stage for subsequent work aimed at reinforcing and accelerating investments toward providing services to manage maternal depression in low-income and middle-income countries. PMID:27650773

  4. Achieving the Middle Ground in an Age of Concentrated Extremes: Mixed Middle-Income Neighborhoods and Emerging Adulthood

    PubMed Central

    SAMPSON, ROBERT J.; MARE, ROBERT D.; PERKINS, KRISTIN L.

    2015-01-01

    This article focuses on stability and change in “mixed middle-income” neighborhoods. We first analyze variation across nearly two decades for all neighborhoods in the United States and in the Chicago area, particularly. We then analyze a new longitudinal study of almost 700 Chicago adolescents over an 18-year span, including the extent to which they are exposed to different neighborhood income dynamics during the transition to young adulthood. The concentration of income extremes is persistent among neighborhoods, generally, but mixed middle-income neighborhoods are more fluid. Persistence also dominates among individuals, though Latino-Americans are much more likely than African Americans or whites to be exposed to mixed middle-income neighborhoods in the first place and to transition into them over time, even when adjusting for immigrant status, education, income, and residential mobility. The results here enhance our knowledge of the dynamics of income inequality at the neighborhood level, and the endurance of concentrated extremes suggests that policies seeking to promote mixed-income neighborhoods face greater odds than commonly thought. PMID:26722129

  5. Political economy of tobacco control in low-income and middle-income countries: lessons from Thailand and Zimbabwe. Global Analysis Project Team.

    PubMed Central

    Chantornvong, S.; Collin, J.; Dodgson, R.; Lee, K.; McCargo, D.; Seddon, D.; Vaughan, P.; Woelk, G.

    2000-01-01

    Crucial to the success of the proposed Framework Convention on Tobacco Control will be an understanding of the political and economic context for tobacco control policies, particularly in low-income and middle-income countries. Policy studies in Thailand and Zimbabwe employed the analytical perspective of political economy and a research strategy that used political mapping, a technique for characterizing and evaluating the political environment surrounding a policy issue, and stakeholder analysis, which seeks to identify key actors and to determine their capacity to shape policy outcomes. These policy studies clearly revealed how tobacco control in low-income and middle-income countries is also being shaped by developments in the global and regional political economy. Hence efforts to strengthen national control policies need to be set within the context of globalization and the international context. Besides the transnational tobacco companies, international tobacco groups and foreign governments, international agencies and nongovernmental organizations are also playing influential roles. It cannot be assumed, therefore, that the tobacco control strategies being implemented in industrialized countries will be just as effective and appropriate when implemented in developing countries. There is an urgent need to expand the number of such tobacco policy studies, particularly in low-income and middle-income countries. Comprehensive guidelines for tobacco policy analysis and research are required to support this process, as is a broader international strategy to coordinate further tobacco policy research studies at country, regional and global levels. PMID:10994265

  6. Adlerian Marital Therapy Strategies with Middle Income Couples Facing Financial Stress.

    ERIC Educational Resources Information Center

    Freeman, Criswell; And Others

    1993-01-01

    Describes the impact of economic stressors on marriage. Discusses how Adlerian marital therapy strategies can be tailored to help middle-income couples deal with such stressors. Identifies problems facing middle income families experiencing financial hardship, describes Adlerian counseling for financial conflict in marriage, and delineates…

  7. Access to Cytotoxic Medicines by Children With Cancer: A Focus on Low and Middle Income Countries.

    PubMed

    Barr, Ronald; Robertson, Jane

    2016-02-01

    The Essential Medicines Working Group of the International Society of Pediatric Oncology (SIOP) has proposed a list of antineoplastic drugs that should be available in low and middle income countries. Data were extracted on the listing of 18 essential and 8 ancillary antineoplastic medicines in the national essential medicines lists (NEMLs) or national reimbursable medicines lists (NRMLs) of 135 countries with gross national income (GNI) per capita of less than US $25,000. Correlations between numbers of medicines listed and GNI per capita, annual government health expenditure (AGHE) per capita, and the number of physicians per million people were examined. Listing of the 18 essential antineoplastic drugs ranged from 27% (thioguanine) to 95% (methotrexate). The median number of medicines listed was 7 (0-18) in low income countries (n = 26) and 14 in lower-middle (n = 42), upper-middle (n = 44), and high income countries (n = 20). For the ancillary eight medicines, the median was one (0-8) across the 135 countries. Correlations with GNI per capita (r = 0.17, P = 0.0266) and physician density (r = 0.25, P = 0.0017) were statistically significant; not so for AGHE per capita (r = 0.00, P = 0.5000). There was large variability within income groups in numbers of antineoplastic agents identified as essential in NEMLs and NRMLs. While not a direct measure of availability, listing is an important step, guiding procurement for the public sector. These results focus attention on deficits in NEMLs and NMRLs as a step to improving access to effective antineoplastic medicines for cancers in children in low and middle income countries. © 2015 Wiley Periodicals, Inc.

  8. Strengthening medical product regulation in low- and middle-income countries.

    PubMed

    Preston, Charles; Valdez, Mary Lou; Bond, Katherine

    2012-01-01

    In summary, the case studies exploring global product supply chains and diethylene glycol poisoning in Panama, clinical trials regulation through AVAREF, premarket assurance through PEPFAR tentative approval, post-market surveillance in sub-Saharan Africa through research on drug and vaccine safety systems, and regulatory science through the creation of a low-cost meningitis vaccine for low- and middle-income countries, demonstrate the essential value of regulatory systems to low- and middle-income countries. When they work, people live; when they fail, people die. As the challenges of globalization mount, and efforts to provide medical products to low- and middle-income countries scale up, there is no better time to put regulatory system strengthening squarely on the global health and development agenda.

  9. Poverty and disability in low- and middle-income countries: A systematic review

    PubMed Central

    Kuper, Hannah; Polack, Sarah

    2017-01-01

    Introduction Disability and poverty are believed to operate in a cycle, with each reinforcing the other. While agreement on the existence of a link is strong, robust empirical evidence substantiating and describing this potential association is lacking. Consequently, a systematic review was undertaken to explore the relationship between disability and economic poverty, with a focus on the situation in low and middle income countries (LMICs). Methods Ten electronic databases were searched to retrieve studies of any epidemiological design, published between 1990-March 2016 with data comparing the level of poverty between people with and without disabilities in LMICs (World Bank classifications). Poverty was defined using economic measures (e.g. assets, income), while disability included both broad assessments (e.g. self-reported functional or activity limitations) and specific impairments/disorders. Data extracted included: measures of association between disability and poverty, population characteristics and study characteristics. Proportions of studies finding positive, negative, null or mixed associations between poverty and disability were then disaggregated by population and study characteristics. Results From the 15,500 records retrieved and screened, 150 studies were included in the final sample. Almost half of included studies were conducted in China, India or Brazil (n = 70, 47%). Most studies were cross-sectional in design (n = 124, 83%), focussed on specific impairment types (n = 115, 77%) and used income as the measure for economic poverty (n = 82, 55%). 122 studies (81%) found evidence of a positive association between disability and a poverty marker. This relationship persisted when results were disaggregated by gender, measure of poverty used and impairment types. By country income group at the time of data collection, the proportion of country-level analyses with a positive association increased with the rising income level, with 59% of low-income, 67

  10. Poverty and disability in low- and middle-income countries: A systematic review.

    PubMed

    Banks, Lena Morgon; Kuper, Hannah; Polack, Sarah

    2017-01-01

    Disability and poverty are believed to operate in a cycle, with each reinforcing the other. While agreement on the existence of a link is strong, robust empirical evidence substantiating and describing this potential association is lacking. Consequently, a systematic review was undertaken to explore the relationship between disability and economic poverty, with a focus on the situation in low and middle income countries (LMICs). Ten electronic databases were searched to retrieve studies of any epidemiological design, published between 1990-March 2016 with data comparing the level of poverty between people with and without disabilities in LMICs (World Bank classifications). Poverty was defined using economic measures (e.g. assets, income), while disability included both broad assessments (e.g. self-reported functional or activity limitations) and specific impairments/disorders. Data extracted included: measures of association between disability and poverty, population characteristics and study characteristics. Proportions of studies finding positive, negative, null or mixed associations between poverty and disability were then disaggregated by population and study characteristics. From the 15,500 records retrieved and screened, 150 studies were included in the final sample. Almost half of included studies were conducted in China, India or Brazil (n = 70, 47%). Most studies were cross-sectional in design (n = 124, 83%), focussed on specific impairment types (n = 115, 77%) and used income as the measure for economic poverty (n = 82, 55%). 122 studies (81%) found evidence of a positive association between disability and a poverty marker. This relationship persisted when results were disaggregated by gender, measure of poverty used and impairment types. By country income group at the time of data collection, the proportion of country-level analyses with a positive association increased with the rising income level, with 59% of low-income, 67% of lower-middle and 72% of

  11. Household Expenditure for Dental Care in Low and Middle Income Countries

    PubMed Central

    Masood, Mohd; Sheiham, Aubrey; Bernabé, Eduardo

    2015-01-01

    This study assessed the extent of household catastrophic expenditure in dental health care and its possible determinants in 41 low and middle income countries. Data from 182,007 respondents aged 18 years and over (69,315 in 18 low income countries, 59,645 in 15 lower middle income countries and 53,047 in 8 upper middle income countries) who participated in the WHO World Health Survey (WHS) were analyzed. Expenditure in dental health care was defined as catastrophic if it was equal to or higher than 40% of the household capacity to pay. A number of individual and country-level factors were assessed as potential determinants of catastrophic dental health expenditure (CDHE) in multilevel logistic regression with individuals nested within countries. Up to 7% of households in low and middle income countries faced CDHE in the last 4 weeks. This proportion rose up to 35% among households that incurred some dental health expenditure within the same period. The multilevel model showed that wealthier, urban and larger households and more economically developed countries had higher odds of facing CDHE. The results of this study show that payments for dental health care can be a considerable burden on households, to the extent of preventing expenditure on basic necessities. They also help characterize households more likely to incur catastrophic expenditure on dental health care. Alternative health care financing strategies and policies targeted to improve fairness in financial contribution are urgently required in low and middle income countries. PMID:25923691

  12. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries.

    PubMed

    Gelaye, Bizu; Rondon, Marta B; Araya, Ricardo; Williams, Michelle A

    2016-10-01

    Maternal depression, a non-psychotic depressive episode of mild to major severity, is one of the major contributors of pregnancy-related morbidity and mortality. Maternal depression (antepartum or post partum) has been linked to negative health-related behaviours and adverse outcomes, including psychological and developmental disturbances in infants, children, and adolescents. Despite its enormous burden, maternal depression in low-income and middle-income countries remains under-recognised and undertreated. In this Series paper, we systematically review studies that focus on the epidemiology of perinatal depression (ie, during antepartum and post-partum periods) among women residing in low-income and middle-income countries. We also summarise evidence for the association of perinatal depression with infant and childhood outcomes. This review is intended to summarise findings from the existing literature, identify important knowledge gaps, and set the research agenda for creating new generalisable knowledge pertinent to increasing our understanding of the prevalence, determinants, and infant and childhood health outcomes associated with perinatal depression. This review is also intended to set the stage for subsequent work aimed at reinforcing and accelerating investments toward providing services to manage maternal depression in low-income and middle-income countries. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Injury incidence among middle school students aged 13-15 years in 47 low-income and middle-income countries.

    PubMed

    Street, Erica J; Jacobsen, Kathryn H

    2016-12-01

    A total of 95 811 students aged 13-15 years participated in nationally representative Global School-based Student Health Surveys (GSHS) in 47 low-income and middle-income countries conducted between 2003 and 2012. On average, about 40% of the participants in each country reported at least one injury in the past year that was serious enough to cause the student to miss at least one full day of usual activities (such as school, sports and a job) or to require treatment by a healthcare professional. In 40 of the 47 countries, boys reported a significantly higher injury rate than girls. Based on these numbers, injuries likely cause approximately four million days of school absence by lower secondary school students annually. Most of these injuries are preventable. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  14. Withholding and withdrawal of life-sustaining treatments in low-middle-income versus high-income Asian countries and regions.

    PubMed

    Phua, Jason; Joynt, Gavin M; Nishimura, Masaji; Deng, Yiyun; Myatra, Sheila Nainan; Chan, Yiong Huak; Binh, Nguyen Gia; Tan, Cheng Cheng; Faruq, Mohammad Omar; Arabi, Yaseen M; Wahjuprajitno, Bambang; Liu, Shih-Feng; Hashemian, Seyed Mohammad Reza; Kashif, Waqar; Staworn, Dusit; Palo, Jose Emmanuel; Koh, Younsuck

    2016-07-01

    To compare the attitudes of physicians towards withholding and withdrawing life-sustaining treatments in intensive care units (ICUs) in low-middle-income Asian countries and regions with those in high-income ones, and to explore differences in the role of families and surrogates, legal risks, and financial considerations between these countries and regions. Questionnaire study conducted in May-December 2012 on 847 physicians from 255 ICUs in 10 low-middle-income countries and regions according to the World Bank's classification, and 618 physicians from 211 ICUs in six high-income countries and regions. After we accounted for personal, ICU, and hospital characteristics on multivariable analyses using generalised linear mixed models, physicians from low-middle-income countries and regions were less likely to limit cardiopulmonary resuscitation, mechanical ventilation, vasopressors and inotropes, tracheostomy and haemodialysis than those from high-income countries and regions. They were more likely to involve families in end-of-life care discussions and to perceive legal risks with limitation of life-sustaining treatments and do-not-resuscitate orders. Nonetheless, they were also more likely to accede to families' requests to withdraw life-sustaining treatments in a patient with an otherwise reasonable chance of survival on financial grounds in a case scenario (adjusted odds ratio 5.05, 95 % confidence interval 2.69-9.51, P < 0.001). Significant differences in ICU physicians' self-reported practice of limiting life-sustaining treatments, the role of families and surrogates, perception of legal risks and financial considerations exist between low-middle-income and high-income Asian countries and regions.

  15. Factors influencing medical students' motivation to practise in rural areas in low-income and middle-income countries: a systematic review

    PubMed Central

    Zwanikken, Prisca A C; Pokharel, Paras K; Scherpbier, Albert J

    2017-01-01

    Objectives There is a shortage of doctors working in rural areas all over the world, especially in low-income and middle-income countries. The choice to practise medicine in a rural area is influenced by many factors. Motivation developed as a medical student is one key determinant of this choice. This study explores influences on medical students' motivation to practise in rural areas of low-income and middle-income countries following graduation. Design A systematic review was conducted to identify influences on medical students' motivation to work in rural areas in low-income and middle-income countries. Papers reporting influences on motivation were included, and content analysis was conducted to select the articles. Articles not published in English were excluded from this review. Results A rural background (ie, being brought up in a rural area), training in rural areas with a community-based curriculum, early exposure to the community during medical training and rural location of medical school motivate medical students to work in rural areas. Perceived lack of infrastructure, high workload, poor hospital management and isolation are among the health facility factors that demotivate medical students for medical practice in rural areas. Conclusions Medical school selection criteria focusing on a rural background factor and medical education curriculum focusing on rural area are more relevant factors in low-income and middle-income countries. The factors identified in this review may assist the planners, medical educators and policymakers in low-income and middle-income countries in designing relevant interventions to positively influence rural choices where the shortage of rural physicians is an ongoing and increasing concern. PMID:28232465

  16. Research protocol: a realist synthesis of cross-border patient mobility from low-income and middle-income countries

    PubMed Central

    Durham, Jo; Blondell, Sarah J

    2014-01-01

    Introduction People are increasingly mobile for numerous reasons, including healthcare. Patient mobility has vast implications for individuals, communities and whole populations and yet, to date, research on patient mobility has been quite limited. Only a small body of evidence exists on patient mobility between low-income and middle-income countries, instead having focused primarily on cross-border movement between high-income and low-income countries. In this paper, we present a protocol for examining this under-studied phenomenon. Methods and analysis We propose to examine patient mobility between low-income and middle-income countries using a realist synthesis approach. Specifically, we aim to document why patients from low-income and middle-income countries cross international borders for healthcare, by identifying the mechanisms through which patients decide to cross-borders, and the contextual characteristics of domestic health markets that influence this choice. An underlying theory was established, based on the lead author's experience and a brief literature review, which will provide the basis to analyse search results in a subsequent paper. Search results will be obtained from databases (Ovid Medline, EMBASE, Scopus, EconLit, Web of Science) and the grey literature. An expert committee will be enlisted, prior to screening results, to review search results to ensure comprehensiveness. Based on this preliminary theory, we propose that, in some low-income and middle-income country markets, the interaction between demand-side and supply-side determinants results in market imperfections that, in turn, lead to patient movement across borders. Ethics and dissemination The study does not involve primary research and, therefore, does not require formal ethical approval; we do, however, follow the relevant standards of utility, usefulness, feasibility, propriety, accuracy and accountability. The standards of realist and meta-narrative evidence synthesis (RAMESES

  17. Ambulatory Blood Pressure Monitoring: A Complementary Strategy for Hypertension Diagnosis and Management in Low-Income and Middle-Income Countries.

    PubMed

    Abdalla, Marwah

    2017-02-01

    Ambulatory blood pressure monitoring (ABPM) can assess out-of-clinic blood pressure. ABPM is an underutilized resource in low-income and middle-income countries but should be considered a complementary strategy to clinic blood pressure measurement for the diagnosis and management of hypertension. Potential uses for ABPM in low-income and middle-income countries include screening of high-risk individuals who have concurrent communicable diseases, such as HIV, and in task-shifting health care strategies. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Uncaging the Dragon: Vietnam and the Middle-Income Trap

    DTIC Science & Technology

    2013-11-01

    compete with high- income advanced economies because it lacks the institutions necessary to continue economic growth . The author suggests that...but then cannot compete with high- income advanced economies because it lacks the institutions necessary to continue economic growth . The author...Vietnam modifies its current economic strategy, the factors that limit economic growth will leave it mired in the middle- income trap. The Communist

  19. Cigarette stick as valuable communicative real estate: a content analysis of cigarettes from 14 low-income and middle-income countries.

    PubMed

    C Smith, Katherine; Washington, Carmen; Welding, Kevin; Kroart, Laura; Osho, Adami; Cohen, Joanna E

    2016-09-01

    The current cigarette market is heavily focused on low-income and middle-income countries. Branding of tobacco products is key to establishing and maintaining a customer base. Greater restrictions on marketing and advertising of tobacco products create an incentive for companies to focus more on branding via the product itself. We consider how tobacco sticks are used for communicative purposes in 14 low-income and middle-income countries with extensive tobacco markets. In 2013, we collected and coded 3232 cigarette and kretek packs that were purchased from vendors in diverse neighbourhoods in 44 cities across the 14 low-income and middle-income countries with the greatest number of smokers. A single stick from each pack was assessed for branding, decorative and communicative elements using a common coding framework. Stick communication variables included brand name, brand image/logo, brand descriptor, colour and design carried through from pack, 'capsule cigarette' symbol, and embellishment of filter end. Communication and branding on the stick is essentially ubiquitous (99.75%); 97% of sticks include explicit branding (brand name or logo present). Colour is commonly carried through from the pack (95%), and some sticks (13%) include decorative elements matching the pack. Decorative elements can be found anywhere on the stick, including the filter tip (8%), and 'convertible' cigarettes include a symbol to show where to push. Cigarette sticks are clearly valuable 'real estate' that tobacco companies are using for communicative purposes. Across all countries and brands, the stick communicates branding via text, colour and imagery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  20. Feeding Practices of Mothers from Varied Income and Racial/Ethnic Groups.

    PubMed

    Worobey, John; Borrelli, Amanda; Espinosa, Carolina; Worobey, Harriet S

    2013-11-01

    Relatively few investigators have explored the role of maternal control in describing the feeding behavior of nonwhite parents of preschool-age children. The present study was conducted to examine if controlling feeding behaviors (i.e., restriction and pressuring) varied by income (middle vs. low) and race/ethnicity (white vs. Hispanic), and if they were associated with the BMI of their 4-year-old offspring. Responses to the "restriction" and "pressure to eat" variables of the Child Feeding Questionnaire were compared between 51 white middle-income mothers and 49 Hispanic low-income mothers. Mothers from both groups gave predominantly "neutral" ratings in their self-reports of feeding practices. However, relative to the Hispanic mothers, white mothers indicated significantly less restriction and pressure to eat. Higher child BMI was predicted by male gender and being Hispanic. The utility of maternal feeding practices in predicting child overweight is discussed, and the significant association between the conceptually different constructs of restriction and pressure to eat is examined.

  1. The association between obesity and severe disability among adults aged 50 or over in nine high-income, middle-income and low-income countries: a cross-sectional study.

    PubMed

    Koyanagi, Ai; Moneta, Maria Victoria; Garin, Noe; Olaya, Beatriz; Ayuso-Mateos, Jose Luis; Chatterji, Somnath; Leonardi, Matilde; Sainio, Päivi; Galas, Aleksander; Haro, Josep Maria

    2015-04-02

    The association between obesity and disability may differ between high-income and low-income/middle-income countries but there are no studies comparing this association between these settings. The aim of the study was to assess this association in nine countries using nationally-representative data from the Collaborative Research on Ageing in Europe (COURAGE) study and the WHO's Study on global AGEing and Adult Health (SAGE). Population-based cross-sectional study The survey was conducted in China, Finland, Ghana, India, Mexico, Poland, Russia, South Africa and Spain between 2007 and 2012. 42 116 individuals 50 years and older. The institutionalised and those with limited cognition were excluded. Disability was defined as severe or extreme difficulty in conducting at least one of six types of basic activities of daily living (ADL). The mean body mass index (BMI) ranged from 20.4 kg/m(2) in India to 30.7 kg/m(2) in South Africa. Compared to normal BMI (18.5-24.9 kg/m(2)), BMI≥35 kg/m(2) was associated with significantly higher odds for ADL disability in Finland (OR 4.64), Poland (OR 2.77), South Africa (OR 2.19) and Spain (OR 2.42). Interaction analysis showed that obese individuals in high-income countries were more likely to have ADL limitations than those in low-income or middle-income countries. The higher odds for disability among obese individuals in high-income countries may imply longer life lived with disability due to factors such as the decline in cardiovascular disease mortality. In South Africa, this may have been due to the exceptionally high prevalence of class III obesity. These findings underscore the importance of obesity prevention to reduce the disability burden among older adults. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data.

    PubMed

    Khatib, Rasha; McKee, Martin; Shannon, Harry; Chow, Clara; Rangarajan, Sumathy; Teo, Koon; Wei, Li; Mony, Prem; Mohan, Viswanathan; Gupta, Rajeev; Kumar, Rajesh; Vijayakumar, Krishnapillai; Lear, Scott A; Diaz, Rafael; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Lanas, Fernando; Yusoff, Khalid; Ismail, Noorhassim; Kazmi, Khawar; Rahman, Omar; Rosengren, Annika; Monsef, Nahed; Kelishadi, Roya; Kruger, Annamarie; Puoane, Thandi; Szuba, Andrzej; Chifamba, Jephat; Temizhan, Ahmet; Dagenais, Gilles; Gafni, Amiram; Yusuf, Salim

    2016-01-02

    WHO has targeted that medicines to prevent recurrent cardiovascular disease be available in 80% of communities and used by 50% of eligible individuals by 2025. We have previously reported that use of these medicines is very low, but now aim to assess how such low use relates to their lack of availability or poor affordability. We analysed information about availability and costs of cardiovascular disease medicines (aspirin, β blockers, angiotensin-converting enzyme inhibitors, and statins) in pharmacies gathered from 596 communities in 18 countries participating in the Prospective Urban Rural Epidemiology (PURE) study. Medicines were considered available if present at the pharmacy when surveyed, and affordable if their combined cost was less than 20% of household capacity-to-pay. We compared results from high-income, upper middle-income, lower middle-income, and low-income countries. Data from India were presented separately given its large, generic pharmaceutical industry. Communities were recruited between Jan 1, 2003, and Dec 31, 2013. All four cardiovascular disease medicines were available in 61 (95%) of 64 urban and 27 (90%) of 30 rural communities in high-income countries, 53 (80%) of 66 urban and 43 (73%) of 59 rural communities in upper middle-income countries, 69 (62%) of 111 urban and 42 (37%) of 114 rural communities in lower middle-income countries, eight (25%) of 32 urban and one (3%) of 30 rural communities in low-income countries (excluding India), and 34 (89%) of 38 urban and 42 (81%) of 52 rural communities in India. The four cardiovascular disease medicines were potentially unaffordable for 0·14% of households in high-income countries (14 of 9934 households), 25% of upper middle-income countries (6299 of 24,776), 33% of lower middle-income countries (13,253 of 40,023), 60% of low-income countries (excluding India; 1976 of 3312), and 59% households in India (9939 of 16,874). In low-income and middle-income countries, patients with previous

  3. Prenatal tobacco prevention and cessation interventions for women in low- and middle-income countries.

    PubMed

    Oncken, Cheryl A; Dietz, Patricia M; Tong, Van T; Belizán, José M; Tolosa, Jorge E; Berghella, Vincenzo; Goldenberg, Robert L; Lando, Harry A; Samet, Jonathan M; Bloch, Michele H

    2010-01-01

    Although the prevalence of tobacco use is decreasing in many high-income countries, it is increasing in many low- and middle-income countries. The health and economic burden of increasing tobacco use and dependence is predictable and will have devastating effects in countries with limited resources, particularly for vulnerable populations such as pregnant women. We sought to review effective tobacco prevention and intervention strategies for decreasing tobacco use and secondhand smoke exposure before and during pregnancy in high-, middle-, and low-income countries. We reviewed several types of interventions, including population-level efforts (increasing tobacco prices, implementing tobacco control policies), community interventions, clinical interventions, and pharmacological treatments. A second purpose of this report is to present findings of an international expert working group that was convened to review the evidence and to establish research priorities in the following areas: (a) preventing the uptake and reducing tobacco use among girls and women of reproductive age; and (b) reducing tobacco use and secondhand smoke exposure among pregnant women. The working group considered the evidence on existing interventions in terms of burden of disease, intervention impact, intervention costs, feasibility of integration into existing services, uniqueness of the contribution, and overall feasibility. Finally, we present the working group's recommendations for intervention research priorities.

  4. Chronic disease self-management education courses: utilization by low-income, middle-aged participants.

    PubMed

    Horrell, Lindsey N; Kneipp, Shawn M; Ahn, SangNam; Towne, Samuel D; Mingo, Chivon A; Ory, Marcia G; Smith, Matthew Lee

    2017-06-27

    Individuals living in lower-income areas face an increased prevalence of chronic disease and, oftentimes, greater barriers to optimal self-management. Disparities in disease management are seen across the lifespan, but are particularly notable among middle-aged adults. Although evidence-based Chronic Disease Self-management Education courses are available to enhance self-management among members of this at-risk population, little information is available to determine the extent to which these courses are reaching those at greatest risk. The purpose of this study is to compare the extent to which middle-aged adults from lower- and higher-income areas have engaged in CDSME courses, and to identify the sociodemographic characteristics of lower-income, middle aged participants. The results of this study were produced through analysis of secondary data collected during the Communities Putting Prevention to Work: Chronic Disease Self-Management Program initiative. During this initiative, data was collected from 100,000 CDSME participants across 45 states within the United States, the District of Columbia, and Puerto Rico. Of the entire sample included in this analysis (19,365 participants), 55 people lived in the most impoverished counties. While these 55 participants represented just 0.3% of the total study sample, researchers found this group completed courses more frequently than participants from less impoverished counties once enrolled. These results signal a need to enhance participation of middle-aged adults from lower-income areas in CDSME courses. The results also provide evidence that can be used to inform future program delivery choices, including decisions regarding recruitment materials, program leaders, and program delivery sites, to better engage this population.

  5. A comparative analysis of avoidable causes of childhood blindness in Malaysia with low income, middle income and high income countries.

    PubMed

    Koay, C L; Patel, D K; Tajunisah, I; Subrayan, V; Lansingh, V C

    2015-04-01

    To determine the avoidable causes of childhood blindness in Malaysia and to compare this to other middle income countries, low income countries and high income countries. Data were obtained from a school of the blind study by Patel et al. and analysed for avoidable causes of childhood blindness. Six other studies with previously published data on childhood blindness in Bangladesh, Ethiopia, Nigeria, Indonesia, China and the United Kingdom were reviewed for avoidable causes. Comparisons of data and limitations of the studies are described. Prevalence of avoidable causes of childhood blindness in Malaysia is 50.5 % of all the cases of childhood blindness, whilst in the poor income countries such as Bangladesh, Ethiopia, Nigeria and Indonesia, the prevalence was in excess of 60 %. China had a low prevalence, but this is largely due to the fact that most schools were urban, and thus did not represent the situation of the country. High income countries had the lowest prevalence of avoidable childhood blindness. In middle income countries, such as Malaysia, cataract and retinopathy of prematurity are the main causes of avoidable childhood blindness. Low income countries continue to struggle with infections such as measles and nutritional deficiencies, such as vitamin A, both of which are the main contributors to childhood blindness. In high income countries, such as the United Kingdom, these problems are almost non-existent.

  6. [Risk sharing methods in middle income countries].

    PubMed

    Inotai, András; Kaló, Zoltán

    2012-01-01

    The pricing strategy of innovative medicines is based on the therapeutic value in the largest pharmaceutical markets. The cost-effectiveness of new medicines with value based ex-factory price is justifiable. Due to the international price referencing and parallel trade the ex-factory price corridor of new medicines has been narrowed in recent years. Middle income countries have less negotiation power to change the narrow drug pricing corridor, although their fair intention is to buy pharmaceuticals at lower price from their scarce public resources compared to higher income countries. Therefore the reimbursement of new medicines at prices of Western-European countries may not be justifiable in Central-Eastern European countries. Confidential pricing agreements (i.e. confidential price discounts, claw-back or rebate) in lower income countries of the European Union can alleviate this problem, as prices of new medicines can be adjusted to local purchasing power without influencing the published ex-factory price and so the accessibility of patients to these drugs in other countries. In order to control the drug budget payers tend to apply financial risk sharing agreements for new medicines in more and more countries to shift the consequences of potential overspending to pharmaceutical manufacturers. The major paradox of financial risk-sharing schemes is that increased mortality, poor persistence of patients, reduced access to healthcare providers, and no treatment reduce pharmaceutical spending. Consequently, payers have started to apply outcome based risk sharing agreements for new medicines recently to improve the quality of health care provision. Our paper aims to review and assess the published financial and outcome based risk sharing methods. Introduction of outcome based risk-sharing schemes can be a major advancement in the drug reimbursement strategy of payers in middle income countries. These schemes can help to reduce the medical uncertainty in coverage

  7. Financing of HIV/AIDS programme scale-up in low-income and middle-income countries, 2009-31.

    PubMed

    Hecht, Robert; Stover, John; Bollinger, Lori; Muhib, Farzana; Case, Kelsey; de Ferranti, David

    2010-10-09

    As the global HIV/AIDS pandemic nears the end of its third decade, the challenges of efficient mobilisation of funds and management of resources are increasingly prominent. The aids2031 project modelled long-term funding needs for HIV/AIDS in developing countries with a range of scenarios and substantial variation in costs: ranging from US$397 to $722 billion globally between 2009 and 2031, depending on policy choices adopted by governments and donors. We examine what these figures mean for individual developing countries, and estimate the proportion of HIV/AIDS funding that they and donors will provide. Scenarios for expanded HIV/AIDS prevention, treatment, and mitigation were analysed for 15 representative countries. We suggest that countries will move in increasingly divergent directions over the next 20 years; middle-income countries with a low burden of HIV/AIDS will gradually be able to take on the modest costs of their HIV/AIDS response, whereas low-income countries with a high burden of disease will remain reliant upon external support for their rapidly expanding costs. A small but important group of middle-income countries with a high prevalence of HIV/AIDS (eg, South Africa) form a third category, in which rapid scale-up in the short term, matched by outside funds, could be phased down within 10 years assuming strategic investments are made for prevention and efficiency gains are made in treatment. Copyright © 2010 Elsevier Ltd. All rights reserved.

  8. Cost-Effectiveness of Haemophilus inuenzae Type b Conjugate Vaccine in Low- and Middle-Income Countries: Regional Analysis and Assessment of Major Determinants

    PubMed Central

    Griffiths, Ulla Kou; Clark, Andrew; Hajjeh, Rana

    2017-01-01

    Objectives To estimate the cost-effectiveness of Haemophilus influenzae type b (Hib) conjugate vaccine in low-and middle-income countries and identify the model variables, which are most important for the result. Study design A static decision tree model was developed to predict incremental costs and health impacts. Estimates were generated for 4 country groups: countries eligible for funding by the GAVI Alliance in Africa and Asia, lower middle-income countries, and upper middle-income countries. Values, including disease incidence, case fatality rates, and treatment costs, were based on international country estimates and the scientific literature. Results From the societal perspective, it is estimated that the probability of Hib conjugate vaccine cost saving is 34%–53% in Global Alliance for Vaccines and Immunization eligible African and Asian countries, respectively. In middle-income countries, costs per discounted disability adjusted life year averted are between US$37 and US$733. Variation in vaccine prices and risks of meningitis sequelae and mortality explain most of the difference in results. For all country groups, disease incidence cause the largest part of the uncertainty in the result. Conclusions Hib conjugate vaccine is cost saving or highly cost-effective in low- and middle-income settings. This conclusion is especially influenced by the recent decline in Hib conjugate vaccine prices and new data revealing the high costs of lost productivity associated with meningitis sequelae. PMID:23773595

  9. Cost-effectiveness of Haemophilus influenzae type b conjugate vaccine in low- and middle-income countries: regional analysis and assessment of major determinants.

    PubMed

    Griffiths, Ulla Kou; Clark, Andrew; Hajjeh, Rana

    2013-07-01

    To estimate the cost-effectiveness of Haemophilus influenzae type b (Hib) conjugate vaccine in low- and middle-income countries and identify the model variables, which are most important for the result. A static decision tree model was developed to predict incremental costs and health impacts. Estimates were generated for 4 country groups: countries eligible for funding by the GAVI Alliance in Africa and Asia, lower middle-income countries, and upper middle-income countries. Values, including disease incidence, case fatality rates, and treatment costs, were based on international country estimates and the scientific literature. From the societal perspective, it is estimated that the probability of Hib conjugate vaccine cost saving is 34%-53% in Global Alliance for Vaccines and Immunization eligible African and Asian countries, respectively. In middle-income countries, costs per discounted disability adjusted life year averted are between US$37 and US$733. Variation in vaccine prices and risks of meningitis sequelae and mortality explain most of the difference in results. For all country groups, disease incidence cause the largest part of the uncertainty in the result. Hib conjugate vaccine is cost saving or highly cost-effective in low- and middle-income settings. This conclusion is especially influenced by the recent decline in Hib conjugate vaccine prices and new data revealing the high costs of lost productivity associated with meningitis sequelae. Copyright © 2013. Published by Mosby, Inc.

  10. Mortality of emergency abdominal surgery in high-, middle- and low-income countries.

    PubMed

    2016-07-01

    Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1·6 per cent at 24 h (high 1·1 per cent, middle 1·9 per cent, low 3·4 per cent; P < 0·001), increasing to 5·4 per cent by 30 days (high 4·5 per cent, middle 6·0 per cent, low 8·6 per cent; P < 0·001). Of the 578 patients who died, 404 (69·9 per cent) did so between 24 h and 30 days following surgery (high 74·2 per cent, middle 68·8 per cent, low 60·5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2·78, 95 per cent c.i. 1·84 to 4·20) and low-income (OR 2·97, 1·84 to 4·81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. NCT02179112 (http://www.clinicaltrials.gov). © 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.

  11. Non-communicable diseases in low- and middle-income countries: context, determinants and health policy

    PubMed Central

    Miranda, J. J.; Kinra, S.; Casas, J. P.; Smith, G. Davey; Ebrahim, S.

    2009-01-01

    Summary The rise of non-communicable diseases and their impact in low- and middle-income countries has gained increased attention in recent years. However, the explanation for this rise is mostly an extrapolation from the history of high-income countries whose experience differed from the development processes affecting today’s low- and middle-income countries. This review appraises these differences in context to gain a better understanding of the epidemic of non-communicable diseases in low- and middle-income countries. Theories of developmental and degenerative determinants of non-communicable diseases are discussed to provide strong evidence for a causally informed approach to prevention. Health policies for non-communicable diseases are considered in terms of interventions to reduce population risk and individual susceptibility and the research needs for low- and middle-income countries are discussed. Finally, the need for health system reform to strengthen primary care is highlighted as a major policy to reduce the toll of this rising epidemic. PMID:18937743

  12. A Multidimensional Model for Child Maltreatment Prevention Readiness in Low- and Middle-Income Countries

    ERIC Educational Resources Information Center

    Mikton, Christopher; Mehra, Radhika; Butchart, Alexander; Addiss, David; Almuneef, Maha; Cardia, Nancy; Cheah, Irene; Chen, JingQi; Makoae, Mokhantso; Raleva, Marija

    2011-01-01

    The study's aim was to develop a multidimensional model for the assessment of child maltreatment prevention readiness in low- and middle-income countries. The model was developed based on a conceptual review of relevant existing models and approaches, an international expert consultation, and focus groups in six countries. The final model…

  13. Education Modifies the Association of Wealth with Obesity in Women in Middle-Income but Not Low-Income Countries: An Interaction Study Using Seven National Datasets, 2005-2010

    PubMed Central

    Aitsi-Selmi, Amina; Bell, Ruth; Shipley, Martin J.; Marmot, Michael G.

    2014-01-01

    Background Education and wealth may have different associations with female obesity but this has not been investigated in detail outside high-income countries. This study examines the separate and inter-related associations of education and household wealth in relation to obesity in women in a representative sample of low- and middle-income countries (LMICs). Methods The seven largest national surveys were selected from a list of Demographic and Health Surveys (DHS) ordered by decreasing sample size and resulted in a range of country income levels. These were nationally representative data of women aged 15–49 years collected in the period 2005–2010. The separate and joint effects, unadjusted and adjusted for age group, parity, and urban/rural residence using a multivariate logistic regression model are presented Results In the four middle-income countries (Colombia, Peru, Jordan, and Egypt), an interaction was found between education and wealth on obesity (P-value for interaction <0.001). Among women with no/primary education the wealth effect was positive whereas in the group with higher education it was either absent or inverted (negative). In the poorer countries (India, Nigeria, Benin), there was no evidence of an interaction. Instead, the associations between each of education and wealth with obesity were independent and positive. There was a statistically significant difference between the average interaction estimates for the low-income and middle-income countries (P<0.001). Conclusions The findings suggest that education may protect against the obesogenic effects of increased household wealth as countries develop. Further research could examine the factors explaining the country differences in education effects. PMID:24608086

  14. Economic Costs of Childhood Lead Exposure in Low- and Middle-Income Countries

    PubMed Central

    Trasande, Leonardo

    2013-01-01

    Background: Children’s blood lead levels have declined worldwide, especially after the removal of lead in gasoline. However, significant exposure remains, particularly in low- and middle-income countries. To date, there have been no global estimates of the costs related to lead exposure in children in developing countries. Objective: Our main aim was to estimate the economic costs attributable to childhood lead exposure in low- and middle-income countries. Methods: We developed a regression model to estimate mean blood lead levels in our population of interest, represented by each 1-year cohort of children < 5 years of age. We used an environmentally attributable fraction model to estimate lead-attributable economic costs and limited our analysis to the neurodevelopmental impacts of lead, assessed as decrements in IQ points. Our main outcome was lost lifetime economic productivity due to early childhood exposure. Results: We estimated a total cost of $977 billions of international dollars in low- and middle-income countries, with economic losses equal to $134.7 billion in Africa [4.03% of gross domestic product (GDP)], $142.3 billion in Latin America and the Caribbean (2.04% of GDP), and $699.9 billion in Asia (1.88% of GDP). Our sensitivity analysis indicates a total economic loss in the range of $728.6–1162.5 billion. Conclusions: We estimated that, in low- and middle-income countries, the burden associated with childhood lead exposure amounts to 1.20% of world GDP in 2011. For comparison, in the United States and Europe lead-attributable economic costs have been estimated at $50.9 and $55 billion, respectively, suggesting that the largest burden of lead exposure is now borne by low- and middle-income countries. Citation: Attina TM, Trasande L. 2013. Economic costs of childhood lead exposure in low- and middle-income countries. Environ Health Perspect 121:1097–1102; http://dx.doi.org/10.1289/ehp.1206424 PMID:23797342

  15. Educational and wealth inequalities in tobacco use among men and women in 54 low-income and middle-income countries.

    PubMed

    Sreeramareddy, Chandrashekhar T; Harper, Sam; Ernstsen, Linda

    2018-01-01

    Socioeconomic differentials of tobacco smoking in high-income countries are well described. However, studies to support health policies and place monitoring systems to tackle socioeconomic inequalities in smoking and smokeless tobacco use common in low-and-middle-income countries (LMICs) are seldom reported. We aimed to describe, sex-wise, educational and wealth-related inequalities in tobacco use in LMICs. We analysed Demographic and Health Survey data on tobacco use collected from large nationally representative samples of men and women in 54 LMICs. We estimated the weighted prevalence of any current tobacco use (including smokeless tobacco) in each country for 4 educational groups and 4 wealth groups. We calculated absolute and relative measures of inequality, that is, the slope index of inequality (SII) and relative index of inequality (RII), which take into account the distribution of prevalence across all education and wealth groups and account for population size. We also calculated the aggregate SII and RII for low-income (LIC), lower-middle-income (lMIC) and upper-middle-income (uMIC) countries as per World Bank classification. Male tobacco use was highest in Bangladesh (70.3%) and lowest in Sao Tome (7.4%), whereas female tobacco use was highest in Madagascar (21%) and lowest in Tajikistan (0.22%). Among men, educational inequalities varied widely between countries, but aggregate RII and SII showed an inverse trend by country wealth groups. RII was 3.61 (95% CI 2.83 to 4.61) in LICs, 1.99 (95% CI 1.66 to 2.38) in lMIC and 1.82 (95% CI 1.24 to 2.67) in uMIC. Wealth inequalities among men varied less between countries, but RII and SII showed an inverse pattern where RII was 2.43 (95% CI 2.05 to 2.88) in LICs, 1.84 (95% CI 1.54 to 2.21) in lMICs and 1.67 (95% CI 1.15 to 2.42) in uMICs. For educational inequalities among women, the RII varied much more than SII varied between the countries, and the aggregate RII was 14.49 (95% CI 8.87 to 23.68) in LICs, 3

  16. Development and implementation of Models of Care for musculoskeletal conditions in middle-income and low-income Asian countries.

    PubMed

    Lim, Keith K; Chan, Madelynn; Navarra, Sandra; Haq, Syed Atiqul; Lau, Chak Sing

    2016-06-01

    This chapter discusses the challenges faced in the development and implementation of musculoskeletal (MSK) Models of Care (MoCs) in middle-income and low-income countries in Asia and outlines the components of an effective MoC for MSK conditions. Case studies of four such countries (The Philippines, Malaysia, Bangladesh and Myanmar) are presented, and their unique implementation issues are discussed. The success experienced in one high-income country (Singapore) is also described as a comparison. The Community Oriented Program for Control of Rheumatic Diseases (COPCORD) project and the role of Asia Pacific League of Associations for Rheumatology (APLAR), a professional body supporting MoC initiatives in this region, are also discussed. The experience and lessons learned from these case studies can provide useful information to guide the implementation of future MSK MoC initiatives in other middle-income and low-income countries. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. The effects of taxing sugar-sweetened beverages across different income groups.

    PubMed

    Sharma, Anurag; Hauck, Katharina; Hollingsworth, Bruce; Siciliani, Luigi

    2014-09-01

    This paper investigates the impact of sugar-sweetened beverages (SSB) taxes on consumption, bodyweight and tax burden for low-income, middle-income and high-income groups using an Almost Ideal Demand System and 2011 Household level scanner data. A significant contribution of our paper is that we compare two types of SSB taxes recently advocated by policy makers: A 20% flat rate sales (valoric) tax and a 20 cent/L volumetric tax. Censored demand is accounted for using a two-step procedure. We find that the volumetric tax would result in a greater per capita weight loss than the valoric tax (0.41 kg vs. 0.29 kg). The difference between the change in weight is substantial for the target group of heavy purchasers of SSBs in low-income households, with a weight reduction of up to 3.20 kg for the volumetric and 2.06 kg for the valoric tax. The average yearly per capita tax burden on low-income households is $17.87 (0.21% of income) compared with $15.17 for high-income households (0.07% of income) for the valoric tax, and $13.80 (0.15%) and $10.10 (0.04%) for the volumetric tax. Thus, the tax burden is lower, and weight reduction is higher under a volumetric tax. Copyright © 2014 John Wiley & Sons, Ltd.

  18. Socio-economic disadvantage is associated with heavier drinking in high but not middle-income countries participating in the International Alcohol Control (IAC) Study.

    PubMed

    Huckle, Taisia; Romeo, Jose S; Wall, Martin; Callinan, Sarah; Holmes, John; Meier, Petra; Mackintosh, Anne-Maree; Piazza, Marina; Chaiyasong, Surasak; Cuong, Pham Viet; Casswell, Sally

    2018-04-30

    To investigate if socio-economic disadvantage, at the individual- and country-level, is associated with heavier drinking in some middle- and high-income countries. Surveys of drinkers were undertaken in some high- and middle-income countries. Participating countries were Australia, England, New Zealand, Scotland (high-income) and Peru, Thailand and Vietnam (middle-income). Disadvantage at the country-level was defined as per World Bank (categorised as middle-or high-income); individual-level measures were (i) years of education and (ii) whether and individual was under or over the poverty line in each country. Measures of heavier drinking were (i) proportion of drinkers that consumed 8+ drinks and (ii) three drinking risk groups (lower, increasing and higher). Multi-level logistic regression models were used. Individual-level measures of disadvantage, lower education and living in poverty, were associated with heavier drinking, consuming 8+ drinks on a typical occasion or drinking at the higher risk level, when all countries were considered together. Drinkers in the middle-income countries had a higher probability of consuming 8+ drinks on a typical occasion relative to drinkers in the high-income countries. Interactions between country-level income and individual-level disadvantage were undertaken: disadvantaged drinkers in the middle-income countries were less likely to be heavier drinkers relative to those with less disadvantage in the high-income countries. Associations between socio-economic disadvantage and heavier drinking vary depending on country-level income. These findings highlight the value of exploring cross-country differences in heavier drinking and disadvantage and the importance of including country-level measurements to better elucidate relationships. © 2018 Australasian Professional Society on Alcohol and other Drugs.

  19. Economic costs of childhood lead exposure in low- and middle-income countries.

    PubMed

    Attina, Teresa M; Trasande, Leonardo

    2013-09-01

    Children's blood lead levels have declined worldwide, especially after the removal of lead in gasoline. However, significant exposure remains, particularly in low- and middle-income countries. To date, there have been no global estimates of the costs related to lead exposure in children in developing countries. Our main aim was to estimate the economic costs attributable to childhood lead exposure in low- and middle-income countries. We developed a regression model to estimate mean blood lead levels in our population of interest, represented by each 1-year cohort of children < 5 years of age. We used an environmentally attributable fraction model to estimate lead-attributable economic costs and limited our analysis to the neurodevelopmental impacts of lead, assessed as decrements in IQ points. Our main outcome was lost lifetime economic productivity due to early childhood exposure. We estimated a total cost of $977 billions of international dollars in low- and middle-income countries, with economic losses equal to $134.7 billion in Africa [4.03% of gross domestic product (GDP)], $142.3 billion in Latin America and the Caribbean (2.04% of GDP), and $699.9 billion in Asia (1.88% of GDP). Our sensitivity analysis indicates a total economic loss in the range of $728.6-1162.5 billion. We estimated that, in low- and middle-income countries, the burden associated with childhood lead exposure amounts to 1.20% of world GDP in 2011. For comparison, in the United States and Europe lead-attributable economic costs have been estimated at $50.9 and $55 billion, respectively, suggesting that the largest burden of lead exposure is now borne by low- and middle-income countries.

  20. Socioeconomic Factors in Adherence to HIV Therapy in Low- and Middle-income Countries

    PubMed Central

    Pengpid, Supa

    2013-01-01

    It is not clear what effect socioeconomic factors have on adherence to antiretroviral therapy (ART) among patients in low- and middle-income countries.  We performed a systematic review of the association of socioeconomic status (SES) with adherence to treatment of patients with HIV/AIDS in low- and middle-income countries. We searched electronic databases to identify studies concerning SES and HIV/AIDS and collected data on the association between various determinants of SES (income, education, occupation) and adherence to ART in low- and middle-income countries. From 252 potentially-relevant articles initially identified, 62 original studies were reviewed in detail, which contained data evaluating the association between SES and adherence to treatment of patients with HIV/AIDS. Income, level of education, and employment/occupational status were significantly and positively associated with the level of adherence in 15 studies (41.7%), 10 studies (20.4%), and 3 studies (11.1%) respectively out of 36, 49, and 27 studies reviewed. One study for income, four studies for education, and two studies for employment found a negative and significant association with adherence to ART. However, the aforementioned SES determinants were not found to be significantly associated with adherence in relation to 20 income-related (55.6%), 35 education-related (71.4%), 23 employment/occupational status-related (81.5%), and 2 SES-related (100%) studies. The systematic review of the available evidence does not provide conclusive support for the existence of a clear association between SES and adherence to ART among adult patients infected with HIV/AIDS in low- and middle-income countries. There seems to be a positive trend among components of SES (income, education, employment status) and adherence to antiretroviral therapy in many of the reviewed studies. PMID:23930333

  1. Socioeconomic factors in adherence to HIV therapy in low- and middle-income countries.

    PubMed

    Peltzer, Karl; Pengpid, Supa

    2013-06-01

    It is not clear what effect socioeconomic factors have on adherence to antiretroviral therapy (ART) among patients in low- and middle-income countries. We performed a systematic review of the association of socioeconomic status (SES) with adherence to treatment of patients with HIV/AIDS in low- and middle-income countries. We searched electronic databases to identify studies concerning SES and HIV/AIDS and collected data on the association between various determinants of SES (income, education, occupation) and adherence to ART in low- and middle-income countries. From 252 potentially-relevant articles initially identified, 62 original studies were reviewed in detail, which contained data evaluating the association between SES and adherence to treatment of patients with HIV/AIDS. Income, level of education, and employment/occupational status were significantly and positively associated with the level of adherence in 15 studies (41.7%), 10 studies (20.4%), and 3 studies (11.1%) respectively out of 36, 49, and 27 studies reviewed. One study for income, four studies for education, and two studies for employment found a negative and significant association with adherence to ART. However, the aforementioned SES determinants were not found to be significantly associated with adherence in relation to 20 income-related (55.6%), 35 education-related (71.4%), 23 employment/occupational status-related (81.5%), and 2 SES-related (100%) studies. The systematic review of the available evidence does not provide conclusive support for the existence of a clear association between SES and adherence to ART among adult patients infected with HIV/ AIDS in low- and middle-income countries. There seems to be a positive trend among components of SES (income, education, employment status) and adherence to antiretroviral therapy in many of the reviewed studies.

  2. Neurodevelopmental Disorders in Low- and Middle-Income Countries

    ERIC Educational Resources Information Center

    Newton, Charles R.

    2012-01-01

    In "Global Perspective on Early Diagnosis and Intervention for Children with Developmental Delays and Disabilities" (p1079-1084, this issue), Scherzer et al. highlighted the potential increase in neurodevelopmental impairments and disabilities affecting an increasing number of children in low- and middle-income countries (LMIC). In this…

  3. Resource availability for the management of maternal sepsis in Malawi, other low-income countries, and lower-middle-income countries.

    PubMed

    Abdu, Mohammed; Wilson, Amie; Mhango, Chisale; Taki, Fatima; Coomarasamy, Arri; Lissauer, David

    2018-02-01

    To assess the availability of key resources for the management of maternal sepsis and evaluate the feasibility of implementing the Surviving Sepsis Campaign (SSC) recommendations in Malawi and other low-resource settings. A cross-sectional study was conducted at health facilities in Malawi, other low-income countries, and lower-middle-income countries during January-March 2016. English-speaking healthcare professionals (e.g. doctors, nurses, midwives, and administrators) completed a questionnaire/online survey to assess the availability of resources for the management of maternal sepsis. Healthcare centers (n=23) and hospitals (n=13) in Malawi showed shortages in the resources for basic monitoring (always available in 5 [21.7%] and 10 [76.9%] facilities, respectively) and basic infrastructure (2 [8.7%] and 7 [53.8%], respectively). The availability of antibiotics varied between Malawian healthcare centers (9 [39.1%]), Malawian hospitals (8 [61.5%]), hospitals in other low-income countries (10/17 [58.8%]), and hospitals in lower-middle-income countries (39/41 [95.1%]). The percentage of SSC recommendations that could be implemented was 33.3% at hospitals in Malawi, 30.3% at hospitals in other low-income countries, and 68.2% at hospitals in lower-middle-income countries. The implementation of existing SSC recommendations is unrealistic in low-income countries because of resource limitations. New maternal sepsis care bundles must be developed that are applicable to low-resource settings. © 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

  4. Cardiovascular risk factor burden in Africa and the Middle East across country income categories: a post hoc analysis of the cross-sectional Africa Middle East Cardiovascular Epidemiological (ACE) study.

    PubMed

    Raal, Frederick J; Alsheikh-Ali, Alawi A; Omar, Mohamed I; Rashed, Wafa; Hamoui, Omar; Kane, Abdoul; Alami, Mohamed; Abreu, Paula; Mashhoud, Walid M

    2018-01-01

    A significant number of cardiovascular disease (CVD)-related deaths occur in developing countries. An increasing prevalence of CVD is associated with a change in the macro-economy of these countries. In this post hoc analysis, CVD risk factor (CVDRF) prevalence is evaluated across countries based on national income in the Africa and Middle East Region (AfME). Data from the Africa Middle East Cardiovascular Epidemiological (ACE) study were used; a cross-sectional study in 14 AfME countries (94 clinics) from July 2011-April 2012, which evaluated CVDRF prevalence in stable adult outpatients. World Bank definitions were used to classify countries as low-income (LI), lower-middle-income (LMI), upper-middle-income (UMI) or high-income (HI) countries. Four thousand three hundred seventy-eight subjects were recruited where 260 (6%), 1324 (30%), 1509 (35%) and 1285 (29%) were from LI, LMI, UMI, and HI countries, respectively. Of all the CVDRFs evaluated, almost two-thirds of the study population across the national income groups had abdominal obesity and dyslipidemia. Countries in the HI category were associated with a higher prevalence of diabetes (32%), obesity (44%) and smoking (16%). UMI and HI countries were associated with higher clustering of CVDRFs where at least one-third of subjects having four or more CVDRFs. Lower income countries had lower blood pressure control rates and lower percentages of outpatients achieving LDL-cholesterol targets. The burden of CVDRFs in stable outpatients is high across the national income categories in the AfME region, with HI countries showing a higher prevalence of CVDRFs. The high burden in lower income countries is associated with sub-optimal control of dyslipidemia and hypertension. Lowering the CVDRF burden would need specific public health actions in line with positive changes in the macro-economy of these countries. The ACE trial is registered under NCT01243138.

  5. Measurement of social capital in relation to health in low and middle income countries (LMIC): a systematic review.

    PubMed

    Agampodi, Thilini Chanchala; Agampodi, Suneth Buddhika; Glozier, Nicholas; Siribaddana, Sisira

    2015-03-01

    Social capital is a neglected determinant of health in low and middle income countries. To date, majority of evidence syntheses on social capital and health are based upon high income countries. We conducted this systematic review to identify the methods used to measure social capital in low and middle-income countries and to evaluate their relative strengths and weaknesses. An electronic search was conducted using Pubmed, Science citation index expanded, Social science citation index expanded, Web of knowledge, Cochrane, Trip, Google scholar and selected grey literature sources. We aimed to include all studies conducted in low and middle-income countries, published in English that have measured any aspect of social capital in relation to health in the study, from 1980 to January 2013. We extracted data using a data extraction form and performed narrative synthesis as the measures were heterogeneous. Of the 472 articles retrieved, 46 articles were selected for the review. The review included 32 studies from middle income countries and seven studies from low income countries. Seven were cross national studies. Most studies were descriptive cross sectional in design (n = 39). Only two randomized controlled trials were included. Among the studies conducted using primary data (n = 32), we identified18 purposely built tools that measured various dimensions of social capital. Validity (n = 11) and reliability (n = 8) of the tools were assessed only in very few studies. Cognitive constructs of social capital, namely trust, social cohesion and sense of belonging had a positive association towards measured health outcome in majority of the studies. While most studies measured social capital at individual/micro level (n = 32), group level measurements were obtained by aggregation of individual measures. As many tools originate in high income contexts, cultural adaptation, validation and reliability assessment is mandatory in adapting the tool to the study setting. Evidence

  6. The vector of the tobacco epidemic: tobacco industry practices in low and middle-income countries.

    PubMed

    Lee, Sungkyu; Ling, Pamela M; Glantz, Stanton A

    2012-03-01

    To understand transnational tobacco companies' (TTCs) practices in low and middle-income countries which serve to block tobacco-control policies and promote tobacco use. Systematic review of published research on tobacco industry activities to promote tobacco use and oppose tobacco-control policies in low and middle-income countries. TTCs' strategies used in low and middle-income countries followed four main themes-economic activity; marketing/promotion; political activity; and deceptive/manipulative activity. Economic activity, including foreign investment and smuggling, was used to enter new markets. Political activities included lobbying, offering voluntary self-regulatory codes, and mounting corporate social responsibility campaigns. Deceptive activities included manipulation of science and use of third-party allies to oppose smoke-free policies, delay other tobacco-control policies, and maintain support of policymakers and the public for a pro-tobacco industry policy environment. TTCs used tactics for marketing, advertising, and promoting their brands that were tailored to specific market environments. These activities included direct and indirect tactis, targeting particular populations, and introducing new tobacco products designed to limit marketing restrictions and taxes, maintain the social acceptability of tobacco use, and counter tobacco-control efforts. TTCs have used similar strategies in high-income countries as these being described in low and middle-income countries. As required by FCTC Article 5.3, to counter tobacco industry pressures and to implement effective tobacco-control policies, governments and health professionals in low and middle-income countries should fully understand TTCs practices and counter them.

  7. Prevalence of Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

    PubMed

    Sarki, Ahmed M; Nduka, Chidozie U; Stranges, Saverio; Kandala, Ngianga-Bakwin; Uthman, Olalekan A

    2015-12-01

    We aimed to obtain overall and regional estimates of hypertension prevalence, and to examine the pattern of this disease condition across different socio-demographic characteristics in low-and middle-income countries. We searched electronic databases from inception to August 2015. We included population-based studies that reported hypertension prevalence using the current definition of blood pressure ≥140/90 mm Hg or self-reported use of antihypertensive medication. We used random-effects meta-analyses to pool prevalence estimates of hypertension, overall, by World Bank region and country income group. Meta-regression analyses were performed to explore sources of heterogeneity across the included studies. A total of 242 studies, comprising data on 1,494,609 adults from 45 countries, met our inclusion criteria. The overall prevalence of hypertension was 32.3% (95% confidence interval [CI] 29.4-35.3), with the Latin America and Caribbean region reporting the highest estimates (39.1%, 95% CI 33.1-45.2). Pooled prevalence estimate was also highest across upper middle income countries (37.8%, 95% CI 35.0-40.6) and lowest across low-income countries (23.1%, 95% CI 20.1-26.2). Prevalence estimates were significantly higher in the elderly (≥65 years) compared with younger adults (<65 years) overall and across the geographical regions; however, there was no significant sex-difference in hypertension prevalence (31.9% vs 30.8%, P = 0.6). Persons without formal education (49.0% vs 24.9%, P < 0.00001), overweight/obese (46.4% vs 26.3%, P < 0.00001), and urban settlers (32.7% vs 25.2%, P = 0.0005) were also more likely to be hypertensive, compared with those who were educated, normal weight, and rural settlers respectively. This study provides contemporary and up-to-date estimates that reflect the significant burden of hypertension in low- and middle-income countries, as well as evidence that hypertension remains a major public health issue across the

  8. Influenza vaccines in low and middle income countries: a systematic review of economic evaluations.

    PubMed

    Ott, Jördis J; Klein Breteler, Janna; Tam, John S; Hutubessy, Raymond C W; Jit, Mark; de Boer, Michiel R

    2013-07-01

    Economic evaluations on influenza vaccination from low resource settings are scarce and have not been evaluated using a systematic approach. Our objective was to conduct a systematic review on the value for money of influenza vaccination in low- and middle-income countries. PubMed and EMBASE were searched for economic evaluations published in any language between 1960 and 2011. Main outcome measures were costs per influenza outcome averted, costs per quality-adjusted life years gained or disability-adjusted life years averted, costs per benefit in monetary units or cost-benefit ratios. Nine economic evaluations on seasonal influenza vaccine met the inclusion criteria. These were model- or randomized-controlled-trial (RCT)-based economic evaluations from middle-income countries. Influenza vaccination provided value for money for elderly, infants, adults and children with high-risk conditions. Vaccination was cost-effective and cost-saving for chronic obstructive pulmonary disease patients and in elderly above 65 y from model-based evaluations, but conclusions from RCTs on elderly varied. Economic evaluations from middle income regions differed in population studied, outcomes and definitions used. Most findings are in line with evidence from high-income countries highlighting that influenza vaccine is likely to provide value for money. However, serious methodological limitations do not allow drawing conclusions on cost-effectiveness of influenza vaccination in middle income countries. Evidence on cost-effectiveness from low-income countries is lacking altogether, and more information is needed from full economic evaluations that are conducted in a standardized manner.

  9. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study.

    PubMed

    2018-05-01

    Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181

  10. Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries.

    PubMed

    Engle, Patrice L; Fernald, Lia C H; Alderman, Harold; Behrman, Jere; O'Gara, Chloe; Yousafzai, Aisha; de Mello, Meena Cabral; Hidrobo, Melissa; Ulkuer, Nurper; Ertem, Ilgi; Iltus, Selim

    2011-10-08

    This report is the second in a Series on early child development in low-income and middle-income countries and assesses the effectiveness of early child development interventions, such as parenting support and preschool enrolment. The evidence reviewed suggests that early child development can be improved through these interventions, with effects greater for programmes of higher quality and for the most vulnerable children. Other promising interventions for the promotion of early child development include children's educational media, interventions with children at high risk, and combining the promotion of early child development with conditional cash transfer programmes. Effective investments in early child development have the potential to reduce inequalities perpetuated by poverty, poor nutrition, and restricted learning opportunities. A simulation model of the potential long-term economic effects of increasing preschool enrolment to 25% or 50% in every low-income and middle-income country showed a benefit-to-cost ratio ranging from 6·4 to 17·6, depending on preschool enrolment rate and discount rate. Copyright © 2011 Elsevier Ltd. All rights reserved.

  11. Neonatal death in low- to middle-income countries: a global network study.

    PubMed

    Belizán, José M; McClure, Elizabeth M; Goudar, Shivaprasad S; Pasha, Omrana; Esamai, Fabian; Patel, Archana; Chomba, Elwyn; Garces, Ana; Wright, Linda L; Koso-Thomas, Marion; Moore, Janet; Althabe, Fernando; Kodkany, Bhala S; Sami, Neelofar; Manasyan, Albert; Derman, Richard J; Liechty, Edward A; Hibberd, Patricia; Carlo, Waldemar A; Hambidge, K Michael; Buekens, Pierre; Jobe, Alan H; Goldenberg, Robert L

    2012-09-01

    To determine population-based neonatal mortality rates in low- and middle-income countries and to examine gestational age, birth weight, and timing of death to assess the potentially preventable neonatal deaths. A prospective observational study was conducted in communities in five low-income countries (Kenya, Zambia, Guatemala, India, and Pakistan) and one middle-income country (Argentina). Over a 2-year period, all pregnant women in the study communities were enrolled by trained study staff and their infants followed to 28 days of age. Between October 2009 and March 2011, 153,728 babies were delivered and followed through day 28. Neonatal death rates ranged from 41 per 1000 births in Pakistan to 8 per 1000 in Argentina; 54% of the neonatal deaths were >37 weeks and 46% weighed 2500 g or more. Half the deaths occurred within 24 hours of delivery. In our population-based low- and middle-income country registries, the majority of neonatal deaths occurred in babies >37 weeks' gestation and almost half weighed at least 2500 g. Most deaths occurred shortly after birth. With access to better medical care and hospitalization, especially in the intrapartum and early neonatal period, many of these neonatal deaths might be prevented. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. The role of health technology assessment on pharmaceutical reimbursement in selected middle-income countries.

    PubMed

    Oortwijn, Wija; Mathijssen, Judith; Banta, David

    2010-05-01

    Middle-income countries are often referred to as developing or emerging economies and face multiple challenges of severe financial stresses in their health care sectors, and high disease burden. The objective of this study is to provide an overview of how health technology assessment (HTA) is used and organized in selected middle-income countries and its role in the process of pharmaceutical coverage. We selected middle-income countries where HTA activities are evident: Argentina, Brazil, China, Colombia, Israel, Mexico, Philippines, Korea, Taiwan, Thailand, and Turkey. We collected and reviewed relevant information to describe the health care and reimbursement systems and how HTA relates to coverage decision-making of pharmaceuticals. This was supplemented by information from a structured survey among professionals working in public and private health insurance, industry, regulatory authorities, ministries of health, academic units or HTA. All countries require market authorization for pharmaceuticals to be sold and most countries have a national plan defining which pharmaceuticals can be reimbursed. However, the use of HTA in reimbursement decisions is still in its early stages with varying levels of HTA guidance implementation. The study provides evidence of the development of HTA in coverage decision-making in middle-income countries. Increased health care spending and the resulting access to modern technology give a strong impetus to HTA. However, HTA is developing with uneven speed in middle-income countries and many countries are building on the organisational and methodological experience from established HTA agencies. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  13. Financing mental health services in low- and middle-income countries.

    PubMed

    Dixon, Anna; McDaid, David; Knapp, Martin; Curran, Claire

    2006-05-01

    Mental disorders account for a significant and growing proportion of the global burden of disease and yet remain a low priority for public financing in health systems globally. In many low-income countries, formal mental health services are paid for directly by patients out-of-pocket and in middle-income countries undergoing transition there has been a decline in coverage. The paper explores the impact of health care financing arrangements on the efficient and equitable utilization of mental health services. Through a review of the literature and a number of country case studies, the paper examines the impact of financing mental health services from out-of-pocket payments, private health insurance, social health insurance and taxation. The implications for the development of financing systems in low- and middle-income countries are discussed. International evidence suggests that charging patients for mental health services results in levels of use which are below socially efficient levels as the benefits of the services are distributed according to ability to pay, resulting in inequitable access to care. Private health insurance poses three main problems for mental health service users: exclusion of mental health benefits, limited access to those without employment and refusal to insure pre-existing conditions. Social health insurance may offer protection to those with mental health problems. However, in many low- and middle-income countries, eligibility is based on contributions and limited to those in formal employment (therefore excluding many with mental health problems). Tax-funded systems provide universal coverage in theory. However, the quality and distribution of publicly financed health care services makes access difficult in practice, particularly for rural poor communities.

  14. The vector of the tobacco epidemic: tobacco industry practices in low and middle-income countries

    PubMed Central

    Lee, Sungkyu; Ling, Pamela M.; Glantz, Stanton A.

    2012-01-01

    Purpose To understand transnational tobacco companiesr’ (TTCs) practices in low and middle-income countries which serve to block tobacco-control policies and promote tobacco use. Methods Systematic review of published research on tobacco industry activities to promote tobacco use and oppose tobacco-control policies in low and middle-income countries. Results TTCs’ strategies used in low and middle-income countries followed four main themes—economic activity; marketing/promotion; political activity; and deceptive/manipulative activity. Economic activity, including foreign investment and smuggling, was used to enter new markets. Political activities included lobbying, offering voluntary self-regulatory codes, and mounting corporate social responsibility campaigns. Deceptive activities included manipulation of science and use of third-party allies to oppose smoke-free policies, delay other tobacco-control policies, and maintain support of policymakers and the public for a pro-tobacco industry policy environment. TTCs used tactics for marketing, advertising, and promoting their brands that were tailored to specific market environments. These activities included direct and indirect tactis, targeting particular populations, and introducing new tobacco products designed to limit marketing restrictions and taxes, maintain the social acceptability of tobacco use, and counter tobacco-control efforts. Conclusions TTCs have used similar strategies in high-income countries as these being described in low and middle-income countries. As required by FCTC Article 5.3, to counter tobacco industry pressures and to implement effective tobacco-control policies, governments and health professionals in low and middle-income countries should fully understand TTCs practices and counter them. PMID:22370696

  15. The burden of diabetes mellitus during pregnancy in low- and middle-income countries: a systematic review.

    PubMed

    Kanguru, Lovney; Bezawada, Navya; Hussein, Julia; Bell, Jacqueline

    2014-01-01

    Little is known about the burden of diabetes mellitus (DM) in pregnancy in low- and middle-income countries despite high prevalence and mortality rates being observed in these countries. To investigate the prevalence and geographical patterns of DM in pregnancy up to 1 year post-delivery in low- and middle-income countries. Medline, Embase, Cochrane (Central), Cinahl and CAB databases were searched with no date restrictions. Articles assessing the prevalence of gestational diabetes mellitus (GDM), and types 1 and 2 DM were sought. Articles were independently screened by at least two reviewers. Forest plots were used to present prevalence rates and linear trends calculated by linear regression where appropriate. A total of 45 articles were included. The prevalence of GDM varied. Diagnosis was made by the American Diabetes Association criteria (1.50-15.5%), the Australian Diabetes in Pregnancy Society criteria (20.8%), the Diabetes in Pregnancy Study Group India criteria (13.4%), the European Association for the Study of Diabetes criteria (1.6%), the International Association of Diabetes and Pregnancy Study Groups criteria (8.9-20.4%), the National Diabetes Data Group criteria (0.56-6.30%) and the World Health Organization criteria (0.4-24.3%). Vietnam, India and Cuba had the highest prevalence rates. Types 1 and 2 DM were less often reported. Reports of maternal mortality due to DM were not found. No geographical patterns of the prevalence of GDM could be confirmed but data from Africa is particularly limited. Existing published data are insufficient to build a clear picture of the burden and distribution of DM in pregnancy in low- and middle-income countries. Consensus on a common diagnostic criterion for GDM is needed. Type 1 and 2 DM in pregnancy and postpartum DM are other neglected areas.

  16. Are low-to-middle-income households experiencing food insecurity in Victoria, Australia? An examination of the Victorian Population Health Survey, 2006-2009.

    PubMed

    Kleve, Sue; Davidson, Zoe E; Gearon, Emma; Booth, Sue; Palermo, Claire

    2017-07-01

    Food insecurity affects health and wellbeing. Little is known about the relationship between food insecurity across income levels. This study aims to investigate the prevalence and frequency of food insecurity in low-to-middle-income Victorian households over time and identify factors associated with food insecurity in these households. Prevalence and frequency of food insecurity was analysed across household income levels using data from the cross-sectional 2006-09 Victorian Population Health Surveys (VPHS). Respondents were categorised as food insecure, if in the last 12 months they had run out of food and were unable to afford to buy more. Multivariable logistic regression was used to describe factors associated with food insecurity in low-to-middle-income households (A$40000-$80000 in 2008). Between 4.9 and 5.5% for total survey populations and 3.9-4.8% in low-to-middle-income respondents were food insecure. Food insecurity was associated with limited help from friends, home ownership status, inability to raise money in an emergency and cost of some foods. Food insecurity exists in households beyond those on a very low income. Understanding the extent and implications of household food insecurity across all income groups in Australia will inform effective and appropriate public health responses.

  17. Anaesthesia-related maternal mortality in low-income and middle-income countries: a systematic review and meta-analysis.

    PubMed

    Sobhy, Soha; Zamora, Javier; Dharmarajah, Kuhan; Arroyo-Manzano, David; Wilson, Matthew; Navaratnarajah, Ramesan; Coomarasamy, Arri; Khan, Khalid S; Thangaratinam, Shakila

    2016-05-01

    The risk factors contributing to maternal mortality from anaesthesia in low-income and middle-income countries and the burden of the problem have not been comprehensively studied up to now. We aimed to obtain precise estimates of anaesthesia-attributed deaths in pregnant women exposed to anaesthesia and to identify the factors linked to adverse outcomes in pregnant women exposed to anaesthesia in low-income and middle-income countries. In this systematic review and meta-analysis, we searched major electronic databases from inception until Oct 1, 2015, for studies reporting risks of maternal death from anaesthesia in low-income and middle-income countries. Studies were included if they assessed maternal and perinatal outcomes in pregnant women exposed to anaesthesia for an obstetric procedure in countries categorised as low-income or middle-income by the World Bank. We excluded studies in high-income countries, those involving non-pregnant women, case reports, and studies published before 1990 to ensure that the estimates reflect the current burden of the condition. Two independent reviewers undertook quality assessment and data extraction. We computed odds ratios for risk factors and anaesthesia-related complications, and pooled them using a random effects model. This study is registered with PROSPERO, number CRD42015015805. 44 studies (632,556 pregnancies) reported risks of death from anaesthesia in women who had an obstetric surgical procedure; 95 (32,149,636 pregnancies and 36,144 deaths) provided rates of anaesthesia-attributed deaths as a proportion of maternal deaths. The risk of death from anaesthesia in women undergoing obstetric procedures was 1·2 per 1000 women undergoing obstetric procedures (95% CI 0·8-1·7, I(2)=83%). Anaesthesia accounted for 2·8% (2·4-3·4, I(2)=75%) of all maternal deaths, 3·5% (2·9-4·3, I(2)=79%) of direct maternal deaths (ie, those that resulted from obstetric complications), and 13·8% (9·0-20·7, I(2)=84%) of deaths

  18. Cigarette stick as valuable communicative real estate: a content analysis of cigarettes from 14 low-income and middle-income countries

    PubMed Central

    C Smith, Katherine; Washington, Carmen; Welding, Kevin; Kroart, Laura; Osho, Adami; Cohen, Joanna E

    2017-01-01

    Background The current cigarette market is heavily focused on low-income and middle-income countries. Branding of tobacco products is key to establishing and maintaining a customer base. Greater restrictions on marketing and advertising of tobacco products create an incentive for companies to focus more on branding via the product itself. We consider how tobacco sticks are used for communicative purposes in 14 low-income and middle-income countries with extensive tobacco markets. Methods In 2013, we collected and coded 3232 cigarette and kretek packs that were purchased from vendors in diverse neighbourhoods in 44 cities across the 14 low-income and middle-income countries with the greatest number of smokers. A single stick from each pack was assessed for branding, decorative and communicative elements using a common coding framework. Stick communication variables included brand name, brand image/logo, brand descriptor, colour and design carried through from pack, ‘capsule cigarette’ symbol, and embellishment of filter end. Results Communication and branding on the stick is essentially ubiquitous (99.75%); 97% of sticks include explicit branding (brand name or logo present). Colour is commonly carried through from the pack (95%), and some sticks (13%) include decorative elements matching the pack. Decorative elements can be found anywhere on the stick, including the filter tip (8%), and ‘convertible’ cigarettes include a symbol to show where to push. Conclusions Cigarette sticks are clearly valuable ‘real estate’ that tobacco companies are using for communicative purposes. Across all countries and brands, the stick communicates branding via text, colour and imagery. PMID:27534777

  19. Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data.

    PubMed

    Attaei, Marjan W; Khatib, Rasha; McKee, Martin; Lear, Scott; Dagenais, Gilles; Igumbor, Ehimario U; AlHabib, Khalid F; Kaur, Manmeet; Kruger, Lanthe; Teo, Koon; Lanas, Fernando; Yusoff, Khalid; Oguz, Aytekin; Gupta, Rajeev; Yusufali, Afzalhussein M; Bahonar, Ahmad; Kutty, Raman; Rosengren, Annika; Mohan, Viswanathan; Avezum, Alvaro; Yusuf, Rita; Szuba, Andrzej; Rangarajan, Sumathy; Chow, Clara; Yusuf, Salim

    2017-09-01

    Hypertension is considered the most important risk factor for cardiovascular diseases, but its control is poor worldwide. We aimed to assess the availability and affordability of blood pressure-lowering medicines, and the association with use of these medicines and blood pressure control in countries at varying levels of economic development. We analysed the availability, costs, and affordability of blood pressure-lowering medicines with data recorded from 626 communities in 20 countries participating in the Prospective Urban Rural Epidemiological (PURE) study. Medicines were considered available if they were present in the local pharmacy when surveyed, and affordable if their combined cost was less than 20% of the households' capacity to pay. We related information about availability and affordability to use of these medicines and blood pressure control with multilevel mixed-effects logistic regression models, and compared results for high-income, upper-middle-income, lower-middle-income, and low-income countries. Data for India are presented separately because it has a large generic pharmaceutical industry and a higher availability of medicines than other countries at the same economic level. The availability of two or more classes of blood pressure-lowering drugs was lower in low-income and middle-income countries (except for India) than in high-income countries. The proportion of communities with four drug classes available was 94% in high-income countries (108 of 115 communities), 76% in India (68 of 90), 71% in upper-middle-income countries (90 of 126), 47% in lower-middle-income countries (107 of 227), and 13% in low-income countries (nine of 68). The proportion of households unable to afford two blood pressure-lowering medicines was 31% in low-income countries (1069 of 3479 households), 9% in middle-income countries (5602 of 65 471), and less than 1% in high-income countries (44 of 10 880). Participants with known hypertension in communities that had

  20. Epidemiology and aetiology of maternal bacterial and viral infections in low- and middle-income countries

    PubMed Central

    Velu, Prasad Palani; Gravett, Courtney A.; Roberts, Tom K.; Wagner, Thor A.; Zhang, Jian Shayne F.; Rubens, Craig E.; Gravett, Michael G.; Campbell, Harry; Rudan, Igor

    2011-01-01

    Background Maternal morbidity and mortality in low- and middle-income countries has remained exceedingly high. However, information on bacterial and viral maternal infections, which are important contributors to poor pregnancy outcomes, is sparse and poorly characterised. This review aims to describe the epidemiology and aetiology of bacterial and viral maternal infections in low- and middle-income countries. Methods A systematic search of published literature was conducted and data on aetiology and epidemiology of maternal infections was extracted from relevant studies for analysis. Searches were conducted in parallel by two reviewers (using OVID) in the following databases: Medline (1950 to 2010), EMBASE (1980 to 2010) and Global Health (1973 to 2010). Results Data from 158 relevant studies was used to characterise the epidemiology of the 10 most extensively reported maternal infections with the following median prevalence rates: Treponema pallidum (2.6%), Neisseria gonorrhoeae (1.5%), Chlamydia trachomatis (5.8%), Group B Streptococcus (8.6%), bacterial vaginosis (20.9%), hepatitis B virus (4.3%), hepatitis C virus (1.4%), Cytomegalovirus (95.7% past infection), Rubella (8.9% susceptible) and Herpes simplex (20.7%). Large variations in the prevalence of these infections between countries and regions were noted. Conclusion This review confirms the suspected high prevalence of maternal bacterial and viral infections and identifies particular diseases and regions requiring urgent attention in public health policy planning, setting research priorities and donor funding towards reducing maternal morbidity and mortality in low- and middle-income countries. PMID:23198117

  1. Inequalities in full immunization coverage: trends in low- and middle-income countries

    PubMed Central

    Barros, Aluísio JD; Wong, Kerry LM; Johnson, Hope L; Pariyo, George; França, Giovanny VA; Wehrmeister, Fernando C; Victora, Cesar G

    2016-01-01

    Abstract Objective To investigate disparities in full immunization coverage across and within 86 low- and middle-income countries. Methods In May 2015, using data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys, we investigated inequalities in full immunization coverage – i.e. one dose of bacille Calmette-Guérin vaccine, one dose of measles vaccine, three doses of vaccine against diphtheria, pertussis and tetanus and three doses of polio vaccine – in 86 low- or middle-income countries. We then investigated temporal trends in the level and inequality of such coverage in eight of the countries. Findings In each of the World Health Organization’s regions, it appeared that about 56–69% of eligible children in the low- and middle-income countries had received full immunization. However, within each region, the mean recorded level of such coverage varied greatly. In the African Region, for example, it varied from 11.4% in Chad to 90.3% in Rwanda. We detected pro-rich inequality in such coverage in 45 of the 83 countries for which the relevant data were available and pro-urban inequality in 35 of the 86 study countries. Among the countries in which we investigated coverage trends, Madagascar and Mozambique appeared to have made the greatest progress in improving levels of full immunization coverage over the last two decades, particularly among the poorest quintiles of their populations. Conclusion Most low- and middle-income countries are affected by pro-rich and pro-urban inequalities in full immunization coverage that are not apparent when only national mean values of such coverage are reported. PMID:27821882

  2. Relationships Between Problem-Gambling Severity and Psychopathology as Moderated by Income.

    PubMed

    Sanacora, Rachel L; Whiting, Seth W; Pilver, Corey E; Hoff, Rani A; Potenza, Marc N

    2016-09-01

    Background and aims Problem and pathological gambling have been associated with elevated rates of both Axis-I and Axis-II psychiatric disorders. Although both problem gambling and psychiatric disorders have been reported as being more prevalent among lower income vs. middle/higher income groups, how income might moderate the relationship between problem-gambling severity and psychopathology is incompletely understood. To examine the associations between problem-gambling severity and psychopathology in lower income and middle/higher income groups. Methods Data from the first wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (n = 43,093) were analyzed in adjusted logistic regression models to investigate the relationships between problem-gambling severity and psychiatric disorders within and across income groups. Results Greater problem-gambling severity was associated with increased odds of multiple psychiatric disorders for both lower income and middle/higher income groups. Income moderated the association between problem/pathological gambling and alcohol abuse/dependence, with a stronger association seen among middle/higher income respondents than among lower income respondents. Discussion and conclusions The findings that problem-gambling severity is related to psychopathology across income groups suggest a need for public health initiatives across social strata to reduce the impact that problem/pathological gambling may have in relation to psychopathology. Middle/higher income populations, perhaps owing to the availability of more "disposable income," may be at greater risk for co-occurring gambling and alcohol-use psychopathology and may benefit preferentially from interventions targeting both gambling and alcohol use.

  3. Relationships Between Problem-Gambling Severity and Psychopathology as Moderated by Income

    PubMed Central

    Sanacora, Rachel L.; Whiting, Seth W.; Pilver, Corey E.; Hoff, Rani A.; Potenza, Marc N.

    2016-01-01

    Background and aims Problem and pathological gambling have been associated with elevated rates of both Axis-I and Axis-II psychiatric disorders. Although both problem gambling and psychiatric disorders have been reported as being more prevalent among lower income vs. middle/higher income groups, how income might moderate the relationship between problem-gambling severity and psychopathology is incompletely understood. To examine the associations between problem-gambling severity and psychopathology in lower income and middle/higher income groups. Methods Data from the first wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (n = 43,093) were analyzed in adjusted logistic regression models to investigate the relationships between problem-gambling severity and psychiatric disorders within and across income groups. Results Greater problem-gambling severity was associated with increased odds of multiple psychiatric disorders for both lower income and middle/higher income groups. Income moderated the association between problem/pathological gambling and alcohol abuse/dependence, with a stronger association seen among middle/higher income respondents than among lower income respondents. Discussion and conclusions The findings that problem-gambling severity is related to psychopathology across income groups suggest a need for public health initiatives across social strata to reduce the impact that problem/pathological gambling may have in relation to psychopathology. Middle/higher income populations, perhaps owing to the availability of more “disposable income,” may be at greater risk for co-occurring gambling and alcohol-use psychopathology and may benefit preferentially from interventions targeting both gambling and alcohol use. PMID:27440475

  4. Authorship ethics in global health research partnerships between researchers from low or middle income countries and high income countries

    PubMed Central

    2014-01-01

    Background Over the past two decades, the promotion of collaborative partnerships involving researchers from low and middle income countries with those from high income countries has been a major development in global health research. Ideally, these partnerships would lead to more equitable collaboration including the sharing of research responsibilities and rewards. While collaborative partnership initiatives have shown promise and attracted growing interest, there has been little scholarly debate regarding the fair distribution of authorship credit within these partnerships. Discussion In this paper, we identify four key authorship issues relevant to global health research and discuss their ethical and practical implications. First, we argue that authorship guidance may not adequately apply to global health research because it requires authors to write or substantially revise the manuscript. Since most journals of international reputation in global health are written in English, this would systematically and unjustly exclude non-English speaking researchers even if they have substantially contributed to the research project. Second, current guidance on authorship order does not address or mitigate unfair practices which can occur in global health research due to power differences between researchers from high and low-middle income countries. It also provides insufficient recognition of “technical tasks” such as local participant recruitment. Third, we consider the potential for real or perceived editorial bias in medical science journals in favour of prominent western researchers, and the risk of promoting misplaced credit and/or prestige authorship. Finally, we explore how diverse cultural practices and expectations regarding authorship may create conflict between researchers from low-middle and high income countries and contribute to unethical authorship practices. To effectively deal with these issues, we suggest: 1) undertaking further empirical and

  5. Authorship ethics in global health research partnerships between researchers from low or middle income countries and high income countries.

    PubMed

    Smith, Elise; Hunt, Matthew; Master, Zubin

    2014-05-28

    Over the past two decades, the promotion of collaborative partnerships involving researchers from low and middle income countries with those from high income countries has been a major development in global health research. Ideally, these partnerships would lead to more equitable collaboration including the sharing of research responsibilities and rewards. While collaborative partnership initiatives have shown promise and attracted growing interest, there has been little scholarly debate regarding the fair distribution of authorship credit within these partnerships. In this paper, we identify four key authorship issues relevant to global health research and discuss their ethical and practical implications. First, we argue that authorship guidance may not adequately apply to global health research because it requires authors to write or substantially revise the manuscript. Since most journals of international reputation in global health are written in English, this would systematically and unjustly exclude non-English speaking researchers even if they have substantially contributed to the research project. Second, current guidance on authorship order does not address or mitigate unfair practices which can occur in global health research due to power differences between researchers from high and low-middle income countries. It also provides insufficient recognition of "technical tasks" such as local participant recruitment. Third, we consider the potential for real or perceived editorial bias in medical science journals in favour of prominent western researchers, and the risk of promoting misplaced credit and/or prestige authorship. Finally, we explore how diverse cultural practices and expectations regarding authorship may create conflict between researchers from low-middle and high income countries and contribute to unethical authorship practices. To effectively deal with these issues, we suggest: 1) undertaking further empirical and conceptual research regarding

  6. Educational Outcomes and Socioeconomic Status: A Decomposition Analysis for Middle-Income Countries

    ERIC Educational Resources Information Center

    Nieto, Sandra; Ramos, Raúl

    2015-01-01

    This article analyzes the factors that explain the gap in educational outcomes between the top and bottom quartile of students in different countries, according to their socioeconomic status. To do so, it uses PISA microdata for 10 middle-income and 2 high-income countries, and applies the Oaxaca-Blinder decomposition method. Its results show that…

  7. Gender gap matters in maternal mortality in low and lower-middle-income countries: A study of the global Gender Gap Index.

    PubMed

    Choe, Seung-Ah; Cho, Sung-Il; Kim, Hongsoo

    2017-09-01

    Reducing maternal mortality has been a crucial part of the global development agenda. According to modernisation theory, the effect of gender equality on maternal health may differ depending on a country's economic development status. We explored the correlation between the Global Gender Gap Index (GGI) provided by the World Economic Forum and the maternal mortality ratio (MMR) obtained from the World Development Indicators database of the World Bank. The relationships between each score in the GGI, including its four sub-indices (measuring gender gaps in economic participation, educational attainment, health and survival, and political empowerment), and the MMR were analysed. When the countries were stratified by gross national income per capita, the low and lower-middle-income countries had lower scores in the GGI, and lower scores in the economic participation, educational attainment, and political empowerment sub-indices than the high-income group. Among the four sub-indices, the educational attainment sub-index showed a significant inverse correlation with the MMR in low and lower-middle-income countries when controlling for the proportion of skilled birth attendance and public share of health expenditure. This finding suggests that strategic efforts to reduce the gender gap in educational attainment could lead to improvements in maternal health in low and lower-middle-income countries.

  8. The use of private-sector contracts for primary health care: theory, evidence and lessons for low-income and middle-income countries.

    PubMed Central

    Palmer, N.

    2000-01-01

    Contracts for the delivery of public services are promoted as a means of harnessing the resources of the private sector and making publicly funded services more accountable, transparent and efficient. This is also argued for health reforms in many low- and middle-income countries, where reform packages often promote the use of contracts despite the comparatively weaker capacity of markets and governments to manage them. This review highlights theories and evidence relating to contracts for primary health care services and examines their implications for contractual relationships in low- and middle-income countries. PMID:10916919

  9. Environmental Exposures and Cardiovascular Disease: A Challenge for Health and Development in Low- and Middle-Income Countries

    PubMed Central

    Burroughs Peña, Melissa S.; Rollins, Allman

    2016-01-01

    Summary Environmental exposures in low- and middle-income countries lie at the intersection of increased economic development and the rising public health burden of cardiovascular disease. Increasing evidence suggests an association of exposure to ambient air pollution, household air pollution from biomass fuel, lead, arsenic, and cadmium with multiple cardiovascular disease outcomes including hypertension, coronary heart disease, stroke, and cardiovascular mortality. While populations in low- and middle-income countries are disproportionately exposed to environmental pollution, the bulk of evidence that links these exposures to cardiovascular disease is derived from populations in high-income countries. More research is needed to further characterize the extent of environmental exposures and develop targeted interventions towards reducing cardiovascular disease in at-risk populations in low- and middle-income countries. PMID:27886791

  10. Ongoing training of community health workers in low-income and middle-income countries: a systematic scoping review of the literature

    PubMed Central

    O’Donovan, Charles; Kuhn, Isla; Sachs, Sonia Ehrlich

    2018-01-01

    Objectives Understanding the current landscape of ongoing training for community health workers (CHWs) in low-income and middle-income countries (LMICs) is important both for organisations responsible for their training, as well as researchers and policy makers. This scoping review explores this under-researched area by mapping the current delivery implementation and evaluation of ongoing training provision for CHWs in LMICs. Design Systematic scoping review. Data sources MEDLINE, Embase, AMED, Global Health, Web of Science, Scopus, ASSIA, LILACS, BEI and ERIC. Study selection Original studies focusing on the provision of ongoing training for CHWs working in a country defined as low income and middle income according to World Bank Group 2012 classification of economies. Results The scoping review found 35 original studies that met the inclusion criteria. Ongoing training activities for CHWs were described as supervision (n=19), inservice or refresher training (n=13) or a mixture of both (n=3). Although the majority of studies emphasised the importance of providing ongoing training, several studies reported no impact of ongoing training on performance indicators. The majority of ongoing training was delivered inperson; however, four studies reported the use of mobile technologies to support training delivery. The outcomes from ongoing training activities were measured and reported in different ways, including changes in behaviour, attitudes and practice measured in a quantitative manner (n=16), knowledge and skills (n=6), qualitative assessments (n=5) or a mixed methods approach combining one of the aforementioned modalities (n=8). Conclusions This scoping review highlights the diverse range of ongoing training for CHWs in LMICs. Given the expansion of CHW programmes globally, more attention should be given to the design, delivery, monitoring and sustainability of ongoing training from a health systems strengthening perspective. PMID:29705769

  11. Systematic Review of Postgraduate Surgical Education in Low- and Middle-Income Countries.

    PubMed

    Rickard, Jennifer

    2016-06-01

    Surgical care is recognized as an important component of public health, however, many low- and middle- income countries (LMICs) are faced with a shortage of trained personnel. In response to this unmet need, many countries have developed local postgraduate training programs in surgery. This study aims to characterize general surgery postgraduate education in LMICs. PubMed, EMBASE, and Global Index Medicus databases were searched for articles related to postgraduate general surgery education in LMICs. Studies in other surgical specialties and those published prior to 1990 were excluded. Data were collected on the characteristics of postgraduate training programs. Sixty-four articles discussed postgraduate surgical education in LMICs. Programs in 34 different countries and 6 different regions were represented. Nine countries were low-income, 12 were low-middle-income, and 13 were upper-middle-income countries. Sixty-four articles described aspects of the local postgraduate training program. Prior to postgraduate training, residents complete an undergraduate medical degree with 19 programs describing a pre-training experience such as internship. Surgical curricula were broad-based to prepare trainees to work in low-resource settings. At the completion of postgraduate training, examination formats varied including oral, written, and clinical exams. Postgraduate general surgery programs ranged from 2.5 to 7 years. Postgraduate surgical education is one mechanism to increase surgical capacity in LMICs. Different strategies have been employed to improve surgical education in LMICs and learning from these programs can optimize surgical education across teaching sites.

  12. Preferred Supportive Services for Middle to Higher Income Retirement Housing.

    ERIC Educational Resources Information Center

    Regnier, Victor; Gelwicks, Louis E.

    1981-01-01

    Reports the service and facility feature preferences for retirement housing of middle and upper income elderly. Mandatory services and activities which require physical exertion were rejected, while security, convenient retail services, public transportation, and emergency health services are preferred. Underscores the importance of supportive…

  13. A snapshot of current gestational diabetes management practices from 26 low-income and lower-middle-income countries.

    PubMed

    Utz, Bettina; Kolsteren, Patrick; De Brouwere, Vincent

    2016-08-01

    To identify screening and management practices for gestational diabetes mellitus (GDM) in low-income and lower-middle-income countries. A cross-sectional survey was conducted between November 12, 2014 and May 11, 2015. Questionnaires were distributed to gynecologists, endocrinologists, and medical doctors who were representatives of national professional societies or were involved in providing care to patients with GDM in low-income or lower-middle-income countries in Africa, South Asia, and Latin America. The data were descriptively analyzed. Questionnaires were sent to 182 individuals and 77 healthcare providers from 26 countries completed the survey. The results demonstrated high diversity in screening and management practices. Only 52 (68%) participants reported that any guidelines were available in their setting. Management of GDM was found to take place mainly at the tertiary level and reported practices, including the frequency of post-diagnosis follow-up, modalities of glucose surveillance, and treatment and practices surrounding delivery, varied and did not always reflect the most recent evidence. Attempts to ensure greater adherence to latest consensus guidelines are required, and should be accompanied by systemic changes to improve the detection and management of GDM at primary- and secondary-level healthcare facilities to facilitate patient access to GDM screening and treatment. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  14. Epidemiology and public health policy of tobacco use and cardiovascular disorders in low- and middle-income countries.

    PubMed

    Saleheen, Danish; Zhao, Wei; Rasheed, Asif

    2014-09-01

    All forms of tobacco lead to an increased risk of cardiovascular disorders. During the past few decades, the number of people who consume tobacco has increased worldwide because of an overall increase in the global population. It is estimated that close to 80% of the >1.3 billion people who smoke tobacco in the world are in low- and middle-income countries. Smokeless forms of tobacco are also widely consumed in low- and middle-income countries, including chewable and snuffed forms. Lack of targeted and effective strategies to control tobacco consumption contributes to a large burden of cardiovascular disorders in low- and middle-income countries, where cardiovascular disorders have become the leading cause of morbidity and mortality. In this review, we evaluate the epidemiology of tobacco use in low- and middle-income countries and assess the public health policies needed to control tobacco use in such regions for the prevention of cardiovascular disorders and other tobacco-related morbidities and mortality. © 2014 American Heart Association, Inc.

  15. Group B Streptococcus vaccine development: present status and future considerations, with emphasis on perspectives for low and middle income countries

    PubMed Central

    Kobayashi, Miwako; Vekemans, Johan; Baker, Carol J.; Ratner, Adam J.; Le Doare, Kirsty; Schrag, Stephanie J.

    2016-01-01

    Globally, group B Streptococcus (GBS) remains the leading cause of sepsis and meningitis in young infants, with its greatest burden in the first 90 days of life. Intrapartum antibiotic prophylaxis (IAP) for women at risk of transmitting GBS to their newborns has been effective in reducing, but not eliminating, the young infant GBS disease burden in many high income countries. However, identification of women at risk and administration of IAP is very difficult in many low and middle income country (LMIC) settings, and is not possible for home deliveries. Immunization of pregnant women with a GBS vaccine represents an alternate pathway to protecting newborns from GBS disease, through the transplacental antibody transfer to the fetus in utero. This approach to prevent GBS disease in young infants is currently under development, and is approaching late stage clinical evaluation. This manuscript includes a review of the natural history of the disease, global disease burden estimates, diagnosis and existing control options in different settings, the biological rationale for a vaccine including previous supportive studies, analysis of current candidates in development, possible correlates of protection and current status of immunogenicity assays. Future potential vaccine development pathways to licensure and use in LMICs, trial design and implementation options are discussed, with the objective to provide a basis for reflection, rather than recommendations. PMID:27803803

  16. Stroke survivors in low- and middle-income countries: A meta-analysis of prevalence and secular trends.

    PubMed

    Ezejimofor, Martinsixtus C; Chen, Yen-Fu; Kandala, Ngianga-Bakwin; Ezejimofor, Benedeth C; Ezeabasili, Aloysius C; Stranges, Saverio; Uthman, Olalekan A

    2016-05-15

    To provide an up-to-date estimate on the changing prevalence of stroke survivors, and examines the geographic and socioeconomic variations in low and middle-income countries (LMICs). We searched MEDLINE, EMBASE, SCOPUS and Web of Science databases and systematically reviewed articles reporting stroke prevalence and risk factors from inception to July 2015. Pooled prevalence estimates and secular trends based on random-effects models were conducted across LMICs, World Bank regions and income groups. Overall, 101 eligible community-based studies were included in the meta-analysis. The pooled crude prevalence of stroke survivors was highest in Latin America and Caribbean (21.2 per 1000, 95% CI 13.7 to 30.29) but lowest in sub-Saharan Africa (3.5 per 1000, 95% CI 1.9 to 5.7). Steepest increase in stroke prevalence occurred in low-income countries, increasing by 14.3% annually while the lowest increase occurred in lower-middle income countries (6% annually), and for every 10years increase in participants' mean age, the prevalence of stroke survivors increases by 62% (95% CI 6% to 147%). The prevalence estimates of stroke survivors are significantly different across LMICs in both magnitude and secular trend. Improved stroke surveillance and care, as well as better management of the underlying risk factors, primarily undetected or uncontrolled high blood pressure (HBP) are needed. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions.

    PubMed

    Sayed, Shahin; Cherniak, William; Lawler, Mark; Tan, Soo Yong; El Sadr, Wafaa; Wolf, Nicholas; Silkensen, Shannon; Brand, Nathan; Looi, Lai Meng; Pai, Sanjay A; Wilson, Michael L; Milner, Danny; Flanigan, John; Fleming, Kenneth A

    2018-05-12

    Insufficient awareness of the centrality of pathology and laboratory medicine (PALM) to a functioning health-care system at policy and governmental level, with the resultant inadequate investment, has meant that efforts to enhance PALM in low-income and middle-income countries have been local, fragmented, and mostly unsustainable. Responding to the four major barriers in PALM service delivery that were identified in the first paper of this Series (workforce, infrastructure, education and training, and quality assurance), this second paper identifies potential solutions that can be applied in low-income and middle-income countries (LMICs). Increasing and retaining a quality PALM workforce requires access to mentorship and continuing professional development, task sharing, and the development of short-term visitor programmes. Opportunities to enhance the training of pathologists and allied PALM personnel by increasing and improving education provision must be explored and implemented. PALM infrastructure must be strengthened by addressing supply chain barriers, and ensuring laboratory information systems are in place. New technologies, including telepathology and point-of-care testing, can have a substantial role in PALM service delivery, if used appropriately. We emphasise the crucial importance of maintaining PALM quality and posit that all laboratories in LMICs should participate in quality assurance and accreditation programmes. A potential role for public-private partnerships in filling PALM services gaps should also be investigated. Finally, to deliver these solutions and ensure equitable access to essential services in LMICs, we propose a PALM package focused on these countries, integrated within a nationally tiered laboratory system, as part of an overarching national laboratory strategic plan. Copyright © 2018 Elsevier Ltd. All rights reserved.

  18. A survey on critical care resources and practices in low- and middle-income countries.

    PubMed

    Vukoja, Marija; Riviello, Elisabeth; Gavrilovic, Srdjan; Adhikari, Neill K J; Kashyap, Rahul; Bhagwanjee, Satish; Gajic, Ognjen; Kilickaya, Oguz

    2014-09-01

    Timely and appropriate care is the key to achieving good outcomes in acutely ill patients, but the effectiveness of critical care may be limited in resource-limited settings. This study sought to understand how to implement best practices in intensive care units (ICU) in low- and middle-income countries (LMIC) and to develop a point-of-care training and decision-support tool. An internationally representative group of clinicians performed a 22-item capacity-and-needs assessment survey in a convenience sample of 13 ICU in Eastern Europe (4), Asia (4), Latin America (3), and Africa (2), between April and July 2012. Two ICU were from low-income, 2 from low-middle-income, and 9 from upper-middle-income countries. Clinician respondents were asked about bed capacity, patient characteristics, human resources, available medications and equipment, access to education, and processes of care. Thirteen clinicians from each of 13 hospitals (1 per ICU) responded. Surveyed hospitals had median of 560 (interquartile range [IQR]: 232, 1,200) beds. ICU had a median of 9 (IQR: 7, 12) beds and treated 40 (IQR: 20, 67) patients per month. Many ICU had ≥ 1 staff member with some formal critical care training (n = 9, 69%) or who completed Fundamental Critical Care Support (n = 7, 54%) or Advanced Cardiac Life Support (n = 9, 69%) courses. Only 2 ICU (15%) used any kind of checklists for acute resuscitation. Ten (77%) ICU listed lack of trained staff as the most important barrier to improving the care and outcomes of critically ill patients. In a convenience sample of 13 ICU from LMIC, specialty-trained staff and standardized processes of care such as checklists are frequently lacking. ICU needs-assessment evaluations should be expanded in LMIC as a global priority, with the goal of creating and evaluating context-appropriate checklists for ICU best practices. Copyright © 2014 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.

  19. The need for sustainability and alignment of future support for National Immunization Technical Advisory Groups (NITAGs) in low and middle-income countries.

    PubMed

    Howard, Natasha; Bell, Sadie; Walls, Helen; Blanchard, Laurence; Brenzel, Logan; Jit, Mark; Mounier-Jack, Sandra

    2018-02-22

    National Immunisation Technical Advisory Groups (NITAGs) provide independent guidance to health ministries to support evidence-based and nationally relevant immunisation decisions. We examined NITAGs' value, sustainability, and need for support in low and middle-income countries, drawing from a mixed-methods study including 130 global and national-level key informant interviews. NITAGs were particularly valued for providing independent and nationally owned evidence-based decision-making (EBDM), but needed to be integrated within national processes to effectively balance independence and influence. Participants agreed that most NITAGs, being relatively new, would need developmental and strengthening support for at least a decade. While national governments could support NITAG functioning, external support is likely needed for requisite capacity building. This might come from Gavi mechanisms and WHO, but would require alignment among stakeholders to be effective.

  20. Tobacco control funding for low-income and middle-income countries in a time of economic hardship.

    PubMed

    Stoklosa, Michal; Ross, Hana

    2014-11-01

    To assess how levels of tobacco control funding for low-income and middle-income countries (LMIC) changed following the 2008-2009 global economic downturn. In order to estimate the amount of tobacco control funding in LMICs, we created an integrated database of Development Assistance to Control Tobacco (DACT). This database includes data on funding from bilateral and multilateral donors, non-governmental organisations, private foundations and the corporate sector. The database contains information on 1389 disbursements awarded by 30 entities between 2000 and 2012. DACT declined only marginally from US$68.8 million (US$0.016 per adult) in 2009 to US$68.2 million (US$0.016 per adult) in 2011, but deviated significantly from its 2000 to 2009 trend. The sources of funding remain highly concentrated, with nearly a half of the money coming from the Bloomberg Initiative and the Bill & Melinda Gates Foundation in 2011. The relative importance of institutional and research grants has declined. Our findings are consistent with the patterns in general levels of development assistance for health: after a decade of rapid growth, funding for tobacco control activities in LMICs has levelled off. Just as the tobacco control community is beginning to envision the endgame for tobacco, the funding remains erratic, inadequate, and highly vulnerable due to its level of concentration. Innovative financing mechanisms might help to increase the funding pool. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Authorship in paediatric research conducted in low- and middle-income countries: parity or parasitism?

    PubMed

    Rees, Chris A; Lukolyo, Heather; Keating, Elizabeth M; Dearden, Kirk A; Luboga, Samuel A; Schutze, Gordon E; Kazembe, Peter N

    2017-11-01

    Interest in global health has increased greatly in the past two decades. Concomitantly, the number and complexity of research partnerships between high-income (HIC) and low- and middle-income countries (LMICs) has grown. We aimed to determine whether there is authorship parity (equitable representation and author order) or parasitism (no authors from study countries) in paediatric research conducted in LMICs. We reviewed all articles published from 2006 to 2015 in the four paediatric journals with the highest Eigenfactor scores. We limited our review to articles from LMICs and abstracted information on author affiliation and order, funding source and study design. We calculated Student's t-tests and chi-square using Fisher's exact test with Monte Carlo estimates. There were 24 169 articles published during the study period, and 1243 met inclusion criteria. Of those, 95.9% (n = 1,192) included at least one author affiliated with a LMIC. Among multicountry studies (n = 165), 40.4% did not include authors from every LMIC involved. Of the 9876 authors, most were affiliated with institutions from upper-middle-income countries (41.7%) and HICs (32.7%), with far fewer affiliated with lower middle-income (15.5%) and low-income countries (5.4%) (P < 0.001). In articles from low-income countries, first and last authors from HICs were more common than authors with low-income country affiliations (P < 0.001). Authorship parasitism was rare overall but common in multicountry studies. In studies conducted in low-income countries, HIC authors more commonly occupied first and last author positions than authors from the study countries. Where LMIC authors make substantial contributions, researchers should strive for authorship parity. © 2017 John Wiley & Sons Ltd.

  2. Out-of-pocket health expenditures and antimicrobial resistance in low-income and middle-income countries: an economic analysis.

    PubMed

    Alsan, Marcella; Schoemaker, Lena; Eggleston, Karen; Kammili, Nagamani; Kolli, Prasanthi; Bhattacharya, Jay

    2015-10-01

    The decreasing effectiveness of antimicrobial agents is a growing global public health concern. Low-income and middle-income countries are vulnerable to the loss of antimicrobial efficacy because of their high burden of infectious disease and the cost of treating resistant organisms. We aimed to assess if copayments in the public sector promoted the development of antibiotic resistance by inducing patients to purchase treatment from less well regulated private providers. We analysed data from the WHO 2014 Antibacterial Resistance Global Surveillance report. We assessed the importance of out-of-pocket spending and copayment requirements for public sector drugs on the level of bacterial resistance in low-income and middle-income countries, using linear regression to adjust for environmental factors purported to be predictors of resistance, such as sanitation, animal husbandry, and poverty, and other structural components of the health sector. Our outcome variable of interest was the proportion of bacterial isolates tested that showed resistance to a class of antimicrobial agents. In particular, we computed the average proportion of isolates that showed antibiotic resistance for a given bacteria-antibacterial combination in a given country. Our sample included 47 countries (23 in Africa, eight in the Americas, three in Europe, eight in the Middle East, three in southeast Asia, and two in the western Pacific). Out-of-pocket health expenditures were the only factor significantly associated with antimicrobial resistance. A ten point increase in the percentage of health expenditures that were out-of-pocket was associated with a 3·2 percentage point increase in resistant isolates (95% CI 1·17-5·15; p=0·002). This association was driven by countries requiring copayments for drugs in the public health sector. Of these countries, moving from the 20th to 80th percentile of out-of-pocket health expenditures was associated with an increase in resistant bacterial isolates

  3. Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: systematic review and meta-analysis.

    PubMed

    Rahman, Md Mizanur; Abe, Sarah Krull; Rahman, Md Shafiur; Kanda, Mikiko; Narita, Saki; Bilano, Ver; Ota, Erika; Gilmour, Stuart; Shibuya, Kenji

    2016-02-01

    Anemia is a leading cause of maternal deaths and adverse pregnancy outcomes in developing countries. We conducted a systematic review and meta-analysis to estimate the pooled prevalence of anemia, the association between maternal anemia and pregnancy outcomes, and the population-attributable fraction (PAF) of these outcomes that are due to anemia in low- and middle-income countries. PubMed, EMBASE, CINAHL, and the British Nursing Index were searched from inception to May 2015 to identify cohort studies of the association between maternal anemia and pregnancy outcomes. The anemic group was defined as having hemoglobin concentrations <10 or <11 g/dL or hematocrit values <33% or <34% depending on the study. A metaregression and stratified analysis were performed to assess the effects of study and participant characteristics on adverse pregnancy risk. The pooled prevalence of anemia in pregnant women by region and country-income category was calculated with the use of a random-effects meta-analysis. Of 8182 articles reviewed, 29 studies were included in the systematic review, and 26 studies were included in the meta-analysis. Overall, 42.7% (95% CI: 37.0%, 48.4%) of women experienced anemia during pregnancy in low- and middle-income countries. There were significantly higher risks of low birth weight (RR: 1.31; 95% CI: 1.13, 1.51), preterm birth (RR: 1.63; 95% CI: 1.33, 2.01), perinatal mortality (RR: 1.51; 95% CI: 1.30, 1.76), and neonatal mortality (RR: 2.72; 95% CI: 1.19, 6.25) in pregnant women with anemia. South Asian, African, and low-income countries had a higher pooled anemia prevalence than did other Asian and upper-middle-income countries. Overall, in low- and middle-income countries, 12% of low birth weight, 19% of preterm births, and 18% of perinatal mortality were attributable to maternal anemia. The proportion of adverse pregnancy outcomes attributable to anemia was higher in low-income countries and in the South Asian region. Maternal anemia remains a

  4. Socioeconomic determinants of infant mortality: a worldwide study of 152 low-, middle-, and high-income countries.

    PubMed

    Schell, Carl Otto; Reilly, Marie; Rosling, Hans; Peterson, Stefan; Ekström, Anna Mia

    2007-01-01

    To reach the Millennium Development Goals for health, influential international bodies advocate for more resources to be directed to the health sector, in particular medical treatment. Yet, health has many determinants beyond the health sector that are less evident than proximate predictors. To assess the relative importance of major socioeconomic determinants of population health, measured as infant mortality rate (IMR), at country level. National-level data from 152 countries based on World Development Indicators 2003 were used for multivariate linear regression analyses of five socioeconomic predictors of IMR: public spending on health, GNI/capita, poverty rate, income equality (Gini index), and young female illiteracy rate. Analyses were performed on a global level and stratified for low-, middle-, and high-income countries. In order of importance, GNI/capita, young female illiteracy, and income equality predicted 92% of the variation in national IMR whereas public spending on health and poverty rate were non-significant determinants when adjusted for confounding. In low-income countries, female illiteracy was more important than GNI/capita. Income equality (Gini index) was an independent predictor of IMR in middle-income countries only. In high-income countries none of these predictors was significant. The relative importance of major health determinants varies between income levels, thus extrapolating health policies from high- to low-income countries is problematic. Since the size, per se, of public health spending does not independently predict health outcomes, functioning health systems are necessary to make health investments efficient. Potential health gains from improved female education and economic growth should be considered in low- and middle-income countries.

  5. Peak oil and health in low- and middle-income countries: impacts and potential responses.

    PubMed

    Winch, Peter; Stepnitz, Rebecca

    2011-09-01

    Peak oil refers to the predicted peak and subsequent decline in global production of petroleum products over the coming decades. We describe how peak oil will affect health, nutrition, and health systems in low- and middle-income countries along 5 pathways. The negative effects of peak oil on health and nutrition will be felt most acutely in the 58 low-income countries experiencing minimal or negative economic growth because of their patterns of sociopolitical, geographic, and economic vulnerability. The global health community needs to take additional steps to build resilience among the residents of low- and middle-income countries and maintain access to maternal and other health services in the face of predicted changes in availability and price of fossil fuels.

  6. Mental health interventions in schools in low-income and middle-income countries.

    PubMed

    Fazel, Mina; Patel, Vikram; Thomas, Saji; Tol, Wietse

    2014-10-01

    Increasing enrolment rates could place schools in a crucial position to support mental health in low-income and middle-income countries. In this Review, we provide evidence for mental health interventions in schools in accordance with a public mental health approach spanning promotion, prevention, and treatment. We identified a systematic review for mental health promotion, and identified further prevention and treatment studies. Present evidence supports schools as places for promotion of positive aspects of mental health using a whole-school approach. Knowledge of effectiveness of prevention and treatment interventions is more widely available for conflict-affected children and adolescents. More evidence is needed to identify the many elements likely to be associated with effective prevention and treatment for children exposed to a range of adversity and types of mental disorders. Dissemination and implementation science is crucial to establish how proven effective interventions could be scaled up and implemented in schools. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Urban adolescent sexual and reproductive health in low-income and middle-income countries.

    PubMed

    Mmari, Kristin; Astone, Nan

    2014-08-01

    One of the most important aspects of adolescent health is sexual and reproductive health (SRH). Currently, sexually transmitted infections (STIs) threaten the health of adolescents more than any other age group, and as many as 2.2 million adolescents are living with HIV. Understanding adolescents' SRH needs and how to invest in improving their health can be best addressed by knowing more about the contexts that increase their vulnerability to poor sexual health outcomes. Recent evidence has highlighted an increasingly marginalised segment of the adolescent population--and that is the urban poor adolescent population in low and middle income countries (LMIC). Using an urban health framework, this paper examines the contextual factors within an urban community that influence the SRH of adolescents in LMIC. Findings show that while there is substantial research that has explored factors within the social environment, there is limited research that has explored factors within the physical environment, as well as research that has specifically explored urban adolescents' use of SRH services and how such services can be best provided to this vulnerable population. This paper highlights the need for further research to understand the relationships between the urban poor environment and the SRH risks that adolescents face while living in such environments. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. Association between Race, Household Income and Grip Strength in Middle- and Older-Aged Adults.

    PubMed

    Thorpe, Roland J Jr; Simonsick, Eleanor; Zonderman, Alan; Evans, Michelle K

    2016-10-20

    Poor grip strength is an indicator of frailty and a precursor to functional limitations. Although poor grip strength is more prevalent in older disabled African American women, little is known about the association between race and poverty-related disparities and grip strength in middle-aged men and women. We examined the cross-sectional relationship between race, socioeconomic status as assessed by household income, and hand grip strength in men and women in the Healthy Aging in Neighborhoods of Diversity across the Life Span study. General linear models examined grip strength (maximum of two trials on both sides) by race and household income adjusted for age, weight, height, hand pain, education, insurance status, family income, and two or more chronic conditions. Of 2,091 adults, 422(45.4%) were male, 509(54.8%) were African American, and 320 (34.5%) were living in households with incomes below 125% of the federal poverty level (low SES). In adjusted models, African American women had greater grip strength than White women independent of SES (low income household: 29.3 vs 26.9 kg and high income household: 30.5 vs. 28.3kg; P<.05 for both); whereas in men, only African Americans in the high income household group had better grip strength than Whites (46.3 vs. 43.2; P<.05). The relationship between grip strength, race and SES as assessed by household income varied in this cohort. Efforts to develop grip strength norms and cut points that indicate frailty and sarcopenia may need to be race- and income-specific.

  9. Early menarche: A systematic review of its effect on sexual and reproductive health in low- and middle-income countries.

    PubMed

    Ibitoye, Mobolaji; Choi, Cecilia; Tai, Hina; Lee, Grace; Sommer, Marni

    2017-01-01

    Adolescent girls aged 15-19 bear a disproportionate burden of negative sexual and reproductive health outcomes in low- and middle-income countries. Research from several high-income countries suggests that early age at menarche is an important determinant of sexual and reproductive health. We conducted this systematic review to better understand whether and how early menarche is associated with various negative sexual and reproductive health outcomes in low- and middle-income countries and the implications of such associations. We systematically searched eight health and social sciences databases for peer-reviewed literature on menarche and sexual and reproductive health in low- and middle-income countries. Two reviewers independently assessed all studies for inclusion, overall quality and risk of bias, and performed data extraction on all included studies. Twenty-four articles met all inclusion criteria-nine of moderate quality and fifteen with several methodological weaknesses. Our review of the minimal existing literature showed that early menarche is associated with early sexual initiation, early pregnancy and some sexually transmitted infections in low- and middle-income countries, similar to what has been observed in high-income countries. Early menarche is also associated with early marriage-an association that may have particularly important implications for countries with high child marriage rates. Early age at menarche may be an important factor affecting the sexual and reproductive health of adolescent girls and young women in low- and middle-income countries. More research is needed to confirm the existence of the identified associations across different settings and to better understand the process through which early menarche and other markers of early pubertal development may contribute to the increased vulnerability of girls to negative sexual and reproductive health outcomes in low- and middle-income countries. Given the association of early

  10. Drifting Apart: New Findings on Growing Income Disparities Between the Rich, the Poor, and the Middle Class.

    ERIC Educational Resources Information Center

    Greenstein, Robert; Barancik, Scott

    Income disparities between wealthy and other Americans widened significantly in the 1980s. The most affluent Americans reaped exceptionally large income gains during that decade, while middle-income Americans gained little, and low-income Americans fell further behind. The richest one percent of all Americans now receive as much income after taxes…

  11. Global women's health: current clinical trials in low- and middle-income countries.

    PubMed

    Merriel, A; Harb, H M; Williams, H; Lilford, R; Coomarasamy, A

    2015-01-01

    Clinical trials in low- and middle-income countries (LMICs) are necessary to develop evidence-based approaches to improve women's health. Understanding what research is currently being conducted will allow the identification of research gaps, avoidance of duplication, planning of future studies, collaboration amongst research groups, and geographical targeting for research investments. To provide an overview of active women's health trials in LMICs. The World Health Organization's International Clinical Trials Registry Platform was searched for trials registered between 1 April 2012 and 31 March 2014. Selected trials were randomised, conducted in LMICs, active, and with a women's health intervention or a significant outcome for the woman. Two reviewers extracted data. Analysis included geographical spread, speciality areas, pre-enrolment registration, study size, and funders. Of the 8966 records, 509 were eligible for inclusion. Gynaecology trials made up 57% of the research, whereas the remaining 43% of trials were in obstetrics. Research activity focused on fertility (17%), the antenatal period (15%), benign gynaecology (14%), intrapartum care (9%), and pre-invasive disease and cancers (8%). The majority of trials (84%) took place in middle-income countries (MICs). In low-income countries (LICs) 83% of research investigated obstetrics, and in MICs 60% of research investigated gynaecology. Most trials (80%) had a sample size of 500 or fewer participants. The median size of trials in LICs was 815 compared with 128 in MICs. Pre-enrolment registration occurred in 54% of trials. The majority (62%) of trials were funded locally. Many LMICs are active in women's health research. The majority of registered trials are located in MICs; however, the trials in LICs are often larger. The focus of research in MICs may be driven by local priorities and funding, with fertility being highly researched. In LICs, pregnancy is the focus, perhaps reflecting the international

  12. Maternal mental health, and child growth and development, in four low-income and middle-income countries.

    PubMed

    Bennett, Ian M; Schott, Whitney; Krutikova, Sofya; Behrman, Jere R

    2016-02-01

    Extend analyses of maternal mental health and infant growth in low- and middle-income countries (LMICs) to children through age eight years, and broaden analyses to cognitive and psychosocial outcomes. Community-based longitudinal cohort study in four LMICs (Ethiopia, India, Peru and Vietnam). Surveys and anthropometric assessments were carried out when the children were approximately ages 1, 5 and 8 years. Risk of maternal common mental disorders (rCMDs) was assessed with the Self-Reporting Questionnaire (SRQ)-20 (score ≥8). Rural and urban as well as low- and middle-income communities. 7722 mothers and their children. Child stunting and underweight (Z score ≤2 of height and weight for age), and <20th centile for: cognitive development (Peabody Picture Vocabulary Test), and the psychosocial outcomes self pride and life satisfaction. A high rate of rCMD, stunting and underweight was seen in the cohorts. After adjusting for confounders, significant associations were found between maternal rCMDs and growth variables in the first year of life, with persistence to age 8 years in India and Vietnam, but not in the other countries. India and Vietnam also showed significant associations between rCMDs and lower cognitive development. After adjustment, rCMD was associated with low life satisfaction in Ethiopia but not in the other cohorts. Associations of maternal rCMD in the first year of life with child outcomes varied across the study cohorts and, in some cases, persisted across the first 8 years of life of the child, and included growth, cognitive development and psychosocial domains. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  13. Neurobiology of food addiction and adolescent obesity prevention in low- and middle-income countries.

    PubMed

    Lee, Albert; Gibbs, Susannah E

    2013-02-01

    Adolescent obesity has become an increasingly urgent issue in low- and middle-income countries. Recent relevant advances include the application of the neurobiology of addiction to food addiction and obesity. The biochemistry of the etiology of obesity indicates the need for multilevel interventions that go beyond simple behavioral approaches. Additional research on the neurobiology of food addiction and adolescent obesity in low- and middle-income countries, as well as program evaluations that examine the biochemical effects of complex interventions, is urgently needed. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  14. Management of NCD in low- and middle-income countries.

    PubMed

    Checkley, William; Ghannem, Hassen; Irazola, Vilma; Kimaiyo, Sylvester; Levitt, Naomi S; Miranda, J Jaime; Niessen, Louis; Prabhakaran, Dorairaj; Rabadán-Diehl, Cristina; Ramirez-Zea, Manuel; Rubinstein, Adolfo; Sigamani, Alben; Smith, Richard; Tandon, Nikhil; Wu, Yangfeng; Xavier, Denis; Yan, Lijing L

    2014-12-01

    Noncommunicable disease (NCD), comprising cardiovascular disease, stroke, diabetes, and chronic obstructive pulmonary disease, are increasing in incidence rapidly in low- and middle-income countries (LMICs). Some patients have access to the same treatments available in high-income countries, but most do not, and different strategies are needed. Most research on noncommunicable diseases has been conducted in high-income countries, but the need for research in LMICs has been recognized. LMICs can learn from high-income countries, but they need to devise their own systems that emphasize primary care, the use of community health workers, and sometimes the use of mobile technology. The World Health Organization has identified "best buys" it advocates as interventions in LMICs. Non-laboratory-based risk scores can be used to identify those at high risk. Targeting interventions to those at high risk for developing diabetes has been shown to work in LMICs. Indoor cooking with biomass fuels is an important cause of chronic obstructive pulmonary disease in LMICs, and improved cookstoves with chimneys may be effective in the prevention of chronic diseases. Copyright © 2014 World Heart Federation (Geneva). All rights reserved.

  15. Social support network typologies and health outcomes of older people in low and middle income countries--a 10/66 Dementia Research Group population-based study.

    PubMed

    Thiyagarajan, Jotheeswaran A; Prince, Martin; Webber, Martin

    2014-08-01

    This study aims to assess the construct validity of the Wenger social support network typology in low and middle income countries. We hypothesize that, in comparison with the integrated network type, the non-integrated network type is associated with loneliness, depression, poor quality of life (less happiness), poor self-reported health, increased disability and higher care needs. Cross-sectional one-phase surveys were conducted of all residents aged 65 and over in catchment areas in eight low and middle income countries (India, China, Cuba, Dominican Republic, Venezuela, Mexico, Peru and Puerto Rico). Wenger's Practitioner Assessment of Network Type (PANT) was used to measure social network type. Family dependent, local self-contained, wider community-focused and private restricted network types were considered non-integrated, in comparison to the locally integrated network type. Overall, 17,031 participants were interviewed. Family dependent and locally integrated network types were the most prevalent. Adjusted pooled estimates across sites showed that loneliness, depression, less happiness, poor health, disability, and need for care were significantly associated with non-integrated network type. The findings of this study support the construct validity of Wenger's network typology in low and middle income countries. However, further research is required to test the criterion validity of Wenger typology using longitudinal data. Identifying older people who are vulnerable could inform the development of social care interventions to support older people and their families in the context of deteriorating health.

  16. Dietary quality and its structural relationships among equivalent income, emotional well-being, and a five-year subjective health in Japanese middle-aged urban dwellers.

    PubMed

    Kodama, Sayuri; Fujii, Nobuya; Furuhata, Tadashi; Sakurai, Naoko; Fujiwara, Yoshinori; Hoshi, Tanji

    2015-01-01

    Although dietary quality in middle-age and the prime age of a person's work career might be determined by positive emotional well-being based on socioeconomic status (SES), causation among determinants of dietary quality still remains unclear. Our purpose was to elucidate the structural relationships among five-year prior dietary quality, equivalent income, emotional well-being, and a five-year subjective health by sex and age group separately. In 2003, 10,000 middle-aged urban dwellers aged 40-64 years, who lived in ward A in the Tokyo metropolitan area, were randomly selected and a questionnaire survey was conducted by mail. In 2008, we made a follow-up survey for dwellers, and were able to gather their survival status. A total of 2507, middle-aged men (n = 1112) and women (n = 1395), were examined at baseline. We created three latent variables for a structural equation modeling (SEM), five-year subjective health reported in 2003 and in 2008, dietary quality of principle food groups diversity and eating behavior in 2003, and emotional well-being constructed by enjoyment & ikigai (meaning of life) and by close people in 2003. Equivalent income in 2003 was calculated as SES indicator. In the SEM analysis of both men and women, there was an indirect effect of the equivalent income on dietary quality and on five-year subjective health, via emotional well-being explained by ikigai and having comforting people close to the individuals, significantly. There tended to be a larger direct effect of emotional well-being on the dietary quality in men than in women, and also a larger effect accompanying with aging. In women, there was a large direct effect of equivalent income on dietary quality than in men. When examined comprehensively, there appeared to be a larger effect of five-year prior equivalent income on subjective health during five-year in men than in women. This study suggests that it is necessary to support the improvement of dietary quality in middle

  17. Tracing the Economic Backgrounds of COFHE Students: Has There Been a "Middle-Income Melt?"

    ERIC Educational Resources Information Center

    Schapiro, Morton Owen; And Others

    This report presents the results of a study examining the effects of rapidly rising tuitions at the nation's "elite" private colleges and universities, and the impact on the enrollment of middle-income students. The paper traces the income background of Consortium on Financing Higher Education (COFHE) schools and shows how students from…

  18. Barriers to Cervical Cancer and Breast Cancer Screening Uptake in Low-Income and Middle-Income Countries: A Systematic Review

    PubMed Central

    Islam, Rakibul M; Billah, Baki; Hossain, Md Nassif; Oldroyd, John

    2017-01-01

    Background: Cervical cancer (CCa) and breast cancer (BCa) are the two leading cancers in women worldwide. Early detection and education to promote early diagnosis and screening of CCa and BCa greatly increases the chances for successful treatment and survival. Screening uptake for CCa and BCa in low and middle - income countries (LMICs) is low, and is consequently failing to prevent these diseases. We conducted a systematic review to identify the key barriers to CCa and BCa screening in women in LMICs. Methods: We performed a systematic literature search using Ovid MEDLINE, EMBASE, PsycINFO, SCOPUS, CINHAL Plus, and Google scholar to retrieve all English language studies from inception to 2015. This review was done in accordance with the PRISMA-P guidelines. Results: 53 eligible studies, 31 CCa screening studies and 22 BCa screening studies, provided information on 81,210 participants. We found fewer studies in low-income and lower - middle - income countries than in upper - middle - income countries. Lack of knowledge about CCa and BCa, and understanding of the role of screening were the key barriers to CCa and BCa screening in LMICs. Factors that are opportunities for knowledge acquisition, such as level of education, urban living, employment outside the home, facilitated CCa and BCa screening uptake in women in LMICs. Conclusions: Improvements to CCa and BCa screening uptake in LMICs must be accompanied by educational interventions which aim to improve knowledge and understanding of CCa and BCa and screening to asymptomatic women. It is imperative for governments and health policy makers in LMICs to implement screening programmes, including educational interventions, to ensure the prevention and early detection of women with CCa and BCa. These programmes and policies will be an integral part of a comprehensive population-based CCa and BCa control framework in LMICs. PMID:28749101

  19. Barriers to Cervical Cancer and Breast Cancer Screening Uptake in Low-Income and Middle-Income Countries: A Systematic Review

    PubMed

    Islam, Rakibul M; Billah, Baki; Hossain, Md Nassif; Oldroyd, John

    2017-07-27

    Background: Cervical cancer (CCa) and breast cancer (BCa) are the two leading cancers in women worldwide. Early detection and education to promote early diagnosis and screening of CCa and BCa greatly increases the chances for successful treatment and survival. Screening uptake for CCa and BCa in low and middle - income countries (LMICs) is low, and is consequently failing to prevent these diseases. We conducted a systematic review to identify the key barriers to CCa and BCa screening in women in LMICs. Methods: We performed a systematic literature search using Ovid MEDLINE, EMBASE, PsycINFO, SCOPUS, CINHAL Plus, and Google scholar to retrieve all English language studies from inception to 2015. This review was done in accordance with the PRISMA-P guidelines. Results: 53 eligible studies, 31 CCa screening studies and 22 BCa screening studies, provided information on 81,210 participants. We found fewer studies in low-income and lower - middle - income countries than in upper - middle - income countries. Lack of knowledge about CCa and BCa, and understanding of the role of screening were the key barriers to CCa and BCa screening in LMICs. Factors that are opportunities for knowledge acquisition, such as level of education, urban living, employment outside the home, facilitated CCa and BCa screening uptake in women in LMICs. Conclusions: Improvements to CCa and BCa screening uptake in LMICs must be accompanied by educational interventions which aim to improve knowledge and understanding of CCa and BCa and screening to asymptomatic women. It is imperative for governments and health policy makers in LMICs to implement screening programmes, including educational interventions, to ensure the prevention and early detection of women with CCa and BCa. These programmes and policies will be an integral part of a comprehensive population-based CCa and BCa control framework in LMICs. Creative Commons Attribution License

  20. Guidelines in lower-middle income countries.

    PubMed

    Olayemi, Edeghonghon; Asare, Eugenia V; Benneh-Akwasi Kuma, Amma A

    2017-06-01

    Guidelines include recommendations intended to optimize patient care; used appropriately, they make healthcare consistent and efficient. In most lower-middle income countries (LMICs), there is a paucity of well-designed guidelines; as a result, healthcare workers depend on guidelines developed in Higher Income Countries (HICs). However, local guidelines are more likely to be implemented because they are applicable to the specific environment; and consider factors such as availability of resources, specialized skills and local culture. If guidelines developed in HICs are to be implemented in LMICs, developers need to incorporate local experts in their development. Involvement of local stakeholders may improve the rates of implementation by identifying and removing barriers to implementation in LMICs. Another option is to encourage local experts to adapt them for use in LMICs; these guidelines may recommend strategies different from those used in HICs, but will be aimed at achieving the best practicable standard of care. Infrastructural deficits in LMICs could be improved by learning from and building on the successful response to the human immunodeficiency virus/acquired immunodeficiency syndrome pandemic through interactions between HICs and LMICs. Similarly, collaborations between postgraduate medical colleges in both HICs and LMICs may help specialist doctors training in LMICs develop skills required for guideline development and implementation. © 2017 John Wiley & Sons Ltd.

  1. Community-based psychosocial interventions for people with schizophrenia in low and middle-income countries: systematic review and meta-analysis.

    PubMed

    Asher, Laura; Patel, Vikram; De Silva, Mary J

    2017-10-30

    There is consensus that the treatment of schizophrenia should combine anti-psychotic medication and psychosocial interventions in order to address complex social, economic and health needs. It is recommended that family therapy or support; community-based rehabilitation; and/or self-help and support groups should be provided for people with schizophrenia in low and middle-income countries. The effectiveness of community-based psychosocial interventions in these settings is unclear. Studies evaluating community-based psychosocial interventions for people with schizophrenia were identified through database searching up to April 2016. Randomised controlled trials were included if they compared the intervention group with a control group receiving treatment as usual including medication. Only studies set in low and middle-income countries were included. Random effects meta-analyses were performed separately for each intervention type. Eleven randomised controlled trials in five middle-income countries were identified, with a total of 1580 participants. The content of included interventions varied from single-faceted psychoeducational interventions, to multi-component rehabilitation-focused interventions, to case management interventions. A third of the included studies did not incorporate any community involvement in the intervention. The quality of evidence was often low. Amongst the seven studies that reported on symptom severity up to 18 months post intervention, the pooled standardised mean difference (SMD) across all intervention types was 0.95 (95% CI 0.28, 1.61; P 0.005; I 2  = 95%; n = 862), representing a strong effect. A strong effect on symptom severity remained after excluding two studies with a high risk of bias (SMD 0.80; 95% CI 0.07, 1.53; P 0.03; I 2  = 94%; n = 676). Community-based psychosocial interventions may also have beneficial impacts on functioning (SMD 1.12; 95% CI 0.25, 2.00; P 0.01; I 2  = 94%; n = 511) and reducing hospital

  2. Impact of Early Numeracy Training on Kindergarteners from Middle-Income Families

    ERIC Educational Resources Information Center

    Meloni, Carla; Fanari, Rachele; Bertucci, Andrea; Berretti, Sara

    2017-01-01

    The aim of this work was to evaluate the effectiveness of a supplemental early numeracy skills training program for typically developing middle-income pre-school and kindergarten children (age 4-5) enrolled in a standard educational program. Three conditions were compared: cooperative learning training; individual learning training; and no…

  3. Global support for new vaccine implementation in middle-income countries.

    PubMed

    Kaddar, Miloud; Schmitt, Sarah; Makinen, Marty; Milstien, Julie

    2013-04-18

    Middle-income countries (MICs) as a group are not only characterized by a wide range of gross national income (GNI) per capita (US $1026 to $12,475), but also by diversity in size, geography, governance, and infrastructure. They include the largest and smallest countries of the world-including 16 landlocked developing countries, 27 small island developing states, and 17 least developed countries-and have a significant diversity in burden of vaccine-preventable diseases. Given the growth in the number of MICs and their considerable domestic income disparities, they are now home to the greatest proportion of the world's poor, having more inhabitants below the poverty line than low-income countries (LICs). However, they have little or no access to external funding for the implementation of new vaccines, nor are they benefiting from an enabling global environment. The MICs are thus not sustainably introducing new life-saving vaccines at the same rate as donor-funded LICs or wealthier countries. The global community, through World Health Assembly resolutions and the inclusion of MIC issues in several recent studies and important documents-including the Global Vaccine Action Plan (GVAP) for the Decade of Vaccines-has acknowledged the sub-optimal situations in some MICs and is actively seeking to enhance the situation by expanding support to these countries. This report documents some of the activities already going on in a subset of MICs, including strengthening of national regulatory authorities and national immunization technical advisory groups, and development of comprehensive multi-year plans. However, some additional tools developed for LICs could prove useful to MICs and thus should be adapted for use by them. In addition, new approaches need to be developed to support MIC-specific needs. It is clear that no one solution will address the needs of this diverse group. We suggest tailored interventions in the four categories of evidence and capacity-building, policy

  4. School Inspections in Low- and Middle-Income Countries: Explaining Impact and Mechanisms of Impact

    ERIC Educational Resources Information Center

    Ehren, Melanie C. M.; Eddy-Spicer, David; Bangpan, Mukdarut; Reid, Andy

    2017-01-01

    Many efforts to implement and improve school inspections have been modelled on examples from high-income countries, and many studies on the effectiveness of such systems have also only been carried out in these countries. However, local contexts in low- and middle-income countries are very different from those in developed countries, and findings…

  5. Correlates of healthy life expectancy in low- and lower-middle-income countries.

    PubMed

    Islam, Md Shariful; Mondal, Md Nazrul Islam; Tareque, Md Ismail; Rahman, Md Aminur; Hoque, Md Nazrul; Ahmed, Md Munsur; Khan, Hafiz T A

    2018-04-11

    Healthy life expectancy (HALE) at birth is an important indicator of health status and quality of life of a country's population. However, little is known about the determinants of HALE as yet globally or even country-specific level. Thus, we examined the factors that are associated with HALE at birth in low- and lower-middle-income countries. In accordance with the World Bank (WB) classification seventy-nine low- and lower-middle-income countries were selected for the study. Data on HALE, demographic, socioeconomic, social structural, health, and environmental factors from several reliable sources, such as the World Health Organization, the United Nations Development Program, Population Reference Bureau, WB, Heritage Foundation, Transparency International, Freedom House, and International Center for Prison Studies were obtained as selected countries. Descriptive statistics, correlation analysis, and regression analysis were performed to reach the research objectives. The lowest and highest HALE were observed in Sierra Leone (44.40 years) and in Sri Lanka (67.00 years), respectively. The mean years of schooling, total fertility rate (TFR), physician density, gross national income per capita, health expenditure, economic freedom, carbon dioxide emission rate, freedom of the press, corruption perceptions index, prison population rate, and achieving a level of health-related millennium development goals (MDGs) were revealed as the correlates of HALE. Among all the correlates, the mean years of schooling, TFR, freedom of the press, and achieving a level of health-related MDGs were found to be the most influential factors. To increase the HALE in low- and lower-middle-income countries, we suggest that TFR is to be reduced as well as to increase the mean years of schooling, freedom of the press, and the achievement of a level of health-related MDGs.

  6. Lessons Learned on Health Adaptation to Climate Variability and Change: Experiences Across Low- and Middle-Income Countries

    PubMed Central

    Otmani del Barrio, Mariam

    2017-01-01

    Background: There is limited published evidence of the effectiveness of adaptation in managing the health risks of climate variability and change in low- and middle-income countries. Objectives: To document lessons learned and good practice examples from health adaptation pilot projects in low- and middle-income countries to facilitate assessing and overcoming barriers to implementation and to scaling up. Methods: We evaluated project reports and related materials from the first five years of implementation (2008–2013) of multinational health adaptation projects in Albania, Barbados, Bhutan, China, Fiji, Jordan, Kazakhstan, Kenya, Kyrgyzstan, Philippines, Russian Federation, Tajikistan, and Uzbekistan. We also collected qualitative data through a focus group consultation and 19 key informant interviews. Results: Our recommendations include that national health plans, policies, and budget processes need to explicitly incorporate the risks of current and projected climate variability and change. Increasing resilience is likely to be achieved through longer-term, multifaceted, and collaborative approaches, with supporting activities (and funding) for capacity building, communication, and institutionalized monitoring and evaluation. Projects should be encouraged to focus not just on shorter-term outputs to address climate variability, but also on establishing processes to address longer-term climate change challenges. Opportunities for capacity development should be created, identified, and reinforced. Conclusions: Our analyses highlight that, irrespective of resource constraints, ministries of health and other institutions working on climate-related health issues in low- and middle-income countries need to continue to prepare themselves to prevent additional health burdens in the context of a changing climate and socioeconomic development patterns. https://doi.org/10.1289/EHP405 PMID:28632491

  7. Management of Noncommunicable Disease in Low- and Middle-Income Countries

    PubMed Central

    Checkley, William; Ghannem, Hassen; Irazola, Vilma; Kimaiyo, Sylvester; Levitt, Naomi S.; Miranda, J. Jaime; Niessen, Louis; Prabhakaran, Dorairaj; Rabadán-Diehl, Cristina; Ramirez-Zea, Manuel; Rubinstein, Adolfo; Sigamani, Alben; Smith, Richard; Tandon, Nikhil; Wu, Yangfeng; Xavier, Denis; Yan, Lijing L.

    2014-01-01

    Noncommunicable disease (NCD), comprising cardiovascular disease, stroke, diabetes, and chronic obstructive pulmonary disease, are increasing in incidence rapidly in low- and middle-income countries (LMICs). Some patients have access to the same treatments available in high-income countries, but most do not, and different strategies are needed. Most research on noncommunicable diseases has been conducted in high-income countries, but the need for research in LMICs has been recognized. LMICs can learn from high-income countries, but they need to devise their own systems that emphasize primary care, the use of community health workers, and sometimes the use of mobile technology. The World Health Organization has identified “best buys” it advocates as interventions in LMICs. Non-laboratory-based risk scores can be used to identify those at high risk. Targeting interventions to those at high risk for developing diabetes has been shown to work in LMICs. Indoor cooking with biomass fuels is an important cause of chronic obstructive pulmonary disease in LMICs, and improved cookstoves with chimneys may be effective in the prevention of chronic diseases. PMID:25592798

  8. Early menarche: A systematic review of its effect on sexual and reproductive health in low- and middle-income countries

    PubMed Central

    Choi, Cecilia; Tai, Hina; Lee, Grace; Sommer, Marni

    2017-01-01

    Background Adolescent girls aged 15–19 bear a disproportionate burden of negative sexual and reproductive health outcomes in low- and middle-income countries. Research from several high-income countries suggests that early age at menarche is an important determinant of sexual and reproductive health. We conducted this systematic review to better understand whether and how early menarche is associated with various negative sexual and reproductive health outcomes in low- and middle-income countries and the implications of such associations. Methods We systematically searched eight health and social sciences databases for peer-reviewed literature on menarche and sexual and reproductive health in low- and middle-income countries. Two reviewers independently assessed all studies for inclusion, overall quality and risk of bias, and performed data extraction on all included studies. Results Twenty-four articles met all inclusion criteria–nine of moderate quality and fifteen with several methodological weaknesses. Our review of the minimal existing literature showed that early menarche is associated with early sexual initiation, early pregnancy and some sexually transmitted infections in low- and middle-income countries, similar to what has been observed in high-income countries. Early menarche is also associated with early marriage–an association that may have particularly important implications for countries with high child marriage rates. Conclusions Early age at menarche may be an important factor affecting the sexual and reproductive health of adolescent girls and young women in low- and middle-income countries. More research is needed to confirm the existence of the identified associations across different settings and to better understand the process through which early menarche and other markers of early pubertal development may contribute to the increased vulnerability of girls to negative sexual and reproductive health outcomes in low- and middle-income

  9. Domestic and donor financing for tuberculosis care and control in low-income and middle-income countries: an analysis of trends, 2002-11, and requirements to meet 2015 targets.

    PubMed

    Floyd, Katherine; Fitzpatrick, Christopher; Pantoja, Andrea; Raviglione, Mario

    2013-08-01

    Progress in tuberculosis control worldwide, including achievement of 2015 global targets, requires adequate financing sustained for many years. WHO began yearly monitoring of tuberculosis funding in 2002. We used data reported to WHO to analyse tuberculosis funding from governments and international donors (in real terms, constant 2011 US$) and associated progress in tuberculosis control in low-income and middle-income countries between 2002 and 2011. We then assessed funding needed to 2015 and how this funding could be mobilised. We included low-income and middle-income countries that reported data about financing for tuberculosis to WHO and had at least three observations between 2002 and 2011. When data were missing for specific country-year combinations, we imputed the missing data. We aggregated country-specific results for eight country groups defined according to income level, political and economic profile, geography, and tuberculosis burden. We compared absolute changes in total funding with those in the total number of patients successfully treated and did cross-country comparisons of cost per successfully treated patient relative to gross domestic product. We estimated funding needs for tuberculosis care and control for all low-income and middle-income countries to 2015, and compared these needs with domestic funding that could be mobilised. Total funding grew from $1·7 billion in 2002 to $4·4 billion in 2011. It was mostly spent on diagnosis and treatment of drug-susceptible tuberculosis. 43 million patients were successfully treated, usually for $100-500 per person in countries with high burdens of tuberculosis. Domestic funding rose from $1·5 billion to $3·9 billion per year, mostly in Brazil, Russia, India, China, and South Africa (BRICS), which collectively account for 45% of global cases, where national contributions accounted for more than 95% of yearly funding. Donor funding increased from $0·2 billion in 2002 to $0·5 billion in 2011, and

  10. Cost-effectiveness of human papillomavirus vaccination in low and middle income countries: a systematic review.

    PubMed

    Fesenfeld, Michaela; Hutubessy, Raymond; Jit, Mark

    2013-08-20

    The World Health Organization recommends establishing that human papillomavirus vaccination is cost-effective before vaccine introduction. We searched Pubmed, Embase and the Cochrane Library to 1 April 2012 for economic evaluations of human papillomavirus vaccination in low and middle income countries. We found 25 articles, but almost all low income countries and many middle income countries lacked country-specific studies. Methods, assumptions and consequently results varied widely, even for studies conducted for the same country. Despite the heterogeneity, most studies conclude that vaccination is likely to be cost-effective and possibly even cost saving, particularly in settings without organized cervical screening programmes. However, study uncertainty could be reduced by clarity about vaccine prices and vaccine delivery costs. The review supports extending vaccination to low income settings where vaccine prices are competitive, donor funding is available, cervical cancer burden is high and screening options are limited. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. Diagnostic reference levels in low- and middle-income countries: early "ALARAm" bells?

    PubMed

    Meyer, Steven; Groenewald, Willem A; Pitcher, Richard D

    2017-04-01

    Background In 1996 the International Commission on Radiological Protection (ICRP) introduced diagnostic reference levels (DRLs) as a quality assurance tool for radiation dose optimization. While many countries have published DRLs, available data are largely from high-income countries. There is arguably a greater need for DRLs in low- and middle-income-countries (LMICs), where imaging equipment may be older and trained imaging technicians are scarce. To date, there has been no critical analysis of the published work on DRLs in LMICs. Such work is important to evaluate data deficiencies and stimulate future quality assurance initiatives. Purpose To review the published work on DRLs in LMICs and to critically analyze the comprehensiveness of available data. Material and Methods Medline, Scopus, and Web of Science database searches were conducted for English-language articles published between 1996 and 2015 documenting DRLs for diagnostic imaging in LMICs. Retrieved articles were analyzed and classified by geographical region, country of origin, contributing author, year of publication, imaging modality, body part, and patient age. Results Fifty-three articles reported DRLs for 28 of 135 LMICs (21%), reflecting data from 26/104 (25%) middle-income countries and 2/31 (6%) low-income countries. General radiography (n = 26, 49%) and computerized tomography (n = 17, 32%) data were most commonly reported. Pediatric DRLs (n = 14, 26%) constituted approximately one-quarter of published work. Conclusion Published DRL data are deficient in the majority of LMICs, with the paucity most striking in low-income countries. DRL initiatives are required in LMICs to enhance dose optimization.

  12. Risk of poor development in young children in low-income and middle-income countries: an estimation and analysis at the global, regional, and country level

    PubMed Central

    Lu, Chunling; Black, Maureen M; Richter, Linda M

    2018-01-01

    Summary Background A 2007 study published in The Lancet estimated that approximately 219 million children aged younger than 5 years were exposed to stunting or extreme poverty in 2004. We updated the 2004 estimates with the use of improved data and methods and generated estimates for 2010. Methods We used country-level prevalence of stunting in children younger than 5 years based on the 2006 Growth Standards proposed by WHO and poverty ratios from the World Bank to estimate children who were either stunted or lived in extreme poverty for 141 low-income and middle-income countries in 2004 and 2010. To avoid counting the same children twice, we excluded children jointly exposed to stunting and extreme poverty from children living in extreme poverty. To examine the robustness of estimates, we also used moderate poverty measures. Findings The 2007 study underestimated children at risk of poor development. The estimated number of children exposed to the two risk factors in low-income and middle-income countries decreased from 279·1 million (95% CI 250·4 million–307·4 million) in 2004 to 249·4 million (209·3 million–292·6 million) in 2010; prevalence of children at risk fell from 51% (95% CI 46–56) to 43% (36–51). The decline occurred in all income groups and regions with south Asia experiencing the largest drop. Sub-Saharan Africa had the highest prevalence in both years. These findings were robust to variations in poverty measures. Interpretation Progress has been made in reducing the number of children exposed to stunting or poverty between 2004 and 2010, but this is still not enough. Scaling up of effective interventions targeting the most vulnerable children is urgently needed. Funding National Institutes of Health, Bill & Melinda Gates Foundation, Hilton Foundation, and WHO. PMID:27717632

  13. The Experience of Middle-Income Countries Participating in PISA 2000. PISA

    ERIC Educational Resources Information Center

    Lockheed, Marlaine E.

    2015-01-01

    This report provides a systematic review and empirical evidence related to the experiences of middle-income countries and economies participating in the Programme for International Student Assessment (PISA), 2000 to 2015. PISA is a triennial survey that aims to evaluate education systems worldwide by testing the skills and knowledge of 15-year-old…

  14. Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21st standard: analysis of CHERG datasets.

    PubMed

    Lee, Anne Cc; Kozuki, Naoko; Cousens, Simon; Stevens, Gretchen A; Blencowe, Hannah; Silveira, Mariangela F; Sania, Ayesha; Rosen, Heather E; Schmiegelow, Christentze; Adair, Linda S; Baqui, Abdullah H; Barros, Fernando C; Bhutta, Zulfiqar A; Caulfield, Laura E; Christian, Parul; Clarke, Siân E; Fawzi, Wafaie; Gonzalez, Rogelio; Humphrey, Jean; Huybregts, Lieven; Kariuki, Simon; Kolsteren, Patrick; Lusingu, John; Manandhar, Dharma; Mongkolchati, Aroonsri; Mullany, Luke C; Ndyomugyenyi, Richard; Nien, Jyh Kae; Roberfroid, Dominique; Saville, Naomi; Terlouw, Dianne J; Tielsch, James M; Victora, Cesar G; Velaphi, Sithembiso C; Watson-Jones, Deborah; Willey, Barbara A; Ezzati, Majid; Lawn, Joy E; Black, Robert E; Katz, Joanne

    2017-08-17

    Objectives  To estimate small for gestational age birth prevalence and attributable neonatal mortality in low and middle income countries with the INTERGROWTH-21 st birth weight standard. Design  Secondary analysis of data from the Child Health Epidemiology Reference Group (CHERG), including 14 birth cohorts with gestational age, birth weight, and neonatal follow-up. Small for gestational age was defined as infants weighing less than the 10th centile birth weight for gestational age and sex with the multiethnic, INTERGROWTH-21 st birth weight standard. Prevalence of small for gestational age and neonatal mortality risk ratios were calculated and pooled among these datasets at the regional level. With available national level data, prevalence of small for gestational age and population attributable fractions of neonatal mortality attributable to small for gestational age were estimated. Setting  CHERG birth cohorts from 14 population based sites in low and middle income countries. Main outcome measures  In low and middle income countries in the year 2012, the number and proportion of infants born small for gestational age; number and proportion of neonatal deaths attributable to small for gestational age; the number and proportion of neonatal deaths that could be prevented by reducing the prevalence of small for gestational age to 10%. Results  In 2012, an estimated 23.3 million infants (uncertainty range 17.6 to 31.9; 19.3% of live births) were born small for gestational age in low and middle income countries. Among these, 11.2 million (0.8 to 15.8) were term and not low birth weight (≥2500 g), 10.7 million (7.6 to 15.0) were term and low birth weight (<2500 g) and 1.5 million (0.9 to 2.6) were preterm. In low and middle income countries, an estimated 606 500 (495 000 to 773 000) neonatal deaths were attributable to infants born small for gestational age, 21.9% of all neonatal deaths. The largest burden was in South Asia, where the prevalence was

  15. Factors that influence a career choice in primary care among medical students from high-, middle-, and low-income countries: a systematic review.

    PubMed

    Puertas, E Benjamín; Arósquipa, Carlos; Gutiérrez, Daniela

    2013-11-01

    To determine which factors influence a medical student's decision to choose a career in primary care; and to establish if these factors are similar or different among students in high-, middle- and low-income countries. An extensive search was done of PubMed, Google Scholar, and Virtual Library of Health for articles on primary care careers published in 2003-2013 in English, Spanish, and/or Portuguese. Initially, 600 records were identified; 74 full-text articles were assessed for eligibility and 55 were selected (42 from high-income countries; 13 from middle- and low-income). These were assessed to identify intrinsic and extrinsic factors that influence career choice among medical students from high-, middle-, and low-income countries. A comparison framework with common and specific factors that influence career choice in primary care among medical students from high-, middle- and low-income was developed. Factors were classified as extrinsic or intrinsic, and as facilitators or barriers. Several factors common to all countries were identified: facilitators were exposure to rural location, role models, working conditions; barriers were low income, prestige, and medical school environment. Some factors specific to middle- and low-income countries were: understanding of rural needs and intellectual challenge. Other factors specific to high-income countries were: attitude towards social problems, voluntary work, influence of family, and length of residency. Further studies on the subject are needed, especially in low- and middle-income countries. Identifying factors as barriers or facilitators for career choice will promote a better understanding of the reasons behind the shortage of primary care professionals and will contribute to policy building, improved training, and recruitment and retention of these professionals.

  16. Early childhood linear growth faltering in low-income and middle-income countries as a whole-population condition: analysis of 179 Demographic and Health Surveys from 64 countries (1993-2015).

    PubMed

    Roth, Daniel E; Krishna, Aditi; Leung, Michael; Shi, Joy; Bassani, Diego G; Barros, Aluisio J D

    2017-12-01

    The causes of early childhood linear growth faltering (known as stunting) in low-income and middle-income countries remain inadequately understood. We aimed to determine if the progressive postnatal decline in mean height-for-age Z score (HAZ) in low-income and middle-income countries is driven by relatively slow growth of certain high-risk children versus faltering of the entire population. Distributions of HAZ (based on WHO growth standards) were analysed in 3-month age intervals from 0 to 36 months of age in 179 Demographic and Health Surveys from 64 low-income and middle-income countries (1993-2015). Mean, standard deviation (SD), fifth percentiles, and 95th percentiles of the HAZ distribution were estimated for each age interval in each survey. Associations between mean HAZ and SD, fifth percentile, and 95th percentile were estimated using multilevel linear models. Stratified analyses were performed in consideration of potential modifiers (world region, national income, sample size, year, or mean HAZ in the 0-3 month age band). We also used Monte Carlo simulations to model the effects of subgroup versus whole-population faltering on the HAZ distribution. Declines in mean HAZ from birth to 3 years of age were accompanied by declines in both the fifth and 95th percentiles, leading to nearly symmetrical narrowing of the HAZ distributions. Thus, children with relatively low HAZ were not more likely to have faltered than taller same-age peers. Inferences were unchanged in surveys regardless of world region, national income, sample size, year, or mean HAZ in the 0-3 month age band. Simulations showed that the narrowing of the HAZ distribution as mean HAZ declined could not be explained by faltering limited to a growth-restricted subgroup of children. In low-income and middle-income countries, declines in mean HAZ with age are due to a downward shift in the entire HAZ distribution, revealing that children across the HAZ spectrum experience slower growth compared to

  17. I 'like' MPOWER: using Facebook, online ads and new media to mobilise tobacco control communities in low-income and middle-income countries.

    PubMed

    Hamill, Stephen; Turk, Tahir; Murukutla, Nandita; Ghamrawy, Mohamed; Mullin, Sandra

    2015-05-01

    New media campaigns hold great potential to grow public awareness about the dangers of tobacco use and advance tobacco control policies, including in low-income and middle-income countries (LMICs), which have shared in a decade of explosive growth in mobile and internet penetration. With the majority of deaths from the tobacco epidemic occurring in LMICs, new media must be harnessed both as an advocacy tool to promote social mobilisation around tobacco issues and to build public support for MPOWER policies. This paper examines three consecutive new media advocacy campaigns that used communication channels such as mobile SMS, Facebook and online advertising to promote tobacco control policies. It includes some of the lessons learned, such as the pitfalls of relying on viral growth as a strategy for obtaining reach and campaign growth; the challenge of translating strategies from traditional media to new media; and the importance of incorporating marketing strategies such as paid advertising, community organising or public relations. It also identifies some of the many knowledge gaps and proposes future research directions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. Sociodemographic factors related to handgrip strength in children and adolescents in a middle income country: The SALUS study.

    PubMed

    Otero, Johanna; Cohen, Daniel Dylan; Herrera, Victor Mauricio; Camacho, Paul Anthony; Bernal, Oscar; López-Jaramillo, Patricio

    2017-01-01

    To determine sociodemographic factors associated with handgrip (HG) strength in a representative sample of children and adolescents from a middle income country. We evaluated youth between the ages of 8 and 17 from a representative sample of individuals from the Department of Santander, Colombia. Anthropometric measures, HG strength, and self-reported physical activity were assessed, and parents/guardians completed sociodemographic questionnairres. Multinomial logistic regression models were used to estimate the association between sociodemographic and anthropometric characteristics and tertiles of relative HG strength. We also produced centile data for raw HG strength using quantile regression. 1,691 young people were evaluated. HG strength increased with age, and was higher in males than females in all age groups. Lower HG strength was associated with indicators of higher socioeconomic status, such as living in an urban area, residence in higher social strata neighborhoods, parent/guardian with secondary education or higher, higher household income, and membership in health insurance schemes. In addition, low HG strength was associated with lower physical activity levels and higher waist-to-hip ratio. In a fully adjusted regression model, all factors remained significant except for health insurance, household income, and physical activity level. While age and gender specific HG strength values were substantially lower than contemporary data from high income countries, we found that within this middle income population indicators of higher socioeconomic status were associated with lower HG strength. This analysis also suggests that in countries undergoing rapid nutrition transition, improvements in socioeconomic conditions may be accompanied by reduction in muscle strength. © 2016 Wiley Periodicals, Inc.

  19. Higher Education Financial Assistance Tools for Middle- and Upper-Income Taxpayers

    ERIC Educational Resources Information Center

    Condon, James V.; Prince, Lori H.

    2008-01-01

    This article describes higher education financial assistance tools designed mainly for students of middle- and upper-income families who may not be eligible for financial aid from other sources. It includes the 2007 legislative updates for these tools, all of which have been devised and offered by either state or federal governments. The authors…

  20. Environmental Exposures and Cardiovascular Disease: A Challenge for Health and Development in Low- and Middle-Income Countries.

    PubMed

    Burroughs Peña, Melissa S; Rollins, Allman

    2017-02-01

    Environmental exposures in low- and middle-income countries lie at the intersection of increased economic development and the rising public health burden of cardiovascular disease. Increasing evidence suggests an association of exposure to ambient air pollution, household air pollution from biomass fuel, lead, arsenic, and cadmium with multiple cardiovascular disease outcomes, including hypertension, coronary heart disease, stroke, and cardiovascular mortality. Although populations in low- and middle-income countries are disproportionately exposed to environmental pollution, evidence linking these exposures to cardiovascular disease is derived from populations in high-income countries. More research is needed to further characterize the extent of environmental exposures. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Mental disorders and termination of education in high-income and low- and middle-income countries: epidemiological study

    PubMed Central

    Lee, S.; Tsang, A.; Breslau, J.; Aguilar-Gaxiola, S.; Angermeyer, M.; Borges, G.; Bromet, E.; Bruffaerts, R.; de Girolamo, G.; Fayyad, J.; Gureje, O.; Haro, J. M.; Kawakami, N.; Levinson, D.; Browne, M. A. Oakley; Ormel, J.; Posada-Villa, J.; Williams, D. R.; Kessler, R. C.

    2009-01-01

    Background Studies of the impact of mental disorders on educational attainment are rare in both high-income and low- and middle-income (LAMI) countries. Aims To examine the association between early-onset mental disorder and subsequent termination of education. Method Sixteen countries taking part in the World Health Organization World Mental Health Survey Initiative were surveyed with the Composite International Diagnostic Interview (n=41 688). Survival models were used to estimate associations between DSM–IV mental disorders and subsequent non-attainment of educational milestones. Results In high-income countries, prior substance use disorders were associated with non-completion at all stages of education (OR 1.4–15.2). Anxiety disorders (OR=1.3), mood disorders (OR=1.4) and impulse control disorders (OR=2.2) were associated with early termination of secondary education. In LAMI countries, impulse control disorders (OR=1.3) and substance use disorders (OR=1.5) were associated with early termination of secondary education. Conclusions Onset of mental disorder and subsequent non-completion of education are consistently associated in both high-income and LAMI countries. PMID:19407270

  2. Group size and group income as influences on marriage patterns in Hawaii.

    PubMed

    Johnson, R C

    1984-01-01

    This paper analyzes the association of ethnic group size and median ethnic group income with the percentages of cross-ethnic marriages and combinations of marriages of each of the 5 major racial/ethnic groups in Hawaii. The data cover marriages that took place from 1975-1977 in Hawaii's 5 major ethnic groups: 1) Caucasian, 2) Chinese, 3) Filipino, 4) Japanese, and 5) Hawaiian or part-Hawaiian. The number of Caucasians marrying in Hawaii are severely inflated by military and tourist marriages. Chinese (highest median income) and Hawaiians or part-Hawaiians (lowest median income) show the highest percentages of outmarriage. The number of persons making up given groups appears to play a role; larger groups have lower outmarriage rates. Since 19 of 20 potential marriage partners a Chinese person meets are of another racial group, as compared to 2 of 3 for Caucasians or Japanese, it is hardly surprising that the Chinese outmarry more often than other groups. Data show a tendency to an East-West split; Chinese-Japanese marriages are overrepresented, and marriages of Japanese men to Caucasian women are underrepresented. However, marriages of Caucasian males to Chinese women are also overrepresented. Also, Puerto Ricans and Filipinos tend to be more representative of the West than Caucasians are. The authors conclude that cultural attributes likely to lead to a given level of income, rather than income per se, influence the probability of persons marrying a member of a given racial/ethnic group other than their own.

  3. Children's height and weight in rural and urban populations in low-income and middle-income countries: a systematic analysis of population-representative data

    PubMed Central

    Paciorek, Christopher J; Stevens, Gretchen A; Finucane, Mariel M; Ezzati, Majid

    2013-01-01

    Summary Background Urban living affects children's nutrition and growth, which are determinants of their survival, cognitive development, and lifelong health. Little is known about urban–rural differences in children's height and weight, and how these differences have changed over time. We aimed to investigate trends in children's height and weight in rural and urban settings in low-income and middle-income countries, and to assess changes in the urban–rural differentials in height and weight over time. Methods We used comprehensive population-based data and a Bayesian hierarchical mixture model to estimate trends in children's height-for-age and weight-for-age Z scores by rural and urban place of residence, and changes in urban–rural differentials in height and weight Z scores, for 141 low-income and middle-income countries between 1985 and 2011. We also estimated the contribution of changes in rural and urban height and weight, and that of urbanisation, to the regional trends in these outcomes. Findings Urban children are taller and heavier than their rural counterparts in almost all low-income and middle-income countries. The urban–rural differential is largest in Andean and central Latin America (eg, Peru, Honduras, Bolivia, and Guatemala); in some African countries such as Niger, Burundi, and Burkina Faso; and in Vietnam and China. It is smallest in southern and tropical Latin America (eg, Chile and Brazil). Urban children in China, Chile, and Jamaica are the tallest in low-income and middle-income countries, and children in rural areas of Burundi, Guatemala, and Niger the shortest, with the tallest and shortest more than 10 cm apart at age 5 years. The heaviest children live in cities in Georgia, Chile, and China, and the most underweight in rural areas of Timor-Leste, India, Niger, and Bangladesh. Between 1985 and 2011, the urban advantage in height fell in southern and tropical Latin America and south Asia, but changed little or not at all in most

  4. Children's height and weight in rural and urban populations in low-income and middle-income countries: a systematic analysis of population-representative data.

    PubMed

    Paciorek, Christopher J; Stevens, Gretchen A; Finucane, Mariel M; Ezzati, Majid

    2013-11-01

    Urban living affects children's nutrition and growth, which are determinants of their survival, cognitive development, and lifelong health. Little is known about urban-rural differences in children's height and weight, and how these differences have changed over time. We aimed to investigate trends in children's height and weight in rural and urban settings in low-income and middle-income countries, and to assess changes in the urban-rural differentials in height and weight over time. We used comprehensive population-based data and a Bayesian hierarchical mixture model to estimate trends in children's height-for-age and weight-for-age Z scores by rural and urban place of residence, and changes in urban-rural differentials in height and weight Z scores, for 141 low-income and middle-income countries between 1985 and 2011. We also estimated the contribution of changes in rural and urban height and weight, and that of urbanisation, to the regional trends in these outcomes. Urban children are taller and heavier than their rural counterparts in almost all low-income and middle-income countries. The urban-rural differential is largest in Andean and central Latin America (eg, Peru, Honduras, Bolivia, and Guatemala); in some African countries such as Niger, Burundi, and Burkina Faso; and in Vietnam and China. It is smallest in southern and tropical Latin America (eg, Chile and Brazil). Urban children in China, Chile, and Jamaica are the tallest in low-income and middle-income countries, and children in rural areas of Burundi, Guatemala, and Niger the shortest, with the tallest and shortest more than 10 cm apart at age 5 years. The heaviest children live in cities in Georgia, Chile, and China, and the most underweight in rural areas of Timor-Leste, India, Niger, and Bangladesh. Between 1985 and 2011, the urban advantage in height fell in southern and tropical Latin America and south Asia, but changed little or not at all in most other regions. The urban-rural weight

  5. Growing Epidemic of Coronary Heart Disease in Low- and Middle-Income Countries

    PubMed Central

    Gaziano, Thomas A.; Bitton, Asaf; Anand, Shuchi; Abrahams-Gessel, Shafika; Murphy, Adrianna

    2010-01-01

    Coronary heart disease (CHD) is the single largest cause of death in the developed countries and is one of the leading causes of disease burden in developing countries. In 2001, there were 7.3 million deaths due to CHD worldwide. Three-fourths of global deaths due to CHD occurred in the low and middle-income countries. The rapid rise in CHD burden in most of the low and middle and income countries is due to socio-economic changes, increase in life span and acquisition of lifestyle related risk factors. The CHD death rate, however, varies dramatically across the developing countries. The varying incidence, prevalence, and mortality rates reflect the different levels of risk factors, other competing causes of death, availability of resources to combat CVD, and the stage of epidemiologic transition that each country or region finds itself. The economic burden of CHD is equally large but solutions exist to manage this growing burden. PMID:20109979

  6. Tax Shelter Use and Retirement Income of Retired Ohio Faculty.

    ERIC Educational Resources Information Center

    Dorfman, Mark S.

    1983-01-01

    Empirical evidence of tax shelter usage is sparse. These data add weight to earlier concerns about whether tax incentives to save for retirement benefit upper-income groups more than middle- and lower-income groups and present the importance of different sources of income in providing retirement funds for this group. (Author/RC)

  7. The association between obesity and severe disability among adults aged 50 or over in nine high-income, middle-income and low-income countries: a cross-sectional study

    PubMed Central

    Moneta, Maria Victoria; Garin, Noe; Olaya, Beatriz; Ayuso-Mateos, Jose Luis; Chatterji, Somnath; Leonardi, Matilde; Sainio, Päivi; Galas, Aleksander; Haro, Josep Maria

    2015-01-01

    Objective The association between obesity and disability may differ between high-income and low-income/middle-income countries but there are no studies comparing this association between these settings. The aim of the study was to assess this association in nine countries using nationally-representative data from the Collaborative Research on Ageing in Europe (COURAGE) study and the WHO's Study on global AGEing and Adult Health (SAGE). Design Population-based cross-sectional study Setting The survey was conducted in China, Finland, Ghana, India, Mexico, Poland, Russia, South Africa and Spain between 2007 and 2012. Participants 42 116 individuals 50 years and older. The institutionalised and those with limited cognition were excluded. Primary outcome measure Disability was defined as severe or extreme difficulty in conducting at least one of six types of basic activities of daily living (ADL). Results The mean body mass index (BMI) ranged from 20.4 kg/m2 in India to 30.7 kg/m2 in South Africa. Compared to normal BMI (18.5–24.9 kg/m2), BMI≥35 kg/m2 was associated with significantly higher odds for ADL disability in Finland (OR 4.64), Poland (OR 2.77), South Africa (OR 2.19) and Spain (OR 2.42). Interaction analysis showed that obese individuals in high-income countries were more likely to have ADL limitations than those in low-income or middle-income countries. Conclusions The higher odds for disability among obese individuals in high-income countries may imply longer life lived with disability due to factors such as the decline in cardiovascular disease mortality. In South Africa, this may have been due to the exceptionally high prevalence of class III obesity. These findings underscore the importance of obesity prevention to reduce the disability burden among older adults. PMID:25838510

  8. Current and future management of treatment failure in low- and middle-income countries.

    PubMed

    Boyd, Mark A

    2010-01-01

    Access to second-line therapy in low- and middle-income countries has been limited to date. The WHO predicts that between 500 000 and 800 000 HIV-infected people on first-line combination antiretroviral therapy will require switch to second-line therapy by 2010. This paper aims to describe and review access to second-line therapy in low- and middle-income countries at present and examine future possibilities. The majority of HIV-infected patients failing first-line combination antiretroviral therapy is identified by way of routine monitoring of clinical and immunological status as a surrogate for virological monitoring. Evidence suggests that immunological and clinical monitoring lack both sensitivity and specificity for virological failure. Consequently, at treatment failure, patients have often selected a degree of resistance within the nucleoside/nucleotide reverse transcriptase inhibitor class that questions the efficacy of using nucleoside/nucleotide reverse transcriptase inhibitors in a second-line regimen. There is a paucity of good-quality evidence on which to base guidelines and policy. Optimally, a second-line regimen would be simple, potent, tolerable and lend itself to provision according to the successful 'public health' approach. Provision of second-line therapy to HIV-infected individuals failing first-line therapy is a major challenge to the ongoing success of access to HIV care programmes in low- and middle-income countries. The optimal second-line combination antiretroviral therapies are unknown. Research trials to help define best practice are in advanced stages of development and implementation.

  9. Role of the private sector in the provision of immunization services in low- and middle-income countries.

    PubMed

    Levin, Ann; Kaddar, Miloud

    2011-07-01

    The authors conducted a literature review on the role of the private sector in low- and middle-income countries. The review indicated that relatively few studies have researched the role of the private sector in immunization service delivery in these countries. The studies suggest that the private sector is playing different roles and functions according to economic development levels, the governance structure and the general presence of the private sector in the health sector. In some countries, generally low-income countries, the private for-profit sector is contributing to immunization service delivery and helping to improve access to traditional EPI vaccines. In other countries, particularly middle-income countries, the private for-profit sector often acts to facilitate early adoption of new vaccines and technologies before introduction and generalization by the public sector. The not-for-profit sector plays an important role in extending access to traditional EPI vaccines, particularly in low-income countries. Not-for-profit facilities are situated in rural as well as urban areas and are more likely to be coordinated with public services than the private for-profit sector. Although numerous studies on non-governmental organizations (NGOs) suggest that the extent of NGO provision of immunization services in low- and middle-income countries is substantial, the contribution of this sector is poorly documented, leading to a lack of recognition of its role at national and global levels. Studies on quality of immunization service provision at private health facilities suggest that it is sometimes inadequate and needs to be monitored. Although some articles on public-private collaboration exist, little was found on the extent to which governments are effectively interacting with and regulating the private sector. The review revealed many geographical and thematic gaps in the literature on the role and regulation of the private sector in the delivery of immunization

  10. Dementia incidence and mortality in middle-income countries, and associations with indicators of cognitive reserve: a 10/66 Dementia Research Group population-based cohort study

    PubMed Central

    Prince, Martin; Acosta, Daisy; Ferri, Cleusa P; Guerra, Mariella; Huang, Yueqin; Rodriguez, Juan J Llibre; Salas, Aquiles; Sosa, Ana Luisa; Williams, Joseph D; Dewey, Michael E; Acosta, Isaac; Jotheeswaran, Amuthavalli T; Liu, Zhaorui

    2012-01-01

    Summary Background Results of the few cohort studies from countries with low incomes or middle incomes suggest a lower incidence of dementia than in high-income countries. We assessed incidence of dementia according to criteria from the 10/66 Dementia Research Group and Diagnostic and Statistical Manual of Mental Disorders (DSM) IV, the effect of dementia at baseline on mortality, and the independent effects of age, sex, socioeconomic position, and indicators of cognitive reserve. Methods We did a population-based cohort study of all people aged 65 years and older living in urban sites in Cuba, the Dominican Republic, and Venezuela, and rural and urban sites in Peru, Mexico, and China, with ascertainment of incident 10/66 and DSM-IV dementia 3–5 years after cohort inception. We used questionnaires to obtain information about age in years, sex, educational level, literacy, occupational attainment, and number of household assets. We obtained information about mortality from all sites. For participants who had died, we interviewed a friend or relative to ascertain the likelihood that they had dementia before death. Findings 12 887 participants were interviewed at baseline. 11 718 were free of dementia, of whom 8137 (69%) were reinterviewed, contributing 34 718 person-years of follow-up. Incidence for 10/66 dementia varied between 18·2 and 30·4 per 1000 person-years, and were 1·4–2·7 times higher than were those for DSM-IV dementia (9·9–15·7 per 1000 person-years). Mortality hazards were 1·56–5·69 times higher in individuals with dementia at baseline than in those who were dementia-free. Informant reports suggested a high incidence of dementia before death; overall incidence might be 4–19% higher if these data were included. 10/66 dementia incidence was independently associated with increased age (HR 1·67; 95% CI 1·56–1·79), female sex (0·72; 0·61–0·84), and low education (0·89; 0·81–0·97), but not with occupational attainment (1

  11. Maternal and child undernutrition and overweight in low-income and middle-income countries.

    PubMed

    Black, Robert E; Victora, Cesar G; Walker, Susan P; Bhutta, Zulfiqar A; Christian, Parul; de Onis, Mercedes; Ezzati, Majid; Grantham-McGregor, Sally; Katz, Joanne; Martorell, Reynaldo; Uauy, Ricardo

    2013-08-03

    Maternal and child malnutrition in low-income and middle-income countries encompasses both undernutrition and a growing problem with overweight and obesity. Low body-mass index, indicative of maternal undernutrition, has declined somewhat in the past two decades but continues to be prevalent in Asia and Africa. Prevalence of maternal overweight has had a steady increase since 1980 and exceeds that of underweight in all regions. Prevalence of stunting of linear growth of children younger than 5 years has decreased during the past two decades, but is higher in south Asia and sub-Saharan Africa than elsewhere and globally affected at least 165 million children in 2011; wasting affected at least 52 million children. Deficiencies of vitamin A and zinc result in deaths; deficiencies of iodine and iron, together with stunting, can contribute to children not reaching their developmental potential. Maternal undernutrition contributes to fetal growth restriction, which increases the risk of neonatal deaths and, for survivors, of stunting by 2 years of age. Suboptimum breastfeeding results in an increased risk for mortality in the first 2 years of life. We estimate that undernutrition in the aggregate--including fetal growth restriction, stunting, wasting, and deficiencies of vitamin A and zinc along with suboptimum breastfeeding--is a cause of 3·1 million child deaths annually or 45% of all child deaths in 2011. Maternal overweight and obesity result in increased maternal morbidity and infant mortality. Childhood overweight is becoming an increasingly important contributor to adult obesity, diabetes, and non-communicable diseases. The high present and future disease burden caused by malnutrition in women of reproductive age, pregnancy, and children in the first 2 years of life should lead to interventions focused on these groups. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Increasing evidence for the efficacy of tobacco control mass media communication programming in low- and middle-income countries.

    PubMed

    Mullin, Sandra; Prasad, Vinayak; Kaur, Jagdish; Turk, Tahir

    2011-08-01

    Antitobacco mass media campaigns have had good success at changing knowledge, attitudes, and behaviors with respect to smoking in high-income countries provided they are sustained. Mass media campaigns should be a critical component of tobacco control programs in low- and lower-middle-income countries. Mounting evidence shows that graphic campaigns and those that evoke negative emotions run over long periods of time have achieved the most influence. These types of campaigns are now being implemented in low- and middle-income countries. The authors provide 3 case studies of first-ever graphic warning mass media campaigns in China, India, and Russia, 3 priority high-burden countries in the global Bloomberg Initiative to Reduce Tobacco Use. In each of these countries, message testing of core messages provided confidence in messages, and evaluations demonstrated message uptake. The authors argue that given the initial success of these campaigns, governments in low- and middle-income countries should consider resourcing and sustaining these interventions as key components of their tobacco control strategies and programs.

  13. Assistive technologies for ageing populations in six low-income and middle-income countries: a systematic review

    PubMed Central

    Marasinghe, Keshini Madara; Lapitan, Jostacio Moreno; Ross, Alex

    2015-01-01

    Despite the benefits derived from the use of assistive technologies (AT), some parts of the world have minimal or no access to AT. In many low-income and middle-income countries (LMIC), only 5–15% of people who require AT have access to them. Rapid demographic changes will exacerbate this situation as populations over 60 years of age, as well as functional limitations among older populations, in LMIC are expected to be higher than in high-income countries in the coming years. Given both these trends, AT are likely to be in high demand and provide many benefits to respond to challenges related to healthy and productive ageing. Multiple databases were searched for English literature. Three groups of keywords were combined: those relating to AT, ageing population and LMIC selected for this study, namely Brazil, Cambodia, Egypt, India, Turkey and Zimbabwe. These countries are expected to see the most rapid growth in the 65 and above population in the coming years. Results indicate that all countries had AT designed for older adults with existing impairment and disability, but had limited AT that are designed to prevent impairment and disability among older adults who do not currently have any disabilities. All countries have ratified the UN Convention on the Rights of Persons with Disabilities. The findings conclude that AT for ageing populations have received some attention in LMIC as attested by the limited literature results. Analysis of review findings indicate the need for a comprehensive, integrated health and social system approach to increase the current availability of AT for ageing populations in LMIC. These would entail, yet not be limited to, work on: (1) promoting initiatives for low-cost AT; (2) awareness raising and capacity building on AT; (3) bridging the gap between AT policy and practice; and (4) fostering targeted research on AT. PMID:26688747

  14. Is the relative increase in income inequality related to tooth loss in middle-aged adults?

    PubMed

    Goulart, Mariél de Aquino; Vettore, Mario Vianna

    2016-01-01

    To assess whether Brazilian middle-aged adults living in cities that experienced a relative increase on income inequality were more likely to have severe tooth loss and lack a functional dentition. Data on Brazilian adults aged 35-44 years from state capitals and Federal District from the 2010 Brazilian Oral Health Survey (SBBrasil 2010) were analyzed. Clinically assessed tooth loss outcomes were severe tooth loss (<9 remaining natural teeth) and lack of functional dentition (<21 natural teeth). Income inequality was assessed by Gini Index in 1991, 2000, and 2003 using tertiles of distribution. Variation in Gini Index was assessed by changes in the tertiles distribution between years. Multilevel logistic regression models were used to estimate odds ratios (ORs) and 95 percent confidence intervals (95 percent CI) between variation in income inequality and tooth loss outcomes adjusting for individual socio-demographic characteristics. Prevalence of severe tooth loss and lack of functional dentition was 4.8 percent and 21.2 percent, respectively. Individuals living in cities with moderate and high increase in income inequality between 1991 and 2003 were more likely to have severe tooth loss and lack a functional dentition in 2010 compared with those living in cities with stable income inequality in the same period. Relationships between low family income and both tooth loss outcomes were significantly attenuated by relative increases in income inequality. Relative increases in income inequality were significantly associated with severe tooth loss and lack of a functional dentition in Brazilian middle-aged adults. © 2015 American Association of Public Health Dentistry.

  15. The Economic Consequences Of Mortality Amenable To High-Quality Health Care In Low- And Middle-Income Countries.

    PubMed

    Alkire, Blake C; Peters, Alexander W; Shrime, Mark G; Meara, John G

    2018-06-01

    We estimated deaths amenable to high-quality health care globally and then modeled the macroeconomic impact in low- and middle-income countries using two macroeconomic perspectives: a value-of-lost-output approach to project gross domestic product (GDP) losses annually for the period 2015-30, and a value-of-lost-welfare approach to estimate the present value of total economic welfare losses in 2015. We estimated that eight million amenable deaths occurred in 2015, 96 percent of them in low- and middle-income countries. The value of lost output resulted in a projected cumulative loss of $11.2 trillion in these countries during 2015-30, with a potential economic output loss of up to 2.6 percent of GDP in low-income countries by 2030, compared to 0.9 percent in upper-middle-income countries. The value-of-lost-welfare approach estimated welfare losses of $6.0 trillion in 2015. Inadequate access to high-quality health care results in significant mortality and imposes a macroeconomic burden that is inequitably distributed, with the largest relative burden falling on low-income countries. Given that these deaths are unnecessary and the projected GDP losses are avoidable, there is a strong ethical and economic case for promoting high-quality health care as an essential component of universal health coverage.

  16. Cost-effectiveness of strategies to improve the utilization and provision of maternal and newborn health care in low-income and lower-middle-income countries: a systematic review.

    PubMed

    Mangham-Jefferies, Lindsay; Pitt, Catherine; Cousens, Simon; Mills, Anne; Schellenberg, Joanna

    2014-07-22

    Each year almost 3 million newborns die within the first 28 days of life, 2.6 million babies are stillborn, and 287,000 women die from complications of pregnancy and childbirth worldwide. Effective and cost-effective interventions and behaviours for mothers and newborns exist, but their coverage remains inadequate in low- and middle-income countries, where the vast majority of deaths occur. Cost-effective strategies are needed to increase the coverage of life-saving maternal and newborn interventions and behaviours in resource-constrained settings. A systematic review was undertaken on the cost-effectiveness of strategies to improve the demand and supply of maternal and newborn health care in low-income and lower-middle-income countries. Peer-reviewed and grey literature published since 1990 was searched using bibliographic databases, websites of selected organizations, and reference lists of relevant studies and reviews. Publications were eligible for inclusion if they report on a behavioural or health systems strategy that sought to improve the utilization or provision of care during pregnancy, childbirth or the neonatal period; report on its cost-effectiveness; and were set in one or more low-income or lower-middle-income countries. The quality of the publications was assessed using the Consolidated Health Economic Evaluation Reporting Standards statement. Incremental cost per life-year saved and per disability-adjusted life-year averted were compared to gross domestic product per capita. Forty-eight publications were identified, which reported on 43 separate studies. Sixteen were judged to be of high quality. Common themes were identified and the strategies were presented in relation to the continuum of care and the level of the health system. There was reasonably strong evidence for the cost-effectiveness of the use of women's groups, home-based newborn care using community health workers and traditional birth attendants, adding services to routine antenatal

  17. Potential ecological footprints of active pharmaceutical ingredients: an examination of risk factors in low-, middle- and high-income countries

    PubMed Central

    Kookana, Rai S.; Williams, Mike; Boxall, Alistair B. A.; Larsson, D. G. Joakim; Gaw, Sally; Choi, Kyungho; Yamamoto, Hiroshi; Thatikonda, Shashidhar; Zhu, Yong-Guan; Carriquiriborde, Pedro

    2014-01-01

    Active pharmaceutical ingredients (APIs) can enter the natural environment during manufacture, use and/or disposal, and consequently public concern about their potential adverse impacts in the environment is growing. Despite the bulk of the human population living in Asia and Africa (mostly in low- or middle-income countries), limited work relating to research, development and regulations on APIs in the environment have so far been conducted in these regions. Also, the API manufacturing sector is gradually shifting to countries with lower production costs. This paper focuses mainly on APIs for human consumption and highlights key differences between the low-, middle- and high-income countries, covering factors such as population and demographics, manufacture, prescriptions, treatment, disposal and reuse of waste and wastewater. The striking differences in populations (both human and animal), urbanization, sewer connectivity and other factors have revealed that the environmental compartments receiving the bulk of API residues differ markedly between low- and high-income countries. High sewer connectivity in developed countries allows capture and treatment of the waste stream (point-source). However, in many low- or middle-income countries, sewerage connectivity is generally low and in some areas waste is collected predominantly in septic systems. Consequently, the diffuse-source impact, such as on groundwater from leaking septic systems or on land due to disposal of raw sewage or septage, may be of greater concern. A screening level assessment of potential burdens of APIs in urban and rural environments of countries representing low- and middle-income as well as high-income has been made. Implications for ecological risks of APIs used by humans in lower income countries are discussed. PMID:25405973

  18. Resources Required for Cervical Cancer Prevention in Low- and Middle-Income Countries.

    PubMed

    Campos, Nicole G; Sharma, Monisha; Clark, Andrew; Kim, Jane J; Resch, Stephen C

    2016-01-01

    Cervical cancer is the fourth leading cause of cancer death in women, with 85% of cases and deaths occurring in developing countries. While organized screening programs have reduced cervical cancer incidence in high-income countries through detection and treatment of precancerous lesions, the implementation of organized screening has not been effective in low-resource settings due to lack of infrastructure and limited budgets. Our objective was to estimate the cost of comprehensive primary and secondary cervical cancer prevention in low- and middle-income countries. We performed a modeling analysis to estimate 1) for girls aged 10 years, the cost of 2-dose human papillomavirus (HPV) vaccination; and 2) for women aged 30 to 49 years, the cost of cervical cancer screening (with visual inspection with acetic acid (VIA), HPV testing, or cytology) and preventive treatment in 102 low- and middle-income countries from 2015 to 2024. We used an Excel-based costing and service utilization model to estimate financial costs (2013 US$) based on prevalence of HPV, prevalence of precancerous lesions, and screening test performance. Where epidemiologic data were unavailable, we extrapolated from settings with data using an individual-based microsimulation model of cervical carcinogenesis (calibrated to 20 settings) and multivariate regression. Total HPV vaccination costs ranged from US$8.6 billion to US$24.2 billion for all scenarios considered (immediate, 5-year, or 10-year roll-out; price per dose US$4.55-US$70 by country income level). The total cost of screening and preventive treatment ranged from US$5.1 billion (10-year roll-out, screening once at age 35 years) to US$42.3 billion (immediate roll-out, high intensity screening). Limitations of this analysis include the assumption of standardized protocols by country income level that did not account for the potential presence of multiple screening modalities or management strategies within a country, and extrapolation of cost

  19. Resources Required for Cervical Cancer Prevention in Low- and Middle-Income Countries

    PubMed Central

    Campos, Nicole G.; Sharma, Monisha; Clark, Andrew; Kim, Jane J.; Resch, Stephen C.

    2016-01-01

    Background Cervical cancer is the fourth leading cause of cancer death in women, with 85% of cases and deaths occurring in developing countries. While organized screening programs have reduced cervical cancer incidence in high-income countries through detection and treatment of precancerous lesions, the implementation of organized screening has not been effective in low-resource settings due to lack of infrastructure and limited budgets. Our objective was to estimate the cost of comprehensive primary and secondary cervical cancer prevention in low- and middle-income countries. Methods and Findings We performed a modeling analysis to estimate 1) for girls aged 10 years, the cost of 2-dose human papillomavirus (HPV) vaccination; and 2) for women aged 30 to 49 years, the cost of cervical cancer screening (with visual inspection with acetic acid (VIA), HPV testing, or cytology) and preventive treatment in 102 low- and middle-income countries from 2015 to 2024. We used an Excel-based costing and service utilization model to estimate financial costs (2013 US$) based on prevalence of HPV, prevalence of precancerous lesions, and screening test performance. Where epidemiologic data were unavailable, we extrapolated from settings with data using an individual-based microsimulation model of cervical carcinogenesis (calibrated to 20 settings) and multivariate regression. Total HPV vaccination costs ranged from US$8.6 billion to US$24.2 billion for all scenarios considered (immediate, 5-year, or 10-year roll-out; price per dose US$4.55-US$70 by country income level). The total cost of screening and preventive treatment ranged from US$5.1 billion (10-year roll-out, screening once at age 35 years) to US$42.3 billion (immediate roll-out, high intensity screening). Limitations of this analysis include the assumption of standardized protocols by country income level that did not account for the potential presence of multiple screening modalities or management strategies within a

  20. Disintegrated care: the Achilles heel of international health policies in low and middle-income countries

    PubMed Central

    Unger, Jean-Pierre; De Paepe, Pierre; Ghilbert, Patricia; Soors, Werner; Green, Andrew

    2006-01-01

    Abstract Purpose To review the evidence basis of international aid and health policy. Context of case Current international aid policy is largely neoliberal in its promotion of commoditization and privatisation. We review this policy's responsibility for the lack of effectiveness in disease control and poor access to care in low and middle-income countries. Data sources National policies, international programmes and pilot experiments are examined in both scientific and grey literature. Conclusions and discussion We document how health care privatisation has led to the pool of patients being cut off from public disease control interventions—causing health care disintegration—which in turn resulted in substandard performance of disease control. Privatisation of health care also resulted in poor access. Our analysis consists of three steps. Pilot local contracting-out experiments are scrutinized; national health care records of Colombia and Chile, two countries having adopted contracting-out as a basis for health care delivery, are critically examined against Costa Rica; and specific failure mechanisms of the policy in low and middle-income countries are explored. We conclude by arguing that the negative impact of neoliberal health policy on disease control and health care in low and middle-income countries justifies an alternative aid policy to improve both disease control and health care. PMID:17006553

  1. Risk of poor development in young children in low-income and middle-income countries: an estimation and analysis at the global, regional, and country level.

    PubMed

    Lu, Chunling; Black, Maureen M; Richter, Linda M

    2016-12-01

    A 2007 study published in The Lancet estimated that approximately 219 million children aged younger than 5 years were exposed to stunting or extreme poverty in 2004. We updated the 2004 estimates with the use of improved data and methods and generated estimates for 2010. We used country-level prevalence of stunting in children younger than 5 years based on the 2006 Growth Standards proposed by WHO and poverty ratios from the World Bank to estimate children who were either stunted or lived in extreme poverty for 141 low-income and middle-income countries in 2004 and 2010. To avoid counting the same children twice, we excluded children jointly exposed to stunting and extreme poverty from children living in extreme poverty. To examine the robustness of estimates, we also used moderate poverty measures. The 2007 study underestimated children at risk of poor development. The estimated number of children exposed to the two risk factors in low-income and middle-income countries decreased from 279·1 million (95% CI 250·4 million-307·4 million) in 2004 to 249·4 million (209·3 million-292·6 million) in 2010; prevalence of children at risk fell from 51% (95% CI 46-56) to 43% (36-51). The decline occurred in all income groups and regions with south Asia experiencing the largest drop. Sub-Saharan Africa had the highest prevalence in both years. These findings were robust to variations in poverty measures. Progress has been made in reducing the number of children exposed to stunting or poverty between 2004 and 2010, but this is still not enough. Scaling up of effective interventions targeting the most vulnerable children is urgently needed. National Institutes of Health, Bill & Melinda Gates Foundation, Hilton Foundation, and WHO. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND license. Published by Elsevier Ltd.. All rights reserved.

  2. Stress Sensitivity and Psychotic Experiences in 39 Low- and Middle-Income Countries

    PubMed Central

    DeVylder, Jordan E.; Koyanagi, Ai; Unick, Jay; Oh, Hans; Nam, Boyoung; Stickley, Andrew

    2016-01-01

    Stress has a central role in most theories of psychosis etiology, but the relation between stress and psychosis has rarely been examined in large population-level data sets, particularly in low- and middle-income countries. We used data from 39 countries in the World Health Survey (n = 176 934) to test the hypothesis that stress sensitivity would be associated with psychotic experiences, using logistic regression analyses. Respondents in low-income countries reported higher stress sensitivity (P < .001) and prevalence of psychotic experiences (P < .001), compared to individuals in middle-income countries. Greater stress sensitivity was associated with increased odds for psychotic experiences, even when adjusted for co-occurring anxiety and depressive symptoms: adjusted odds ratio (95% CI) = 1.17 (1.15–1.19) per unit increase in stress sensitivity (range 2–10). This association was consistent and significant across nearly every country studied, and translated into a difference in psychotic experience prevalence ranging from 6.4% among those with the lowest levels of stress sensitivity up to 22.2% among those with the highest levels. These findings highlight the generalizability of the association between psychosis and stress sensitivity in the largest and most globally representative community-level sample to date, and support the targeting of stress sensitivity as a potential component of individual- and population-level interventions for psychosis. PMID:27109925

  3. The impact of occupation according to income on depressive symptoms in South Korean individuals: Findings from the Korean Welfare Panel Study.

    PubMed

    Kim, Woorim; Park, Eun-Cheol; Lee, Tae-Hoon; Ju, Yeong Jun; Shin, Jaeyong; Lee, Sang Gyu

    2016-05-01

    In South Korea, societal perceptions on occupation are distinct, with people favouring white collar jobs. Hence both occupation type and income can have mental health effects. To examine the relationship between occupational classification and depression, along with the combined effect of occupational classification and household income. Data were from the Korean Welfare Panel Study (KOWEPS), 2010-2013. A total of 4,694 economically active participants at baseline were followed. Association between occupational classification and depression, measured using the Center for Epidemiological Studies Depression (CES-D) scale 11, was investigated using the linear mixed effects model. Blue collar (β: 0.3871, p = .0109) and sales and service worker groups (β: 0.3418, p = .0307) showed higher depression scores than the white collar group. Compared to the white collar high-income group, white collar low income, blue collar middle income, blue collar middle-low income, blue collar low income, sales and service middle-high income, sales and service middle-low income and sales and service low-income groups had higher depression scores. Occupational classification is associated with increasing depression scores. Excluding the highest income group, blue collar and sales and service worker groups exhibit higher depression scores than their white collar counterparts, implying the importance of addressing these groups. © The Author(s) 2016.

  4. Availability of alcohol: Location, time and ease of purchase in high- and middle-income countries: Data from the International Alcohol Control study.

    PubMed

    Gray-Phillip, Gaile; Huckle, Taisia; Callinan, Sarah; Parry, Charles D H; Chaiyasong, Surasak; Cuong, Pham Viet; Mackintosh, Anne-Marie; Meier, Petra; Kazantseva, Elena; Piazza, Marina; Parker, Karl; Casswell, Sally

    2018-03-26

    Cross-country studies on alcohol purchasing and access are rare. We examined where and when people access alcohol to understand patterns of availability across a range of middle- and high-income countries. Surveys of drinkers in the International Alcohol Control study in high-income countries (Australia, England, Scotland, New Zealand and St Kitts and Nevis) and middle-income countries (Mongolia, South Africa, Peru, Thailand and Vietnam) were analysed. Measures were: location of purchase from on-premise and take-away outlets, proportion of alcohol consumed on-premise versus take-away outlets, hours of purchase, access among underage drinkers and time to access alcohol. On-premise purchasing was prevalent in the high-income countries. However, the vast majority of alcohol consumed in all countries, except St Kitts and Nevis (high-income), was take-away. Percentages of drinkers purchasing from different types of on-premise and take-away outlets varied between countries. Late purchasing was common in Peru and less common in Thailand and Vietnam. Alcohol was easily accessed by drinkers in all countries, including underage drinkers in the middle-income countries. In nine out of 10 countries the vast majority of alcohol consumed was take-away. Alcohol was readily available and relatively easy for underage drinkers to access, particularly in the middle-income countries. Research is needed to assess the harms associated with take-away consumption including late at night. Attention is needed to address the easy access by underage drinkers in the middle-income countries which has been less of a focus than in high-income countries. © 2018 The Authors Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.

  5. An international survey of nutritional practices in low- and middle-income countries: a report from the International Society of Pediatric Oncology (SIOP) PODC Nutrition Working Group.

    PubMed

    Murphy, A J; Mosby, T T; Rogers, P C; Cohen, J; Ladas, E J

    2014-12-01

    Optimal nutritional status is important in children with cancer, as it can influence clinical outcomes. To improve the nutritional health of children and adolescents receiving treatment for cancer residing in low income and middle-income countries (LMIC), we investigated nutrition practices among these nations' institutions providing treatment for childhood cancer. A cross-sectional survey of nutrition practice was administered to staff members at institutions providing treatment for children with cancer between 2011 and 2012. Countries classified as low income and middle income were divided by geographical region. Final analysis was performed with 96 surveys, which included 27 institutions from Asia, 27 institutions from Latin America and Caribbean, 27 institutions from Africa and 15 institutions from Europe. The study found that 55% of institutions had a dietician available on their service. Access to dieticians, lack of nutrition resources and lack of nutrition education of staff were the main barriers to providing nutrition care in LMIC. Half of the institutions performed nutritional assessment at diagnosis, and the methods used varied widely. Twenty-nine percent of all institutions used complementary and alternate therapies within their clinical practice, and 35% of institutions reported that nutrition education was provided to patients and families. Priority areas for improving the nutritional management in LMIC include the following: (1) improved nutrition education and assessment tools for doctors and nurses; (2) increased availability of nutrition education resources for families and patients; and (3) identification of the role of complementary and alternative therapies in closing gaps in symptom management in these institutions.

  6. Effectiveness of Influenza Vaccination for Individuals with Chronic Obstructive Pulmonary Disease (COPD) in Low- and Middle-Income Countries.

    PubMed

    Lall, Dorothy; Cason, E; Pasquel, F J; Ali, M K; Narayan, K M V

    2016-01-01

    Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death globally. In addition to the mortality associated with it, people with COPD experience significant morbidity, making this set of conditions a major public health concern. Infections caused by influenza virus are a preventable cause of morbidity and vaccination has been shown to be effective. The evidence of their benefit in persons with COPD mainly comes from high-income countries where influenza vaccination is used in routine practice, but little is known about the effectiveness, cost-effectiveness, and scalability of vaccination in low- and middle-income countries. We therefore systematically reviewed and present evidence related to vaccination against influenza in persons with COPD with a special focus on studies from low- and middle-income countries (LMICs). Available data from 19 studies suggest that the use of influenza vaccine in persons with COPD is beneficial, cost-effective, and may be relevant for low- and middle-income countries. Wider implementation of this intervention needs to take into account the health care delivery systems of LMICs and use of prevalent viral strains in vaccines to be most cost effective.

  7. Perspectives of physicians practicing in low and middle income countries towards generic medicines: a narrative review.

    PubMed

    Hassali, Mohamed Azmi; Wong, Zhi Yen; Alrasheedy, Alian A; Saleem, Fahad; Mohamad Yahaya, Abdul Haniff; Aljadhey, Hisham

    2014-09-01

    This review was conducted to document published literature related to physicians' knowledge, attitudes, and perceptions of generic medicines in low- and middle-income countries (LMICs) and to compare the findings with high-income countries. A systematic search of articles published in peer-reviewed journals from January 2001 to February 2013 was performed. The search comprised nine electronic databases. The search strategy involved using Boolean operators for combinations of the following terms: generic medicines, generic medications, generic drugs, generic, generic substitution, generic prescribing, international non-proprietary, prescribers, doctors, general practitioners, physicians, and specialists. Sixteen articles were included in this review. The majority (n=11) were from high income countries and five from LMICs. The main difference between high income countries and LMICs is that physicians from high income countries generally have positive views whereas those from LMICs tend to have mixed views regarding generic medicines. Few similarities were identified among different country income groups namely low level of physicians' knowledge of the basis of bioequivalence testing, cost of generic medicines as an encouraging factor for generic medicine prescribing, physicians' concerns towards safety and quality of generic medicines and effect of pharmaceutical sales representative on generic medicine prescribing. The present literature review revealed that physicians from LMICs tend to have mixed views regarding generic medicines. This may be due to differences in the health care system and pharmaceutical funding system, medicine policies, the level of educational interventions, and drug information sources in countries of different income levels. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  8. The socioeconomic gradient of secondhand smoke exposure in children: evidence from 26 low-income and middle-income countries.

    PubMed

    Hajizadeh, Mohammad; Nandi, Arijit

    2016-12-01

    To provide the first analysis of socioeconomic inequalities in children's daily exposure to indoor smoking in households in 26 low-income and middle-income countries (LMICs). We used nationally representative household samples (n=369 654) collected through the Demographic Health Surveys between 2010 and 2014 to calculate daily exposure to secondhand smoke (ESHS) among children aged 0-5 years. The relative and absolute concentration (RC and AC) indices were used to quantify wealth-based inequalities in daily ESHS in each country and in urban and rural areas in each country. We decomposed total socioeconomic inequalities in ESHS into within-group and between-group (rural-urban) inequalities to identify the sources of wealth-based inequality in ESHS in LMICs. We observed substantial variation across countries in the prevalence of daily ESHS among children. Children's ESHS was higher in rural areas compared to urban areas in the majority of the countries. The RC and AC demonstrated that daily ESHS was concentrated among poorer children in almost all countries (RC, median=-0.179, IQR=0.186 and AC, median=-0.040, IQR=0.055). The concentration of ESHS among poorer children was greater in urban relative to rural areas. The decomposition of the overall socioeconomic inequality in daily ESHS revealed that wealth-based differences in ESHS within urban and rural areas were the main contributor to socioeconomic inequalities in most countries (median=46%, IQR=32%). Special attention should be given to reduce ESHS among children from rural and socioeconomically disadvantaged households as social inequalities in ESHS might contribute to social inequalities in health over the life course. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  9. Food Group Categories of Low-Income African American Women

    ERIC Educational Resources Information Center

    Lynch, Elizabeth B.; Holmes, Shane

    2011-01-01

    Objective: Describe lay food group categories of low-income African American women and assess the overlap of lay food groups and MyPyramid food groups. Design: A convenience sample of African American mothers from a low-income Chicago neighborhood performed a card-sorting task in which they grouped familiar food items into food groups. Setting:…

  10. Centre-based day care for children younger than five years of age in low- and middle-income countries.

    PubMed

    Brown, Taylor W; van Urk, Felix C; Waller, Rebecca; Mayo-Wilson, Evan

    2014-09-25

    Because of poverty, children and families in low- and middle-income countries often face significant impediments to health and well-being. Centre-based day care services may influence the development of children and the economic situation of parents by providing good quality early childhood care and by freeing parents to participate in the labour force. To assess the effects of centre-based day care without additional interventions (e.g. psychological or medical services, parent training) on the development, health and well-being of children and families in low- and middle-income countries (as defined by the World Bank 2011). In April 2014, we searched CENTRAL, Ovid MEDLINE, EMBASE, PsycINFO, ERIC and 16 other sources, including several World Health Organization (WHO) regional databases. We also searched two trials registers, websites of government and non-government agencies and reference lists of relevant studies. We included randomised and quasi-randomised controlled trials and prospective non-randomised studies with contemporaneous control groups and assessments both before and after intervention. We considered non-randomised controlled trials, as centre-based care in low- and middle-income countries is unlikely to be studied using randomised controlled trials (Higgins 2011). We included the following outcomes: child intellectual development, child psychosocial development, maternal and family outcomes and incidence of infectious diseases. Two review authors independently assessed risk of bias and extracted data from the single included study. Only one trial, involving 256 children, met the inclusion criteria for this review. This study was assessed as having high risk of bias because of non-random allocation, incomplete outcome data and insufficient control of confounding factors. Results from this study suggest that centre-based day care may have a positive effect on child cognitive ability compared with no treatment (care at home) (assessed using a modified

  11. Underutilization of cervical cancer prevention services in low and middle income countries: a review of contributing factors

    PubMed Central

    Chidyaonga-Maseko, Fresier; Chirwa, Maureen Leah; Muula, Adamson Sinjani

    2015-01-01

    This review aims at identifying barriers to utilization of cervical cancer prevention services in low- and middle-income countries. An electronic search was conducted using the following key words, HPV vaccination, screening, barriers, utilization and low and middle income/developed countries. Using the Garrard (1999) Matrix method approach, a modified matrix was designed and used as a data collection tool and data related to each category listed on the tool were entered into a matrix containing columns reflecting the categories. Constant comparative analysis was used to identify thematic categories. 31 articles published between 2001 and 2014 were yielded from the search. Analysis of the contents of the articles showed that the underutilization of cervical cancer screening services in low and middle-income countries is the result of barriers in accessing and utilizing of the prevention services. Though not mutually exclusive, the barriers were categorized in three categories; individual, community and health system related. Individual barriers include lack of awareness and knowledge about risk factors and prevention of cervical cancer. Age, marital status, diffidence, social economic status, cultural and religious belief of the women also determine the women's' willingness to utilize the services. In some communities there is stigma attached to discussing reproductive health issues and this limits the young women's awareness of cervical cancer and its prevention. Understanding individual, community and health system barriers that hinder women's utilization of cervical cancer prevention services is very crucial in designing effective cervical cancer control programs in low- and middle-income countries. PMID:26523173

  12. Reflections on the development of health economics in low- and middle-income countries

    PubMed Central

    Mills, Anne

    2014-01-01

    Health economics is a relatively new discipline, though its antecedents can be traced back to William Petty FRS (1623–1687). In high-income countries, the academic discipline and scientific literature have grown rapidly since the 1960s. In low- and middle-income countries, the growth of health economics has been strongly influenced by trends in health policy, especially among the international and bilateral agencies involved in supporting health sector development. Valuable and influential research has been done in areas such as cost–benefit and cost-effectiveness analysis, financing of healthcare, healthcare provision, and health systems analysis, but there has been insufficient questioning of the relevance of theories and policy recommendations in the rich world literature to the circumstances of poorer countries. Characteristics such as a country's economic structure, strength of political and social institutions, management capacity, and dependence on external agencies, mean that theories and models cannot necessarily be transferred between settings. Recent innovations in the health economics literature on low- and middle-income countries indicate how health economics can be shaped to provide more relevant advice for policy. For this to be taken further, it is critical that such countries develop stronger capacity for health economics within their universities and research institutes, with greater local commitment of funding. PMID:25009059

  13. A New Approach of Measuring Hospital Performance for Low- and Middle-income Countries

    PubMed Central

    Sapkota, Vishnu Prasad; Supakankunti, Siripen

    2015-01-01

    Efficiency of the hospitals affects the price of health services. Health care payments have equity implications. Evidence on hospital performance can support to design the policy; however, the recent literature on hospital efficiency produced conflicting results. Consequently, policy decisions are uncertain. Even the most of evidence were produced by using data from high income countries. Conflicting results were produced particularly due to differences in methods of measuring performance. Recently a management approach has been developed to measure the hospital performance. This approach to measure the hospital performance is very useful from policy perspective to improve health system from cost-effective way in low and middle income countries. Measuring hospital performance through management approach has some basic characteristics such as scoring management practices through double blind survey, measuring hospital outputs using various indicators, estimating the relationship between management practices and outputs of the hospitals. This approach has been successfully applied to developed countries; however, some revisions are required without violating the fundamental principle of this approach to replicate in low- and middle-income countries. The process has been clearly defined and applied to Nepal. As the results of this, the approach produced expected results. The paper contributes to improve the approach to measure hospital performance. PMID:26617448

  14. Emergency general surgery in a low-middle income health care setting: Determinants of outcomes.

    PubMed

    Shah, Adil A; Latif, Asad; Zogg, Cheryl K; Zafar, Syed Nabeel; Riviello, Robert; Halim, Muhammad Sohail; Rehman, Zia; Haider, Adil H; Zafar, Hasnain

    2016-02-01

    Emergency general surgery (EGS) has emerged as an important component of frontline operative care. Efforts in high-income settings have described its burden but have yet to consider low- and middle-income health care settings in which emergent conditions represent a high proportion of operative need. The objective of this study was to describe the disease spectrum of EGS conditions and associated factors among patients presenting in a low-middle income context. March 2009-April 2014 discharge data from a university teaching hospital in South Asia were obtained for patients (≥16 years) with primary International Classification of Diseases, 9(th) revision, Clinical Modification diagnosis codes consistent with an EGS condition as defined by the American Association for the Surgery of Trauma. Outcomes included in-hospital mortality and occurrence of ≥1 major complication(s). Multivariable analyses were performed, adjusting for differences in demographic and case-mix factors. A total of 13,893 discharge records corresponded to EGS conditions. Average age was 47.2 years (±16.8, standard deviation), with a male preponderance (59.9%). The majority presented with admitting diagnoses of biliary disease (20.2%), followed by soft-tissue disorders (15.7%), hernias (14.9%), and colorectal disease (14.3%). Rates of death and complications were 2.7% and 6.6%, respectively; increasing age was an independent predictor of both. Patients in need of resuscitation (n = 225) had the greatest rates of mortality (72.9%) and complications (94.2%). This study takes an important step toward quantifying outcomes and complications of EGS, providing one of the first assessments of EGS conditions using American Association for the Surgery of Trauma definitions in a low-middle income health care setting. Further efforts in varied settings are needed to promote representative benchmarking worldwide. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. The Diagnosis of Autism and Autism Spectrum Disorder in Low- and Middle-Income Countries: Experience from Jamaica

    ERIC Educational Resources Information Center

    Samms-Vaughan, Maureen; Rahbar, Mohammad H.; Dickerson, Aisha S.; Loveland, Katherine A.; Hessabi, Manouchehr; Pearson, Deborah A.; Bressler, Jan; Shakespeare-Pellington, Sydonnie; Grove, Megan L.; Coore-Desai, Charlene; Reece, Jody; Boerwinkle, Eric

    2017-01-01

    The administration requirements of the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised, widely used in high-income countries, make them less feasible for diagnosis of autism spectrum disorder in low- and middle-income countries. The flexible administration requirements of the Childhood Autism Rating Scale have…

  16. Chronic kidney disease in low- and middle-income countries

    PubMed Central

    Stanifer, John W.; Muiru, Anthony; Jafar, Tazeen H.; Patel, Uptal D.

    2016-01-01

    Most of the global burden of chronic kidney disease (CKD) is occurring in low- and middle-income countries (LMICs). As a result of rapid urbanization in LMICs, a growing number of populations are exposed to numerous environmental toxins, high infectious disease burdens and increasing rates of noncommunicable diseases. For CKD, this portends a high prevalence related to numerous etiologies, and it presents unique challenges. A better understanding of the epidemiology of CKD in LMICs is urgently needed, but this must be coupled with strong public advocacy and broad, collaborative public health efforts that address environmental, communicable, and non-communicable risk factors. PMID:27217391

  17. Characterizing the Achievement Motivation Orientation of Children from Low- and Middle-Income Families

    ERIC Educational Resources Information Center

    Day, Crystal A.; Burns, Barbara M.

    2011-01-01

    Research Findings: The current study examined achievement motivation orientation in preschool-age children from low- and middle-income families. Participants were 126 children who were attending an urban Head Start site or a private preschool. Children's motivation orientation was assessed as being performance oriented or mastery oriented using a…

  18. A pilot comparison of standardized online surgical curricula for use in low- and middle-income countries.

    PubMed

    Goldstein, Seth D; Papandria, Dominic; Linden, Allison; Azzie, Georges; Borgstein, Eric; Calland, James Forrest; Finlayson, Samuel R G; Jani, Pankaj; Klingensmith, Mary; Labib, Mohamed; Lewis, Frank; Malangoni, Mark A; O'Flynn, Eric; Ogendo, Stephen; Riviello, Robert; Abdullah, Fizan

    2014-04-01

    Surgical conditions are an important component of global disease burden, due in part to critical shortages of adequately trained surgical providers in low- and middle-income countries. To assess the use of Internet-based educational platforms as a feasible approach to augmenting the education and training of surgical providers in these settings. Access to two online curricula was offered to 75 surgical faculty and trainees from 12 low- and middle-income countries for 60 days. The Surgical Council on Resident Education web portal was designed for general surgery trainees in the United States, and the School for Surgeons website was built by the Royal College of Surgeons in Ireland specifically for the College of Surgeons of East, Central and Southern Africa. Participants completed an anonymous online survey detailing their experiences with both platforms. Voluntary respondents were daily Internet users and endorsed frequent use of both print and online textbooks as references. Likert scale survey questionnaire responses indicating overall and content-specific experiences with the Surgical Council on Resident Education and School for Surgeons curricula. Survey responses were received from 27 participants. Both online curricula were rated favorably, with no statistically significant differences in stated willingness to use and recommend either platform to colleagues. Despite regional variations in practice context, there were few perceived hurdles to future curriculum adoption. Both the Surgical Council on Resident Education and School for Surgeons educational curricula were well received by respondents in low- and middle-income countries. Although one was designed for US surgical postgraduates and the other for sub-Saharan African surgical providers, there were no significant differences detected in participant responses between the two platforms. Online educational resources have promise as an effective means to enhance the education of surgical providers in low

  19. Tobacco use and second-hand smoke exposure in young adolescents aged 12-15 years: data from 68 low-income and middle-income countries.

    PubMed

    Xi, Bo; Liang, Yajun; Liu, Yunxia; Yan, Yinkun; Zhao, Min; Ma, Chuanwei; Bovet, Pascal

    2016-11-01

    Tobacco use is an important risk factor for non-communicable diseases worldwide. However, the global extent and prevalence of tobacco use in adolescents is poorly described. Using previously collected survey data, we aimed to assess tobacco use and second-hand smoke exposure in young adolescents aged 12-15 years in 68 low-income and middle-income countries. We used data from the Global School-based Student Health Survey (2006-13) and the China Global Tobacco Youth Survey (2013), which are school-based surveys of young adolescents aged 12-15 years that assess health behaviours using a standardised, anonymous, self-reported questionnaire. We calculated the prevalence of current tobacco use and exposure to second-hand smoke in young adolescents from 68 low-income and middle-income countries that collected these data in the surveys. We used a multilevel model to estimate the association between parental tobacco use, second-hand smoke, and adolescent tobacco use, adjusting for sex, age, school, school class, country's purchasing power parity, smoking initiation age, national prevalence of tobacco use among adults, year the WHO FCTC was ratified for each country, proxy of socioeconomic status, and survey year. The mean prevalence of current tobacco use was 13·6%, ranging from 2·8% in Tajikistan to 44·7% in Samoa. In most countries, the prevalence of tobacco use was higher for boys than girls, and higher for adolescents aged 14-15 years than for those aged 12-13 years. The overall prevalence of second-hand smoke exposure was 55·9%, ranging from 16·4% in Tajikistan to 85·4% in Indonesia. Parental tobacco use (as reported by the young adolescents), especially maternal use, was associated with tobacco use in young adolescents (odds ratio 2·06, 95% CI 1·93-2·19, for maternal and 1·29, 1·23-1·35 for paternal use). Second-hand smoke exposure was also a risk factor for young adolescents' tobacco use (2·56, 2·43-2·69). However, the prevalence of tobacco use was not

  20. Stress Sensitivity and Psychotic Experiences in 39 Low- and Middle-Income Countries.

    PubMed

    DeVylder, Jordan E; Koyanagi, Ai; Unick, Jay; Oh, Hans; Nam, Boyoung; Stickley, Andrew

    2016-11-01

    Stress has a central role in most theories of psychosis etiology, but the relation between stress and psychosis has rarely been examined in large population-level data sets, particularly in low- and middle-income countries. We used data from 39 countries in the World Health Survey (n = 176 934) to test the hypothesis that stress sensitivity would be associated with psychotic experiences, using logistic regression analyses. Respondents in low-income countries reported higher stress sensitivity (P < .001) and prevalence of psychotic experiences (P < .001), compared to individuals in middle-income countries. Greater stress sensitivity was associated with increased odds for psychotic experiences, even when adjusted for co-occurring anxiety and depressive symptoms: adjusted odds ratio (95% CI) = 1.17 (1.15-1.19) per unit increase in stress sensitivity (range 2-10). This association was consistent and significant across nearly every country studied, and translated into a difference in psychotic experience prevalence ranging from 6.4% among those with the lowest levels of stress sensitivity up to 22.2% among those with the highest levels. These findings highlight the generalizability of the association between psychosis and stress sensitivity in the largest and most globally representative community-level sample to date, and support the targeting of stress sensitivity as a potential component of individual- and population-level interventions for psychosis. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  1. Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

    PubMed

    2018-04-05

    Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. NCT02179112.

  2. Cost-effectiveness of strategies to improve the utilization and provision of maternal and newborn health care in low-income and lower-middle-income countries: a systematic review

    PubMed Central

    2014-01-01

    Background Each year almost 3 million newborns die within the first 28 days of life, 2.6 million babies are stillborn, and 287,000 women die from complications of pregnancy and childbirth worldwide. Effective and cost-effective interventions and behaviours for mothers and newborns exist, but their coverage remains inadequate in low- and middle-income countries, where the vast majority of deaths occur. Cost-effective strategies are needed to increase the coverage of life-saving maternal and newborn interventions and behaviours in resource-constrained settings. Methods A systematic review was undertaken on the cost-effectiveness of strategies to improve the demand and supply of maternal and newborn health care in low-income and lower-middle-income countries. Peer-reviewed and grey literature published since 1990 was searched using bibliographic databases, websites of selected organizations, and reference lists of relevant studies and reviews. Publications were eligible for inclusion if they report on a behavioural or health systems strategy that sought to improve the utilization or provision of care during pregnancy, childbirth or the neonatal period; report on its cost-effectiveness; and were set in one or more low-income or lower-middle-income countries. The quality of the publications was assessed using the Consolidated Health Economic Evaluation Reporting Standards statement. Incremental cost per life-year saved and per disability-adjusted life-year averted were compared to gross domestic product per capita. Results Forty-eight publications were identified, which reported on 43 separate studies. Sixteen were judged to be of high quality. Common themes were identified and the strategies were presented in relation to the continuum of care and the level of the health system. There was reasonably strong evidence for the cost-effectiveness of the use of women’s groups, home-based newborn care using community health workers and traditional birth attendants, adding

  3. Revisiting typhoid fever surveillance in low and middle income countries: lessons from systematic literature review of population-based longitudinal studies.

    PubMed

    Mogasale, Vittal; Mogasale, Vijayalaxmi V; Ramani, Enusa; Lee, Jung Seok; Park, Ju Yeon; Lee, Kang Sung; Wierzba, Thomas F

    2016-01-29

    The control of typhoid fever being an important public health concern in low and middle income countries, improving typhoid surveillance will help in planning and implementing typhoid control activities such as deployment of new generation Vi conjugate typhoid vaccines. We conducted a systematic literature review of longitudinal population-based blood culture-confirmed typhoid fever studies from low and middle income countries published from 1(st) January 1990 to 31(st) December 2013. We quantitatively summarized typhoid fever incidence rates and qualitatively reviewed study methodology that could have influenced rate estimates. We used meta-analysis approach based on random effects model in summarizing the hospitalization rates. Twenty-two papers presented longitudinal population-based and blood culture-confirmed typhoid fever incidence estimates from 20 distinct sites in low and middle income countries. The reported incidence and hospitalizations rates were heterogeneous as well as the study methodology across the sites. We elucidated how the incidence rates were underestimated in published studies. We summarized six categories of under-estimation biases observed in these studies and presented potential solutions. Published longitudinal typhoid fever studies in low and middle income countries are geographically clustered and the methodology employed has a potential for underestimation. Future studies should account for these limitations.

  4. [Socioeconomic differences in physical activity in the middle-aged working population: The role of education, occupation, and income].

    PubMed

    Hoebel, Jens; Finger, Jonas D; Kuntz, Benjamin; Lampert, Thomas

    2016-02-01

    Regular physical activity has positive effects on health at all ages. This study aims to investigate how far physical activity and regular sports engagement, as a more specific type of physical activity, are associated with socioeconomic factors in the middle-aged working population. Data were obtained from 21,699 working men and women aged between 30 and 64 years who participated in the 2009 and 2010 population-based national German Health Update (GEDA) surveys conducted by the Robert Koch Institute. Besides a multi-dimensional index of socioeconomic status (SES), three single dimensions of SES (education, occupation, and income) were used to analyse socioeconomic differences in total physical activity and regular sports engagement. While the prevalence of total physical activity increased with lower SES, the proportion of people with regular sports engagement decreased with lower SES. These associations remained after adjusting for age in men and women. After mutual adjustment of the three single socioeconomic dimensions, physical activity was independently associated with lower education and lower occupational status. Regular sports engagement was observed to be independently associated with higher education, higher occupational status, as well as higher income after mutual adjustment. This study demonstrates significant socioeconomic differences in physical and sports activity in the middle-aged working population. Education, occupation, and income show varying independent associations with physical activity behaviour. Such differences need to be considered when identifying target groups for health-enhancing physical activity interventions.

  5. Interventions for Children with Pervasive Developmental Disorders in Low and Middle Income Countries

    ERIC Educational Resources Information Center

    Hastings, Richard P.; Robertson, Janet; Yasamy, M. T.

    2012-01-01

    Background: Although interventions for children with pervasive developmental disorders (PDD) have been the focus of research effort and evidence reviews in many Western countries, this evidence has not been assessed in the context of low- and middle-income (LAMI) countries especially in terms of the fit with different cultures and resources.…

  6. Substance Use During Imprisonment in Low- and Middle-Income Countries

    PubMed Central

    Mundt, Adrian P; Baranyi, Gergő; Gabrysch, Caroline; Fazel, Seena

    2018-01-01

    Abstract Substance use disorders are among the most common health problems of people involved with the criminal justice system. Scaling up addiction services in prisons is a global public health and human rights challenge, especially in poorly resourced countries. We systematically reviewed the prevalence of substance use in prison populations in low- and middle-income countries. We searched for studies reporting prevalence rates of nicotine, alcohol, illicit drug, and injection drug use during imprisonment in unselected samples of imprisoned people in low- and middle-income countries. Data meta-analysis was conducted and sources of heterogeneity were examined by meta-regression. Prevalence of nicotine use during imprisonment ranged from 5% to 87%, with a random-effects pooled estimate of 56% (95% confidence interval (CI): 45, 66) with significant geographical heterogeneity. Alcohol use varied from 1% to 76% (pooled prevalence, 16%, 95% CI: 9, 25). Approximately one-quarter of people (25%; 95% CI: 17, 33; range, 0–78) used illicit drugs during imprisonment. The prevalence of injection drug use varied from 0% to 26% (pooled estimate, 1.6%, 95% CI: 0.8, 3.0). Lifetime substance use was investigated in secondary analyses. The high prevalence of smoking in prison suggests that policies regarding smoking need careful review. Furthermore, the findings underscore the importance of timely, scalable, and available treatments for alcohol and illegal drug use by people involved with the criminal justice system. PMID:29584860

  7. The health, poverty, and financial consequences of a cigarette price increase among 500 million male smokers in 13 middle income countries: compartmental model study

    PubMed Central

    2018-01-01

    Abstract Objective To examine the impact of a 50% increase in market prices of cigarettes on health, poverty, and financial protection. Design Compartmental model study. Setting 13 middle income countries, totalling two billion men. Participants 500 million male smokers. Main outcome measures Life years gained, averted treatment costs, number of men avoiding catastrophic healthcare expenditures and poverty, and additional tax revenue by income group. Results A 50% increase in cigarette prices would lead to about 450 million years of life gained across the 13 countries from smoking cessation, with half of these in China. Across all countries, men in the bottom income group (poorest 20% of the population) would gain 6.7 times more life years than men in the top income group (richest 20% of the population; 155 v 23 million). The average life years gained from cessation for each smoker in the bottom income group was 5.1 times that of the top group (1.46 v 0.23 years). Of the $157bn (£113bn; €127bn) in averted treatment costs, the bottom income group would avert 4.6 times more costs than the top income group ($46bn v $10bn). About 15.5 million men would avoid catastrophic health expenditures in a subset of seven countries without universal health coverage. As result, 8.8 million men, half of them in the bottom income group, would avoid falling below the World Bank definition of extreme poverty. These 8.8 million men constitute 2.4% of people living in extreme poverty in these countries. In contrast, the top income group would pay twice as much as the bottom income group of the $122bn additional tax collected. Overall, the bottom income group would get 31% of the life years saved and 29% each of the averted disease costs and averted catastrophic health expenditures, while paying only 10% of the additional taxes. Conclusions Higher prices of cigarettes provide more health and financial gains to the poorest 20% than to the richest 20% of the population. Higher excise

  8. Carbon Dioxide Emission Peak and Green Innovation-Driven — Research of Escaping Middle Income Trap for China

    NASA Astrophysics Data System (ADS)

    Liu, Jianya; Sun, Zhenqing; Lan, Zirui; Kou, Chunxiao

    2018-06-01

    This study explains and demonstrates whether China has the capability to avoid the Middle Income Trap. The 19th National Congress of CPC report points out: by 2035, China will become an international leader in innovation. At present, China is in the juncture of changing the mode of development, optimizing the economic structure and transforming the growth momentum. The juncture means that it is possible to be stagnation or retrogression of national economy as the national ability of innovation is insufficient, then sticking in the middle-income trap (MIC) for a long time. In this paper, we used the TFP to prove that the input-output ratio of different regions of China, with the per capita GDP and carbon emissions are fitting again, dividing China into optimized zones and non-optimized zones. It can be seen from the results that the optimized zones have achieved the peak of carbon emission and had relative advantages in green innovation. However, if China wants to achieve her overall carbon emissions and get out of the middle income trap, she must optimize the development zones to spillover technologies and talents.

  9. Indexation of psychiatric journals from low- and middle-income countries: a survey and a case study

    PubMed Central

    KIELING, CHRISTIAN; HERRMAN, HELEN; PATEL, VIKRAM; MARI, JAIR DE JESUS

    2009-01-01

    There is a marked underepresentation of low- and middle-income countries (LAMIC) in the psychiatric literature, which may reflect an overall low representation of LAMIC publications in databases of indexed journals. This paper investigates the worldwide distribution of indexed psychiatric journals. A survey in both Medline and ISI Web of Science was performed in order to identify journals in the field of psychiatry according to their country of origin. Two hundred and twenty-two indexed psychiatric journals were found. Of these, 213 originated from high-income countries and only nine (4.1%) from middle-income countries. None were found in low-income countries. We also present the experience of a LAMIC psychiatric journal, the Revista Brasileira de Psiquiatria, in its recent indexation process. This case study may serve as an example for other LAMIC journals to pursue indexation in major databases as a strategy to widen the international foundation of psychiatric research. There is an important need for the inclusion of LAMIC psychiatric publications in the major indexation databases. This process will require multiple agents to partner with journals from LAMIC to improve their quality and strengthen their chances of being indexed. PMID:19293959

  10. Evaluation of research on interventions aligned to WHO 'Best Buys' for NCDs in low-income and lower-middle-income countries: a systematic review from 1990 to 2015.

    PubMed

    Allen, Luke N; Pullar, Jessica; Wickramasinghe, Kremlin Khamarj; Williams, Julianne; Roberts, Nia; Mikkelsen, Bente; Varghese, Cherian; Townsend, Nick

    2018-01-01

    Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide, with low-income and middle-income countries experiencing a disproportionately high burden. Since 2010 WHO has promoted 24 highly cost-effective interventions for NCDs, dubbed 'best buys'. It is unclear whether these interventions have been evaluated in low-income and lower-middle-income countries (LLMICs). To systematically review research on interventions aligned to WHO 'best buys' for NCDs in LLMICs. We searched 13 major databases and included papers conducted in the 83 World Bank-defined LLMICs, published between 1 January 1990 and 5 February 2015. Two reviewers independently screened papers and assessed risk of bias. We adopted a narrative approach to data synthesis. The primary outcomes were NCD-related mortality and morbidity, and risk factor prevalence. We identified 2672 records, of which 36 were included (608 940 participants). No studies on 'best buys' were found in 89% of LLMICs. Nineteen of the 36 studies reported on the effectiveness of tobacco-related 'best buys', presenting good evidence for group interventions in reducing tobacco use but weaker evidence for interventions targeting individuals. There were fewer studies on smoking bans, warning labels and mass media campaigns, and no studies on taxes or marketing restrictions. There was supportive evidence that cervical screening and hepatitis B immunisation prevent cancer in LLMICs. A single randomised controlled trial supported polypharmacy for cardiovascular disease. Fourteen of the 'best buy' interventions did not have any good evidence for effectiveness in LLMICs. We found studies on only 11 of the 24 interventions aligned with the WHO 'best buys' from LLMIC settings. Most LLMICs have not conducted research on these interventions in their populations. LLMICs should take action to implement and evaluate 'best buys' in their national context, based on national priorities, and starting with interventions with

  11. Off-premise alcohol purchasing in Australia: Variations by age group, income level and annual amount purchased.

    PubMed

    Jiang, Heng; Callinan, Sarah; Livingston, Michael; Room, Robin

    2017-03-01

    To delineate what type and how much alcohol is purchased from different types of off-licence premises and how this varies across demographic sub-groups, as a basis for public debate and decisions on pricing and planning policies to reduce alcohol-related harm in Australia. The data on alcohol purchasing from off-licence premises are taken from the Australian Alcohol Consumption and Purchasing survey-a nationally representative landline and mobile telephone survey in 2013 on the experiences with alcohol consumption and purchasing of 2020 Australians aged 16+. The present analysis uses data from 1730 respondents who purchased alcohol from off-licence premises in the previous 6 months. The majority (54%) of alcohol purchased from off-licence premises was sold from liquor barns (large warehouse-style alcohol stores), with bottle shops (31%) the second most common outlet. Cask wine was the cheapest alcohol available at off-licence premises in Australia. Respondents in higher alcohol purchasing quintiles and with those with lower income purchased a higher percentage of cheaper alcohol in their total volume of purchasing than lower purchasing quintiles and those with middle and higher income, and younger respondents purchased more expensive alcohol than older age groups. A minimum unit price or increasing alcohol taxes may effectively reduce alcohol purchasing for lower income heavy alcohol purchasers and older age groups from off-licence premise sources, and may be less effective on younger age groups. [Jiang H, Callinan S, Livingston M, Room R. Off-premise alcohol purchasing in Australia: Variations by age group, income level and annual amount purchased. Drug Alcohol Rev 2017;36:210-219]. © 2016 Australasian Professional Society on Alcohol and other Drugs.

  12. Interventions to close the divide for women with breast and cervical cancer between low-income and middle-income countries and high-income countries.

    PubMed

    Denny, Lynette; de Sanjose, Silvia; Mutebi, Miriam; Anderson, Benjamin O; Kim, Jane; Jeronimo, Jose; Herrero, Rolando; Yeates, Karen; Ginsburg, Ophira; Sankaranarayanan, Rengaswamy

    2017-02-25

    Breast and cervical cancers are the commonest cancers diagnosed in women living in low-income and middle-income countries (LMICs), where opportunities for prevention, early detection, or both, are few. Yet several cost-effective interventions could be used to reduce the burden of these two cancers in resource-limited environments. Population- wide vaccination against human papillomavirus (HPV) linked to cervical screening, at least once, for adult women has the potential to reduce the incidence of cervical cancer substantially. Strategies such as visual inspection with acetic acid and testing for oncogenic HPV types could make prevention of cervical cancer programmatically feasible. These two cancers need not be viewed as inevitably fatal, and can be cured, particularly if detected and treated at an early stage. Investing in the health of girls and women is an investment in the development of nations and their futures. Here we explore ways to lessen the divide between LMICs and high-income countries for breast and cervical cancers. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Essential medicines for breast cancer in low and middle income countries.

    PubMed

    Bazargani, Y T; de Boer, A; Schellens, J H M; Leufkens, H G M; Mantel-Teeuwisse, Aukje K

    2015-08-18

    Breast cancer is the most common type of cancer among women worldwide. In low and middle-income countries (LMICs), appropriate selection of medicines on national essential medicines lists (NEMLs) is a first step towards adequate access to treatment. We studied selection of systemic treatments for breast cancer on NEMLs and assessed its alignment with treatment guidelines for different types of early and advanced breast cancer. Furthermore, influence of country characteristics on the selection was investigated. NEMLs from 75 LMICs were studied for inclusion of all components of therapy in each stage of breast cancer according to international consensus guidelines. The results were then grouped by income level, WHO region and the NEMLs' release date. Non parametric tests were used for statistical analysis. Unlike HER2-targeted therapies (<10%), aromatase inhibitors (12%) and taxanes (28%); tamoxifen and first generation chemotherapeutic regimens (e.g., anthracycline-based regimens) were frequently found in the NEMLs (71-78%). Consequently, all components of treatment for "Luminal A" early breast cancer and non HER2 overexpressed advanced breast cancer were found on the NEMLs of over 70% of countries. However, 40% of the low income countries did not have all the components of therapy for any type of early breast cancer in their NEMLs, and adequate treatment of HER2 overexpressed breast cancer was hardly possible with the current selections. Recent NEMLs were more aligned with the guidelines (p < 0.05). Eastern Mediterranean and African regions less frequently incorporated all components of breast cancer treatment in their NEMLs. Alignment of selection with guidelines' recommendations was inconsistent for different types of early and advanced breast cancer in NEMLs. Regular updates and more attention to clinical guidelines is therefore recommended.

  14. Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here?

    PubMed

    Piette, John D; Lun, K C; Moura, Lincoln A; Fraser, Hamish S F; Mechael, Patricia N; Powell, John; Khoja, Shariq R

    2012-05-01

    E-health encompasses a diverse set of informatics tools that have been designed to improve public health and health care. Little information is available on the impacts of e-health programmes, particularly in low- and middle-income countries. We therefore conducted a scoping review of the published and non-published literature to identify data on the effects of e-health on health outcomes and costs. The emphasis was on the identification of unanswered questions for future research, particularly on topics relevant to low- and middle-income countries. Although e-health tools supporting clinical practice have growing penetration globally, there is more evidence of benefits for tools that support clinical decisions and laboratory information systems than for those that support picture archiving and communication systems. Community information systems for disease surveillance have been implemented successfully in several low- and middle-income countries. Although information on outcomes is generally lacking, a large project in Brazil has documented notable impacts on health-system efficiency. Meta-analyses and rigorous trials have documented the benefits of text messaging for improving outcomes such as patients' self-care. Automated telephone monitoring and self-care support calls have been shown to improve some outcomes of chronic disease management, such as glycaemia and blood pressure control, in low- and middle-income countries. Although large programmes for e-health implementation and research are being conducted in many low- and middle-income countries, more information on the impacts of e-health on outcomes and costs in these settings is still needed.

  15. Impacts of e-health on the outcomes of care in low- and middle-income countries: where do we go from here?

    PubMed Central

    Lun, KC; Moura, Lincoln A; Fraser, Hamish SF; Mechael, Patricia N; Powell, John; Khoja, Shariq R

    2012-01-01

    Abstract E-health encompasses a diverse set of informatics tools that have been designed to improve public health and health care. Little information is available on the impacts of e-health programmes, particularly in low- and middle-income countries. We therefore conducted a scoping review of the published and non-published literature to identify data on the effects of e-health on health outcomes and costs. The emphasis was on the identification of unanswered questions for future research, particularly on topics relevant to low- and middle-income countries. Although e-health tools supporting clinical practice have growing penetration globally, there is more evidence of benefits for tools that support clinical decisions and laboratory information systems than for those that support picture archiving and communication systems. Community information systems for disease surveillance have been implemented successfully in several low- and middle-income countries. Although information on outcomes is generally lacking, a large project in Brazil has documented notable impacts on health-system efficiency. Meta-analyses and rigorous trials have documented the benefits of text messaging for improving outcomes such as patients’ self-care. Automated telephone monitoring and self-care support calls have been shown to improve some outcomes of chronic disease management, such as glycaemia and blood pressure control, in low- and middle-income countries. Although large programmes for e-health implementation and research are being conducted in many low- and middle-income countries, more information on the impacts of e-health on outcomes and costs in these settings is still needed. PMID:22589570

  16. Acute coronary syndromes in low- and middle-income countries: Moving forward.

    PubMed

    Seligman, Benjamin; Vedanthan, Rajesh; Fuster, Valentin

    2016-08-01

    Cardiovascular disease remains the leading cause of death worldwide, particularly in low- and middle-income countries (LMICs), with substantial mortality from acute coronary syndromes. These deaths, when compared against high-income countries, occur at younger ages, and, beyond the lives lost, often result in economic privation for families deprived of a breadwinner and indebted by the oftentimes catastrophic cost of inpatient medical care. This burden will likely grow in scale in the years ahead as more countries pass through the epidemiologic transition. Billions around the world are beginning to experience the comforts that even modestly increased incomes can provide, including diets high in fats and sugars, more sedentary lifestyles, and tobacco and alcohol use and abuse. Health care systems in many of these countries are ill-equipped to prevent the harms caused by these lifestyles, as well as treat the acute coronary syndromes that result from them-including insufficient access to appropriate facilities and medications, difficulties with transport, and low awareness of the symptoms and need for emergent evaluation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Reflections on the development of health economics in low- and middle-income countries.

    PubMed

    Mills, Anne

    2014-08-22

    Health economics is a relatively new discipline, though its antecedents can be traced back to William Petty FRS (1623-1687). In high-income countries, the academic discipline and scientific literature have grown rapidly since the 1960s. In low- and middle-income countries, the growth of health economics has been strongly influenced by trends in health policy, especially among the international and bilateral agencies involved in supporting health sector development. Valuable and influential research has been done in areas such as cost-benefit and cost-effectiveness analysis, financing of healthcare, healthcare provision, and health systems analysis, but there has been insufficient questioning of the relevance of theories and policy recommendations in the rich world literature to the circumstances of poorer countries. Characteristics such as a country's economic structure, strength of political and social institutions, management capacity, and dependence on external agencies, mean that theories and models cannot necessarily be transferred between settings. Recent innovations in the health economics literature on low- and middle-income countries indicate how health economics can be shaped to provide more relevant advice for policy. For this to be taken further, it is critical that such countries develop stronger capacity for health economics within their universities and research institutes, with greater local commitment of funding. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

  18. The prevalence and determinants of catastrophic health expenditures attributable to non-communicable diseases in low- and middle-income countries: a methodological commentary.

    PubMed

    Goryakin, Yevgeniy; Suhrcke, Marc

    2014-11-07

    Non-communicable diseases (NCDs), while traditionally considered a "rich world"-problem, have been spreading fast in low and middle income countries and by now account for a large share of mortality and ill-health in these countries, too. In addition to the disease burden, NCDs may also impose a substantial economic cost. One way in which NCDs might impact people's economic well-being may be via the out-of-pocket expenditures required to cover treatment and other costs associated with suffering from an NCD. In this commentary, we identify and discuss the methodological challenges related to cross-country comparison of-out-of-pocket and catastrophic out-of-pocket health care expenditures, attributable to NCDs, focussing on low and middle income countries. There is significant evidence of substantial cost burden placed by NCDs on patients living in low and middle income countries, with most of it being heavily concentrated among low socioeconomic status groups. However, a large variation in definition of COOPE between studies prevents cross-country comparison. In addition, as most studies tend to be observational, causal inferences are often not possible. This is further complicated by the cross-sectional nature of studies, small sample sizes, and/or limited duration of follow-up of patients. Most evidence for certain conditions (e.g., cancer) tends to be collected in high-income countries only. The definitions for COOPEs should be standardized as much as possible, to enable comparison of COOPE prevalence between countries. Prospective study design using larger samples representative of broader sections of local population, collecting better data on both direct and indirect treatment costs is also needed.

  19. Feeding Practices of Mothers from Varied Income and Racial/Ethnic Groups

    ERIC Educational Resources Information Center

    Worobey, John; Borrelli, Amanda; Espinosa, Carolina; Worobey, Harriet S.

    2013-01-01

    Objective: Relatively few investigators have explored the role of maternal control in describing the feeding behaviour of nonwhite parents of preschool-age children. The present study was conducted to examine if controlling feeding behaviours (i.e. restriction and pressuring) varied by income (middle vs. low) and race/ethnicity (white vs.…

  20. Gender bias in under-five mortality in low/middle-income countries.

    PubMed

    Costa, Janaína Calu; da Silva, Inacio Crochemore Mohnsam; Victora, Cesar Gomes

    2017-01-01

    Due to biological reasons, boys are more likely to die than girls. The detection of gender bias requires knowing the expected relation between male and female mortality rates at different levels of overall mortality, in the absence of discrimination. Our objective was to compare two approaches aimed at assessing excess female under-five mortality rate (U5MR) in low/middle-income countries. We compared the two approaches using data from 60 Demographic and Health Surveys (2005-2014). The prescriptive approach compares observed mortality rates with historical patterns in Western societies where gender discrimination was assumed to be low or absent. The descriptive approach is derived from global estimates of all countries with available data, including those affected by gender bias. The prescriptive approach showed significant excess female U5MR in 20 countries, compared with only one country according to the descriptive approach. Nevertheless, both models showed similar country rankings. The 13 countries with the highest and the 10 countries with the lowest rankings were the same according to both approaches. Differences in excess female mortality among world regions were significant, but not among country income groups. Both methods are useful for monitoring time trends, detecting gender-based inequalities and identifying and addressing its causes. The prescriptive approach seems to be more sensitive in the identification of gender bias, but needs to be updated using data from populations with current-day structures of causes of death.

  1. Socioeconomic status and COPD among low- and middle-income countries.

    PubMed

    Grigsby, Matthew; Siddharthan, Trishul; Chowdhury, Muhammad Ah; Siddiquee, Ali; Rubinstein, Adolfo; Sobrino, Edgardo; Miranda, J Jaime; Bernabe-Ortiz, Antonio; Alam, Dewan; Checkley, William

    2016-01-01

    Socioeconomic status (SES) is a strong social determinant of health. There remains a limited understanding of the association between SES and COPD prevalence among low- and middle-income countries where the majority of COPD-related morbidity and mortality occurs. We examined the association between SES and COPD prevalence using data collected in Argentina, Bangladesh, Chile, Peru, and Uruguay. We compiled lung function, demographic, and SES data from three population-based studies for 11,042 participants aged 35-95 years. We used multivariable alternating logistic regressions to study the association between COPD prevalence and SES indicators adjusted for age, sex, self-reported daily smoking, and biomass fuel smoke exposure. Principal component analysis was performed on monthly household income, household size, and education to create a composite SES index. Overall COPD prevalence was 9.2%, ranging from 1.7% to 15.4% across sites. The adjusted odds ratio of having COPD was lower for people who completed secondary school (odds ratio [OR] =0.73, 95% CI 0.55-0.98) and lower with higher monthly household income (OR =0.96 per category, 95% CI 0.93-0.99). When combining SES factors into a composite index, we found that the odds of having COPD was greater with lower SES (interquartile OR =1.23, 95% CI 1.05-1.43) even after controlling for subject-specific factors and environmental exposures. In this analysis of multiple population-based studies, lower education, lower household income, and lower composite SES index were associated with COPD. Since household income may be underestimated in population studies, adding household size and education into a composite index may provide a better surrogate for SES.

  2. Resource requirements for cancer registration in areas with limited resources: Analysis of cost data from four low- and middle-income countries☆

    PubMed Central

    Tangka, Florence K.L.; Subramanian, Sujha; Edwards, Patrick; Cole-Beebe, Maggie; Parkin, D. Maxwell; Bray, Freddie; Joseph, Rachael; Mery, Les; Saraiya, Mona

    2018-01-01

    Background The key aims of this study were to identify sources of support for cancer registry activities, to quantify resource use and estimate costs to operate registries in low- and middle-income countries (LMIC) at different stages of development across three continents. Methods Using the Centers for Disease Control and Prevention’s (CDC’s) International Registry Costing Tool (IntRegCosting Tool), cost and resource use data were collected from eight population-based cancer registries, including one in a low-income country (Uganda [Kampala)]), two in lower to middle-income countries (Kenya [Nairobi] and India [Mumbai]), and five in an upper to middle-income country (Colombia [Pasto, Barranquilla, Bucaramanga, Manizales and Cali cancer registries]). Results Host institution contributions accounted for 30%–70% of total investment in cancer registry activities. Cancer registration involves substantial fixed cost and labor. Labor accounts for more than 50% of all expenditures across all registries. The cost per cancer case registered in low-income and lower-middle-income countries ranged from US $3.77 to US $15.62 (United States dollars). In Colombia, an upper to middle-income country, the cost per case registered ranged from US $41.28 to US $113.39. Registries serving large populations (over 15 million inhabitants) had a lower cost per inhabitant (less than US $0.01 in Mumbai, India) than registries serving small populations (under 500,000 inhabitants) [US $0.22] in Pasto, Colombia. Conclusion This study estimates the total cost and resources used for cancer registration across several countries in the limited-resource setting, and provides cancer registration stakeholders and registries-with opportunities to identify cost savings and efficiency improvements. Our results suggest that cancer registration involve substantial fixed costs and labor, and that partnership with other institutions is critical for the operation and sustainability of cancer registries

  3. Resource requirements for cancer registration in areas with limited resources: Analysis of cost data from four low- and middle-income countries.

    PubMed

    Tangka, Florence K L; Subramanian, Sujha; Edwards, Patrick; Cole-Beebe, Maggie; Parkin, D Maxwell; Bray, Freddie; Joseph, Rachael; Mery, Les; Saraiya, Mona

    2016-12-01

    The key aims of this study were to identify sources of support for cancer registry activities, to quantify resource use and estimate costs to operate registries in low- and middle-income countries (LMIC) at different stages of development across three continents. Using the Centers for Disease Control and Prevention's (CDC's) International Registry Costing Tool (IntRegCosting Tool), cost and resource use data were collected from eight population-based cancer registries, including one in a low-income country (Uganda [Kampala)]), two in lower to middle-income countries (Kenya [Nairobi] and India [Mumbai]), and five in an upper to middle-income country (Colombia [Pasto, Barranquilla, Bucaramanga, Manizales and Cali cancer registries]). Host institution contributions accounted for 30%-70% of total investment in cancer registry activities. Cancer registration involves substantial fixed cost and labor. Labor accounts for more than 50% of all expenditures across all registries. The cost per cancer case registered in low-income and lower-middle-income countries ranged from US $3.77 to US $15.62 (United States dollars). In Colombia, an upper to middle-income country, the cost per case registered ranged from US $41.28 to US $113.39. Registries serving large populations (over 15 million inhabitants) had a lower cost per inhabitant (less than US $0.01 in Mumbai, India) than registries serving small populations (under 500,000 inhabitants) [US $0.22] in Pasto, Colombia. This study estimates the total cost and resources used for cancer registration across several countries in the limited-resource setting, and provides cancer registration stakeholders and registries with opportunities to identify cost savings and efficiency improvements. Our results suggest that cancer registration involve substantial fixed costs and labor, and that partnership with other institutions is critical for the operation and sustainability of cancer registries in limited resource settings. Although we

  4. Impact and cost-effectiveness of new tuberculosis vaccines in low- and middle-income countries

    PubMed Central

    Knight, Gwenan M.; Griffiths, Ulla K.; Sumner, Tom; Laurence, Yoko V.; Gheorghe, Adrian; Vassall, Anna; Glaziou, Philippe; White, Richard G.

    2014-01-01

    To help reach the target of tuberculosis (TB) disease elimination by 2050, vaccine development needs to occur now. We estimated the impact and cost-effectiveness of potential TB vaccines in low- and middle-income countries using an age-structured transmission model. New vaccines were assumed to be available in 2024, to prevent active TB in all individuals, to have a 5-y to lifetime duration of protection, to have 40–80% efficacy, and to be targeted at “infants” or “adolescents/adults.” Vaccine prices were tiered by income group (US $1.50–$10 per dose), and cost-effectiveness was assessed using incremental cost per disability adjusted life year (DALY) averted compared against gross national income per capita. Our results suggest that over 2024–2050, a vaccine targeted to adolescents/adults could have a greater impact than one targeted at infants. In low-income countries, a vaccine with a 10-y duration and 60% efficacy targeted at adolescents/adults could prevent 17 (95% range: 11–24) million TB cases by 2050 and could be considered cost-effective at $149 (cost saving to $387) per DALY averted. If targeted at infants, 0.89 (0.42–1.58) million TB cases could be prevented at $1,692 ($634–$4,603) per DALY averted. This profile targeted at adolescents/adults could be cost-effective at $4, $9, and $20 per dose in low-, lower-middle–, and upper-middle–income countries, respectively. Increased investments in adult-targeted TB vaccines may be warranted, even if only short duration and low efficacy vaccines are likely to be feasible, and trials among adults should be powered to detect low efficacies. PMID:25288770

  5. Interventions to improve adherence to treatment for paediatric tuberculosis in low- and middle-income countries: a systematic review and meta-analysis

    PubMed Central

    Weaver, Meaghann S; Lönnroth, Knut; Howard, Scott C; Roter, Debra L

    2015-01-01

    Abstract Objective To assess the design, delivery and outcomes of interventions to improve adherence to treatment for paediatric tuberculosis in low- and middle-income countries and develop a contextual framework for such interventions. Methods We searched PubMed and Cochrane databases for reports published between 1 January 2003 and 1 December 2013 on interventions to improve adherence to treatment for tuberculosis that included patients younger than 20 years who lived in a low- or middle-income country. For potentially relevant articles that lacked paediatric outcomes, we contacted the authors of the studies. We assessed heterogeneity and risk of bias. To evaluate treatment success – i.e. the combination of treatment completion and cure – we performed random-effects meta-analysis. We identified areas of need for improved intervention practices. Findings We included 15 studies in 11 countries for the qualitative analysis and of these studies, 11 qualified for the meta-analysis – representing 1279 children. Of the interventions described in the 15 studies, two focused on education, one on psychosocial support, seven on care delivery, four on health systems and one on financial provisions. The children in intervention arms had higher rates of treatment success, compared with those in control groups (odds ratio: 3.02; 95% confidence interval: 2.19–4.15). Using the results of our analyses, we developed a framework around factors that promoted or threatened treatment completion. Conclusion Various interventions to improve adherence to treatment for paediatric tuberculosis appear both feasible and effective in low- and middle-income countries. PMID:26600612

  6. Prevention and management of chronic disease: a litmus test for health-systems strengthening in low-income and middle-income countries.

    PubMed

    Samb, Badara; Desai, Nina; Nishtar, Sania; Mendis, Shanti; Bekedam, Henk; Wright, Anna; Hsu, Justine; Martiniuk, Alexandra; Celletti, Francesca; Patel, Kiran; Adshead, Fiona; McKee, Martin; Evans, Tim; Alwan, Ala; Etienne, Carissa

    2010-11-20

    National health systems need strengthening if they are to meet the growing challenge of chronic diseases in low-income and middle-income countries. By application of an accepted health-systems framework to the evidence, we report that the factors that limit countries' capacity to implement proven strategies for chronic diseases relate to the way in which health systems are designed and function. Substantial constraints are apparent across each of the six key health-systems components of health financing, governance, health workforce, health information, medical products and technologies, and health-service delivery. These constraints have become more evident as development partners have accelerated efforts to respond to HIV, tuberculosis, malaria, and vaccine-preventable diseases. A new global agenda for health-systems strengthening is arising from the urgent need to scale up and sustain these priority interventions. Most chronic diseases are neglected in this dialogue about health systems, despite the fact that non-communicable diseases (most of which are chronic) will account for 69% of all global deaths by 2030 with 80% of these deaths in low-income and middle-income countries. At the same time, advocates for action against chronic diseases are not paying enough attention to health systems as part of an effective response. Efforts to scale up interventions for management of common chronic diseases in these countries tend to focus on one disease and its causes, and are often fragmented and vertical. Evidence is emerging that chronic disease interventions could contribute to strengthening the capacity of health systems to deliver a comprehensive range of services-provided that such investments are planned to include these broad objectives. Because effective chronic disease programmes are highly dependent on well-functioning national health systems, chronic diseases should be a litmus test for health-systems strengthening. Copyright © 2010 Elsevier Ltd. All rights

  7. Attained educational level and incident atherothrombotic events in low- and middle-income compared with high-income countries.

    PubMed

    Goyal, Abhinav; Bhatt, Deepak L; Steg, P Gabriel; Gersh, Bernard J; Alberts, Mark J; Ohman, E Magnus; Corbalán, Ramón; Eagle, Kim A; Gaxiola, Efrain; Gao, Runlin; Goto, Shinya; D'Agostino, Ralph B; Califf, Robert M; Smith, Sidney C; Wilson, Peter W F

    2010-09-21

    Studies report a protective effect of higher attained educational level (AEL) on cardiovascular outcomes. However, most of these studies have been conducted in high-income countries (HICs) and lack representation from low- and middle-income countries (LMICs), which bear >80% of the global burden of cardiovascular disease. The Reduction of Atherothrombosis for Continued Health (REACH) Registry is a prospective study of 67 888 subjects with either established atherothrombotic (coronary, cerebrovascular, and/or peripheral arterial) disease or multiple atherothrombotic risk factors enrolled from 5587 physician practices in 44 countries. At baseline, AEL (0 to 8 years, 9 to 12 years, trade or technical school, and university) was self-reported for 61 332 subjects. Outcomes included the baseline prevalence of atherothrombotic risk factors and the rate of incident cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) through 23 months across AEL groups, stratified by sex and world region (LMICs or HICs). Educational attainment was inversely associated with age and diabetes mellitus and directly associated with hypercholesterolemia in all subjects. However, for other risk factors such as obesity, smoking, hypertension, and baseline burden of vascular disease, AEL was protective (inversely associated) in HICs but not protective in LMICs. The protective effect of greater AEL on incident cardiovascular events was strongest in men from HICs (P<0.0001), more modest in women from HICs (P=0.0026) and in men from LMICs (P=0.082), and essentially absent in women from LMICs (P=0.32). In contrast to HICs, higher AEL may not be protective against cardiovascular events in LMICs, particularly in women.

  8. Screening for Autism Spectrum Disorder in Low- and Middle-Income Countries: A Systematic Review

    ERIC Educational Resources Information Center

    Stewart, Lydia A.; Lee, Li-Ching

    2017-01-01

    This review contributes to the growing body of global autism spectrum disorder literature by examining the use of screening instruments in low- and middle-income countries with respect to study design and methodology, instrument adaptation and performance, and collaboration with community stakeholders in research. A systematic review was conducted…

  9. Considering long-term care insurance for middle-income countries: comparing South Korea with Japan and Germany.

    PubMed

    Rhee, Jong Chul; Done, Nicolae; Anderson, Gerard F

    2015-10-01

    Financing and provision of long-term care is an increasingly important concern for many middle-income countries experiencing rapid population aging. We examine three countries (South Korea, Japan, and Germany) that use social insurance to finance medical care and have developed long-term care insurance (LTCI) systems. These countries have adopted different approaches to LTCI design within the social insurance framework. We contrast their financing systems and draw lessons regarding revenue generation, benefits design, and eligibility. Based on this review, it seems important for middle-income countries to start developing LTCI schemes early, before aging becomes a significant problem and substantial revenues are needed. Early financing also ensures that the service delivery system has time to adapt because most middle-income countries lack the infrastructure for providing long-term care services. One approach is to start with a limited benefit package and strict eligibility rules and expanded the program as the country develops sufficient experience and more providers became available. All three countries use some form of cost-sharing to discourage service overuse, combined with subsidies for poor populations to maintain appropriate access. A major policy choice is between cash benefits or direct provision of services and the approach will have a large impact on the workforce participation of women. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  10. The effect of social franchising on access to and quality of health services in low- and middle-income countries.

    PubMed

    Koehlmoos, Tracey Perez; Gazi, Rukhsana; Hossain, S Shahed; Zaman, K

    2009-01-21

    Social franchising has developed as a possible means of improving provision of health services through engaging the non-state sector in low- and middle-income countries. To examine the evidence that social franchising has on access to and quality of health services in low- and middle-income countries. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (up to October 2007), Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 3), MEDLINE, Ovid (1950 to September Week 3 2007), EMBASE, Ovid (1980 to 2007 Week 38), CINAHL, Ovid (1982 to September Week 3 2007), EconLit, WebSPIRS (1969 to Sept 2007), LILACS, Science Citation Index Expanded and Social Sciences Citation Index (1975 to March 2008), Sociological Abstracts, CSA Illumnia (1952 September 2007), WHOLIS (1948 November 2007). Randomized controlled trials, non-randomized controlled trials, controlled before and after studies and interrupted time series comparing social franchising models with other models of health service delivery, other social franchising models or absence of health services. Two review authors independently applied the criteria for inclusion and exclusion of studies to scan titles and abstracts. The same two review authors independently screened full reports of selected citations . At each stage, results were compared and discrepancies settled through discussion. No studies were found which were eligible for inclusion in this review. There is a need to develop rigorous studies to evaluate the effects of social franchising on access to and quality of health services in low- and middle-income countries. Such studies should be informed by the wider literature to identify models of social franchising that have a sound theoretical basis and empirical research addressing their reach, acceptability, feasibility, maintenance and measurability.

  11. Challenges and barriers for implementation of the World Health Organization Global Disability Action Plan in low- and middle- income countries.

    PubMed

    Khan, Fary; Owolabi, Mayowa Ojo; Amatya, Bhasker; Hamzat, Talhatu Kolapo; Ogunniyi, Adesola; Oshinowo, Helen; Elmalik, Alaeldin; Galea, Mary P

    2018-04-18

    To identify potential barriers and facilitators for implementation of the World Health Organization Global Disability Action Plan (GDAP) in Nigeria and compare these with other low- and middle-income countries. A rehabilitation team from the Royal Melbourne Hospital, Parkville, Australia, conducted intensive workshops at medical/academic institutions in Nigeria for healthcare professionals from various local Physical Medicine and Rehabilitation facilities. A modified Delphi method identified challenges for person with disability, using 3 GDAP objectives. Findings were compared with similar exercises in Madagascar, Pakistan and Mongolia. Despite differences in the healthcare system and practice, the challenges reported in Nigeria were similar to those in other 3 low- and middle-income countries, at both macro (governmental/policymakers) and micro levels (community/social/individual). Common challenges identified were: limited knowledge of disability services, limited Physical Medicine and Rehabilitation workforce, guidelines and accreditation standards; coordination amongst healthcare sectors; social issues; data and research; legislation and political commitment. Common potential facilitators included: need for strong leadership; advocacy of disability-inclusive development; investment in infrastructure/human resources; coordination/partnerships in healthcare sector; and research. Disability care is an emerging priority in low- and middle-income countries to address the needs of people with disability. The challenges identified in Nigeria are common to most low- and middle-income countries. The GDAP framework can facilitate access and strengthen Physical Medicine and Rehabilitation services.

  12. The mental health workforce gap in low- and middle-income countries: a needs-based approach

    PubMed Central

    Scheffler, Richard M; Shen, Gordon; Yoon, Jangho; Chisholm, Dan; Morris, Jodi; Fulton, Brent D; Dal Poz, Mario R; Saxena, Shekhar

    2011-01-01

    Abstract Objective To estimate the shortage of mental health professionals in low- and middle-income countries (LMICs). Methods We used data from the World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS) from 58 LMICs, country-specific information on the burden of various mental disorders and a hypothetical core service delivery package to estimate how many psychiatrists, nurses and psychosocial care providers would be needed to provide mental health care to the total population of the countries studied. We focused on the following eight problems, to which WHO has attached priority: depression, schizophrenia, psychoses other than schizophrenia, suicide, epilepsy, dementia, disorders related to the use of alcohol and illicit drugs, and paediatric mental disorders. Findings All low-income countries and 59% of the middle-income countries in our sample were found to have far fewer professionals than they need to deliver a core set of mental health interventions. The 58 LMICs sampled would need to increase their total mental health workforce by 239 000 full-time equivalent professionals to address the current shortage. Conclusion Country-specific policies are needed to overcome the large shortage of mental health-care staff and services throughout LMICs. PMID:21379414

  13. Galvanizing mental health research in low- and middle- income countries: the role of scientific journals.

    PubMed

    2004-07-01

    The Department of Mental Health and Substance Abuse, World Health Organization, organized a meeting on Mental Health Research in Developing Countries: Role of Scientific Journals in Geneva on 20 and 21 November 2003 that was attended by twenty-five editors representing journals publishing mental health research. A number of other editors reviewed and contributed to the background and follow-up material. This statement is issued by all participants jointly (see Appendix B for the list of journals/organizations and their representatives). Research is needed to address the enormous unmet mental health needs of low- and middle-income (LAMI) countries. Scientific journals play an important role in production and dissemination of research. However, at present, only a minute proportion of research published in widely accessible mental health and psychiatric journals is from or about these countries. Yet over 85% of the world's population lives in the 153 countries categorized as low and middle income, according to World Bank criteria. Even more worrying is the observation that the gap between these and high-income countries may be widening in terms of their number of publications. The meeting was aimed at finding ways of resolving this unsatisfactory situation.

  14. Cardiovascular Diseases and Risk-Factor Burden in Urban and Rural Communities in High-, Middle-, and Low-Income Regions of China: A Large Community-Based Epidemiological Study.

    PubMed

    Yan, Ruohua; Li, Wei; Yin, Lu; Wang, Yang; Bo, Jian

    2017-02-06

    Most cardiovascular diseases occur in low- and middle-income regions of the world, but the socioeconomic distribution within China remains unclear. Our study aims to investigate whether the prevalence of cardiovascular diseases differs among high-, middle-, and low-income regions of China and to explore the reasons for the disparities. We enrolled 46 285 individuals from 115 urban and rural communities in 12 provinces across China between 2005 and 2009. We recorded their medical histories of cardiovascular diseases and calculated the INTERHEART Risk Score for the assessment of cardiovascular risk-factor burden, with higher scores indicating greater burden. The mean INTERHEART Risk Score was higher in high- and middle-income regions than in low-income regions (9.47, 9.48, and 8.58, respectively, P<0.0001). By contrast, the prevalence of total cardiovascular disease (stroke, ischemic heart disease, and other heart diseases that led to hospitalization) was lower in high- and middle-income regions than in low-income regions (7.46%, 7.42%, and 8.36%, respectively, P trend =0.0064). In high- and middle-income regions, urban communities have higher INTERHEART Risk Score and higher prevalent rate than rural communities. In low-income regions, however, the prevalence of total cardiovascular disease was similar between urban and rural areas despite the significantly higher INTERHEART Risk Score for urban settings. We detected an inverse trend between risk-factor burden and cardiovascular disease prevalence in urban and rural communities in high-, middle-, and low-income regions of China. Such asymmetry may be attributed to the interregional differences in residents' awareness, quality of healthcare, and availability and affordability of medical services. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  15. Childhood diarrhoeal deaths in seven low- and middle-income countries

    PubMed Central

    Rahman, Ahmed Ehsanur; Moinuddin, Md; Molla, Mitike; Worku, Alemayehu; Hurt, Lisa; Kirkwood, Betty; Mohan, Sanjana Brahmawar; Mazumder, Sarmila; Bhutta, Zulfiqar; Raza, Farrukh; Mrema, Sigilbert; Masanja, Honorati; Kadobera, Daniel; Waiswa, Peter; Bahl, Rajiv; Zangenberg, Mike

    2014-01-01

    Abstract Objective To investigate the clinical characteristics of children who died from diarrhoea in low- and middle-income countries, such as the duration of diarrhoea, comorbid conditions, care-seeking behaviour and oral rehydration therapy use. Methods The study included verbal autopsy data on children who died from diarrhoea between 2000 and 2012 at seven sites in Bangladesh, Ethiopia, Ghana, India, Pakistan, Uganda and the United Republic of Tanzania, respectively. Data came from demographic surveillance sites, randomized trials and an extended Demographic and Health Survey. The type of diarrhoea was classified as acute watery, acute bloody or persistent and risk factors were identified. Deaths in children aged 1 to 11 months and 1 to 4 years were analysed separately. Findings The proportion of childhood deaths due to diarrhoea varied considerably across the seven sites from less than 3% to 30%. Among children aged 1–4 years, acute watery diarrhoea accounted for 31–69% of diarrhoeal deaths, acute bloody diarrhoea for 12–28%, and persistent diarrhoea for 12–56%. Among infants aged 1–11 months, persistent diarrhoea accounted for over 30% of diarrhoeal deaths in Ethiopia, India, Pakistan, Uganda and the United Republic of Tanzania. At most sites, more than 40% of children who died from persistent diarrhoea were malnourished. Conclusion Persistent diarrhoea remains an important cause of diarrhoeal death in young children in low- and middle-income countries. Research is needed on the public health burden of persistent diarrhoea and current treatment practices to understand why children are still dying from the condition. PMID:25378757

  16. Dietary health behaviour and beliefs among university students from 26 low, middle and high income countries.

    PubMed

    Pengpid, Supa; Peltzer, Karl

    2015-01-01

    The aim of this study was to assess the prevalence of six healthy dietary behaviours and associated factors in university students from 26 low, middle and high income countries. In a cross-sectional survey, we used a self-administered questionnaire (largely based on the European Health and Behaviour Survey) among 19503 undergraduate university students (mean age 20.8, Standard deviation=2.8, age range of 16-30 years) from 27 universities in 26 countries. Results indicated that for a total of six healthy dietary behaviours, overall, students scored a mean of 2.8 healthy dietary behaviours. More female than male students indicated healthy dietary behaviours. In multivariate linear regression among men and women, living in an upper middle income or high income country, dieting to lose weight, the high importance of dietary health benefits, high non-organized religious activity, high physical activity and currently a non-tobacco user were associated with the healthy dietary behaviour index. The study found a high prevalence of relatively poor dietary healthy behaviours.

  17. The Decline of the Guru: "The Academic Profession in Developing and Middle-Income Countries."

    ERIC Educational Resources Information Center

    Altbach, Philip G., Ed.

    Contributions to this collection shed light on the dramatic changes in the academic profession in developing and middle-income countries. The chapters are: (1) "Centers and Peripheries in the Academic Profession: The Special Challenges of Developing Countries" (Philip G. Altbach); (2) "Big City Love: The Academic Workplace in Mexico" (Manuel…

  18. Early adolescent childbearing in low- and middle-income countries: associations with income inequity, human development and gender equality.

    PubMed

    Decker, Michele R; Kalamar, Amanda; Tunçalp, Özge; Hindin, Michelle J

    2017-03-01

    Reducing unwanted adolescent childbearing is a global priority. Little is known about how national-level economic and human development indicators relate to early adolescent childbearing. This ecological study evaluates associations of Gross Domestic Product (GDP), GINI index, Human Development Index (HDI) and Gender-related Development Index (GDI; i.e. the HDI adjusted for gender disparities) with early adolescent childbearing in 27 low- and middle-income countries (LMICs) across three time periods. Among women ages 18–24, prevalence estimates for early birth (<16 years) were calculated by nation, and weighted linear regressions evaluated associations between national indicators and early childbearing. To examine temporal trends, analyses were stratified by year groupings. Early adolescent childbearing declined over time, with the greatest change observed in Bangladesh (31.49% in 1996/7 to 19.69% in 2011). In adjusted models, GDI was negatively associated with early childbearing, i.e. early childbearing prevalence decreased as GDI increased. In the most recent time period, relative to the lowest GDI group, the average prevalence of early childbearing was significantly lower in the middle (-12.40, P < 0.00) and upper (-10.96, P = 0.03) tertiles after adjustment for the other indicators. These other indicators showed no consistent association with early childbearing. As national-level GDI increased, early adolescent childbearing declined. The GDI, which reflects human development adjusted for gender disparities in educational and economic prospects, was more consistently related to early adolescent childbearing than the absolute development prospects as given by the HDI. While creating gender equality is an important goal in and of itself, the findings emphasize the potential for improved national-level gender equitable development as a means to improve adolescents’ sexual and reproductive health.

  19. Global educational disparities in the associations between body mass index and diabetes mellitus in 49 low-income and middle-income countries.

    PubMed

    Wang, Aolin; Stronks, Karien; Arah, Onyebuchi A

    2014-08-01

    Despite the well-established link between body mass index (BMI) and diabetes mellitus (DM), it remains unclear whether this association is more pronounced at certain levels of education. This study assessed the modifying effect of educational attainment on the associations between BMI and DM-as well as the joint associations of BMI and education with DM-in low-income countries (LICs) and middle-income countries (MICs). The authors used cross-sectional data from 160 381 participants among 49 LICs and MICs in the World Health Survey. Overweight and obesity levels were defined using WHO's classification. Educational attainment was classified in four categories: 'no formal education', 'some/completed primary school', 'secondary/high school completed' and 'college and beyond'. We used random-intercept multilevel logistic regressions to investigate the modifying influence of educational attainment on the associations of different BMI levels-as well as their joint associations-with DM. We found positive associations between excessive BMI and DM at each education level in both LICs and MICs. We found that the joint associations of BMI and education with DM were larger than the product of their separate single associations among females in LICs. With joint increases in BMI and education, males and females in LICs had similar increased odds of DM, but males had higher such odds than females in MICs. BMI and education are associated with the DM, but the associations seem to differ in complex ways between LICs and MICs and by gender. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. Reducing child conduct problems and promoting social skills in a middle-income country: cluster randomised controlled trial.

    PubMed

    Baker-Henningham, Helen; Scott, Stephen; Jones, Kelvyn; Walker, Susan

    2012-08-01

    There is an urgent need for effective, affordable interventions to prevent child mental health problems in low- and middle-income countries. To determine the effects of a universal pre-school-based intervention on child conduct problems and social skills at school and at home. In a cluster randomised design, 24 community pre-schools in inner-city areas of Kingston, Jamaica, were randomly 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 ISRCTN35476268. 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. 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.

  1. Social capital, mental health and biomarkers in Chile: Assessing the effects of social capital in a middle-income country

    PubMed Central

    Riumallo-Herl, Carlos Javier; Kawachi, Ichiro; Avendano, Mauricio

    2014-01-01

    In high-income countries, higher social capital is associated with better health. However, there is little evidence of this association in low- and middle-income countries. We examine the association between social capital (social support and trust) and both self-rated and biologically assessed health outcomes in Chile, a middle-income country that experienced a major political transformation and welfare state expansion in the last two decades. Based on data from the Chilean National Health Survey (2009–10), we modeled self-rated health, depression, measured diabetes and hypertension as a function of social capital indicators, controlling for socio-economic status and health behavior. We used an instrumental variable approach to examine whether social capital was causally associated with health. We find that correlations between social capital and health observed in high-income countries are also observed in Chile. All social capital indicators are significantly associated with depression at all ages, and at least one social capital indicator is associated with self-rated health, hypertension and diabetes at ages 45 and above. Instrumental variable models suggest that associations for depression may reflect a causal effect from social capital indicators on mental well-being. Using aggregate social capital as instrument, we also find evidence that social capital may be causally associated with hypertension and diabetes, early markers of cardiovascular risk. Our findings highlight the potential role of social capital in the prevention of depression and early cardiovascular disease in middle-income countries. PMID:24495808

  2. Cost effective interventions for the prevention of cardiovascular disease in low and middle income countries: a systematic review

    PubMed Central

    2013-01-01

    Background While there is good evidence to show that behavioural and lifestyle interventions can reduce cardiovascular disease risk factors in affluent settings, less evidence exists in lower income settings. This study systematically assesses the evidence on cost-effectiveness for preventive cardiovascular interventions in low and middle-income settings. Methods Design: Systematic review of economic evaluations on interventions for prevention of cardiovascular disease. Data sources: PubMed, Web of Knowledge, Scopus and Embase, Opensigle, the Cochrane database, Business Source Complete, the NHS Economic Evaluations Database, reference lists and email contact with experts. Eligibility criteria for selecting studies: we included economic evaluations conducted in adults, reporting the effect of interventions to prevent cardiovascular disease in low and middle income countries as defined by the World Bank. The primary outcome was a change in cardiovascular disease occurrence including coronary heart disease, heart failure and stroke. Data extraction: After selection of the studies, data were extracted by two independent investigators using a previously constructed tool and quality was evaluated using Drummond’s quality assessment score. Results From 9731 search results we found 16 studies, which presented economic outcomes for interventions to prevent cardiovascular disease in low and middle income settings, with most of these reporting positive cost effectiveness results. When the same interventions were evaluated across settings, within and between papers, the likelihood of an intervention being judged cost effective was generally lower in regions with lowest gross national income. While population based interventions were in most cases more cost effective, cost effectiveness estimates for individual pharmacological interventions were overall based upon a stronger evidence base. Conclusions While more studies of cardiovascular preventive interventions are needed in

  3. Cost effective interventions for the prevention of cardiovascular disease in low and middle income countries: a systematic review.

    PubMed

    Shroufi, Amir; Chowdhury, Rajiv; Anchala, Raghupathy; Stevens, Sarah; Blanco, Patricia; Han, Tha; Niessen, Louis; Franco, Oscar H

    2013-03-28

    While there is good evidence to show that behavioural and lifestyle interventions can reduce cardiovascular disease risk factors in affluent settings, less evidence exists in lower income settings.This study systematically assesses the evidence on cost-effectiveness for preventive cardiovascular interventions in low and middle-income settings. Systematic review of economic evaluations on interventions for prevention of cardiovascular disease. PubMed, Web of Knowledge, Scopus and Embase, Opensigle, the Cochrane database, Business Source Complete, the NHS Economic Evaluations Database, reference lists and email contact with experts. we included economic evaluations conducted in adults, reporting the effect of interventions to prevent cardiovascular disease in low and middle income countries as defined by the World Bank. The primary outcome was a change in cardiovascular disease occurrence including coronary heart disease, heart failure and stroke. After selection of the studies, data were extracted by two independent investigators using a previously constructed tool and quality was evaluated using Drummond's quality assessment score. From 9731 search results we found 16 studies, which presented economic outcomes for interventions to prevent cardiovascular disease in low and middle income settings, with most of these reporting positive cost effectiveness results.When the same interventions were evaluated across settings, within and between papers, the likelihood of an intervention being judged cost effective was generally lower in regions with lowest gross national income. While population based interventions were in most cases more cost effective, cost effectiveness estimates for individual pharmacological interventions were overall based upon a stronger evidence base. While more studies of cardiovascular preventive interventions are needed in low and mid income settings, the available high-level of evidence supports a wide range of interventions for the prevention

  4. Extending Marketplace Tax Credits Would Make Coverage More Affordable for Middle-Income Adults.

    PubMed

    Liu, Jodi; Eiber, Christine

    2017-07-01

    ISSUE: Affordability of health coverage is a growing challenge for Americans facing rising premiums, deductibles, and copayments. The Affordable Care Act's tax credits make marketplace insurance more affordable for eligible lower-income individuals. However, individuals lose tax credits when their income exceeds 400 percent of the federal poverty level, creating a steep cliff. GOALS: To analyze the effects of extending eligibility for tax credits to individuals with incomes above 400 percent of the federal poverty level. METHODS: We used RAND's COMPARE microsimulation model to examine changes in insurance coverage and health care spending. KEY FINDINGS AND CONCLUSIONS: Extending tax-credit eligibility increases insurance enrollment by 1.2 million, at a total federal cost of $6.0 billion. Those who would benefit from the tax-credit extension are mostly middle-income adults ages 50 to 64. These new enrollees would be healthier than current enrollees their age, which would improve the risk pool and lower premiums. Eliminating the cliff at 400 percent of the federal poverty level is one policy option that may be considered to increase affordability of insurance.

  5. Children's Environmental Health Indicators for Low- and Middle-Income Countries in Asia.

    PubMed

    Jung, Eun Mi; Kim, Eun Mee; Kang, Minah; Goldizen, Fiona; Gore, Fiona; Drisse, Marie Noel Brune; Ha, Eun Hee

    Given that low- and middle-income countries (LMICs) in Asia still have high child mortality rates, improved monitoring using children's environmental health indicators (CEHI) may help reduce preventable deaths by creating healthy environments. Thus, the aim of this study is to build a set of targeted CEHI that can be applied in LMICs in Asia through the CEHI initiative using a common conceptual framework. A systematic review was conducted to identify the most frequently used framework for developing CEHI. Due to the limited number of eligible records, a hand search of the reference lists and an extended search of Google Scholar were also performed. Based on our findings, we designed a set of targeted CEHI to address the children's environmental health situation in LMICs in Asia. The Delphi method was then adopted to assess the relevance, appropriateness, and feasibility of the targeted CEHI. The systematic review indicated that the Driving-Pressure-State-Exposure-Effect-Action framework and the Multiple-Exposures-Multiple-Effects model were the most common conceptual frameworks for developing CEHI. The Multiple-Exposures-Multiple-Effects model was adopted, given that its population of interest is children and its emphasis on the many-to-many relationship. Our review also showed that most of the previous studies covered upper-middle- or high-income countries. The Delphi results validated the targeted CEHI. The targeted CEHI were further specified by age group, gender, and place of residence (urban/rural) to enhance measurability. Improved monitoring systems of children's environmental health using the targeted CEHI may mitigate the data gap and enhance the quality of data in LMICs in Asia. Furthermore, critical information on the complex interaction between the environment and children's health using the CEHI will help establish a regional environmental children's health action plan, named "The Children's Environment and Health Action Plan for Asia." Copyright

  6. A model for scale up of family health innovations in low-income and middle-income settings: a mixed methods study.

    PubMed

    Bradley, Elizabeth H; Curry, Leslie A; Taylor, Lauren A; Pallas, Sarah Wood; Talbert-Slagle, Kristina; Yuan, Christina; Fox, Ashley; Minhas, Dilpreet; Ciccone, Dana Karen; Berg, David; Pérez-Escamilla, Rafael

    2012-01-01

    Many family health innovations that have been shown to be both efficacious and cost-effective fail to scale up for widespread use particularly in low-income and middle-income countries (LMIC). Although individual cases of successful scale-up, in which widespread take up occurs, have been described, we lack an integrated and practical model of scale-up that may be applicable to a wide range of public health innovations in LMIC. To develop an integrated and practical model of scale-up that synthesises experiences of family health programmes in LMICs. We conducted a mixed methods study that included in-depth interviews with 33 key informants and a systematic review of peer-reviewed and grey literature from 11 electronic databases and 20 global health agency web sites. We included key informants and studies that reported on the scale up of several family health innovations including Depo-Provera as an example of a product innovation, exclusive breastfeeding as an example of a health behaviour innovation, community health workers (CHWs) as an example of an organisational innovation and social marketing as an example of a business model innovation. Key informants were drawn from non-governmental, government and international organisations using snowball sampling. An article was excluded if the article: did not meet the study's definition of the innovation; did not address dissemination, diffusion, scale up or sustainability of the innovation; did not address low-income or middle-income countries; was superficial in its discussion and/or did not provide empirical evidence about scale-up of the innovation; was not available online in full text; or was not available in English, French, Spanish or Portuguese, resulting in a final sample of 41 peer-reviewed articles and 30 grey literature sources. We used the constant comparative method of qualitative data analysis to extract recurrent themes from the interviews, and we integrated these themes with findings from the

  7. Contribution of chronic diseases to disability in elderly people in countries with low and middle incomes: a 10/66 Dementia Research Group population-based survey.

    PubMed

    Sousa, Renata M; Ferri, Cleusa P; Acosta, Daisy; Albanese, Emiliano; Guerra, Mariella; Huang, Yueqin; Jacob, K S; Jotheeswaran, A T; Rodriguez, Juan J Llibre; Pichardo, Guillermina Rodriguez; Rodriguez, Marina Calvo; Salas, Aquiles; Sosa, Ana Luisa; Williams, Joseph; Zuniga, Tirso; Prince, Martin

    2009-11-28

    Disability in elderly people in countries with low and middle incomes is little studied; according to Global Burden of Disease estimates, visual impairment is the leading contributor to years lived with disability in this population. We aimed to assess the contribution of physical, mental, and cognitive chronic diseases to disability, and the extent to which sociodemographic and health characteristics account for geographical variation in disability. We undertook cross-sectional surveys of residents aged older than 65 years (n=15 022) in 11 sites in seven countries with low and middle incomes (China, India, Cuba, Dominican Republic, Venezuela, Mexico, and Peru). Disability was assessed with the 12-item WHO disability assessment schedule 2.0. Dementia, depression, hypertension, and chronic obstructive pulmonary disease were ascertained by clinical assessment; diabetes, stroke, and heart disease by self-reported diagnosis; and sensory, gastrointestinal, skin, limb, and arthritic disorders by self-reported impairment. Independent contributions to disability scores were assessed by zero-inflated negative binomial regression and Poisson regression to generate population-attributable prevalence fractions (PAPF). In regions other than rural India and Venezuela, dementia made the largest contribution to disability (median PAPF 25.1% [IQR 19.2-43.6]). Other substantial contributors were stroke (11.4% [1.8-21.4]), limb impairment (10.5% [5.7-33.8]), arthritis (9.9% [3.2-34.8]), depression (8.3% [0.5-23.0]), eyesight problems (6.8% [1.7-17.6]), and gastrointestinal impairments (6.5% [0.3-23.1]). Associations with chronic diseases accounted for around two-thirds of prevalent disability. When zero inflation was taken into account, between-site differences in disability scores were largely attributable to compositional differences in health and sociodemographic characteristics. On the basis of empirical research, dementia, not blindness, is overwhelmingly the most important

  8. Big data in global health: improving health in low- and middle-income countries

    PubMed Central

    Vaillancourt, Samuel; Perry, William; Mannava, Priya; Folaranmi, Temitope; Celi, Leo Anthony

    2015-01-01

    Abstract Over the last decade, a massive increase in data collection and analysis has occurred in many fields. In the health sector, however, there has been relatively little progress in data analysis and application despite a rapid rise in data production. Given adequate governance, improvements in the quality, quantity, storage and analysis of health data could lead to substantial improvements in many health outcomes. In low- and middle-income countries in particular, the creation of an information feedback mechanism can move health-care delivery towards results-based practice and improve the effective use of scarce resources. We review the evolving definition of big data and the possible advantages of – and problems in – using such data to improve health-care delivery in low- and middle-income countries. The collection of big data as mobile-phone based services improve may mean that development phases required elsewhere can be skipped. However, poor infrastructure may prevent interoperability and the safe use of patient data. An appropriate governance framework must be developed and enforced to protect individuals and ensure that health-care delivery is tailored to the characteristics and values of the target communities. PMID:25767300

  9. Depression and type 2 diabetes in low- and middle-income countries: a systematic review.

    PubMed

    Mendenhall, Emily; Norris, Shane A; Shidhaye, Rahul; Prabhakaran, Dorairaj

    2014-02-01

    Eighty percent of people with type 2 diabetes reside in low- and middle-income countries (LMICs). Yet much of the research around depression among people with diabetes has been conducted in high-income countries (HICs). In this systematic review we searched Ovid Medline, PubMed, and PsychINFO for studies that assessed depression among people with type 2 diabetes in LMICs. Our focus on quantitative studies provided a prevalence of comorbid depression among those with diabetes. We reviewed 48 studies from 1,091 references. We found that this research has been conducted primarily in middle-income countries, including India (n = 8), Mexico (n = 8), Brazil (n = 5), and China (n = 5). There was variation in prevalence of comorbid depression across studies, but these differences did not reveal regional differences and seemed to result from study sample (e.g., urban vs rural and clinical vs population-based samples). Fifteen depression inventories were administered across the studies. We concluded that despite substantial diabetes burden in LMICs, few studies have reviewed comorbid depression and diabetes. Our review suggests depression among people with diabetes in LMICs may be higher than in HICs. Evidence from these 48 studies underscores the need for comprehensive mental health care that can be integrated into diabetes care within LMIC health systems. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  10. The Sexual and Reproductive Health of Young People in Low and Middle Income Countries

    ERIC Educational Resources Information Center

    Edwards, Orain; Peterson, Nicholas

    2013-01-01

    Young people ages 10-24 account for 25 percent of the world's population: a total of 1.8 billion, most of whom are living in low- and middle-income countries. They face significant challenges, including HIV, sexually transmitted infections (STIs), adolescent pregnancy, unsafe abortion, and gender-based violence. Youth have the right to lead…

  11. The My Child Matters programme: effect of public-private partnerships on paediatric cancer care in low-income and middle-income countries.

    PubMed

    Howard, Scott C; Zaidi, Alia; Cao, Xueyuan; Weil, Olivier; Bey, Pierre; Patte, Catherine; Samudio, Angelica; Haddad, Laurie; Lam, Catherine G; Moreira, Claude; Pereira, Augusto; Harif, Mhamed; Hessissen, Laila; Choudhury, Salma; Fu, Ligia; Caniza, Miguela A; Lecciones, Julius; Traore, Fousseyni; Ribeiro, Raul C; Gagnepain-Lacheteau, Anne

    2018-05-01

    In low-income and middle-income countries, an excess in treatment failure for children with cancer usually results from misdiagnosis, inadequate access to treatment, death from toxicity, treatment abandonment, and relapse. The My Child Matters programme of the Sanofi Espoir Foundation has funded 55 paediatric cancer projects in low-income and middle-income countries over 10 years. We assessed the impact of the projects in these regions by using baseline assessments that were done in 2006. Based on these data, estimated 5-year survival in 2016 increased by a median of 5·1%, ranging from -1·5% in Venezuela to 17·5% in Ukraine. Of the 26 861 children per year who develop cancer in the ten index countries with My Child Matters projects that were evaluated in 2006, an estimated additional 1343 children can now expect an increase in survival outcome. For example, in Paraguay, a network of paediatric oncology satellite clinics was established and scaled up to a national level and has managed 884 patients since initiation in 2006. Additionally, the African Retinoblastoma Network was scaled up from a demonstration project in Mali to a network of retinoblastoma referral centres in five sub-Saharan African countries, and the African School of Paediatric Oncology has trained 42 physicians and 100 nurses from 16 countries. The My Child Matters programme has catalysed improvements in cancer care and has complemented the efforts of government, civil society, and the private sector to sustain and scale improvements in health care to a national level. Key elements of successful interventions include strong and sustained local leadership, community engagement, international engagement, and capacity building and support from government. Copyright © 2018 Elsevier Ltd. All rights reserved.

  12. Improving Care for Children With Cancer in Low- and Middle-Income Countries--a SIOP PODC Initiative.

    PubMed

    Arora, Ramandeep Singh; Challinor, Julia M; Howard, Scott C; Israels, Trijn

    2016-03-01

    The Paediatric Oncology in Developing Countries (PODC) committee of International Society of Paediatric Oncology (SIOP) has 10 working groups that provide a forum for individuals to engage, network, and implement improvements in the care of children with cancer in low- and middle-income countries. The development of adapted guidelines (medulloblastoma, retinoblastoma, Wilms tumor, neuroblastoma, retinoblastoma, Burkitt lymphoma, supportive care), advocacy and awareness (on hospital detention and essential drugs), education and training, and global mapping (nutritional practice, abandonment rates, and twinning collaborations) have been the initial areas of focus, and the impact of some of these activities is evident, for example, in the SIOP Africa PODC Collaborative Wilms tumor project. © 2015 Wiley Periodicals, Inc.

  13. Feasibility and effectiveness of a brief, intensive phylogenetics workshop in a middle-income country.

    PubMed

    Pollett, S; Leguia, M; Nelson, M I; Maljkovic Berry, I; Rutherford, G; Bausch, D G; Kasper, M; Jarman, R; Melendrez, M

    2016-01-01

    There is an increasing role for bioinformatic and phylogenetic analysis in tropical medicine research. However, scientists working in low- and middle-income regions may lack access to training opportunities in these methods. To help address this gap, a 5-day intensive bioinformatics workshop was offered in Lima, Peru. The syllabus is presented here for others who want to develop similar programs. To assess knowledge gained, a 20-point knowledge questionnaire was administered to participants (21 participants) before and after the workshop, covering topics on sequence quality control, alignment/formatting, database retrieval, models of evolution, sequence statistics, tree building, and results interpretation. Evolution/tree-building methods represented the lowest scoring domain at baseline and after the workshop. There was a considerable median gain in total knowledge scores (increase of 30%, p<0.001) with gains as high as 55%. A 5-day workshop model was effective in improving the pathogen-applied bioinformatics knowledge of scientists working in a middle-income country setting. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  14. Sun protection use behaviour among University students from 25 low, middle income and emerging economy countries.

    PubMed

    Pengpid, Supa; Peltzer, Karl

    2015-01-01

    The aim of this study was to investigate the sun protection use behaviour among university students from 25 low, middle income and emerging economy countries. Using anonymous questionnaires, data were collected from 18,687 undergraduate university students aged 18-30 years (mean age 20.8, SD=2.8) from 26 universities in 25 countries across Asia, Africa and the Americas. Overall, 57.2% of university students reported liking to sunbathe and of those only 48.1% used sun protection when sunbathing. In multivariate logistic regression, younger age, being female, coming from a wealthy or quite well off economic family background, living in an upper middle or high income country, lighter skin tone, and other health behaviours were found to be associated with sun protection use behaviour. Low sun protection use calls for health promotion programmes to prevent unprotected sun exposure.

  15. Socio-demographic patterns of disability among older adult populations of low-income and middle-income countries: results from World Health Survey.

    PubMed

    Hosseinpoor, Ahmad Reza; Bergen, Nicole; Kostanjsek, Nenad; Kowal, Paul; Officer, Alana; Chatterji, Somnath

    2016-04-01

    Our objective was to quantify disability prevalence among older adults of low- and middle-income countries, and measure socio-demographic distribution of disability. World Health Survey data included 53,447 adults aged 50 or older from 43 low- and middle-income countries. Disability was a binary classification, based on a composite score derived from self-reported functional difficulties. Socio-demographic variables included sex, age, marital status, area of residence, education level, and household economic status. A multivariate Poisson regression model with robust variance was used to assess associations between disability and socio-demographic variables. Overall, 33.3 % (95 % CI 32.2-34.4 %) of older adults reported disability. Disability was 1.5 times more common in females, and was positively associated with increasing age. Divorced/separated/widowed respondents reported higher disability rates in all but one study country, and education and wealth levels were inversely associated with disability rates. Urban residence tended to be advantageous over rural. Country-level datasets showed disparate patterns. Effective approaches aimed at disability prevention and improved disability management are warranted, including the inclusion of equity considerations in monitoring and evaluation activities.

  16. Impact of Noncommunicable Disease Multimorbidity on Healthcare Utilisation and Out-Of-Pocket Expenditures in Middle-Income Countries: Cross Sectional Analysis.

    PubMed

    Lee, John Tayu; Hamid, Fozia; Pati, Sanghamitra; Atun, Rifat; Millett, Christopher

    2015-01-01

    The burden of non-communicable disease (NCDs) has grown rapidly in low- and middle-income countries (LMICs), where populations are ageing, with rising prevalence of multimorbidity (more than two co-existing chronic conditions) that will significantly increase pressure on already stretched health systems. We assess the impact of NCD multimorbidity on healthcare utilisation and out-of-pocket expenditures in six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa. Secondary analyses of cross-sectional data from adult participants (>18 years) in the WHO Study on Global Ageing and Adult Health (SAGE) 2007-2010. We used multiple logistic regression to determine socio-demographic correlates of multimorbidity. Association between the number of NCDs and healthcare utilisation as well as out-of-pocket spending was assessed using logistic, negative binominal and log-linear models. The prevalence of multimorbidity in the adult population varied from 3.9% in Ghana to 33.6% in Russia. Number of visits to doctors in primary and secondary care rose substantially for persons with increasing numbers of co-existing NCDs. Multimorbidity was associated with more outpatient visits in China (coefficient for number of NCD = 0.56, 95% CI = 0.46, 0.66), a higher likelihood of being hospitalised in India (AOR = 1.59, 95% CI = 1.45, 1.75), higher out-of-pocket expenditures for outpatient visits in India and China, and higher expenditures for hospital visits in Russia. Medicines constituted the largest proportion of out-of-pocket expenditures in persons with multimorbidity (88.3% for outpatient, 55.9% for inpatient visit in China) in most countries. Multimorbidity is associated with higher levels of healthcare utilisation and greater financial burden for individuals in middle-income countries. Our study supports the WHO call for universal health insurance and health service coverage in LMICs, particularly for vulnerable groups such as the elderly with multimorbidity.

  17. Variations in Diabetes Prevalence in Low-, Middle-, and High-Income Countries: Results From the Prospective Urban and Rural Epidemiological Study.

    PubMed

    Dagenais, Gilles R; Gerstein, Hertzel C; Zhang, Xiaohe; McQueen, Matthew; Lear, Scott; Lopez-Jaramillo, Patricio; Mohan, Viswanathan; Mony, Prem; Gupta, Rajeev; Kutty, V Raman; Kumar, Rajesh; Rahman, Omar; Yusoff, Khalid; Zatonska, Katarzyna; Oguz, Aytekin; Rosengren, Annika; Kelishadi, Roya; Yusufali, Afzalhussein; Diaz, Rafael; Avezum, Alvaro; Lanas, Fernando; Kruger, Annamarie; Peer, Nasheeta; Chifamba, Jephat; Iqbal, Romaina; Ismail, Noorhassim; Xiulin, Bai; Jiankang, Liu; Wenqing, Deng; Gejie, Yue; Rangarajan, Sumathy; Teo, Koon; Yusuf, Salim

    2016-05-01

    The goal of this study was to assess whether diabetes prevalence varies by countries at different economic levels and whether this can be explained by known risk factors. The prevalence of diabetes, defined as self-reported or fasting glycemia ≥7 mmol/L, was documented in 119,666 adults from three high-income (HIC), seven upper-middle-income (UMIC), four lower-middle-income (LMIC), and four low-income (LIC) countries. Relationships between diabetes and its risk factors within these country groupings were assessed using multivariable analyses. Age- and sex-adjusted diabetes prevalences were highest in the poorer countries and lowest in the wealthiest countries (LIC 12.3%, UMIC 11.1%, LMIC 8.7%, and HIC 6.6%; P < 0.0001). In the overall population, diabetes risk was higher with a 5-year increase in age (odds ratio 1.29 [95% CI 1.28-1.31]), male sex (1.19 [1.13-1.25]), urban residency (1.24 [1.11-1.38]), low versus high education level (1.10 [1.02-1.19]), low versus high physical activity (1.28 [1.20-1.38]), family history of diabetes (3.15 [3.00-3.31]), higher waist-to-hip ratio (highest vs. lowest quartile; 3.63 [3.33-3.96]), and BMI (≥35 vs. <25 kg/m(2); 2.76 [2.52-3.03]). The relationship between diabetes prevalence and both BMI and family history of diabetes differed in higher- versus lower-income country groups (P for interaction < 0.0001). After adjustment for all risk factors and ethnicity, diabetes prevalences continued to show a gradient (LIC 14.0%, LMIC 10.1%, UMIC 10.9%, and HIC 5.6%). Conventional risk factors do not fully account for the higher prevalence of diabetes in LIC countries. These findings suggest that other factors are responsible for the higher prevalence of diabetes in LIC countries. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  18. Health-related quality of life and psychological distress among cancer survivors in a middle-income country.

    PubMed

    Subramaniam, Shridevi; Kong, Yek-Ching; Chinna, Karuthan; Kimman, Merel; Ho, Yan-Zheng; Saat, Nadiah; Abdul Malik, Rozita; Taib, Nur Aishah; Abdullah, Matin Mellor; Chin-Chye Lim, Gerard; Ibrahim Tamin, Nor-Saleha; Woo, Yin-Ling; Chang, Kian-Meng; Goh, Pik-Pin; Yip, Cheng-Har; Bhoo-Pathy, Nirmala

    2018-06-01

    Quality of life and psychological well-being are important patient-centered outcomes, which are useful in evaluation of cancer care delivery. However, evidence from low- and middle-income countries remains scarce. We assessed health-related quality of life (HRQoL) and prevalence of psychological distress (anxiety or depression), as well as their predictors, among cancer survivors in a middle-income setting. Through the ASEAN Costs in Oncology study, 1490 newly-diagnosed cancer patients were followed-up in Malaysia for one year. HRQoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and EuroQol-5 (EQ-5D) dimensions questionnaires at baseline, 3 months and 12 months. Psychological distress was assessed using Hospital Anxiety and Depression Scale. Data were modeled using general linear and logistic regressions analyses. One year after diagnosis, the mean EORTC QLQ-C30 Global Health score of the cancer survivors remained low at 53.0 over 100 (SD 21.4). Fifty-four percent of survivors reported at least moderate levels of anxiety while 27% had at least moderate levels of depression. Late stage at diagnosis was the strongest predictor of low HRQoL. Increasing age, being married, high-income status, hospital type, presence of comorbidities, and chemotherapy administration were also associated with worse HRQoL. The significant predictors of psychological distress were cancer stage and hospital type. Cancer survivors in this middle-income setting have persistently impaired HRQoL and high levels of psychological distress. Development of a holistic cancer survivorship program addressing wider aspects of well-being is urgently needed in our settings. This article is protected by copyright. All rights reserved.

  19. Carriage of Streptococcus pneumoniae and Other Respiratory Bacterial Pathogens in Low and Lower-Middle Income Countries: A Systematic Review and Meta-Analysis

    PubMed Central

    Adegbola, Richard A.; DeAntonio, Rodrigo; Hill, Philip C.; Roca, Anna; Usuf, Effua; Hoet, Bernard; Greenwood, Brian M.

    2014-01-01

    Background Infection with Streptococcus pneumoniae is a major cause of childhood morbidity and mortality worldwide, especially in low income countries where pneumococcal conjugate vaccines (PCVs) are still underused. In countries where PCVs have been introduced, much of their efficacy has resulted from their impact on nasopharyngeal carriage in vaccinated children. Understanding the epidemiology of carriage for S. pneumoniae and other common respiratory bacteria in developing countries is crucial for implementing appropriate vaccination strategies and evaluating their impact. Methods and Findings We have systematically reviewed published studies reporting nasopharyngeal or oropharyngeal carriage of S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Neisseria meningitidis in children and adults in low and lower-middle income countries. Studies reporting pneumococcal carriage for healthy children <5 years of age were selected for a meta-analysis. The prevalences of carriage for S. pneumoniae, H. influenzae, and M. catarrhalis were generally higher in low income than in lower-middle income countries and were higher in young children than in adults. The prevalence of S. aureus was high in neonates. Meta-analysis of data from young children before the introduction of PCVs showed a pooled prevalence estimate of 64.8% (95% confidence interval, 49.8%–76.1%) in low income countries and 47.8% (95% confidence interval, 44.7%–50.8%) in lower-middle income countries. The most frequent serotypes were 6A, 6B, 19A, 19F, and 23F. Conclusions In low and lower-middle income countries, pneumococcal carriage is frequent, especially in children, and the spectrum of serotypes is wide. However, because data are limited, additional studies are needed to adequately assess the impact of PCV introduction on carriage of respiratory bacteria in these countries. PMID:25084351

  20. A global prospective of income distribution and its effect on life cycle assessment of municipal solid waste management: a review.

    PubMed

    Yadav, Pooja; Samadder, S R

    2017-04-01

    This study reviewed the municipal solid waste (MSW) composition, the management practices, and the use of life cycle assessment (LCA) tool for MSW management (MSWM) options in the various income group countries. LCA studies require inventory data, which is difficult to procure for any country including higher income group countries, and this issue gets compounded in low-income and lower middle-income group countries, which limits the implementation of LCA. This paper compared the use of LCA for MSWM between high-income and low-income group countries and also highlights the gap in using LCA for MSWM. A very limited number of LCA studies on MSWM were found for low-income group countries in comparison to high-income group countries. The study also provided a critical discussion on the challenges in applications of LCA in MSWM for better solid waste management in low-income and lower middle-income group countries. The study will help in taking up LCA studies in low-income countries to improve the overall MSWM efficiency.

  1. Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21st standard: analysis of CHERG datasets

    PubMed Central

    Kozuki, Naoko; Cousens, Simon; Stevens, Gretchen A; Blencowe, Hannah; Silveira, Mariangela F; Sania, Ayesha; Rosen, Heather E; Schmiegelow, Christentze; Adair, Linda S; Baqui, Abdullah H; Barros, Fernando C; Bhutta, Zulfiqar A; Caulfield, Laura E; Christian, Parul; Clarke, Siân E; Fawzi, Wafaie; Gonzalez, Rogelio; Humphrey, Jean; Huybregts, Lieven; Kariuki, Simon; Kolsteren, Patrick; Lusingu, John; Manandhar, Dharma; Mongkolchati, Aroonsri; Mullany, Luke C; Ndyomugyenyi, Richard; Nien, Jyh Kae; Roberfroid, Dominique; Saville, Naomi; Terlouw, Dianne J; Tielsch, James M; Victora, Cesar G; Velaphi, Sithembiso C; Watson-Jones, Deborah; Willey, Barbara A; Ezzati, Majid; Lawn, Joy E; Black, Robert E; Katz, Joanne

    2017-01-01

    Objectives To estimate small for gestational age birth prevalence and attributable neonatal mortality in low and middle income countries with the INTERGROWTH-21st birth weight standard. Design Secondary analysis of data from the Child Health Epidemiology Reference Group (CHERG), including 14 birth cohorts with gestational age, birth weight, and neonatal follow-up. Small for gestational age was defined as infants weighing less than the 10th centile birth weight for gestational age and sex with the multiethnic, INTERGROWTH-21st birth weight standard. Prevalence of small for gestational age and neonatal mortality risk ratios were calculated and pooled among these datasets at the regional level. With available national level data, prevalence of small for gestational age and population attributable fractions of neonatal mortality attributable to small for gestational age were estimated. Setting CHERG birth cohorts from 14 population based sites in low and middle income countries. Main outcome measures In low and middle income countries in the year 2012, the number and proportion of infants born small for gestational age; number and proportion of neonatal deaths attributable to small for gestational age; the number and proportion of neonatal deaths that could be prevented by reducing the prevalence of small for gestational age to 10%. Results In 2012, an estimated 23.3 million infants (uncertainty range 17.6 to 31.9; 19.3% of live births) were born small for gestational age in low and middle income countries. Among these, 11.2 million (0.8 to 15.8) were term and not low birth weight (≥2500 g), 10.7 million (7.6 to 15.0) were term and low birth weight (<2500 g) and 1.5 million (0.9 to 2.6) were preterm. In low and middle income countries, an estimated 606 500 (495 000 to 773 000) neonatal deaths were attributable to infants born small for gestational age, 21.9% of all neonatal deaths. The largest burden was in South Asia, where the prevalence was the

  2. Social capital, mental health and biomarkers in Chile: assessing the effects of social capital in a middle-income country.

    PubMed

    Riumallo-Herl, Carlos Javier; Kawachi, Ichiro; Avendano, Mauricio

    2014-03-01

    In high-income countries, higher social capital is associated with better health. However, there is little evidence of this association in low- and middle-income countries. We examine the association between social capital (social support and trust) and both self-rated and biologically assessed health outcomes in Chile, a middle-income country that experienced a major political transformation and welfare state expansion in the last two decades. Based on data from the Chilean National Health Survey (2009-10), we modeled self-rated health, depression, measured diabetes and hypertension as a function of social capital indicators, controlling for socio-economic status and health behavior. We used an instrumental variable approach to examine whether social capital was causally associated with health. We find that correlations between social capital and health observed in high-income countries are also observed in Chile. All social capital indicators are significantly associated with depression at all ages, and at least one social capital indicator is associated with self-rated health, hypertension and diabetes at ages 45 and above. Instrumental variable models suggest that associations for depression may reflect a causal effect from social capital indicators on mental well-being. Using aggregate social capital as instrument, we also find evidence that social capital may be causally associated with hypertension and diabetes, early markers of cardiovascular risk. Our findings highlight the potential role of social capital in the prevention of depression and early cardiovascular disease in middle-income countries. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Classroom Literacy Practices in Low- and Middle-Income Countries: An Interpretative Synthesis of Ethnographic Studies

    ERIC Educational Resources Information Center

    Nag, Sonali; Snowling, Margaret J.; Asfaha, Yonas Mesfun

    2016-01-01

    Surveys in low- and middle-income (LMI countries) reveal persistently low levels of learning among children in disadvantaged communities. Against this background, our synthesis of ethnographies aims at a fresh interpretation of classroom practices to clarify instruction-related barriers to literacy attainments. The review focuses on the period…

  4. Interventions Provided by Parents for Children with Intellectual Disabilities in Low and Middle Income Countries

    ERIC Educational Resources Information Center

    Einfeld, Stewart L.; Stancliffe, Roger J.; Gray, Kylie M.; Sofronoff, Kate; Rice, Lauren; Emerson, Eric; Yasamy, M. T.

    2012-01-01

    Background: In low- and middle-income (LAMI) countries, there is a lack of well-trained therapists to provide specialist interventions for children with intellectual disabilities and their families. We sought to identify strategies deliverable by families or non-specialist workers. Materials and Methods: After searches of appropriate scientific…

  5. Socioeconomic inequality in neonatal mortality in countries of low and middle income: a multicountry analysis.

    PubMed

    McKinnon, Britt; Harper, Sam; Kaufman, Jay S; Bergevin, Yves

    2014-03-01

    Neonatal mortality rates (NMRs) in countries of low and middle income have been only slowly decreasing; coverage of essential maternal and newborn health services needs to increase, particularly for disadvantaged populations. Our aim was to produce comparable estimates of changes in socioeconomic inequalities in NMR in the past two decades across these countries. We used data from Demographic and Health Surveys (DHS) for countries in which a survey was done in 2008 or later and one about 10 years previously. We measured absolute inequalities with the slope index of inequality and relative inequalities with the relative index of inequality. We used an asset-based wealth index and maternal education as measures of socioeconomic position and summarised inequality estimates for all included countries with random-effects meta-analysis. 24 low-income and middle-income countries were eligible for inclusion. In most countries, absolute and relative wealth-related and educational inequalities in NMR decreased between survey 1 and survey 2. In five countries (Cameroon, Nigeria, Malawi, Mozambique, and Uganda), the difference in NMR between the top and bottom of the wealth distribution was reduced by more than two neonatal deaths per 1000 livebirths per year. By contrast, wealth-related inequality increased by more than 1·5 neonatal deaths per 1000 livebirths per year in Ethiopia and Cambodia. Patterns of change in absolute and relative educational inequalities in NMR were similar to those of wealth-related NMR inequalities, although the size of educational inequalities tended to be slightly larger. Socioeconomic inequality in NMR seems to have decreased in the past two decades in most countries of low and middle income. However, a substantial survival advantage remains for babies born into wealthier households with a high educational level, which should be considered in global efforts to further reduce NMR. Canadian Institutes of Health Research. Copyright © 2014 Mc

  6. Anesthesia Care Capacity at Health Facilities in 22 Low- and Middle-Income Countries.

    PubMed

    Hadler, Rachel A; Chawla, Sagar; Stewart, Barclay T; McCunn, Maureen C; Kushner, Adam L

    2016-05-01

    Globally, an estimated 2 billion people lack access to surgical and anesthesia care. We sought to pool results of anesthesia care capacity assessments in low- and middle-income countries (LMICs) to identify patterns of deficits and provide useful targets for advocacy and intervention. A systematic review of PubMed, Cochrane Database of Systematic Reviews, and Google Scholar identified reports that documented anesthesia care capacity from LMICs. When multiple assessments from one country were identified, only the study with the most facilities assessed was included. Patterns of availability or deficit were described. We identified 22 LMICs (15 low- and 8 middle-income countries) with anesthesia care capacity assessments (614 facilities assessed). Anesthesia care resources were often unavailable, including relatively low-cost ones (e.g., oxygen and airway supplies). Capacity varied markedly between and within countries, regardless of the national income. The availability of fundamental resources for safe anesthesia, such as airway supplies and functional pulse oximeters, was often not reported (72 and 36 % of hospitals assessed, respectively). Anesthesia machines and the capability to perform general anesthesia were unavailable in 43 % (132/307 hospitals) and 56 % (202/361) of hospitals, respectively. We identified a pattern of critical deficiencies in anesthesia care capacity in LMICs, including some low-cost, high-value added resources. The global health community should advocate for improvements in anesthesia care capacity and the potential benefits of doing so to health system planners. In addition, better quality data on anesthesia care capacity can improve advocacy, as well as the monitoring and evaluation of changes over time and the impact of capacity improvement interventions.

  7. "Safe Foods" or "Fear Foods": the implications of food avoidance in college students from low- and middle-income countries.

    PubMed

    James, C; Harrison, A; Seixas, A; Powell, M; Pengpid, S; Peltzer, K

    2017-09-01

    The primary objective of this study was to explore if self-reported food avoidance (fats, carbohydrates and protein) exists among college students in low- and middle-income countries (LMICs) and its relationship with body mass index (BMI), dieting, mood/anxiety symptoms, physical activities and general health knowledge. This study is a subset (N = 6096) of a larger 26 LMICs cross-sectional survey, which consisted of 21,007 college students. We ascertained socio-demographic information, food avoidance, physical activities, dieting behaviours, depressive and PTSD symptoms, and recorded anthropometric measurements. Chi-square analyses assessed the relationship between predictor variables and food categories eliminated from participants' diet. Multiple logistic regression assessed if food avoidance predicts outcome variables such as binge drinking, high physical activity, being underweight, exhibiting significant depressive and PTSD symptoms. Food avoidance exists in as many as one-third of college students in low- and middle-income countries, with this being more likely in persons who are trying to lose weight whether by dieting or otherwise. Food avoidance was associated with higher BMI, depressive symptoms, and high intensity exercises, as well as the level of health knowledge influencing the types of food avoided. A significant difference was noted between lower middle-income and upper middle-income countries with respect to the foods they avoided. Despite being knowledgeable about health-related behaviours, we found that college students in our sample were not that different from those in developed countries and may be influenced by a similar advice given by non-experts about macronutrients. These results hold implications for intervention programmes and policy makers. Level V, descriptive cross-sectional survey.

  8. The Identification of Children with, or at Significant Risk of, Intellectual Disabilities in Low- and Middle-Income Countries: A Review

    ERIC Educational Resources Information Center

    Robertson, Janet; Hatton, Chris; Emerson, Eric; Yasamy, M. Taghi

    2012-01-01

    Background: Developmental monitoring of children is an important strategy for the early detection and management of intellectual disabilities (ID) in high-income countries. This review summarizes the literature on identifying children with ID in low- and middle-income (LAMI) countries. Materials and methods: Electronic literature database searches…

  9. AB027. Developing capacity for variant data sharing in low and middle income countries: HVP’s Global Globin 2020 Challenge

    PubMed Central

    Robinson, Helen M.

    2015-01-01

    required to protect patients at the same time that the biotechnical procedures are developed; (II) to ensure that the storage, curation and sharing of the relevant DNA variation information is sustainable in the medium and longer term by expanding and strengthening the international network of professionals, including curators, researchers, clinicians, bioinformaticians, counsellors, patient groups and policymakers. Pursuit of these goals will raise the profile of genomic medicine in low and middle income countries in national, regional and international research organizations. It will also develop the capability of professionals required for diagnosing, treating and counseling carriers in low and middle income countries thus giving them a greater voice and profile among genomic researchers globally so they can actively participate in regional and international partnerships related to genomic research. Initially the GG2020 Challenge will focus on a group of countries that have already formed groups of the relevant professionals including: Belgium, China, Cyprus, Egypt, France, Malaysia, Mexico, Mozambique, Nigeria, South Africa, Venezuela, Vietnam, Portugal, and The Netherlands. Other countries are ready to be included as the project expands. HVP will utilize its relationship with both UNESCO and WHO to ensure that the necessary international standards and procedures are developed in a consultative and harmonized manner.

  10. Implementation Science in Cancer Prevention and Control: A framework for research and programs in low and middle-income countries

    PubMed Central

    Sanchez, Michael A.; Rimer, Barbara K.; Samet, Jonathan M.; Glasgow, Russell E.

    2014-01-01

    Implementation Science is a set of tools, principles and methodologies that can be used to bring scientific evidence into action, improve health care quality and delivery and improve public health. As the burden of cancer increases in low- and middle-income countries, it is important to plan cancer control programs that are both evidence-based and delivered in ways that are feasible, cost-effective, contextually appropriate and sustainable. This review presents a framework for using implementation science for cancer control planning and implementation and discusses potential areas of focus for research and programs in low and middle-income countries interested in integrating research into practice and policy. PMID:25178984

  11. A Cross-Sectional Study of the Microeconomic Impact of Cardiovascular Disease Hospitalization in Four Low- and Middle-Income Countries

    PubMed Central

    Huffman, Mark D.; Rao, Krishna D.; Pichon-Riviere, Andres; Zhao, Dong; Harikrishnan, S.; Ramaiya, Kaushik; Ajay, V. S.; Goenka, Shifalika; Calcagno, Juan I.; Caporale, Joaquín E.; Niu, Shaoli; Li, Yan; Liu, Jing; Thankappan, K. R.; Daivadanam, Meena; van Esch, Jan; Murphy, Adrianna; Moran, Andrew E.; Gaziano, Thomas A.; Suhrcke, Marc; Reddy, K. Srinath; Leeder, Stephen; Prabhakaran, Dorairaj

    2011-01-01

    Objective To estimate individual and household economic impact of cardiovascular disease (CVD) in selected low- and middle-income countries (LMIC). Background Empirical evidence on the microeconomic consequences of CVD in LMIC is scarce. Methods and Findings We surveyed 1,657 recently hospitalized CVD patients (66% male; mean age 55.8 years) from Argentina, China, India, and Tanzania to evaluate the microeconomic and functional/productivity impact of CVD hospitalization. Respondents were stratified into three income groups. Median out-of-pocket expenditures for CVD treatment over 15 month follow-up ranged from 354 international dollars (2007 INT$, Tanzania, low-income) to INT$2,917 (India, high-income). Catastrophic health spending (CHS) was present in >50% of respondents in China, India, and Tanzania. Distress financing (DF) and lost income were more common in low-income respondents. After adjustment, lack of health insurance was associated with CHS in Argentina (OR 4.73 [2.56, 8.76], India (OR 3.93 [2.23, 6.90], and Tanzania (OR 3.68 [1.86, 7.26] with a marginal association in China (OR 2.05 [0.82, 5.11]). These economic effects were accompanied by substantial decreases in individual functional health and productivity. Conclusions Individuals in selected LMIC bear significant financial burdens following CVD hospitalization, yet with substantial variation across and within countries. Lack of insurance may drive much of the financial stress of CVD in LMIC patients and their families. PMID:21695127

  12. Protocol for a systematic review of the effects of interventions to inform or educate caregivers about childhood vaccination in low and middle-income countries.

    PubMed

    Lukusa, Lungeni A; Mbeye, Nyanyiwe N; Adeniyi, Folasade B; Wiysonge, Charles S

    2015-07-13

    childhood vaccination coverage in low and middle-income countries. PROSPERO, CRD42014010141. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  13. Consumer-led demand side financing in health and education and its relevance for low and middle income countries.

    PubMed

    Ensor, Tim

    2004-01-01

    There is increasing awareness that supply subsidies for health and education services often fail to benefit those that are most vulnerable in a community. This recognition has led to a growing interest in and experimentation with, consumer-led demand side financing systems (CL-DSF). These mechanisms place purchasing power in the hands of consumers to spend on specific services at accredited facilities. International evidence in education and health sectors suggest a limited success of CL-DSF in raising the consumption of key services amongst priority groups. There is also some evidence that vouchers can be used to improve targeting of vulnerable groups. There is very little positive evidence on the effect of CL-DSF on service quality as a consequence of greater competition. Location of services relative to population means that areas with more provider choice, particularly in the private sector, tend to be dominated by higher and middle-income households. Extending CL-DSF in low-income countries requires the development of capacity in administering these financing schemes and also accrediting providers. Schemes could focus primarily on fixed packages of key services aimed at easily identifiable groups. Piloting and robust evaluation is required to fill the evidence gap on the impact of these mechanisms. Extending demand financing to less predictable services, such as hospital coverage for the population, is likely to require the development of a voucher scheme to purchase insurance. This suggests an already developed insurance market and is unlikely to be appropriate in most low-income countries for some time.

  14. Organization of primary health care for diabetes and hypertension in high, low and middle income countries.

    PubMed

    Lall, Dorothy; Prabhakaran, Dorairaj

    2014-08-01

    Chronic non-communicable diseases, predominantly diabetes and cardiovascular disease are a major public health problem globally. The chronicity of these diseases necessitates a restructuring of healthcare to address the multidisciplinary, sustained care including psychosocial support and development of self-management skills. Primary healthcare with elements of the chronic-care model provides the best opportunity for engagement with the health system. In this review, the authors discuss aspects of primary healthcare for management of diabetes and hypertension and innovations such as mobile-phone messaging, web-based registries, computer-based decision support systems and multifaceted health professionals in the care team among others that are being tested to improve the quality of care for these diseases in high, middle and low-income countries. The goal of quality care for diabetes and hypertension demands innovation within the realities of health systems both in high as well as low and middle-income countries.

  15. Financial stress, parent functioning and adolescent problem behavior: an actor-partner interdependence approach to family stress processes in low-, middle-, and high-income families.

    PubMed

    Ponnet, Koen

    2014-10-01

    The family stress model proposes that financial stress experienced by parents is associated with problem behavior in adolescents. The present study applied an actor-partner interdependence approach to the family stress model and focused on low-, middle-, and high-income families to broaden our understanding of the pathways by which the financial stress of mothers and fathers are related to adolescent outcomes. The study uses dyadic data (N = 798 heterosexual couples) from the Relationship between Mothers, Fathers and Children study in which two-parent families with an adolescent between 11 and 17 years of age participated. Path-analytic results indicated that in each of the families the association between parents' financial stress and problem behavior in adolescents is mediated through parents' depressive symptoms, interparental conflict, and positive parenting. Family stress processes also appear to operate in different ways for low-, middle-, and high-income families. In addition to a higher absolute level of financial stress in low-income families, financial stress experienced by mothers and fathers in these families had significant direct and indirect effects on problem behavior in adolescents, while in middle- and high-income families only significant indirect effects were found. The financial stress of a low-income mother also had a more detrimental impact on her level of depressive feelings than it had on mothers in middle-income families. Furthermore, the study revealed gender differences in the pathways of mothers and fathers. Implications for research, clinical practice, and policy are also discussed.

  16. Impact of Education on the Income of Different Social Groups

    ERIC Educational Resources Information Center

    Yue, Changjun; Liu, Yanping

    2007-01-01

    This study investigates, statistically and econometrically, the income level, income inequality, education inequality, and the relationship between education and income of different social groups, on the basis of the Chinese Urban Household Survey conducted in 2005, the Gini coefficient and the quartile regression method. Research findings…

  17. Social Groups in the Middle School.

    ERIC Educational Resources Information Center

    Lockledge, Ann

    In a study investigating whether middle school students can identify their own social groups, over 200 sixth- and seventh-graders were asked to name the kinds of groups to which they thought students in their school belonged, and to explain or define the groups. Data indicated that the students seemed to have no trouble in agreeing on certain…

  18. Inequities in postnatal care in low- and middle-income countries: a systematic review and meta-analysis.

    PubMed

    Langlois, Étienne V; Miszkurka, Malgorzata; Zunzunegui, Maria Victoria; Ghaffar, Abdul; Ziegler, Daniela; Karp, Igor

    2015-04-01

    To assess the socioeconomic, geographical and demographic inequities in the use of postnatal health-care services in low- and middle-income countries. We searched Medline, Embase and Cochrane Central databases and grey literature for experimental, quasi-experimental and observational studies that had been conducted in low- and middle-income countries. We summarized the relevant studies qualitatively and performed meta-analyses of the use of postnatal care services according to selected indicators of socioeconomic status and residence in an urban or rural setting. A total of 36 studies were included in the narrative synthesis and 10 of them were used for the meta-analyses. Compared with women in the lowest quintile of socioeconomic status, the pooled odds ratios for use of postnatal care by women in the second, third, fourth and fifth quintiles were: 1.14 (95% confidence interval, CI : 0.96-1.34), 1.32 (95% CI: 1.12-1.55), 1.60 (95% CI: 1.30-1.98) and 2.27 (95% CI: 1.75-2.93) respectively. Compared to women living in rural settings, the pooled odds ratio for the use of postnatal care by women living in urban settings was 1.36 (95% CI: 1.01-1.81). A qualitative assessment of the relevant published data also indicated that use of postnatal care services increased with increasing level of education. In low- and middle-income countries, use of postnatal care services remains highly inequitable and varies markedly with socioeconomic status and between urban and rural residents.

  19. Targeting the affordability of cigarettes: a new benchmark for taxation policy in low-income and-middle-income countries.

    PubMed

    Blecher, Evan

    2010-08-01

    To investigate the appropriateness of tax incidence (the percentage of the retail price occupied by taxes) benchmarking in low-income and-middle-income countries (LMICs) with rapidly growing economies and to explore the viability of an alternative tax policy rule based on the affordability of cigarettes. The paper outlines criticisms of tax incidence benchmarking, particularly in the context of LMICs. It then considers an affordability-based benchmark using relative income price (RIP) as a measure of affordability. The RIP measures the percentage of annual per capita GDP required to purchase 100 packs of cigarettes. Using South Africa as a case study of an LMIC, future consumption is simulated using both tax incidence benchmarks and affordability benchmarks. I show that a tax incidence benchmark is not an optimal policy tool in South Africa and that an affordability benchmark could be a more effective means of reducing tobacco consumption in the future. Although a tax incidence benchmark was successful in increasing prices and reducing tobacco consumption in South Africa in the past, this approach has drawbacks, particularly in the context of a rapidly growing LMIC economy. An affordability benchmark represents an appropriate alternative that would be more effective in reducing future cigarette consumption.

  20. Ethical Considerations in Conducting Research on Autism Spectrum Disorders in Low and Middle Income Countries

    ERIC Educational Resources Information Center

    Daley, Tamara C.; Singhal, Nidhi; Krishnamurthy, Vibha

    2013-01-01

    Autism spectrum disorder (ASD) is being identified in an ever-increasing number of countries, including many that are low or middle income (LMIC). Research conducted in these countries requires awareness of unique ethical issues. Drawing on the experience of two organizations that have been involved in conducting and collaborating in ASD research…

  1. 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.

    PubMed

    Lear, Scott A; Hu, Weihong; Rangarajan, Sumathy; Gasevic, Danijela; Leong, Darryl; Iqbal, Romaina; Casanova, Amparo; Swaminathan, Sumathi; Anjana, R M; Kumar, Rajesh; Rosengren, Annika; Wei, Li; Yang, Wang; Chuangshi, Wang; Huaxing, Liu; Nair, Sanjeev; Diaz, Rafael; Swidon, Hany; Gupta, Rajeev; Mohammadifard, Noushin; Lopez-Jaramillo, Patricio; Oguz, Aytekin; Zatonska, Katarzyna; Seron, Pamela; Avezum, Alvaro; Poirier, Paul; Teo, Koon; Yusuf, Salim

    2017-12-16

    per week) and high physical activity (>3000 MET × minutes or >750 minutes per week) were associated with graded 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. 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. 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. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Syphilis in Drug Users in Low and Middle Income Countries

    PubMed Central

    Coffin, Lara S.; Newberry, Ashley; Hagan, Holly; Cleland, Charles M.; Des Jarlais, Don C.; Perlman, David C.

    2009-01-01

    Background Genital ulcer disease (GUD), including syphilis, is an important cause of morbidity in low and middle income (LMI) countries and syphilis transmission is associated with HIV transmission. Methods We conducted a literature review to evaluate syphilis infection among drug users in LMI countries for the period 1995–2007. Countries were categorized using the World Bank Atlas method (The World Bank, 2007) according to 2006 gross national income per capita. Results Thirty-two studies were included (N=13,848 subjects), mostly from Southeast Asia with some from Latin America, Eastern Europe, Central and East Asia, North Africa and the Middle East but none from regions such as Sub-Saharan Africa. The median prevalence of overall lifetime syphilis (N=32 studies) was 11.1% (interquartile range: 6.3% to 15.3%) and of HIV (N=31 studies) was 1.1% (interquartile range: 0.22% to 5.50%). There was a modest relation (r=0.27) between HIV and syphilis prevalence. Median syphilis prevalence by gender was 4.0% (interquartile range: 3.4% to 6.6%) among males (N=11 studies) and 19.9% (interquartile range: 11.4% to 36.0%) among females (N=6 studies). There was a strong relation (r= 0.68) between syphilis prevalence and female gender that may be related to female sex work. Conclusion Drug users in LMI countries have a high prevalence of syphilis but data are limited and, in some regions, entirely lacking. Further data are needed, including studies targeting the risks of women. Interventions to promote safer sex, testing, counseling and education, as well as health care worker awareness, should be integrated in harm reduction programs and health care settings to prevent new syphilis infections and reduce HIV transmission among drug users and their partners in LMI countries. PMID:19361976

  3. Contribution of chronic diseases to disability in elderly people in countries with low and middle incomes: a 10/66 Dementia Research Group population-based survey

    PubMed Central

    Sousa, Renata M; Ferri, Cleusa P; Acosta, Daisy; Albanese, Emiliano; Guerra, Mariella; Huang, Yueqin; Jacob, KS; Jotheeswaran, AT; Rodriguez, Juan J Llibre; Pichardo, Guillermina Rodriguez; Rodriguez, Marina Calvo; Salas, Aquiles; Sosa, Ana Luisa; Williams, Joseph; Zuniga, Tirso; Prince, Martin

    2009-01-01

    Summary Background Disability in elderly people in countries with low and middle incomes is little studied; according to Global Burden of Disease estimates, visual impairment is the leading contributor to years lived with disability in this population. We aimed to assess the contribution of physical, mental, and cognitive chronic diseases to disability, and the extent to which sociodemographic and health characteristics account for geographical variation in disability. Methods We undertook cross-sectional surveys of residents aged older than 65 years (n=15 022) in 11 sites in seven countries with low and middle incomes (China, India, Cuba, Dominican Republic, Venezuela, Mexico, and Peru). Disability was assessed with the 12-item WHO disability assessment schedule 2.0. Dementia, depression, hypertension, and chronic obstructive pulmonary disease were ascertained by clinical assessment; diabetes, stroke, and heart disease by self-reported diagnosis; and sensory, gastrointestinal, skin, limb, and arthritic disorders by self-reported impairment. Independent contributions to disability scores were assessed by zero-inflated negative binomial regression and Poisson regression to generate population-attributable prevalence fractions (PAPF). Findings In regions other than rural India and Venezuela, dementia made the largest contribution to disability (median PAPF 25·1% [IQR 19·2–43·6]). Other substantial contributors were stroke (11·4% [1·8–21·4]), limb impairment (10·5% [5·7–33·8]), arthritis (9·9% [3·2–34·8]), depression (8·3% [0·5–23·0]), eyesight problems (6·8% [1·7–17·6]), and gastrointestinal impairments (6·5% [0·3–23·1]). Associations with chronic diseases accounted for around two-thirds of prevalent disability. When zero inflation was taken into account, between-site differences in disability scores were largely attributable to compositional differences in health and sociodemographic characteristics. Interpretation On the basis

  4. Urbanization and kidney function decline in low and middle income countries.

    PubMed

    Jagannathan, Ram; Patzer, Rachel E

    2017-08-29

    Urbanization is expected to increase in low and middle-income countries (LMICs), and might contribute to the increased disease burden. The association between urbanization and CKD is incompletely understood among LMICs. Recently, Inoue et al., explored the association of urbanization on renal function from the China Health and Nutrition Survey. The study found that individuals living in an urban environment had a higher odds of reduced renal function independent of behavioral and cardiometabolic measures, and this effect increased in a dose dependent manner. In this commentary, we discuss the results of these findings and explain the need for more surveillance studies among LMICs.

  5. Socioeconomic status and alcohol use in low- and lower-middle income countries: A systematic review.

    PubMed

    Allen, L N; Townsend, Nick; Williams, Julianne; Mikkelsen, Bente; Roberts, Nia; Wickramasinghe, Kremlin

    2017-12-27

    Harmful use of alcohol is a major cause of global morbidity and mortality. The role of alcohol as a driver of the unfolding non-communicable disease crisis has led to high-profile calls for better epidemiological data. Despite causing a disproportionate amount of harm in low-income groups, there is a critical dearth of evidence on the intra-national socioeconomic patterning of alcohol use in low- and lower-middle income countries (LLMICs). This review aims to fill the gap, providing evidence on the association between socioeconomic status (SES) and alcohol use in these low-income settings. We conducted a comprehensive literature search for primary research published between January 1, 1990 and June 30, 2015 using 13 electronic databases, including Embase and Medline. We also hand-searched references and reviewed 'gray literature' - studies that have not been published in peer-reviewed journals. We included studies from LLMICs presenting data on multiple measures of socioeconomic status and alcohol use. No age or language restrictions were applied. Due to high heterogeneity, we used a narrative approach for data synthesis. After reviewing 4242 records and 247 full-text articles, 23 studies met our inclusion criteria, reporting data on 861,295 individuals aged >10 years from 10 countries. Alcohol use was found to be more prevalent in lower socioeconomic groups in the majority of Southeast Asian studies. The association was mixed for African studies, although these tended to have smaller sample sizes and weaker methods. Studies that measured multiple domains of SES found good agreement between different indicators. Definitions of alcohol use and abuse varied widely between studies, as did socioeconomic groupings. The lack of consistency between studies and the abject lack of data from the majority of LLMICs present a major barrier to policymakers tasked with reducing alcohol-related harm in these settings. Adherence to standardized definitions, the publication of WHO

  6. Evidence-informed frameworks for cost-effective cancer care and prevention in low, middle, and high-income countries.

    PubMed

    Chalkidou, Kalipso; Marquez, Patricio; Dhillon, Preet K; Teerawattananon, Yot; Anothaisintawee, Thunyarat; Gadelha, Carlos Augusto Grabois; Sullivan, Richard

    2014-03-01

    Evidence-informed frameworks for cost-effective cancer prevention and management are essential for delivering equitable outcomes and tackling the growing burden of cancer in all resource settings. Evidence can help address the demand side pressures (ie, pressures exerted by people who need care) faced by economies with high, middle, and low incomes, particularly in the context of transitioning towards (or sustaining) universal health-care coverage. Strong systems, as opposed to technology-based solutions, can drive the development and implementation of evidence-informed frameworks for prevention and management of cancer in an equitable and affordable way. For this to succeed, different stakeholders-including national governments, global donors, the commercial sector, and service delivery institutions-must work together to address the growing burden of cancer across economies of low, middle, and high income. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. The emerging use of social media for health-related purposes in low and middle-income countries: A scoping review.

    PubMed

    Hagg, Emily; Dahinten, V Susan; Currie, Leanne M

    2018-07-01

    Social media allows for instant access to, and dissemination of, information around the globe. Access to social media in low- and middle-income countries has increased exponentially in recent years due to technological advances. Despite this growth, the use of social media in low- and middle-income countries is less well-researched than in high-income countries. To identify, explore and summarize the current state of the literature on the use of social media for health in low- and middle-income countries. A scoping review was conducted on literature available to December 2017. Six databases were searched, and grey literature was identified through the Google and Google Scholar search engines. Literature was considered for inclusion if it (1) was published in English, (2) was conducted in or in relation to a low or middle-income country, (3) reported on as least one type of social media or social media use generally for health purposes, and (4) reported on at least one aspect of human health. Content analysis was performed to identify themes. Forty articles met the inclusion criteria. Thirty-one were research articles, and nine were review/discussion/descriptive and evaluative reports. Since 2010, when the first article was published, most of the literature has focused on Asian (n = 15) and African (n = 12) countries. Twitter (n = 11) and Facebook (n = 10) were the most frequently discussed individual social media platforms. Four themes were identified: (1) use for health education and influence (sub-themes were health behaviour and health education); (2) use within infectious disease and outbreak situations; (3) use within natural disaster, terrorism, crisis and emergency response situations; and (4) producers and consumers of social media for health (sub-themes were misinformation, organizational challenges, users' expectations, and challenges of unique sub-populations). Most studies addressed more than one theme. Social media has the ability to

  8. Influencing policy change: the experience of health think tanks in low- and middle-income countries

    PubMed Central

    Bennett, Sara; Corluka, Adrijana; Doherty, Jane; Tangcharoensathien, Viroj; Patcharanarumol, Walaiporn; Jesani, Amar; Kyabaggu, Joseph; Namaganda, Grace; Hussain, A M Zakir; de-Graft Aikins, Ama

    2012-01-01

    In recent years there has been a growth in the number of independent health policy analysis institutes in low- and middle-income countries which has occurred in response to the limitation of government analytical capacity and pressures associated with democratization. This study aimed to: (i) investigate the contribution made by health policy analysis institutes in low- and middle-income countries to health policy agenda setting, formulation, implementation and monitoring and evaluation; and (ii) assess which factors, including organizational form and structure, support the role of health policy analysis institutes in low- and middle-income countries in terms of positively contributing to health policy. Six case studies of health policy analysis institutes in Bangladesh, Ghana, India, South Africa, Uganda and Vietnam were conducted including two NGOs, two university and two government-owned policy analysis institutes. Case studies drew on document review, analysis of financial information, semi-structured interviews with staff and other stakeholders, and iterative feedback of draft findings. Some of the institutes had made major contributions to policy development in their respective countries. All of the institutes were actively engaged in providing policy advice and most undertook policy-relevant research. Relatively few were engaged in conducting policy dialogues, or systematic reviews, or commissioning research. Much of the work undertaken by institutes was driven by requests from government or donors, and the primary outputs for most institutes were research reports, frequently combined with verbal briefings. Several factors were critical in supporting effective policy engagement. These included a supportive policy environment, some degree of independence in governance and financing, and strong links to policy makers that facilitate trust and influence. While the formal relationship of the institute to government was not found to be critical, units within

  9. Influencing policy change: the experience of health think tanks in low- and middle-income countries.

    PubMed

    Bennett, Sara; Corluka, Adrijana; Doherty, Jane; Tangcharoensathien, Viroj; Patcharanarumol, Walaiporn; Jesani, Amar; Kyabaggu, Joseph; Namaganda, Grace; Hussain, A M Zakir; de-Graft Aikins, Ama

    2012-05-01

    In recent years there has been a growth in the number of independent health policy analysis institutes in low- and middle-income countries which has occurred in response to the limitation of government analytical capacity and pressures associated with democratization. This study aimed to: (i) investigate the contribution made by health policy analysis institutes in low- and middle-income countries to health policy agenda setting, formulation, implementation and monitoring and evaluation; and (ii) assess which factors, including organizational form and structure, support the role of health policy analysis institutes in low- and middle-income countries in terms of positively contributing to health policy. Six case studies of health policy analysis institutes in Bangladesh, Ghana, India, South Africa, Uganda and Vietnam were conducted including two NGOs, two university and two government-owned policy analysis institutes. Case studies drew on document review, analysis of financial information, semi-structured interviews with staff and other stakeholders, and iterative feedback of draft findings. Some of the institutes had made major contributions to policy development in their respective countries. All of the institutes were actively engaged in providing policy advice and most undertook policy-relevant research. Relatively few were engaged in conducting policy dialogues, or systematic reviews, or commissioning research. Much of the work undertaken by institutes was driven by requests from government or donors, and the primary outputs for most institutes were research reports, frequently combined with verbal briefings. Several factors were critical in supporting effective policy engagement. These included a supportive policy environment, some degree of independence in governance and financing, and strong links to policy makers that facilitate trust and influence. While the formal relationship of the institute to government was not found to be critical, units within

  10. Health Disparities from Economic Burden of Diabetes in Middle-income Countries: Evidence from México

    PubMed Central

    Arredondo, Armando; Reyes, Gabriela

    2013-01-01

    The rapid growth of diabetes in middle-income countries is generating disparities in global health. In this context we conducted a study to quantify the health disparities from the economic burden of diabetes in México. Evaluative research based on a longitudinal design, using cost methodology by instrumentation. For the estimation of epidemiological changes during the 2010–2012 period, several probabilistic models were developed using the Box-Jenkins technique. The financial requirements were obtained from expected case management costs by disease and the application of an econometric adjustment factor to control the effects of inflation. Comparing the economic impact in 2010 versus 2012 (p<0.05), there was a 33% increase in financial requirements. The total amount for diabetes in 2011 (US dollars) was $7.7 billion. It includes $3.4 billion in direct costs and $4.3 in indirect costs. The total direct costs were $.4 billion to the Ministry of Health (SSA), serving the uninsured population; $1.2 to the institutions serving the insured population (Mexican Institute for Social Security–IMSS-, and Institute for Social Security and Services for State Workers-ISSSTE-); $1.8 to users; and $.1 to Private Health Insurance (PHI). If the risk factors and the different health care models remain as they currently are in the analyzed institutions, health disparities in terms of financial implications will have the greatest impact on users’ pockets. In middle-income countries, health disparities generated by the economic burden of diabetes is one of the main reasons for catastrophic health expenditure. Health disparities generated by the economic burden of diabetes suggests the need to design and review the current organization of health systems and the relevance of moving from biomedical models and curative health care to preventive and socio-medical models to meet expected challenges from diseases like diabetes in middle-income countries. PMID:23874629

  11. A Developmental Analysis of Caregiving Modalities across Infancy in 38 Low- and Middle-Income Countries

    ERIC Educational Resources Information Center

    Bornstein, Marc H.; Putnick, Diane L.; Lansford, Jennifer E.; Deater-Deckard, Kirby; Bradley, Robert H.

    2015-01-01

    Caregiving is requisite to wholesome child development from the beginning of life. A cross-sectional microgenetic analysis of six caregiving practices across the child's 1st year (0-12 months) in 42,539 families from nationally representative samples in 38 low- and middle-income countries is reported. Rates of caregiving varied tremendously within…

  12. Getting it right: Culturally safe approaches to health partnership work in low to middle income countries.

    PubMed

    Taylor, Alison

    2017-05-01

    Many health professionals become engaged in international health and education work in low to middle income countries, often as part of health partnerships. This type of work, increasingly popular in an age of global health, can present a number of challenges. Many of these involve cultural factors which are often acknowledged in the literature on overseas health work but rarely explored in depth. This paper aims to illustrate the key cultural considerations to be made by those currently engaged in or considering overseas health and education work in a low to middle income country. A comprehensive literature review methodology was used to examine data through the lens of Cultural Safety Theory and as a result provide guidance for professionals working with international colleagues. Recommendations for practice are based on the importance of gaining an understanding of the host country's history and social context and of professionals examining their own individual worldviews. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  13. Soft drink prices, sales, body mass index and diabetes: Evidence from a panel of low-, middle- and high-income countries.

    PubMed

    Goryakin, Yevgeniy; Monsivais, Pablo; Suhrcke, Marc

    2017-12-01

    We take advantage of four different cross-country datasets containing data on 78 countries for the period 1999-2014, in order to assess the relationship of carbonated soft drinks' sales, as well as their prices, with body mass index (BMI), overweight, obesity and diabetes. Using an ecological study design and multivariate regression longitudinal estimation approaches, we find that carbonated soft drink sales were significantly positively related to BMI, overweight and obesity - but only in the low and lower-middle income countries. This finding was robust to a number of sensitivity and falsification checks. In this sub-sample, an increase in per capita soft drink sales by 1 litre per year was related to an increase of BMI by about 0.009 kg/m 2 (p < 0.1).. This is a small effect, implying that halving annual consumption per capita in this group of countries would result in a drop of BMI by only about 0.03 kg/m 2 . Although soft drink prices were negatively related to weight-related outcomes in the sample of higher middle income and high income countries, this finding was not robust to falsification checks. The results thus suggest that sales restrictions to steer consumers away from soft drinks could indeed have a beneficial health effects in poorer countries, although the effect magnitude appears to be very small. However, given potential limitations of using ecological research design, results from individual level studies would be required to further ascertain the role of soft drink sales and prices in obesity and diabetes.

  14. Securing support for eye health policy in low- and middle-income countries: identifying stakeholders through a multi-level analysis.

    PubMed

    Morone, Piergiuseppe; Camacho Cuena, Eva; Kocur, Ivo; Banatvala, Nicholas

    2014-05-01

    This article empirically evaluates advocacy in low- and middle-income countries as a key tool for raising policy priority and securing high-level decision maker support in eye health. We used a unique data set based on a survey conducted by World Health Organization in 2011 on eye care and prevention of blindness in 82 low- and middle-income countries. The theoretical framework derives from the idea that a plethora of stakeholders at local and global level pressure national governments, acting in economic and the political spheres. Previously, eye care has not been investigated in such a framework. We found structural differences across countries with different income levels and proposed policy recommendations to secure high-level decision makers' support for promoting eye health. Three case studies suggest that, in order to secure more support and resources for eye health, domestic and international stakeholders must strengthen their engagement with ministries of health at political and above all economic levels.

  15. The relevance of systematic reviews on pharmaceutical policy to low- and middle-income countries.

    PubMed

    Gray, Andrew Lofts; Suleman, Fatima

    2015-10-01

    Low- and middle-income countries (LMICs) rely on available evidence when devising and implementing pharmaceutical policies. Aim of the review To provide a critical overview of systematic reviews of pharmaceutical policies, with particular focus on the relevance of such reviews in low- and middle-income countries. A search for systematic reviews (SRs) of studies of the interventions of interest was conducted until May 2009 in MEDLINE, EconLit, CINAHL, the Cochrane site, ProQuest, EMBASE, JOLIS, ISI Web of Science, International Pharmaceutical Abstracts, International Network for Rational Use of Drugs, National Technical Information Service, Public Affairs Information Service, SourceOECD, the System for Information on Grey Literature in Europe, and the WHO library database. The search was updated to July 2013, based on the yields of the initial search strategy. 20 SRs that met all inclusion criteria were retrieved in full text. Four SRs were subsequently rejected on the basis of quality considerations and the findings of 16 SRs were extracted and their applicability in LMICs considered. Of these, 5 were Cochrane Reviews. All included SRs were published in English. SRs related to registration and classification policies, marketing policies, prescribing policies, reimbursement policies, policies on price and payments, co-payments and caps and multi-component policies were retrieved. No SRs related to patent and profit policies, sales and dispensing policies, policies that regulate the provision of health insurance, or policies on patient information were retrieved. Only one of the systematic reviews retrieved utilised a study conducted in a developing country. The direct applicability of the evidence from these SRs in LMICs is limited. However, as middle-income countries move towards universal health coverage, the multi-component policies that govern reimbursement for medicines, and which impose caps on payments and co-payments by patients, may become more applicable

  16. Children's Emerging Digital Literacies: Investigating Home Computing in Low- and Middle-Income Families. CCT Reports.

    ERIC Educational Resources Information Center

    Ba, Harouna; Tally, Bill; Tsikalas, Kallen

    The EDC (Educational Development Center) Center for Children and Technology (CCT) and Computers for Youth (CFY) completed a 1-year comparative study of children's use of computers in low- and middle-income homes. The study explores the digital divide as a literacy issue, rather than merely a technical one. Digital literacy is defined as a set of…

  17. Understanding Caregivers' Attitudes towards Physical Punishment of Children: Evidence from 34 Low- and Middle-Income Countries

    ERIC Educational Resources Information Center

    Cappa, Claudia; Khan, Shane M.

    2011-01-01

    Objectives: This article presents findings on caregivers' attitudes towards physical punishment of children from 34 household surveys conducted in low- and middle-income countries in 2005 and 2006. The article analyzes the variability in attitudes by background characteristics of the respondents to examine whether various factors at the individual…

  18. Educational Quality Differences in a Middle-Income Country: The Urban-Rural Gap in Malaysian Primary Schools

    ERIC Educational Resources Information Center

    Othman, Mariam; Muijs, Daniel

    2013-01-01

    Shortcomings of educational quality in rural schools remain a key focus in the literature related to developing countries. This paper studies whether rural primary schools in Malaysia, an upper middle-income developing country, are still experiencing lower levels of educational resources, school climate, school leadership, and parental involvement…

  19. Substance use and suicidal ideation and behaviour in low- and middle-income countries: a systematic review.

    PubMed

    Breet, Elsie; Goldstone, Daniel; Bantjes, Jason

    2018-04-24

    Understanding relationships between substance use and suicidal ideation and behaviour (SIB) has important public health implications for suicide prevention in low- and middle-income countries (LMICs), where 75% of suicides occur. This systematic review explored the associations between substance use and SIB in LMICs. We searched five databases using a combination of keywords for substance use, SIB and LMICs to identify English-written quantitative studies published between January 2006 and February 2016. Data were extracted to provide an overview of what is known about the topic, highlight gaps in the literature, and explore the implications of current knowledge for suicide prevention. Studies included in the review were assessed for methodological quality using the Scottish Intercollegiate Guidelines Network checklist. Analysis of included studies (N = 108) demonstrated a consistent positive association between substance use and SIB across all substances (i.e. alcohol, tobacco, cannabis, illicit drugs, non-medical use of prescription drugs), all substance use dimensions (i.e. intoxication, use, and pathological use) and all SIB dimensions (i.e. suicidal ideation, non-fatal suicidal behaviour, and suicide). Most of the available research evidence comes from upper-middle-income countries, only 22% comes from lower-middle-income and low-income countries. Most studies focused on alcohol and tobacco, while neglecting substances such as cannabis, opioids, sedatives, stimulants, misuse of prescription medication, inhalants, and hallucinogens. Most of the studies employed a cross-sectional design, were conducted within a risk-factor paradigm, and provided little information about the potential interaction between variables. Public health suicide prevention policy and research in LMICs should take account of the fact that: substance use is a potentially modifiable risk factor; assessment and management of substance use is integral to the care of at-risk patients

  20. Income Elasticities of Educational Expenditure by Income Class: The Case of Japanese Households.

    ERIC Educational Resources Information Center

    Hashimoto, Keiji; Heath, Julia A.

    1995-01-01

    Uses data from Japanese households to calculate the income elasticities of educational expenditure, allowing elasticities to vary nonmonotonically with household income. Explores whether income elasticities for education peak in the middle-income categories and diminish for the lower and upper ends of income distribution. Income elasticities do…

  1. Comparison of medicines management strategies in insurance schemes in middle-income countries: four case studies.

    PubMed

    Kaplan, Warren A; Ashigbie, Paul G; Brooks, Mohamad I; Wirtz, Veronika J

    2017-01-01

    Many middle-income countries are scaling up health insurance schemes to provide financial protection and access to affordable medicines to poor and uninsured populations. Although there is a wealth of evidence on how high income countries with mature insurance schemes manage cost-effective use of medicines, there is limited evidence on the strategies used in middle-income countries. This paper compares the medicines management strategies that four insurance schemes in middle-income countries use to improve access and cost-effective use of medicines among beneficiaries. We compare key strategies promoting cost-effective medicines use in the New Rural Cooperative Medical Scheme (NCMS) in China, National Health Insurance Scheme in Ghana, Jamkesmas in Indonesia and Seguro Popular in Mexico. Through the peer-reviewed and grey literature as of late 2013, we identified strategies that met our inclusion criteria as well as any evidence showing if, and/or how, these strategies affected medicines management. Stakeholders involved and affected by medicines coverage policies in these insurance schemes were asked to provide relevant documents describing the medicines related aspects of these insurance programs. We also asked them specifically to identify publications discussing the unintended consequences of the strategies implemented. Use of formularies, bulk procurement, standard treatment guidelines and separation of prescribing and dispensing were present in all four schemes. Also, increased transparency through publication of tender agreements and procurement prices was introduced in all four. Common strategies shared by three out of four schemes were medicine price negotiation or rebates, generic reference pricing, fixed salaries for prescribers, accredited preferred provider network, disease management programs, and monitoring of medicines purchases. Cost-sharing and payment for performance was rarely used. There was a lack of performance monitoring strategies in all

  2. Are State-Sponsored New Radiation Therapy Facilities Economically Viable in Low- and Middle-Income Countries?

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Datta, Niloy R., E-mail: nrdatta@yahoo.com; Samiei, Massoud; Bodis, Stephan

    Purpose: The economic viability of establishing a state-funded radiation therapy (RT) infrastructure in low- and middle-income countries (LMICs) in accordance with the World Bank definition has been assessed through computation of a return on investment (ROI). Methods and Materials: Of the 139 LMICs, 100 were evaluated according to their RT facilities, gross national income (GNI) per capita, and employment/population ratio. The assumption was an investment of US$5 million for a basic RT center able to treat 1000 patients annually. The national breakeven points and percentage of ROI (%ROI) were calculated according to the GNI per capita and patient survival ratesmore » of 10% to 50% at 2 years. It was assumed that 50% of these patients would be of working age and that, if employed and able to work after treatment, they would contribute to the country's GNI for at least 2 years. The cumulative GNI after attaining the breakeven point until the end of the 15-year lifespan of the teletherapy unit was calculated to estimate the %ROI. The recurring and overhead costs were assumed to vary from 5.5% to 15% of the capital investment. Results: The %ROI was dependent on the GNI per capita, employment/population ratio and 2-year patient survival (all P<.001). Accordingly, none of the low-income countries would attain an ROI. If 50% of the patients survived for 2 years, the %ROI in the lower-middle and upper-middle income countries could range from 0% to 159.9% and 11.2% to 844.7%, respectively. Patient user fees to offset recurring and overhead costs could vary from “nil” to US$750, depending on state subsidies. Conclusions: Countries with a greater GNI per capita, higher employment/population ratio, and better survival could achieve a faster breakeven point, resulting in a higher %ROI. Additional factors such as user fees have also been considered. These can be tailored to the patient's ability to pay to cover the recurring costs. Certain pragmatic steps that could be

  3. Oral health behaviour and social and health factors in university students from 26 low, middle and high income countries.

    PubMed

    Peltzer, Karl; Pengpid, Supa

    2014-11-26

    Poor oral health is still a major burden for populations throughout the world, particularly in developing countries. The aim of this study was investigate oral health behaviour (tooth brushing and dental attendance) and associated factors in low, middle and high income countries. Using anonymous questionnaires, data were collected from 19,560 undergraduate university students (mean age 20.8, SD = 2.8) from 27 universities in 26 countries across Asia, Africa and the Americas. Results indicate that 67.2% of students reported to brush their teeth twice or more times a day, 28.8% about once a day and 4.0% never. Regarding dental check-up visit, 16.3% reported twice a year, 25.6% once a year, 33.9% rarely and 24.3% never. In a multivariate logistic regression analysis, being a male, coming from a wealthy or quite well off family background, living in low income or lower middle income, weak beliefs in the importance of regular tooth brushing, depression and PTSD symptoms, tobacco use and frequent gambling, low physical activity, and low daily meal and snacks frequency were associated with inadequate tooth brushing (income or lower middle income, weak beliefs in the importance of regular tooth brushing, PTSD symptoms, illicit drug use, low physical activity, and low daily snacks frequency, skipping breakfast and inadequate fruit and vegetables consumption were associated with less than one annual dental care visit. Oral health behaviour among the students was found to be low. Various risk factors identified can be used to guide interventions to improve oral health behaviour among university students.

  4. Oral Health Behaviour and Social and Health Factors in University Students from 26 Low, Middle and High Income Countries

    PubMed Central

    Peltzer, Karl; Pengpid, Supa

    2014-01-01

    Poor oral health is still a major burden for populations throughout the world, particularly in developing countries. The aim of this study was investigate oral health behaviour (tooth brushing and dental attendance) and associated factors in low, middle and high income countries. Using anonymous questionnaires, data were collected from 19,560 undergraduate university students (mean age 20.8, SD = 2.8) from 27 universities in 26 countries across Asia, Africa and the Americas. Results indicate that 67.2% of students reported to brush their teeth twice or more times a day, 28.8% about once a day and 4.0% never. Regarding dental check-up visit, 16.3% reported twice a year, 25.6% once a year, 33.9% rarely and 24.3% never. In a multivariate logistic regression analysis, being a male, coming from a wealthy or quite well off family background, living in low income or lower middle income, weak beliefs in the importance of regular tooth brushing, depression and PTSD symptoms, tobacco use and frequent gambling, low physical activity, and low daily meal and snacks frequency were associated with inadequate tooth brushing (income or lower middle income, weak beliefs in the importance of regular tooth brushing, PTSD symptoms, illicit drug use, low physical activity, and low daily snacks frequency, skipping breakfast and inadequate fruit and vegetables consumption were associated with less than one annual dental care visit. Oral health behaviour among the students was found to be low. Various risk factors identified can be used to guide interventions to improve oral health behaviour among university students. PMID:25431876

  5. Etiology of Severe Febrile Illness in Low- and Middle-Income Countries: A Systematic Review

    PubMed Central

    Prasad, Namrata; Murdoch, David R.; Reyburn, Hugh; Crump, John A.

    2015-01-01

    Background With apparent declines in malaria worldwide during the last decade and more widespread use of malaria rapid diagnostic tests, healthcare workers in low-resource areas face a growing proportion of febrile patients without malaria. We sought to describe current knowledge and identify information gaps of the etiology severe febrile illness in low-and middle-income countries. Methods and Findings We conducted a systematic review of studies conducted in low-and-middle income countries 1980–2013 that prospectively assessed consecutive febrile patients admitted to hospital using rigorous laboratory-based case definitions. We found 45 eligible studies describing 54,578 patients; 9,771 (17.9%) had a positive result for ≥1 pathogen meeting diagnostic criteria. There were no eligible studies identified from Southern and Middle Africa, Eastern Asia, Oceania, Latin American and Caribbean regions, and the European region. The median (range) number of diagnostic tests meeting our confirmed laboratory case definitions was 2 (1 to 11) per study. Of diagnostic tests, 5,052 (10.3%) of 49,143 had confirmed bacterial or fungal bloodstream infection; 709 (3.8%) of 18,142 had bacterial zoonosis; 3,488 (28.5%) of 12,245 had malaria; and 1,804 (17.4%) of 10,389 had a viral infection. Conclusions We demonstrate a wide range of pathogens associated with severe febrile illness and highlight the substantial information gaps regarding the geographic distribution and role of common pathogens. High quality severe febrile illness etiology research that is comprehensive with respect to pathogens and geographically representative is needed. PMID:26126200

  6. Smokers' responses to television advertisements about the serious harms of tobacco use: pre-testing results from 10 low- to middle-income countries.

    PubMed

    Wakefield, Melanie; Bayly, Megan; Durkin, Sarah; Cotter, Trish; Mullin, Sandra; Warne, Charles

    2013-01-01

    While television advertisements (ads) that communicate the serious harms of smoking are effective in prompting quitting-related thoughts and actions, little research has been conducted among smokers in low- to middle-income countries to guide public education efforts. 2399 smokers aged 18-34 years in 10 low- to middle-income countries (Bangladesh, China, Egypt, India, Indonesia, Mexico, Philippines, Russia, Turkey and Vietnam) viewed and individually rated the same five anti-smoking ads on a standard questionnaire and then engaged in a structured group discussion about each ad. Multivariate logistic regression analysis, with robust SEs to account for the same individual rating multiple ads, was performed to compare outcomes (message acceptance, perceived personalised effectiveness, feel uncomfortable, likelihood of discussing the ad) across ads and countries, adjusting for covariates. Ads by country interactions were examined to assess consistency of ratings across countries. Three ads with graphic imagery performed consistently highly across all countries. Two of these ads showed diseased human tissue or body parts, and a third used a disgust-provoking metaphor to demonstrate tar accumulation in smokers' lungs. A personal testimonial ad performed more variably, as many smokers did not appreciate that the featured woman's lung cancer was due to smoking or that her altered physical appearance was due to chemotherapy. An ad using a visual metaphor for lung disease was also more variable, mostly due to lack of understanding of the term 'emphysema'. Television ads that graphically communicate the serious harms of tobacco use are likely to be effective with smokers in low- to middle-income countries and can be readily translated and adapted for local use. Ads with complex medical terms or metaphors, or those that feature personal testimonials, are more variable and at least require more careful pre-testing and adaptation to maximise their potential.

  7. Convergence of prevalence rates of diabetes and cardiometabolic risk factors in middle and low income groups in urban India: 10-year follow-up of the Chennai Urban Population Study.

    PubMed

    Deepa, Mohan; Anjana, Ranjit Mohan; Manjula, Datta; Narayan, K M Venkat; Mohan, Viswanathan

    2011-07-01

    The aim of this study was to look for temporal changes in the prevalence of diabetes and cardiometabolic risk factors in two residential colonies in Chennai. Chennai Urban Population Study (CUPS) was carried out between 1996-1998 in Chennai in two residential colonies representing the middle income group (MIG) and lower income group (LIG), respectively. The MIG had twice the prevalence rate of diabetes as the LIG and higher prevalence rates of hypertension, obesity, and dyslipidemia. They were motivated to increase their physical activity, which led to the building of a park. The LIG was given standard lifestyle advice. Follow-up surveys of both colonies were performed after a period of 10 years. In the MIG, the prevalence of diabetes increased from 12.4 to 15.4% (24% increase), while in the LIG, it increased from 6.5 to 15.3% (135% increase, p < .001). In the LIG, the prevalence rates of central obesity (baseline vs follow-up, male: 30.8 vs 50.9%, p < .001; female: 16.9 vs 49.8%, p < .001), hypertension (8.4 vs 20.1%, p < .001), hypercholesterolemia (14.2 vs. 20.4%, p < .05), and hypertriglyceridemia (8.0 vs 23.5%, p < .001) significantly increased and became similar to that seen in the MIG. There is a rapid reversal of socioeconomic gradient for diabetes and cardiometabolic risk factors in urban India with a convergence of prevalence rates among people in the MIG and LIG. This could have a serious economic impact on poor people in developing countries such as India. © 2011 Diabetes Technology Society.

  8. A Brief Assessment of Learning for Orphaned and Abandoned Children in Low and Middle Income Countries

    PubMed Central

    O’Donnell, Karen; Murphy, Robert; Ostermann, Jan; Masnick, Max; Whetten, Rachel A.; Madden, Elisabeth; Thielman, Nathan M.; Whetten, Kathryn

    2013-01-01

    Assessment of children’s learning and performance in low and middle income countries has been critiqued as lacking a gold standard, an appropriate norm reference group, and demonstrated applicability of assessment tasks to the context. This study was designed to examine the performance of three nonverbal and one adapted verbal measure of children’s problem solving, memory, motivation, and attention across five culturally diverse sites. The goal was to evaluate the tests as indicators of individual differences affected by life events and care circumstances for vulnerable children. We conclude that the measures can be successfully employed with fidelity in non-standard settings in LMICs, and are associated with child age and educational experience across the settings. The tests can be useful in evaluating variability in vulnerable child outcomes. PMID:21538088

  9. Influences on Middle-Income, First-Generation Prospective College Students: Perspectives of College-Bound High School Seniors

    ERIC Educational Resources Information Center

    Dillon, Mary A.

    2010-01-01

    The purpose of this study was to explore the ways in which prospective first-generation students from middle-income families make decisions about attending college. I sought to discover the following: (1) what influenced students' decisions, and how the students felt about these influences; (2) how students interpreted the importance of going to…

  10. Education and risk for acute myocardial infarction in 52 high, middle and low-income countries: INTERHEART case-control study.

    PubMed

    Rosengren, A; Subramanian, S V; Islam, S; Chow, C K; Avezum, A; Kazmi, K; Sliwa, K; Zubaid, M; Rangarajan, S; Yusuf, S

    2009-12-01

    To determine the effect of education and other measures of socioeconomic status (SES) on risk of acute myocardial infarction (AMI) in patients and controls from countries with diverse economic circumstances (high, middle, and low income countries). Case-control study. 52 countries from all inhabited regions of the world. 12242 cases and 14622 controls. First non-fatal AMI. SES was measured using education, family income, possessions in the household and occupation. Low levels of education (< or =8 years) were more common in cases compared to controls (45.0% and 38.1%; p<0.0001). The odds ratio (OR) for low education adjusted for age, sex and region was 1.56 (95% confidence interval 1.47 to 1.66). After further adjustment for psychosocial, lifestyle, other factors and mutually for other socioeconomic factors, the OR associated with education < or =8 years was 1.31 (1.20 to 1.44) (p<0.0001). Modifiable lifestyle factors (smoking, exercise, consumption of vegetables and fruits, alcohol and abdominal obesity) explained about half of the socioeconomic gradient. Family income, numbers of possessions and non-professional occupation were only weakly or not at all independently related to AMI. In high-income countries (World Bank Classification), the risk factor adjusted OR associated with low education was 1.61 (1.33 to 1.94), whereas it was substantially lower in low-income and middle-income countries: 1.25 (1.14 to 1.37) (p for interaction 0.045). Of the SES measures we studied, low education was the marker most consistently associated with increased risk for AMI globally, most markedly in high-income countries.

  11. Determinants of government HIV/AIDS financing: a 10-year trend analysis from 125 low- and middle-income countries.

    PubMed

    Ávila, Carlos; Loncar, Dejan; Amico, Peter; De Lay, Paul

    2013-07-19

    Trends and predictors of domestic spending from public sources provide national authorities and international donors with a better understanding of the HIV financing architecture, the fulfillment of governments' commitments and potential for long-term sustainability. We analyzed government financing of HIV using evidence from country reports on domestic spending. Panel data from 2000 to 2010 included information from 647 country-years amongst 125 countries. A random-effects model was used to analyze ten year trends and identify independent predictors of public HIV spending. Low- and middle-income countries spent US$ 2.1 billion from government sources in 2000, growing to US$ 6.6 billion in 2010, a three-fold increase. Per capita spending in 2010 ranged from 5 cents in low-level HIV epidemics in the Middle East to US$ 32 in upper-middle income countries with generalized HIV epidemics in Southern Africa. The average domestic public spending per capita was US$ 2.55. The analysis found that GDP per capita and HIV prevalence are positively associated with increasing levels of HIV-spending from public sources; a 10 percent increase in HIV prevalence is associated with a 2.5 percent increase in domestic funding for HIV. Additionally, a 10 percent increase in GDP per capita is associated with an 11.49 percent increase in public spending for HIV and these associations were highly significant. Domestic resources in low- and middle-income countries showed a threefold increase between 2000 and 2010 and currently support 50 percent of the global response with 41 percent coming from sub-Saharan Africa. Domestic spending in LMICs was associated with increased economic growth and an increased burden of HIV. Sustained increases in funding for HIV from public sources were observed in all regions and emphasize the increasing importance of government financing.

  12. The economic consequences of neurosurgical disease in low- and middle-income countries.

    PubMed

    Rudolfson, Niclas; Dewan, Michael C; Park, Kee B; Shrime, Mark G; Meara, John G; Alkire, Blake C

    2018-05-18

    OBJECTIVE The objective of this study was to estimate the economic consequences of neurosurgical disease in low- and middle-income countries (LMICs). METHODS The authors estimated gross domestic product (GDP) losses and the broader welfare losses attributable to 5 neurosurgical disease categories in LMICs using two distinct economic models. The value of lost output (VLO) model projects annual GDP losses due to neurosurgical disease during 2015-2030, and is based on the WHO's "Projecting the Economic Cost of Ill-health" tool. The value of lost economic welfare (VLW) model estimates total welfare losses, which is based on the value of a statistical life and includes nonmarket losses such as the inherent value placed on good health, resulting from neurosurgical disease in 2015 alone. RESULTS The VLO model estimates the selected neurosurgical diseases will result in $4.4 trillion (2013 US dollars, purchasing power parity) in GDP losses during 2015-2030 in the 90 included LMICs. Economic losses are projected to disproportionately affect low- and lower-middle-income countries, risking up to a 0.6% and 0.54% loss of GDP, respectively, in 2030. The VLW model evaluated 127 LMICs, and estimates that these countries experienced $3 trillion (2013 US dollars, purchasing power parity) in economic welfare losses in 2015. Regardless of the model used, the majority of the losses can be attributed to stroke and traumatic brain injury. CONCLUSIONS The economic impact of neurosurgical diseases in LMICs is significant. The magnitude of economic losses due to neurosurgical diseases in LMICs provides further motivation beyond already compelling humanitarian reasons for action.

  13. Financing universal health coverage--effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries.

    PubMed

    Reeves, Aaron; Gourtsoyannis, Yannis; Basu, Sanjay; McCoy, David; McKee, Martin; Stuckler, David

    2015-07-18

    How to finance progress towards universal health coverage in low-income and middle-income countries is a subject of intense debate. We investigated how alternative tax systems affect the breadth, depth, and height of health system coverage. We used cross-national longitudinal fixed effects models to assess the relationships between total and different types of tax revenue, health system coverage, and associated child and maternal health outcomes in 89 low-income and middle-income countries from 1995-2011. Tax revenue was a major statistical determinant of progress towards universal health coverage. Each US$100 per capita per year of additional tax revenues corresponded to a yearly increase in government health spending of $9.86 (95% CI 3.92-15.8), adjusted for GDP per capita. This association was strong for taxes on capital gains, profits, and income ($16.7, 9.16 to 24.3), but not for consumption taxes on goods and services (-$4.37, -12.9 to 4.11). In countries with low tax revenues (<$1000 per capita per year), an additional $100 tax revenue per year substantially increased the proportion of births with a skilled attendant present by 6.74 percentage points (95% CI 0.87-12.6) and the extent of financial coverage by 11.4 percentage points (5.51-17.2). Consumption taxes, a more regressive form of taxation that might reduce the ability of the poor to afford essential goods, were associated with increased rates of post-neonatal mortality, infant mortality, and under-5 mortality rates. We did not detect these adverse associations with taxes on capital gains, profits, and income, which tend to be more progressive. Increasing domestic tax revenues is integral to achieving universal health coverage, particularly in countries with low tax bases. Pro-poor taxes on profits and capital gains seem to support expanding health coverage without the adverse associations with health outcomes observed for higher consumption taxes. Progressive tax policies within a pro-poor framework

  14. Developing capacity-building activities for mental health system strengthening in low- and middle-income countries for service users and caregivers, service planners, and researchers.

    PubMed

    Semrau, M; Alem, A; Abdulmalik, J; Docrat, S; Evans-Lacko, S; Gureje, O; Kigozi, F; Lempp, H; Lund, C; Petersen, I; Shidhaye, R; Thornicroft, G; Hanlon, C

    2018-02-01

    There is increasing international recognition of the need to build capacity to strengthen mental health systems. This is a fundamental goal of the 'Emerging mental health systems in low- and middle-income countries' (Emerald) programme, which is being implemented in six low- and middle-income countries (LMICs) (Ethiopia, India, Nepal, Nigeria, South Africa, Uganda). This paper discusses Emerald's capacity-building approaches and outputs for three target groups in mental health system strengthening: (1) mental health service users and caregivers, (2) service planners and policy-makers, and (3) mental health researchers. When planning the capacity-building activities, the approach taken included a capabilities/skills matrix, needs assessments, a situational analysis, systematic reviews, qualitative interviews and stakeholder meetings, as well as the application of previous theory, evidence and experience. Each of the Emerald LMIC partners was found to have strengths in aspects of mental health system strengthening, which were complementary across the consortium. Furthermore, despite similarities across the countries, capacity-building interventions needed to be tailored to suit the specific needs of individual countries. The capacity-building outputs include three publicly and freely available short courses/workshops in mental health system strengthening for each of the target groups, 27 Masters-level modules (also open access), nine Emerald-linked PhD students, two MSc studentships, mentoring of post-doctoral/mid-level researchers, and ongoing collaboration and dialogue with the three groups. The approach taken by Emerald can provide a potential model for the development of capacity-building activities across the three target groups in LMICs.

  15. Perceptions and impact of plain packaging of tobacco products in low and middle income countries, middle to upper income countries and low-income settings in high-income countries: a systematic review of the literature.

    PubMed

    Hughes, Nicole; Arora, Monika; Grills, Nathan

    2016-03-21

    To review the current literature around the potential impact, effectiveness and perceptions of plain packaging in low income settings. A systematic review of the literature. 9 databases (PubMed, Global Health, Social Policy and Practice, Applied Social Sciences Index and Abstracts (ASSIA), CINAHL, PsycINFO, British Library for Development Studies (BLDS), Global Health Library and Scopus) were searched. The terms used for searching combined terms for smoking and tobacco use with terms for plain packaging. Studies investigating the impact of plain packaging on the determinants of tobacco use, such as smoking behaviour, appeal, prominence, effectiveness of health warnings, response to plain packs, attitudes towards quitting or likelihood of smoking in low-income settings, were identified. Studies must have been published in English and be original research of any level of rigour. Two independent reviewers assessed studies for inclusion and extracted data. The results were synthesised qualitatively, with themes grouped under four key headings: appeal and attractiveness; salience of health warnings and perceptions of harm; enjoyment and perceived taste ratings; and perceptions of the impact on tobacco usage behaviour. This review has identified four articles that met the inclusion criteria. Studies identified that tobacco products in plain packaging had less appeal than in branded packaging in low-income settings. This review indicates that plain packaging appears to be successful in reducing appeal of smoking and packets, and supports the call for plain packaging to be widely implemented in conjunction with other tobacco control policies. However, there are considerable gaps in the amount of research conducted outside high-income countries. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  16. Physical inactivity and associated factors among university students in 23 low-, middle- and high-income countries.

    PubMed

    Pengpid, Supa; Peltzer, Karl; Kassean, Hemant Kumar; Tsala Tsala, Jacques Philippe; Sychareun, Vanphanom; Müller-Riemenschneider, Falk

    2015-07-01

    The aim of this study was to determine estimates of the prevalence and social correlates of physical inactivity among university students in 23 low-, middle- and high-income countries. The International Physical Activity Questionnaire was used to collect data from 17,928 undergraduate university students (mean age 20.8, SD = 2.8) from 24 universities in 23 countries. The prevalence of physical inactivity was 41.4 %, ranging from 21.9 % in Kyrgyzstan to 80.6 % in Pakistan. In multivariate logistic regression, older age (22-30 years), studying in a low- or lower middle-income country, skipping breakfast and lack of social support were associated with physical inactivity. In men, being underweight, being overweight or obese, not avoiding fat and cholesterol, not having severe depression symptoms, low beliefs in the health benefits of physical activity, low personal control and knowledge of exercise-heart link, and in women, not trying to eat fibre, low personal mastery and medium personal control were additionally associated with physical inactivity. Four in each ten students are physically inactive, calling for strategic interventions by relevant professionals in higher educational institutions.

  17. Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda.

    PubMed

    Niessen, Louis W; Mohan, Diwakar; Akuoku, Jonathan K; Mirelman, Andrew J; Ahmed, Sayem; Koehlmoos, Tracey P; Trujillo, Antonio; Khan, Jahangir; Peters, David H

    2018-05-19

    Five Sustainable Development Goals (SDGs) set targets that relate to the reduction of health inequalities nationally and worldwide. These targets are poverty reduction, health and wellbeing for all, equitable education, gender equality, and reduction of inequalities within and between countries. The interaction between inequalities and health is complex: better economic and educational outcomes for households enhance health, low socioeconomic status leads to chronic ill health, and non-communicable diseases (NCDs) reduce income status of households. NCDs account for most causes of early death and disability worldwide, so it is alarming that strong scientific evidence suggests an increase in the clustering of non-communicable conditions with low socioeconomic status in low-income and middle-income countries since 2000, as previously seen in high-income settings. These conditions include tobacco use, obesity, hypertension, cancer, and diabetes. Strong evidence from 283 studies overwhelmingly supports a positive association between low-income, low socioeconomic status, or low educational status and NCDs. The associations have been differentiated by sex in only four studies. Health is a key driver in the SDGs, and reduction of health inequalities and NCDs should become key in the promotion of the overall SDG agenda. A sustained reduction of general inequalities in income status, education, and gender within and between countries would enhance worldwide equality in health. To end poverty through elimination of its causes, NCD programmes should be included in the development agenda. National programmes should mitigate social and health shocks to protect the poor from events that worsen their frail socioeconomic condition and health status. Programmes related to universal health coverage of NCDs should specifically target susceptible populations, such as elderly people, who are most at risk. Growing inequalities in access to resources for prevention and treatment need to

  18. Evaluating capacity-building for mental health system strengthening in low- and middle-income countries for service users and caregivers, service planners and researchers.

    PubMed

    Hanlon, C; Semrau, M; Alem, A; Abayneh, S; Abdulmalik, J; Docrat, S; Evans-Lacko, S; Gureje, O; Jordans, M; Lempp, H; Mugisha, J; Petersen, I; Shidhaye, R; Thornicroft, G

    2018-02-01

    Efforts to support the scale-up of integrated mental health care in low- and middle-income countries (LMICs) need to focus on building human resource capacity in health system strengthening, as well as in the direct provision of mental health care. In a companion editorial, we describe a range of capacity-building activities that are being implemented by a multi-country research consortium (Emerald: Emerging mental health systems in low- and middle-income countries) for (1) service users and caregivers, (2) service planners and policy-makers and (3) researchers in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda). In this paper, we focus on the methodology being used to evaluate the impact of capacity-building in these three target groups. We first review the evidence base for approaches to evaluation of capacity-building, highlighting the gaps in this area. We then describe the adaptation of best practice for the Emerald capacity-building evaluation. The resulting mixed method evaluation framework was tailored to each target group and to each country context. We identified a need to expand the evidence base on indicators of successful capacity-building across the different target groups. To address this, we developed an evaluation plan to measure the adequacy and usefulness of quantitative capacity-building indicators when compared with qualitative evaluation. We argue that evaluation needs to be an integral part of capacity-building activities and that expertise needs to be built in methods of evaluation. The Emerald evaluation provides a potential model for capacity-building evaluation across key stakeholder groups and promises to extend understanding of useful indicators of success.

  19. Challenges in the management of breast cancer in low- and middle-income countries.

    PubMed

    Yip, Cheng-Har; Taib, Nur Aishah

    2012-12-01

    The incidence of breast cancer is rising in low- and middle-income countries (LMICs) due to 'westernization' of risk factors for developing breast cancer. However, survival remains low because of barriers in early detection and optimal access to treatment, which are the two main determinants of breast cancer outcome. A multidisciplinary approach to treatment gives the best results. An accurate diagnosis is dependent on a reliable pathology service, which will provide an adequate pathology report with prognostic and predictor information to allow optimal oncological treatment. Stratification of clinical practice guidelines based on resource level will ensure that women will have access to treatment even in a low-resource setting. Advocacy and civil society play a role in galvanizing the political will required to meet the challenge of providing opportunities for breast cancer control in LMICs. Collaboration between high-income countries and LMICs could be a strategy in facing these challenges.

  20. Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review.

    PubMed

    Allen, Luke; Williams, Julianne; Townsend, Nick; Mikkelsen, Bente; Roberts, Nia; Foster, Charlie; Wickramasinghe, Kremlin

    2017-03-01

    Non-communicable diseases are the leading global cause of death and disproportionately afflict those living in low-income and lower-middle-income countries (LLMICs). The association between socioeconomic status and non-communicable disease behavioural risk factors is well established in high-income countries, but it is not clear how behavioural risk factors are distributed within LLMICs. We aimed to systematically review evidence on the association between socioeconomic status and harmful use of alcohol, tobacco use, unhealthy diets, and physical inactivity within LLMICs. We searched 13 electronic databases, including Embase and MEDLINE, grey literature, and reference lists for primary research published between Jan 1, 1990, and June 30, 2015. We included studies from LLMICs presenting data on multiple measures of socioeconomic status and tobacco use, alcohol use, diet, and physical activity. No age or language restrictions were applied. We excluded studies that did not allow comparison between more or less advantaged groups. We used a piloted version of the Cochrane Effective Practice and Organisation of Care Group data collection checklist to extract relevant data at the household and individual level from the included full text studies including study type, methods, outcomes, and results. Due to high heterogeneity, we used a narrative approach for data synthesis. We used descriptive statistics to assess whether the prevalence of each risk factor varied significantly between members of different socioeconomic groups. The study protocol is registered with PROSPERO, number CRD42015026604. After reviewing 4242 records, 75 studies met our inclusion criteria, representing 2 135 314 individuals older than 10 years from 39 LLMICs. Low socioeconomic groups were found to have a significantly higher prevalence of tobacco and alcohol use than did high socioeconomic groups. These groups also consumed less fruit, vegetables, fish, and fibre than those of high

  1. Nothing Succeeds Like Success? Equity, Student Outcomes, and Opportunity to Learn in High- and Middle-Income Countries

    ERIC Educational Resources Information Center

    Santibañez, Lucrecia; Fagioli, Loris

    2016-01-01

    A strong relationship between article background and educational outcomes fuels a negative inequality cycle. This paper explores the interplay between student socioeconomic status and educational outcomes, and the mediating role of Opportunity-to-Learn (OTL) in high- and middle-income countries. Using data from PISA 2012, we find that the…

  2. Doing away with Debt: Using Existing Resources to Ensure College Affordability for Low and Middle-Income Families

    ERIC Educational Resources Information Center

    Dannenberg, Michael; Voight, Mamie

    2013-01-01

    America's college financial-aid system has helped millions of students obtain a postsecondary education, but the system's flaws are increasingly apparent. Growth in tuition and fees outpace available resources, particularly for students striving to rise out of poverty. Low- and middle-income students confront frightening levels of education debt.…

  3. Low and Middle Income Mothers' Regulation of Negative Emotion: Effects of Children's Temperament and Situational Emotional Responses

    ERIC Educational Resources Information Center

    Martini, Tanya S.; Root, Carol A.; Jenkins, Jennifer M.

    2004-01-01

    The present study investigated the effects of situational (child situational emotions) and dispositional (child temperament) child variables on mothers' regulation of their own hostile (anger) and nonhostile (sadness and anxiety) emotions. Participants included 94 low and middle income mothers and their children (41 girls; 53 boys) aged 3 to 6…

  4. Differential Contributions of Three Parenting Dimensions to Preschool Literacy and Social Skills in a Middle-Income Sample

    ERIC Educational Resources Information Center

    Hindman, Annemarie H.; Morrison, Frederick J.

    2012-01-01

    This study investigated parenting practices among families of preschoolers in a middle-income community, as well as the contributions of these practices to children's literacy and learning-related social skills. A total of 229 families of preschoolers were recruited. Parents completed a survey describing their parenting practices, while children's…

  5. Relationship between gross domestic product and duration of untreated psychosis in low- and middle-income countries.

    PubMed

    Large, Matthew; Farooq, Saeed; Nielssen, Olav; Slade, Tim

    2008-10-01

    The duration of untreated psychosis (DUP), the period between the first onset of psychotic symptoms and treatment, has an important influence on the outcome of schizophrenia. To compare the published studies of DUP in low- and middle-income (LAMI) countries with the DUP of high-income countries, and examine a possible association between DUP and per capita income. We used six search strategies to locate studies of the DUP from LAMI countries published between January 1975 and January 2008. We then examined the relationship between DUP and measures of economic activity, which was assessed using the LAMI classification of countries and gross domestic product (GDP) purchasing power parity. The average mean DUP in studies from LAMI countries was 125.0 weeks compared with 63.4 weeks in studies from high-income countries (P=0.012). Within the studies from LAMI countries, mean DUP fell by 6 weeks for every $1000 of GDP purchasing power parity. There appears to be an inverse relationship between income and DUP in LAMI countries. The cost of treatment is an impediment to care and subsidised antipsychotic medication would improve the access to treatment and the outcome of psychotic illness in LAMI countries.

  6. Food (In)Security in Rapidly Urbanising, Low-Income Contexts.

    PubMed

    Tacoli, Cecilia

    2017-12-11

    Urbanisation in low and middle-income nations presents both opportunities and immense challenges. As urban centres grow rapidly, inadequate housing and the lack of basic infrastructure and services affect a large and growing proportion of their population. There is also a growing body of evidence on urban poverty and its links with environmental hazards. There is, however, limited knowledge of how these challenges affect the ways in which poor urban residents gain access to food and secure healthy and nutritious diets. With some important exceptions, current discussions on food security continue to focus on production, with limited attention to consumption. Moreover, urban consumers are typically treated as a homogenous group and access to food markets is assumed to be sufficient. This paper describes how, for the urban poor in low and middle-income countries, food affordability and utilisation are shaped by the income and non-income dimensions of poverty that include the urban space.

  7. Food (In)Security in Rapidly Urbanising, Low-Income Contexts

    PubMed Central

    2017-01-01

    Urbanisation in low and middle-income nations presents both opportunities and immense challenges. As urban centres grow rapidly, inadequate housing and the lack of basic infrastructure and services affect a large and growing proportion of their population. There is also a growing body of evidence on urban poverty and its links with environmental hazards. There is, however, limited knowledge of how these challenges affect the ways in which poor urban residents gain access to food and secure healthy and nutritious diets. With some important exceptions, current discussions on food security continue to focus on production, with limited attention to consumption. Moreover, urban consumers are typically treated as a homogenous group and access to food markets is assumed to be sufficient. This paper describes how, for the urban poor in low and middle-income countries, food affordability and utilisation are shaped by the income and non-income dimensions of poverty that include the urban space. PMID:29232936

  8. The Road Traffic Injuries Research Network: a decade of research capacity strengthening in low- and middle-income countries.

    PubMed

    Hyder, Adnan A; Norton, Robyn; Pérez-Núñez, Ricardo; Mojarro-Iñiguez, Francisco R; Peden, Margie; Kobusingye, Olive

    2016-02-27

    Road traffic crashes have been an increasing threat to the wellbeing of road users worldwide; an unacceptably high number of people die or become disabled from them. While high-income countries have successfully implemented effective interventions to help reduce the burden of road traffic injuries (RTIs) in their countries, low- and middle-income countries (LMICs) have not yet achieved similar results. Both scientific research and capacity development have proven to be useful for preventing RTIs in high-income countries. In 1999, a group of leading researchers from different countries decided to join efforts to help promote research on RTIs and develop the capacity of professionals from LMICs. This translated into the creation of the Road Traffic Injuries Research Network (RTIRN) - a partnership of over 1,100 road safety professionals from 114 countries collaborating to facilitate reductions in the burden of RTIs in LMICs by identifying and promoting effective, evidenced-based interventions and supporting research capacity building in road safety research in LMICs. This article presents the work that RTIRN has done over more than a decade, including production of a dozen scientific papers, support of nearly 100 researchers, training of nearly 1,000 people and 35 scholarships granted to researchers from LMICs to attend world conferences, as well as lessons learnt and future challenges to maximize its work.

  9. Financing pediatric surgery in low-, and middle-income countries.

    PubMed

    Hsiung, Grace; Abdullah, Fizan

    2016-02-01

    Congenital anomalies once considered fatal, are now surgically correctable conditions that now allow children to live a normal life. Pediatric surgery, traditionally thought of as a privilege of the rich, as being too expensive and impractical, and which has previously been overlooked and excluded in resource-poor settings, is now being reexamined as a cost-effective strategy to reduce the global burden of disease-particularly in low, and middle-income countries (LMICs). However, to date, global pediatric surgical financing suffers from an alarming paucity of data. To leverage valuable resources and prioritize pediatric surgical services, timely, accurate and detailed global health spending and financing for pediatric surgical care is needed to inform policy making, strategic health-sector budgeting and resource allocation. This discussions aims to characterize and highlight the evidence gaps that currently exist in global financing and funding flow for pediatric surgical care in LMICs. Copyright © 2016. Published by Elsevier Inc.

  10. Associations between active travel and weight, blood pressure and diabetes in six middle income countries: a cross-sectional study in older adults.

    PubMed

    Laverty, Anthony A; Palladino, Raffaele; Lee, John Tayu; Millett, Christopher

    2015-05-20

    There is little published data on the potential health benefits of active travel in low and middle-income countries. This is despite increasing levels of adiposity being linked to increases in physical inactivity and non-communicable diseases. This study will examine: (1) socio-demographic correlates of using active travel (walking or cycling for transport) among older adults in six populous middle-income countries (2) whether use of active travel is associated with adiposity, systolic blood pressure and self-reported diabetes in these countries. Data are from the WHO Study on Global Ageing and Adult Health (SAGE) of China, India, Mexico, Ghana, Russia and South Africa with a total sample size of 40,477. Correlates of active travel (≥150 min/week) were examined using logistic regression. Logistic and linear regression analyses were used to examine health related outcomes according to three groups of active travel use per week. 46.4% of the sample undertook ≥150 min of active travel per week (range South Africa: 21.9% Ghana: 57.8%). In pooled analyses those in wealthier households were less likely to meet this level of active travel (Adjusted Risk Ratio (ARR) 0.77, 95% Confidence Intervals 0.67; 0.88 wealthiest fifth vs. poorest). Older people and women were also less likely to use active travel for ≥150 min per week (ARR 0.71, 0.62; 0.80 those aged 70+ years vs. 18-29 years old, ARR 0.82, 0.74; 0.91 women vs. men). In pooled fully adjusted analyses, high use of active travel was associated with lower risk of overweight (ARR 0.71, 0.59; 0.86), high waist-to-hip ratio (ARR 0.71, 0.61; 0.84) and lower BMI (-0.54 kg/m(2), -0.98;- 0.11). Moderate (31-209 min/week) and high use (≥210 min/week) of active travel was associated with lower waist circumference (-1.52 cm (-2.40; -0.65) and -2.16 cm (3.07; -1.26)), and lower systolic blood pressure (-1.63 mm/Hg (-3.19; -0.06) and -2.33 mm/Hg (-3.98; -0.69)). In middle-income countries use of active travel for ≥150 min

  11. Human development, occupational structure and physical inactivity among 47 low and middle income countries

    PubMed Central

    Atkinson, Kaitlin; Lowe, Samantha; Moore, Spencer

    2015-01-01

    This study aimed to (a) assess the relationship between a person's occupational category and their physical inactivity, and (b) analyze the association among country-level variables and physical inactivity. The World Health Survey (WHS) was administered in 2002–2003 among 47 low- and middle-income countries (n = 196,742). The International Physical Activity Questionnaire (IPAQ) was used to collect verbal reports of physical activity and convert responses into measures of physical inactivity. Economic development (GDP/c), degree of urbanization, and the Human Development Index (HDI) were used to measure country-level variables and physical inactivity. Multilevel logistic regression analysis was used to examine the association among country-level factors, individual occupational status, and physical inactivity. Overall, the worldwide prevalence of physical inactivity in 2002–2003 was 23.7%. Individuals working in the white-collar industry compared to agriculture were 84% more likely to be physically inactive (OR: 1.84, CI: 1.73–1.95). Among low- and middle-income countries increased HDI values were associated with decreased levels of physical inactivity (OR: 0.98, CI: 0.97–0.99). This study is one of the first to adjust for within-country differences, specifically occupation while analyzing physical inactivity. As countries experience economic development, changes are also seen in their occupational structure, which result in increased countrywide physical inactivity levels. PMID:26844185

  12. Human development, occupational structure and physical inactivity among 47 low and middle income countries.

    PubMed

    Atkinson, Kaitlin; Lowe, Samantha; Moore, Spencer

    2016-06-01

    This study aimed to (a) assess the relationship between a person's occupational category and their physical inactivity, and (b) analyze the association among country-level variables and physical inactivity. The World Health Survey (WHS) was administered in 2002-2003 among 47 low- and middle-income countries (n = 196,742). The International Physical Activity Questionnaire (IPAQ) was used to collect verbal reports of physical activity and convert responses into measures of physical inactivity. Economic development (GDP/c), degree of urbanization, and the Human Development Index (HDI) were used to measure country-level variables and physical inactivity. Multilevel logistic regression analysis was used to examine the association among country-level factors, individual occupational status, and physical inactivity. Overall, the worldwide prevalence of physical inactivity in 2002-2003 was 23.7%. Individuals working in the white-collar industry compared to agriculture were 84% more likely to be physically inactive (OR: 1.84, CI: 1.73-1.95). Among low- and middle-income countries increased HDI values were associated with decreased levels of physical inactivity (OR: 0.98, CI: 0.97-0.99). This study is one of the first to adjust for within-country differences, specifically occupation while analyzing physical inactivity. As countries experience economic development, changes are also seen in their occupational structure, which result in increased countrywide physical inactivity levels.

  13. An analysis of government immunization program expenditures in lower and lower middle income countries 2006-12.

    PubMed

    Nader, Alice Abou; de Quadros, Ciro; Politi, Claudio; McQuestion, Michael

    2015-04-01

    Financing is becoming increasingly important as the cost of immunizing the world's children continues to rise. By 2015, that cost will likely exceed US$60 per infant as new vaccines are introduced into national immunization programs. In 2006, 51 lower and lower middle income countries reported spending a mean US$12 per surviving infant on routine immunization. By 2012, the figure had risen to $20, a 67% increase. This study tests the hypothesis that lower and lower middle income countries will spend more on their routine immunization programs as their economies grow. A panel data regression approach is used. Expenditures reported by governments annually (2006-12) through the World Health Organization/UNICEF Joint Reporting Form are regressed on lagged annual per capita gross national income (GNI), controlling for prevailing mortality levels, immunization program performance, corruption control efforts, geographical region and correct reporting. Results show the expenditures increased with GNI. Expressed as an elasticity, the countries spent approximately $6.32 on immunization for every $100 in GNI increase from 2006 to 2012. Projecting forward and assuming continued annual GNI growth rates of 10.65%, countries could be spending $60 per infant by 2020 if national investment functions increase 4-fold. Given the political will, this result implies countries could fully finance their routine immunization programs without cutting funding for other programs. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

  14. Increasing fruit and vegetable consumption among schoolchildren: efforts in middle-income countries.

    PubMed

    Wijesinha-Bettoni, Ramani; Orito, Aya; Löwik, Marianne; Mclean, Catherine; Muehlhoff, Ellen

    2013-03-01

    To reverse the trend of rising child obesity rates in many middle-income countries, recommendations include increasing fruit and vegetable consumption. Schools can positively impact children's eating behavior, and multicomponent interventions that include the curriculum, school food environments, and parental involvement are most effective. To find out how fruits and vegetables feature in the dietary guidelines provided to schools, what specific schemes are available for providing these foods, the extent to which nutrition education is included in the curriculum, and how vegetables and fruits are procured in primary schools. In 2008, a survey questionnaire previously validated and revised was sent electronically to national program managers and focal points for school feeding programs in 58 middle-income countries. The rationale was to obtain information relevant to the entire country from these key informants. The survey response rate was 46%. The information provided by 22 respondents in 18 countries was included in the current study. On average, respondents answered 88% of the questions analyzed in this paper. Of the respondents, 73% worked for the national authority responsible for school food programs, with 45% at the program coordinator or director level. Few countries have any special fruit and vegetable schemes; implementation constraints include cost and lack of storage facilities. Although 11 of 18 countries have both nutrient-based guidelines and school food guidelines for meals, fruits and vegetables are often not adequately specified. In some countries, nutrition education, special activities, school gardens, and parental participation are used to promote fruits and vegetables. Specific schemes are needed in some, together with school food guidelines that include fruits and vegetables.

  15. Associations between hair cortisol concentration, income, income dynamics and status incongruity in healthy middle-aged women

    PubMed Central

    Serwinski, Bianca; Salavecz, Gyöngyvér; Kirschbaum, Clemens; Steptoe, Andrew

    2016-01-01

    A body of research demonstrates that financial disadvantage is associated with general health inequalities and higher mortality rates. Most studies make use of cross-sectional analyses, although income can also be viewed as a dynamic concept. The use of endocrine-markers as proxies for health can provide information about the pathways involved in these associations. Hair cortisol analysis has been developed as a method for assessing sustained cortisol output as it provides an estimate of cumulative cortisol secretion over a prolonged time. The present study assessed income and income trajectory over a 4-year period in 164 working women (aged 26–65) in relation to hair cortisol in a longitudinal design. A negative association between hair cortisol and concurrent income was found (p = 0.025) and hair cortisol and changes in income over 4 years (p < 0.001), after adjustment for age, BMI, smoking status, hair treatment and country. Status incongruity, a mismatch between educational status and income group, was related to higher cortisol levels compared with status congruity (p = 0.009). These findings suggest that psychoneuroendocrinological pathways might partially explain the relationship between lower socio-economic status and adverse health outcomes. Future longitudinal research using hair cortisol analysis is warranted to clarify the time course of social mobility in relation to long-term cortisol, to investigate other underlying psychosocial factors implicated in these associations, and to determine the exact health implications of the neuroendocrine perturbations in individuals with limited economic resources. PMID:26923848

  16. Associations between hair cortisol concentration, income, income dynamics and status incongruity in healthy middle-aged women.

    PubMed

    Serwinski, Bianca; Salavecz, Gyöngyvér; Kirschbaum, Clemens; Steptoe, Andrew

    2016-05-01

    A body of research demonstrates that financial disadvantage is associated with general health inequalities and higher mortality rates. Most studies make use of cross-sectional analyses, although income can also be viewed as a dynamic concept. The use of endocrine-markers as proxies for health can provide information about the pathways involved in these associations. Hair cortisol analysis has been developed as a method for assessing sustained cortisol output as it provides an estimate of cumulative cortisol secretion over a prolonged time. The present study assessed income and income trajectory over a 4-year period in 164 working women (aged 26-65) in relation to hair cortisol in a longitudinal design. A negative association between hair cortisol and concurrent income was found (p=0.025) and hair cortisol and changes in income over 4 years (p<0.001), after adjustment for age, BMI, smoking status, hair treatment and country. Status incongruity, a mismatch between educational status and income group, was related to higher cortisol levels compared with status congruity (p=0.009). These findings suggest that psychoneuroendocrinological pathways might partially explain the relationship between lower socio-economic status and adverse health outcomes. Future longitudinal research using hair cortisol analysis is warranted to clarify the time course of social mobility in relation to long-term cortisol, to investigate other underlying psychosocial factors implicated in these associations, and to determine the exact health implications of the neuroendocrine perturbations in individuals with limited economic resources. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  17. Minimum Wage and Overweight and Obesity in Adult Women: A Multilevel Analysis of Low and Middle Income Countries.

    PubMed

    Conklin, Annalijn I; Ponce, Ninez A; Frank, John; Nandi, Arijit; Heymann, Jody

    2016-01-01

    To describe the relationship between minimum wage and overweight and obesity across countries at different levels of development. A cross-sectional analysis of 27 countries with data on the legislated minimum wage level linked to socio-demographic and anthropometry data of non-pregnant 190,892 adult women (24-49 y) from the Demographic and Health Survey. We used multilevel logistic regression models to condition on country- and individual-level potential confounders, and post-estimation of average marginal effects to calculate the adjusted prevalence difference. We found the association between minimum wage and overweight/obesity was independent of individual-level SES and confounders, and showed a reversed pattern by country development stage. The adjusted overweight/obesity prevalence difference in low-income countries was an average increase of about 0.1 percentage points (PD 0.075 [0.065, 0.084]), and an average decrease of 0.01 percentage points in middle-income countries (PD -0.014 [-0.019, -0.009]). The adjusted obesity prevalence difference in low-income countries was an average increase of 0.03 percentage points (PD 0.032 [0.021, 0.042]) and an average decrease of 0.03 percentage points in middle-income countries (PD -0.032 [-0.036, -0.027]). This is among the first studies to examine the potential impact of improved wages on an important precursor of non-communicable diseases globally. Among countries with a modest level of economic development, higher minimum wage was associated with lower levels of obesity.

  18. The association between objective income and subjective financial need and depressive symptoms in South Koreans aged 60 and older.

    PubMed

    Kim, Woorim; Kim, Tae Hyun; Lee, Tae-Hoon; Ju, Yeong Jun; Park, Eun-Cheol

    2017-11-01

    This study aimed to investigate the effect of the gap between objective income and subjective financial need on depressive symptoms in individuals aged 60 and older. Data from the 2011 and 2013 Korean Retirement and Income Study were used. A total of 4891 individuals aged 60 and older were included at baseline. The Generalized Estimating Equation model was used to examine the association between the gap in objective income and subjective financial need and the presence of depressive symptoms, which were measured using the Center for Epidemiological Studies Depression Scale. Compared to individuals in the middle objective income-middle subjective financial need group, individuals in the low-low category (odds ratio (OR): 1.30, 95% confidence interval (CI): 1.04-1.61) and the low-middle category (OR: 1.26, 95%CI: 1.09-1.45) showed a statistically significant higher likelihood of having depressive symptoms. In contrast, participants in the middle-low (OR: 0.74, 95%CI: 0.54-0.99), high-low (OR: 0.50, 95%CI: 0.34-0.73), high-middle (OR: 0.74, 95%CI: 0.63-0.87), and high-high categories (OR: 0.74, 95%CI: 0.55-0.99) were less likely to exhibit depressive symptoms. Additionally, the lower likelihood of depressive symptoms found in middle- and high-income groups with lower levels of subjective financial need was strong among individuals with chronic disease. Differences in the prevalence of depressive symptoms generally exist between individuals of the same income category depending on perceived income adequacy. Therefore, it is important to consider discrepancies in objective income and subjective financial need when assessing risk factors for depressive symptoms in older populations. © 2017 Japanese Psychogeriatric Society.

  19. Family Income at the Bottom and at the Top: Income Sources and Family Characteristics

    PubMed Central

    Raffalovich, Lawrence E.; Monnat, Shannon M.; Tsao, Hui-shien

    2009-01-01

    Attention has recently been focused on wealth as a source of long-term economic security and on wealth ownership as a crucial aspect of the racial economic divisions in the United States. This literature, however has been concerned primarily with the wealth gap between poor and middle-class families, and between the white and black middle class. In this paper, we investigate the incomes of families at the top and bottom of the family income distribution. We examine the sources of income and the demographic characteristics of these high-income and low-income families using family level data from the 1988-2003 Current Population Surveys. We find that, at the bottom of the distribution, transfer income is the major income source; in particular, income from social security, supplemental security, and public assistance. At the top, employment income is the largest component of family income. Non-white, female, and non-married householders are disproportionately located at the bottom of the family income distribution. These families consist of both young and old adults, with high-school educations or less, in low-level service occupations. Many are disabled, many are retired. Householders at the top of the income distribution are typically male, white, and married. Householders and spouses at the top are typically middle-age, with college educations, employed in professional service and managerial occupations. We find that wealth is not an important source of income for families at the highest percentiles. The highest income families during this period in the U.S. were not a “property elite”: their income is mostly from employment. We speculate, however, that they will join the “property elite” later in the life-course as they retire and receive income from their investments. PMID:20161570

  20. Family Income at the Bottom and at the Top: Income Sources and Family Characteristics.

    PubMed

    Raffalovich, Lawrence E; Monnat, Shannon M; Tsao, Hui-Shien

    2009-12-01

    Attention has recently been focused on wealth as a source of long-term economic security and on wealth ownership as a crucial aspect of the racial economic divisions in the United States. This literature, however has been concerned primarily with the wealth gap between poor and middle-class families, and between the white and black middle class. In this paper, we investigate the incomes of families at the top and bottom of the family income distribution. We examine the sources of income and the demographic characteristics of these high-income and low-income families using family level data from the 1988-2003 Current Population Surveys.We find that, at the bottom of the distribution, transfer income is the major income source; in particular, income from social security, supplemental security, and public assistance. At the top, employment income is the largest component of family income. Non-white, female, and non-married householders are disproportionately located at the bottom of the family income distribution. These families consist of both young and old adults, with high-school educations or less, in low-level service occupations. Many are disabled, many are retired. Householders at the top of the income distribution are typically male, white, and married. Householders and spouses at the top are typically middle-age, with college educations, employed in professional service and managerial occupations.We find that wealth is not an important source of income for families at the highest percentiles. The highest income families during this period in the U.S. were not a "property elite": their income is mostly from employment. We speculate, however, that they will join the "property elite" later in the life-course as they retire and receive income from their investments.

  1. Structural Barriers to Diagnosis and Treatment of Cancer in Low- and Middle-Income Countries: The Urgent Need for Scaling Up

    PubMed Central

    Magrath, Ian; Kingham, T. Peter; Elzawawy, Ahmed

    2016-01-01

    Noncommunicable diseases are now recognized by the United Nations and WHO as a major public health crisis. Cancer is a main part of this problem, and health care systems are facing a great challenge to improve cancer care, control costs, and increase systems efficiency. The disparity in access to care and outcomes between high-income countries and low- and middle-income countries is staggering. The reasons for this disparity include cost, access to care, manpower and training deficits, and a lack of awareness in the lay and medical communities. Diagnosis and treatment play an important role in this complex environment. In different regions and countries of the world, a variety of health care systems are in place, but most of them are fragmented or poorly coordinated. The need to scale up cancer care in the low- and middle-income countries is urgent, and this article reviews many of the structural mechanisms of the problem, describes the current situation, and proposes ways for improvement. The organization of cancer services is also included in the analysis. PMID:26578618

  2. The impact of a private sector living wage intervention on consumption and cardiovascular disease risk factors in a middle income country.

    PubMed

    Rehkopf, David H; Burmaster, Katharine; Landefeld, John C; Adler-Milstein, Sarah; Flynn, Emily P; Acevedo, Maria Cecilia; Jones-Smith, Jessica C; Adler, Nancy; Fernald, Lia C H

    2018-01-25

    A positive association of socioeconomic position and health is well established in high-income countries. In poorer nations, however, higher income individuals often have more cardiovascular risk factors (including obesity) than do those with less income. Our study goal was to estimate the effects of receiving a living wage (340% higher income) on short-term changes in consumption and cardiovascular risk factors among low-wage workers in a middle-income country. This cross-sectional study matched workers at an apparel factory (n=105) in the Dominican Republic with those at a similar factory (n=99) nearby, 15 months after the intervention factory introduced a substantially higher living wage. Statistical matching on non-time varying individual characteristics (childhood health, childhood living conditions, work experience, demographic factors) strengthened causal inference. Primary outcomes were blood pressure (systolic and diastolic), pulse rate, body mass index and waist circumference. Secondary outcomes were dietary consumption and spending on services, consumables and durable goods. Receiving the living wage was associated with increased consumption of protein, dairy, soda and juice and sugars, but not with cardiovascular risk factors. Intervention factory workers spent more on grocery items and household durable goods. While having a higher income in a middle-income country might be expected to increase obesity and its associated health risks, the current study found no short-term negative associations. There may be possible longer-term negative health consequences of increases in consumption of soda, juice and sugars, however. It is important to consider complementary interventions to support healthy dietary intake in areas with increasing wages.

  3. Effective screening programmes for cervical cancer in low- and middle-income developing countries.

    PubMed

    Sankaranarayanan, R; Budukh, A M; Rajkumar, R

    2001-01-01

    Cervical cancer is an important public health problem among adult women in developing countries in South and Central America, sub-Saharan Africa, and south and south-east Asia. Frequently repeated cytology screening programmes--either organized or opportunistic--have led to a large decline in cervical cancer incidence and mortality in developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening. This article briefly reviews the experience from existing screening and research initiatives in developing countries. Substantial costs are involved in providing the infrastructure, manpower, consumables, follow-up and surveillance for both organized and opportunistic screening programmes for cervical cancer. Owing to their limited health care resources, developing countries cannot afford the models of frequently repeated screening of women over a wide age range that are used in developed countries. Many low-income developing countries, including most in sub-Saharan Africa, have neither the resources nor the capacity for their health services to organize and sustain any kind of screening programme. Middle-income developing countries, which currently provide inefficient screening, should reorganize their programmes in the light of experiences from other countries and lessons from their past failures. Middle-income countries intending to organize a new screening programme should start first in a limited geographical area, before considering any expansion. It is also more realistic and effective to target the screening on high-risk women once or twice in their lifetime using a highly sensitive test, with an emphasis on high coverage (>80%) of the targeted population. Efforts to organize an effective screening programme in these developing countries will have to find adequate financial resources, develop the infrastructure, train the needed manpower, and elaborate surveillance mechanisms

  4. Effective screening programmes for cervical cancer in low- and middle-income developing countries.

    PubMed Central

    Sankaranarayanan, R.; Budukh, A. M.; Rajkumar, R.

    2001-01-01

    Cervical cancer is an important public health problem among adult women in developing countries in South and Central America, sub-Saharan Africa, and south and south-east Asia. Frequently repeated cytology screening programmes--either organized or opportunistic--have led to a large decline in cervical cancer incidence and mortality in developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening. This article briefly reviews the experience from existing screening and research initiatives in developing countries. Substantial costs are involved in providing the infrastructure, manpower, consumables, follow-up and surveillance for both organized and opportunistic screening programmes for cervical cancer. Owing to their limited health care resources, developing countries cannot afford the models of frequently repeated screening of women over a wide age range that are used in developed countries. Many low-income developing countries, including most in sub-Saharan Africa, have neither the resources nor the capacity for their health services to organize and sustain any kind of screening programme. Middle-income developing countries, which currently provide inefficient screening, should reorganize their programmes in the light of experiences from other countries and lessons from their past failures. Middle-income countries intending to organize a new screening programme should start first in a limited geographical area, before considering any expansion. It is also more realistic and effective to target the screening on high-risk women once or twice in their lifetime using a highly sensitive test, with an emphasis on high coverage (>80%) of the targeted population. Efforts to organize an effective screening programme in these developing countries will have to find adequate financial resources, develop the infrastructure, train the needed manpower, and elaborate surveillance mechanisms

  5. Assessing the impact of drinking water and sanitation on diarrhoeal disease in low- and middle-income settings: systematic review and meta-regression.

    PubMed

    Wolf, Jennyfer; Prüss-Ustün, Annette; Cumming, Oliver; Bartram, Jamie; Bonjour, Sophie; Cairncross, Sandy; Clasen, Thomas; Colford, John M; Curtis, Valerie; De France, Jennifer; Fewtrell, Lorna; Freeman, Matthew C; Gordon, Bruce; Hunter, Paul R; Jeandron, Aurelie; Johnston, Richard B; Mäusezahl, Daniel; Mathers, Colin; Neira, Maria; Higgins, Julian P T

    2014-08-01

    To assess the impact of inadequate water and sanitation on diarrhoeal disease in low- and middle-income settings. The search strategy used Cochrane Library, MEDLINE & PubMed, Global Health, Embase and BIOSIS supplemented by screening of reference lists from previously published systematic reviews, to identify studies reporting on interventions examining the effect of drinking water and sanitation improvements in low- and middle-income settings published between 1970 and May 2013. Studies including randomised controlled trials, quasi-randomised trials with control group, observational studies using matching techniques and observational studies with a control group where the intervention was well defined were eligible. Risk of bias was assessed using a modified Ottawa-Newcastle scale. Study results were combined using meta-analysis and meta-regression to derive overall and intervention-specific risk estimates. Of 6819 records identified for drinking water, 61 studies met the inclusion criteria, and of 12,515 records identified for sanitation, 11 studies were included. Overall, improvements in drinking water and sanitation were associated with decreased risks of diarrhoea. Specific improvements, such as the use of water filters, provision of high-quality piped water and sewer connections, were associated with greater reductions in diarrhoea compared with other interventions. The results show that inadequate water and sanitation are associated with considerable risks of diarrhoeal disease and that there are notable differences in illness reduction according to the type of improved water and sanitation implemented. © 2014 John Wiley & Sons Ltd The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

  6. The 5/95 gap in the indexation of psychiatric journals of low- and middle-income countries

    PubMed Central

    Mari, J J; Patel, V; Kieling, C; Razzouk, D; Tyrer, P; Herrman, H

    2010-01-01

    Mari JJ, Patel V, Kieling C, Razzouk D, Tyrer P, Herrman H. The 5/95 gap in the indexation of psychiatric journals of low- and middle-income countries. Objective: To investigate the relationship between science production and the indexation level of low- and middle-income countries (LAMIC) journals in international databases. Method: Indicators of productivity in research were based on the number of articles produced over the 1994–2004 period. A survey in both Medline and ISI/Thomson was conducted to identify journals according to their country of origin. A WPA Task Force designed a collaborative process to assess distribution and quality of non-indexed LAMIC journals. Results: Twenty LAMIC were found to present more than 100 publications and a total of 222 indexed psychiatric journals were found, but only nine were from LAMIC. The Task Force received 26 questionnaires from editors of non-indexed journals, and concluded that five journals would meet criteria for indexation. Conclusion: Barriers to indexation of journals contribute to the difficulties in achieving fair representation in the main literature databases for the scientific production in these countries. PMID:19764927

  7. Medical Abortion Provision by Pharmacies and Drug Sellers in Low- and Middle-Income Countries: A Systematic Review.

    PubMed

    Footman, Katharine; Keenan, Katherine; Reiss, Kate; Reichwein, Barbara; Biswas, Pritha; Church, Kathryn

    2018-03-01

    We undertook a systematic review to assess 1) the level and quality of pharmacy and drug shop provision of medical abortion (MA) in low- and middle-income countries (LMICs) and 2) interventions to improve quality of provision. We used standardized terms to search six databases for peer-reviewed and grey literature. We double-extracted data using a standardized template, and double-graded studies for methodological quality. We identified 22 studies from 16 countries reporting on level and quality of MA provision through pharmacies and drug sellers, and three intervention studies. Despite widespread awareness and provision of MA drugs, even in legally restricted contexts, most studies found that pharmacy workers and drug sellers had poor knowledge of effective regimens. Evidence on interventions to improve pharmacy and drug shop provision of MA was limited and generally low quality, but indicated that training could be effective in improving knowledge. Programmatic attention should focus on the development and rigorous evaluation of innovative interventions to improve women's access to information about MA self-management in low-and middle-income countries. © 2018 The Population Council, Inc.

  8. Epidemiological and Economic Impact of Monovalent and Pentavalent Rotavirus Vaccines in Low and Middle Income Countries: A Cost-effectiveness Modeling Analysis.

    PubMed

    Paternina-Caicedo, Angel; De la Hoz-Restrepo, Fernando; Alvis-Guzmán, Nelson

    2015-07-01

    The competing choices of vaccination with either RV1 or RV5, the potential budget impact of vaccines on the EPI with different prices and new evidence make important an updated analysis for health decision makers in each country. The objective of this study is to assess cost-effectiveness of the monovalent and pentavalent rotavirus vaccines and impact on children deaths, inpatient and outpatient visits in 116 low and middle income countries that represent approximately 99% of rotavirus mortality. A decision tree model followed hypothetical cohorts of children from birth up to 5 years of age for each country in 2010. Inputs were gathered from international databases and previous research on incidence and effectiveness of monovalent and pentavalent vaccines. Costs were expressed in 2010 international dollars. Outcomes were reported in terms of cost per disability-adjusted life-year averted, comparing no vaccination with either monovalent or pentavalent mass introduction. Vaccine price was assumed fixed for all world low-income and middle-income countries. Around 292,000 deaths, 3.34 million inpatient cases and 23.09 million outpatient cases would occur with no vaccination. In the base-case scenario, monovalent vaccination would prevent 54.7% of inpatient cases and 45.4% of deaths. Pentavalent vaccination would prevent 51.4% of inpatient cases and 41.1% of deaths. The vaccine was cost-effective in all world countries in the base-case scenario for both vaccines. Cost per disability-adjusted life-year averted in all selected countries was I$372 for monovalent, and I$453 for pentavalent vaccination. Rotavirus vaccine is cost-effective in most analyzed countries. Despite cost-effectiveness analysis is a useful tool for decision making in middle-income countries, for low-income countries health decision makers should also assess the impact of introducing either vaccine on local resources and budget impact analysis of vaccination.

  9. Methodological Issues to Consider When Collecting Data to Estimate Poverty Impact in Economic Evaluations in Low-income and Middle-income Countries.

    PubMed

    Sweeney, Sedona; Vassall, Anna; Foster, Nicola; Simms, Victoria; Ilboudo, Patrick; Kimaro, Godfather; Mudzengi, Don; Guinness, Lorna

    2016-02-01

    Out-of-pocket spending is increasingly recognized as an important barrier to accessing health care, particularly in low-income and middle-income countries (LMICs) where a large portion of health expenditure comes from out-of-pocket payments. Emerging universal healthcare policies prioritize reduction of poverty impact such as catastrophic and impoverishing healthcare expenditure. Poverty impact is therefore increasingly evaluated alongside and within economic evaluations to estimate the impact of specific health interventions on poverty. However, data collection for these metrics can be challenging in intervention-based contexts in LMICs because of study design and practical limitations. Using a set of case studies, this letter identifies methodological challenges in collecting patient cost data in LMIC contexts. These components are presented in a framework to encourage researchers to consider the implications of differing approaches in data collection and to report their approach in a standardized and transparent way. © 2016 The Authors. Health Economics published by John Wiley & Sons Ltd.

  10. Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries

    PubMed Central

    Reeves, Aaron; Gourtsoyannis, Yannis; Basu, Sanjay; McCoy, David; McKee, Martin; Stuckler, David

    2015-01-01

    Summary Background How to finance progress towards universal health coverage in low-income and middle-income countries is a subject of intense debate. We investigated how alternative tax systems affect the breadth, depth, and height of health system coverage. Methods We used cross-national longitudinal fixed effects models to assess the relationships between total and different types of tax revenue, health system coverage, and associated child and maternal health outcomes in 89 low-income and middle-income countries from 1995–2011. Findings Tax revenue was a major statistical determinant of progress towards universal health coverage. Each US$100 per capita per year of additional tax revenues corresponded to a yearly increase in government health spending of $9·86 (95% CI 3·92–15·8), adjusted for GDP per capita. This association was strong for taxes on capital gains, profits, and income ($16·7, 9·16 to 24·3), but not for consumption taxes on goods and services (−$4·37, −12·9 to 4·11). In countries with low tax revenues (<$1000 per capita per year), an additional $100 tax revenue per year substantially increased the proportion of births with a skilled attendant present by 6·74 percentage points (95% CI 0·87–12·6) and the extent of financial coverage by 11·4 percentage points (5·51–17·2). Consumption taxes, a more regressive form of taxation that might reduce the ability of the poor to afford essential goods, were associated with increased rates of post-neonatal mortality, infant mortality, and under-5 mortality rates. We did not detect these adverse associations with taxes on capital gains, profits, and income, which tend to be more progressive. Interpretation Increasing domestic tax revenues is integral to achieving universal health coverage, particularly in countries with low tax bases. Pro-poor taxes on profits and capital gains seem to support expanding health coverage without the adverse associations with health outcomes observed for

  11. Comparison of motives underlying food choice and barriers to healthy eating among low medium income consumers in Uruguay.

    PubMed

    Ares, Gastón; Machín, Leandro; Girona, Alejandra; Curutchet, María Rosa; Giménez, Ana

    2017-05-18

    Interventions aimed at changing dietary patterns should be designed based on the main motives underlying the food choices of specific target populations. The aim of the present study was to identify motives underlying food choice and barriers to healthy eating among consumers in two socioeconomic levels in Uruguay. Eleven focus groups were carried out with a total of 76 participants. Six of the groups involved low income participants and the others were conducted with middle income participants. Discussions were held around frequently consumed products, motives underlying food choices and barriers to healthy eating. Results confirmed the strong influence of income level on motives underlying food choice and barriers to the adoption of healthy eating. Low income participants described their choices as mainly driven by economic factors and satiety, whereas convenience was the main determinant of food selection for middle income participants. Implications for the design of public policies targeted at each group are discussed.

  12. Risk factors for falls with severe fracture in elderly people living in a middle-income country: a case control study.

    PubMed

    Coutinho, Evandro S F; Fletcher, Astrid; Bloch, Katia V; Rodrigues, Laura C

    2008-08-26

    Fracture after falling has been identified as an important problem in public health. Most studies of risk factors for fractures due to falls have been carried out in developed countries, although the size of the elderly population is increasing fast in middle income countries. The objective of this paper is to identify risk factors for fall related to severe fractures in those aged 60 or more in a middle-income country. A case-control study was carried out in Rio de Janeiro-Brazil based general hospitals between 2002-2003. Two hundred-fifty hospitalised cases of fracture were matched with 250 community controls by sex, age group and living area. Data were collected for socio-demographic variables, health status and drugs used before the fall. A conditional logistic regression model was fitted to identify variables associated with the risk of fall related severe fracture. Low body mass index, cognitive impairment, stroke and lack of urine control were associated with increased risk of severe fall related fractures. Benzodiazepines and muscle relaxants were also related to an increased risk of severe fractures while moderate use of alcohol was associated with reduced risk. Although the association between benzodiazepines and fractures due to fall has been consistently demonstrated for old people, this has not been the case for muscle relaxant drugs. The decision to prescribe muscle relaxants for elderly people should take into account the risk of severe fracture associated with these drugs.

  13. The value of demonstration projects for new interventions: The case of human papillomavirus vaccine introduction in low- and middle-income countries.

    PubMed

    Howard, N; Mounier-Jack, S; Gallagher, K E; Kabakama, S; Griffiths, U K; Feletto, M; LaMontagne, D S; Burchett, H E D; Watson-Jones, D

    2016-09-01

    Demonstration projects or pilots of new public health interventions aim to build learning and capacity to inform country-wide implementation. Authors examined the value of HPV vaccination demonstration projects and initial national programmes in low-income and lower-middle-income countries, including potential drawbacks and how value for national scale-up might be increased. Data from a systematic review and key informant interviews, analyzed thematically, included 55 demonstration projects and 8 national programmes implemented between 2007-2015 (89 years' experience). Initial demonstration projects quickly provided consistent lessons. Value would increase if projects were designed to inform sustainable national scale-up. Well-designed projects can test multiple delivery strategies, implementation for challenging areas and populations, and integration with national systems. Introduction of vaccines or other health interventions, particularly those involving new target groups or delivery strategies, needs flexible funding approaches to address specific questions of scalability and sustainability, including learning lessons through phased national expansion.

  14. Cervical cancer prevention: new guidelines in the United States and new opportunities for low- and middle-income countries.

    PubMed

    Waxman, Alan G

    2013-06-01

    Developments from late 2011 to early 2013, including consensus conferences and the introduction of low-cost, rapid-turnaround testing of human papillomavirus, will change prevention strategies for cervical cancer in the United States and in low- and middle-income countries. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Are alcohol policies associated with alcohol consumption in low- and middle-income countries?

    PubMed

    Cook, Won Kim; Bond, Jason; Greenfield, Thomas K

    2014-07-01

    To examine the associations between alcohol control policies in four regulatory domains with alcohol consumption in low- and middle-income countries (LAMICs), controlling for country-level living standards and drinking patterns. Cross-sectional analyses of individual-level alcohol consumption survey data and country-level alcohol policies using multi-level modeling. Data from 15 LAMICs collected in the Gender, Alcohol, and Culture: an International Study (GENACIS) data set. Individuals aged 18-65 years. Alcohol policy data compiled by the World Health Organization; individual-level current drinking status, usual quantity and frequency of drinking, binge drinking frequency and total drinking volume; gross domestic product based on purchasing power parity (GDP-PPP) per capita; detrimental drinking pattern scale; and age and gender as individual-level covariates. Alcohol policies regulating the physical availability of alcohol, particularly those concerning business hours or involving a licensing system for off-premises alcohol retail sales, as well as minimum legal drinking age, were the most consistent predictors of alcohol consumption. Aggregate relative alcohol price levels were associated inversely with all drinking variables (P < 0.05) except drinking volume. Greater restrictions on alcohol advertising, particularly beer advertising, were associated inversely with alcohol consumption (P < 0.05). Policies that set legal blood alcohol concentration (BAC) limits for drivers and random breath testing to enforce BAC limits were not associated significantly with alcohol consumption. Alcohol policies that regulate the physical availability of alcohol are associated with lower alcohol consumption in low- and middle-income countries. © 2014 Society for the Study of Addiction.

  16. Addressing barriers to exclusive breast-feeding in low- and middle-income countries: a systematic review and programmatic implications.

    PubMed

    Kavle, Justine A; LaCroix, Elizabeth; Dau, Hallie; Engmann, Cyril

    2017-12-01

    Despite numerous global initiatives on breast-feeding, trend data show exclusive breast-feeding (EBF) rates have stagnated over the last two decades. The purpose of the present systematic review was to determine barriers to exclusive breast-feeding in twenty-five low- and middle-income countries and discuss implications for programmes. A search of Scopus, MEDLINE, CINAHL and PsychINFO was conducted to retrieve studies from January 2000 to October 2015. Using inclusion criteria, we selected both qualitative and quantitative studies that described barriers to EBF. Low- and middle-income countries. Following application of systematic review criteria, forty-eight articles from fourteen countries were included in the review. Sixteen barriers to EBF were identified in the review. There is moderate evidence of a negative association between maternal employment and EBF practices. Studies that examined EBF barriers at childbirth and the initial 24 h post-delivery found strong evidence that caesarean section can impede EBF. There is moderate evidence for early initiation of breast-feeding and likelihood of practising EBF. Breast-feeding problems were commonly reported from cross-sectional or observational studies. Counselling on EBF and the presence of family and/or community support have demonstrated improvements in EBF. Improving the counselling skills of health workers to address breast-feeding problems and increasing community support for breast-feeding are critical components of infant and young child feeding programming, which will aid in attaining the 2025 World Health Assembly EBF targets. Legislation and regulations on marketing of breast-milk substitutes, paid maternity leave and breast-feeding breaks for working mothers require attention in low- and middle-income countries.

  17. The Gender Gap in Mathematics: Evidence from Low- and Middle-Income Countries. NBER Working Paper No. 18464

    ERIC Educational Resources Information Center

    Bharadwaj, Prashant; De Giorgi, Giacomo; Hansen, David; Neilson, Christopher

    2012-01-01

    We establish the presence of a gender gap in mathematics across many low- and middle-income countries using detailed, comparable test score data. Examining micro level data on school performance linked to household demographics we note that first, the gender gap appears to increase with age. Indeed, the gap nearly doubles when comparing 4th grade…

  18. Dolutegravir for first-line antiretroviral therapy in low-income and middle-income countries: uncertainties and opportunities for implementation and research.

    PubMed

    Dorward, Jienchi; Lessells, Richard; Drain, Paul K; Naidoo, Kogieleum; de Oliveira, Tulio; Pillay, Yogan; Abdool Karim, Salim S; Garrett, Nigel

    2018-06-05

    A new first-line antiretroviral therapy (ART) regimen containing dolutegravir is being rolled out in low-income and middle-income countries (LMICs). In studies from predominantly high-income settings, dolutegravir-based regimens had superior efficacy, tolerability, and durability compared with existing first-line regimens. However, several questions remain about the roll out of dolutegravir in LMICs, where most people with HIV are women of reproductive age, tuberculosis prevalence can be high, and access to viral load and HIV drug resistance testing is limited. Findings from cohort studies suggest that dolutegravir is safe when initiated in pregnancy, but more data are needed to determine the risk of adverse birth outcomes when dolutegravir-based regimens are initiated before conception. Increasing access to viral load testing to monitor the effectiveness of dolutegravir remains crucial, but the best strategy to manage patients with viraemia is unclear. Furthermore, evidence to support the effectiveness of dolutegravir when given with tuberculosis treatment is scarce, particularly in programmatic settings in LMICs. Lastly, whether nucleoside reverse transcriptase inhibitor resistance will affect the long-term efficacy of dolutegravir-based regimens in first-line, and potentially second-line, ART is unknown. Clinical trials, cohorts, and surveillance of HIV drug resistance will be necessary to answer these questions and to maximise the benefits of this new regimen. Copyright © 2018 Elsevier Ltd. All rights reserved.

  19. Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies.

    PubMed

    Petersen, Inge; Marais, Debbie; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Chisholm, Dan; Egbe, Catherine; Gureje, Oye; Hanlon, Charlotte; Lund, Crick; Shidhaye, Rahul; Jordans, Mark; Kigozi, Fred; Mugisha, James; Upadhaya, Nawaraj; Thornicroft, Graham

    2017-06-01

    Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries. © The

  20. Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies

    PubMed Central

    Marais, Debbie; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Chisholm, Dan; Egbe, Catherine; Gureje, Oye; Hanlon, Charlotte; Lund, Crick; Shidhaye, Rahul; Jordans, Mark; Kigozi, Fred; Mugisha, James; Upadhaya, Nawaraj; Thornicroft, Graham

    2017-01-01

    Abstract Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries

  1. Patterns of authorship on community health workers in low-and-middle-income countries: an analysis of publications (2012-2016).

    PubMed

    Schneider, Helen; Maleka, Nelisiwe

    2018-01-01

    Studies of authorship provide a barometer of local research capacity and ownership of research, considered key to defining appropriate research priorities, developing contextualised responses to health problems and ensuring that research informs policy and practice. This paper reports on an analysis of patterns of research authorship of the now substantial literature on community health workers (CHWs) in low-and-middle-income countries (LMICs) for the 5-year period: 2012-2016. A search of five databases identified a total of 649 indexed publications reporting on CHWs in LMICs and meeting the inclusion criteria. The country, region and income classification of studies, affiliations (country, organisation) of lead (first) and last authors, proportions of all authors locally affiliated, programme area (eg, maternal child health) and funding source were extracted. The 649 papers reported experiences from 51 countries, 55% from middle-income countries (MICs) and 32% from low-income countries (LICs), with the remaining 13% multicountry studies. Overall, 47% and 54% of all the papers had a high-income country (HIC) lead and last author, respectively. Authorship followed three patterns: (1) a concentrated HIC pattern, with US-based authors numerically dominating LIC-based and multicountry studies; (2) an MIC pattern of autonomy, with a handful of countries-India, South Africa and Brazil, in particular-leading >70% of their CHW publications and (3) a pattern of unevenness among LICs in their lead authorship of publications varying from 14% (Malawi) to 54% (Uganda). Region, programme area and funding source were all associated with the distribution of authorship across country income categories. The findings in this analysis mirror closely that of other authorship studies in global health. Collectively these provide a common message-that investments in global health programmes in the Millennium Development Goal era may have benefited health but not necessarily capacity for

  2. Buying into the Computer Age: A Look at the Hispanic Middle Class.

    ERIC Educational Resources Information Center

    Wilhelm, Anthony G.

    The Tomas Rivera Policy Institute conducted focus groups in the summer of 1997 to gain insight into why there is a gap in computer ownership between Hispanic middle-class families and non-Hispanic families of the same middle class income bracket (between 25 and 50 thousand dollars). Results from 6 focus groups of 15 to 20 heads of household each…

  3. Tectonic Structure of the Middle America Pacific Margin and Incoming Cocos Plate From Costa Rica to Guatemala

    NASA Astrophysics Data System (ADS)

    Ranero, C. R.; Weinrebe, W.; Grevemeyer, I.; Phipps Morgan, J.; Vannucchi, P.; von Huene, R.

    2003-12-01

    A new multibeam bathymetry and magnetic survey with R/V SONNE in summer 2003 has mapped the continental margin and incoming plate of NW Nicaragua, El Salvador and Guatemala, extending existing coverage from offshore Costa Rica and part of Nicaragua to a full coverage map of about 1200 km long by 100 km wide area along the plate boundary. The incoming plate along Nicaragua, El Salvador and Guatemala is of similar age and was formed at superfast spreading rates; however, its morphology changes drastically along strike. The seafloor-spreading inherited morphology is very smooth along Nicaragua, but with ridges up to 800 m high in Guatemala, with a transition across El Salvador. The development and dimensions of the dominant inherited fabric seems to be related to discontinuities at the paleospreading center. A series of troughs oblique to the main fabric may indicate the location of pseudofaults and correspond to areas where the seafloor fabric is most prominent. Bending of the oceanic plate into the trench reactivates the inherited fabric forming a well pervasive faulting system along the oceanic trench slope. The continental slope displays three morphotectonic units that roughly correspond to the upper, middle and lower slope, although the across slope width of each unit is fairly variable. Small canyons and gullies that form at the sudden dip change across the shelf break carve the upper slope. The canyons coalesce and become shallower as the dip decreases downslope. Locally some large canyons continue into the slope toe. The middle slope is a rough terrain variable in width and dip sculptured by pervasive normal faulting and locally by mass wasting processes. The lower slope is formed by en echelon terraces striking similar to the rough terrain of the incoming plate and mimicking the half graben morphology of the underthusting plate. The three morphotectonic slope domains represent differences in tectonic activity, with more stable upper slope, a middle slope

  4. Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies.

    PubMed

    Berendes, Sima; Heywood, Peter; Oliver, Sandy; Garner, Paul

    2011-04-01

    In developing countries, the private sector provides a substantial proportion of primary health care to low income groups for communicable and non-communicable diseases. These providers are therefore central to improving health outcomes. We need to know how their services compare to those of the public sector to inform policy options. We summarised reliable research comparing the quality of formal private versus public ambulatory health care in low and middle income countries. We selected studies against inclusion criteria following a comprehensive search, yielding 80 studies. We compared quality under standard categories, converted values to a linear 100% scale, calculated differences between providers within studies, and summarised median values of the differences across studies. As the results for for-profit and not-for-profit providers were similar, we combined them. Overall, median values indicated that many services, irrespective of whether public or private, scored low on infrastructure, clinical competence, and practice. Overall, the private sector performed better in relation to drug supply, responsiveness, and effort. No difference between provider groups was detected for patient satisfaction or competence. Synthesis of qualitative components indicates the private sector is more client centred. Although data are limited, quality in both provider groups seems poor, with the private sector performing better in drug availability and aspects of delivery of care, including responsiveness and effort, and possibly being more client orientated. Strategies seeking to influence quality in both groups are needed to improve care delivery and outcomes for the poor, including managing the increasing burden of non-communicable diseases.

  5. Minimum Wage and Overweight and Obesity in Adult Women: A Multilevel Analysis of Low and Middle Income Countries

    PubMed Central

    Conklin, Annalijn I.; Ponce, Ninez A.; Frank, John; Nandi, Arijit; Heymann, Jody

    2016-01-01

    Objectives To describe the relationship between minimum wage and overweight and obesity across countries at different levels of development. Methods A cross-sectional analysis of 27 countries with data on the legislated minimum wage level linked to socio-demographic and anthropometry data of non-pregnant 190,892 adult women (24–49 y) from the Demographic and Health Survey. We used multilevel logistic regression models to condition on country- and individual-level potential confounders, and post-estimation of average marginal effects to calculate the adjusted prevalence difference. Results We found the association between minimum wage and overweight/obesity was independent of individual-level SES and confounders, and showed a reversed pattern by country development stage. The adjusted overweight/obesity prevalence difference in low-income countries was an average increase of about 0.1 percentage points (PD 0.075 [0.065, 0.084]), and an average decrease of 0.01 percentage points in middle-income countries (PD -0.014 [-0.019, -0.009]). The adjusted obesity prevalence difference in low-income countries was an average increase of 0.03 percentage points (PD 0.032 [0.021, 0.042]) and an average decrease of 0.03 percentage points in middle-income countries (PD -0.032 [-0.036, -0.027]). Conclusion This is among the first studies to examine the potential impact of improved wages on an important precursor of non-communicable diseases globally. Among countries with a modest level of economic development, higher minimum wage was associated with lower levels of obesity. PMID:26963247

  6. Performance of 21 HPV vaccination programs implemented in low and middle-income countries, 2009–2013

    PubMed Central

    2014-01-01

    Background Cervical cancer is the third most common cancer in women worldwide, with high incidence in lowest income countries. Vaccination against Human Papilloma Virus (HPV) may help to reduce the incidence of cervical cancer. The aim of the study was to analyze HPV vaccination programs performance implemented in low and middle-income countries. Methods The Gardasil Access Program provides HPV vaccine at no cost to help national institutions gain experience implementing HPV vaccination. Data on vaccine delivery model, number of girls vaccinated, number of girls completing the three-dose campaign, duration of vaccination program, community involvement and sensitization strategies were collected from each program upon completion. Vaccine Uptake Rate (VUR) and Vaccine Adherence between the first and third doses (VA) rate were calculated. Multivariate linear regressions analyses were fitted. Results Twenty-one programs were included in 14 low and middle-income countries. Managing institutions were non-governmental organizations (NGOs) (n = 8) or Ministries of Health (n = 13). Twelve programs were school-based, five were health clinic-based and four utilized a mixed model. A total of 217,786 girls received a full course of vaccination. Mean VUR was 88.7% (SD = 10.5) and VA was 90.8% (SD = 7.3). The mean total number of girls vaccinated per program-month was 2,426.8 (SD = 2,826.6) in school model, 335.1 (SD = 202.5) in the health clinic and 544.7 (SD = 369.2) in the mixed models (p = 0.15). Community involvement in the follow-up of girls participating in the vaccination campaign was significantly associated with VUR. Multivariate analyses identified school-based (β = 13.35, p = 0.001) and health clinic (β = 13.51, p = 0.03) models, NGO management (β = 14.58, p < 10-3) and duration of program vaccination (β = -1.37, p = 0.03) as significant factors associated with VUR. Conclusion School and health clinic

  7. Methods for medical device and equipment procurement and prioritization within low- and middle-income countries: findings of a systematic literature review.

    PubMed

    Diaconu, Karin; Chen, Yen-Fu; Cummins, Carole; Jimenez Moyao, Gabriela; Manaseki-Holland, Semira; Lilford, Richard

    2017-08-18

    Forty to 70 % of medical devices and equipment in low- and middle-income countries are broken, unused or unfit for purpose; this impairs service delivery to patients and results in lost resources. Undiscerning procurement processes are at the heart of this issue. We conducted a systematic review of the literature to August 2013 with no time or language restrictions to identify what product selection or prioritization methods are recommended or used for medical device and equipment procurement planning within low- and middle-income countries. We explore the factors/evidence-base proposed for consideration within such methods and identify prioritization criteria. We included 217 documents (corresponding to 250 texts) in the narrative synthesis. Of these 111 featured in the meta-summary. We identify experience and needs-based methods used to reach procurement decisions. Equipment costs (including maintenance) and health needs are the dominant issues considered. Extracted data suggest that procurement officials should prioritize devices with low- and middle-income country appropriate technical specifications - i.e. devices and equipment that can be used given available human resources, infrastructure and maintenance capacity. Suboptimal device use is directly linked to incomplete costing and inadequate consideration of maintenance services and user training during procurement planning. Accurate estimation of life-cycle costing and careful consideration of device servicing are of crucial importance.

  8. Behaviour change techniques and contraceptive use in low and middle income countries: a review.

    PubMed

    Phiri, Mwelwa; King, R; Newell, J N

    2015-10-30

    We aimed to identify effective behaviour change techniques to increase modern contraceptive use in low and middle income countries (LMICs). Literature was identified in Global Health, Web of Science, MEDLINE, PsycINFO and Popline, as well as peer reviewed journals. Articles were included if they were written in English, had an outcome evaluation of contraceptive use, modern contraceptive use, contraceptive initiation/uptake, contraceptive adherence or continuation of contraception, were a systematic review or randomised controlled trial, and were conducted in a low or middle income country. We assessed the behaviour change techniques used in each intervention and included a new category of male partner involvement. We identified six studies meeting the inclusion criteria. The most effective interventions were those that involve male partner involvement in the decision to initiate contraceptive use. The findings also suggest that providing access to contraceptives in the community promotes their use. The interventions that had positive effects on contraceptive use used a combination of behaviour change techniques. Performance techniques were not used in any of the interventions. The use of social support techniques, which are meant to improve wider social acceptability, did not appear except in two of the interventions. Our findings suggest that when information and contraceptives are provided, contraceptive use improves. Recommendations include reporting of behaviour change studies to include more details of the intervention and techniques employed. There is also a need for further research to understand which techniques are especially effective.

  9. Do cash transfer programmes yield better health in the first year of life? A systematic review linking low-income/middle-income and high-income contexts.

    PubMed

    Siddiqi, Arjumand; Rajaram, Akshay; Miller, Steven P

    2018-04-28

    Decades of research unequivocally demonstrates that no matter the society, socioeconomic resources are perhaps the most fundamental determinants of health throughout the life course, including during its very earliest stages. As a result, societies have implemented 'cash transfer' programmes, whichprovide income supplementation to reduce socioeconomic disadvantage among the poorest families with young children. Despite this being a common approach of societies around the world, research on effects of these programmes in low-income/middle-income countries, and those in high-income countries has been conducted as if they are entirely distinct phenomena. In this paper, we systematically review the international literature on the association between cash transfer programmes and health outcomes during the first year of life. We conducted a systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Using a variety of relevant keywords, we searched MEDLINE, EMBASE, CINAHL, Cochrane Reviews, EconLit and Social Sciences Citations Index. Our review yielded 14 relevant studies. These studies suggested cash transfer programmes that were not attached to conditions tended to yield positive effects on outcomes such as birth weight and infant mortality. Programmes that were conditional on use of health services also carried positive effects, while those that carried labour-force participation conditionalities tended to yield no positive effects. Given several dynamics involved in determining whether children are healthy or not, which are common worldwide, viewing the literature from a global perspective produces novel insights regarding the tendency of policies and programmes to reduce or, to exacerbate, the effects of socioeconomic disadvantage on child health. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise

  10. Food prices and consumer demand: differences across income levels and ethnic groups.

    PubMed

    Ni Mhurchu, Cliona; Eyles, Helen; Schilling, Chris; Yang, Qing; Kaye-Blake, William; Genç, Murat; Blakely, Tony

    2013-01-01

    Targeted food pricing policies may improve population diets. To assess their effects on inequalities, it is important to determine responsiveness to price changes across income levels and ethnic groups. Our goal was to estimate price elasticity (PE) values for major commonly consumed food groups in New Zealand, by income and ethnicity. PE values represent percentage change in demand associated with 1% change in price of that good (own-PE) or another good (cross-PE). We used food expenditure data from national household economic surveys in 2007/08 and 2009/10 and Food Price Index data from 2007 and 2010. Adopting an Almost Ideal Demand System approach, own-PE and cross-PE estimates were derived for 24 food categories, household income quintiles, and two ethnic groups (Māori and non-Māori). Own-PE estimates (with two exceptions) ranged from -0.44 to -1.78. Cross-PE estimates were generally small; only 31% of absolute values were greater than 0.10. Excluding the outlier 'energy drinks', nine of 23 food groups had significantly stronger own-PEs for the lowest versus highest income quintiles (average regression-based difference across food groups -0.30 (95% CI -0.62 to 0.02)). Six own-PEs were significantly stronger among Māori; the average difference for Māori: non-Māori across food groups was -0.26 (95% CI -0.52 to 0.00). Food pricing policies have potential to improve population diets. The greater sensitivity of low-income households and Māori to price changes suggests the beneficial effects of such policies on health would be greatest for these groups.

  11. Hong Kong men with low incomes have worse health-related quality of life as judged by SF-36 scores.

    PubMed

    Ko, G T C; Wai, H P S; Tsang, P C C; Chan, H C K

    2006-10-01

    To analyse the association between income and health-related quality of life using the Medical Outcome Study Short Form 36 (SF-36) Chinese version in Hong Kong Chinese working population. Cross-sectional observation study. A commercial company in Hong Kong. All clerical and administrative staff of a commercial company was invited to participate; 876 of the 1003 staff agreed. The subjects were categorised into three income groups according to monthly income in Hong Kong dollars (low, < or =10,000; middle, >10,000-25,000; high, >25,000). The mean age of the 288 men and 588 women was 34.9 (standard deviation, 7.9; median, 34.0; range, 18-71) years. SF-36 scores on health-related quality of life. The distribution of income was 30% in high-, 54.8% in middle-, and 15.2% in low-income groups. Women had similar SF-36 scores among different income groups. In men, for most variables there was a significant positive linear correlation between income and SF-36 scores. Low income is associated with a worse health-related quality of life in Hong Kong Chinese men.

  12. Availability of healthy snack foods and beverages in stores near high-income urban, low-income urban, and rural elementary and middle schools in Oregon.

    PubMed

    Findholt, Nancy E; Izumi, Betty T; Nguyen, Thuan; Pickus, Hayley; Chen, Zunqiu

    2014-08-01

    Food stores near schools are an important source of snacks for children. However, few studies have assessed availability of healthy snacks in these settings. The aim of this study was to assess availability of healthy snack foods and beverages in stores near schools and examine how availability of healthy items varied by poverty level of the school and rural-urban location. Food stores were selected based on their proximity to elementary/middle schools in three categories: high-income urban, low-income urban, and rural. Audits were conducted within the stores to assess the presence or absence of 48 items in single-serving sizes, including healthy beverages, healthy snacks, fresh fruits, and fresh vegetables. Overall, availability of healthy snack foods and beverages was low in all stores. However, there was significant cross-site variability in availability of several snack and fruit items, with stores near high-income urban schools having higher availability, compared to stores near low-income urban and/or rural schools. Stores near rural schools generally had the lowest availability, although several fruits were found more often in rural stores than in urban stores. There were no significant differences in availability of healthy beverages and fresh vegetables across sites. Availability of healthy snack foods and beverages was limited in stores near schools, but these limitations were more severe in stores proximal to rural and low-income schools. Given that children frequent these stores to purchase snacks, efforts to increase the availability of healthy products, especially in stores near rural and low-income schools, should be a priority.

  13. Integration of mental health into primary care in low- and middle-income countries: the PRIME mental healthcare plans.

    PubMed

    Lund, Crick; Tomlinson, Mark; Patel, Vikram

    2016-01-01

    This supplement outlines the development and piloting of district mental healthcare plans from five low- and middle-income countries, together with the methods for their design, evaluation and costing. In this editorial we consider the challenges that these programmes face, highlight their innovations and draw conclusions. © The Royal College of Psychiatrists 2016.

  14. Prevalence of Thinness in Adolescent Girls in Low- and Middle-Income Countries and Associations With Wealth, Food Security, and Inequality.

    PubMed

    Candler, Toby; Costa, Silvia; Heys, Michelle; Costello, Anthony; Viner, Russell M

    2017-04-01

    Adequate nutrition during adolescence is important for optimal physical and cognitive development and for pregnancy either during adolescence or later life. Thinness among adolescent girls in low- and middle-income countries has been little studied. We used body mass index data from 40 countries from the Global School Health Survey to estimate the prevalence of moderate and severe thinness in 12- to 18-year-olds using the World Health Organization 2007 growth reference. Self-report data on going to bed hungry were used as a proxy for household food insecurity. We used multilevel models to assess whether national wealth (gross domestic product), income inequality (Gini index), national gender inequality (Gender Inequality Index), and food security (Global Food Security Index) were associated with undernutrition. Prevalence rates of moderate and severe thinness across 61,603 girls from 40 countries were 6.30% (95% confidence interval [CI]: 5.71-6.95) and 1.34% (1.12-1.59), respectively, with higher rates in Asia. Combined moderate/severe thinness was more common among early (12-14 years) than later adolescents (15-18 years). Going to bed hungry sometimes was associated with increased risk of moderate/severe thinness (odds ratio [OR]: 1.102; 95% CI: 1.007-1.206). A significant inverse relationship was found between thinness and gross domestic product (OR: .94; 95% CI: .88-.99) and Global Food Security Index (OR: .96; 95% CI: .93-.99) but not Gini or Gender Inequality Index. Thinness remains prevalent in adolescent schoolgirls in low- and middle-income countries and poses a significant threat to their health and that of the next generation. Further research is needed to assess potential interventions for this group. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  15. Open access for operational research publications from low- and middle-income countries: who pays?

    PubMed Central

    Kumar, A. M. V.; Reid, A. J.; Van den Bergh, R.; Isaakidis, P.; Draguez, B.; Delaunois, P.; Nagaraja, S. B.; Ramsay, A.; Reeder, J. C.; Denisiuk, O.; Ali, E.; Khogali, M.; Hinderaker, S. G.; Kosgei, R. J.; van Griensven, J.; Quaglio, G. L.; Maher, D.; Billo, N. E.; Terry, R. F.; Harries, A. D.

    2014-01-01

    Open-access journal publications aim to ensure that new knowledge is widely disseminated and made freely accessible in a timely manner so that it can be used to improve people's health, particularly those in low- and middle-income countries. In this paper, we briefly explain the differences between closed- and open-access journals, including the evolving idea of the ‘open-access spectrum’. We highlight the potential benefits of supporting open access for operational research, and discuss the conundrum and ways forward as regards who pays for open access. PMID:26400799

  16. Ethics issues in social media-based HIV prevention in low- and middle-income countries.

    PubMed

    Chiu, Chingche J; Menacho, Luis; Fisher, Celia; Young, Sean D

    2015-07-01

    Questions have been raised regarding participants' safety and comfort when participating in e-health education programs. Although researchers have begun to explore this issue in the United States, little research has been conducted in low- and middle-income countries, where Internet and social media use is rapidly growing. This article reports on a quantitative study with Peruvian men who have sex with men who had previously participated in the Harnessing Online Peer Education (HOPE) program, a Facebook-based HIV education program. The survey assessed participants' ethics-relevant perspectives during recruitment, consent, intervention, and follow-up.

  17. Launching Low-Income Entrepreneurs

    ERIC Educational Resources Information Center

    Laney, Kahliah

    2013-01-01

    With middle-income jobs in decline, entrepreneurship offers an increasingly promising pathway out of poverty; but few low-income New Yorkers are currently taking this route to economic self-sufficiency. This report provides the most comprehensive examination of low-income entrepreneurship in New York. The report documents current self-employment…

  18. Critical review of the emerging research evidence on agricultural biodiversity, diet diversity, and nutritional status in low- and middle-income countries

    PubMed Central

    Jones, Andrew D

    2017-01-01

    The declining diversity of agricultural production and food supplies worldwide may have important implications for global diets. The primary objective of this review is to assess the nature and magnitude of the associations of agricultural biodiversity with diet quality and anthropometric outcomes in low- and middle-income countries. A comprehensive review of 5 databases using a priori exclusion criteria and application of a systematic, qualitative analysis to the findings of identified studies revealed that agricultural biodiversity has a small but consistent association with more diverse household- and individual-level diets, although the magnitude of this association varies with the extent of existing diversification of farms. Greater on-farm crop species richness is also associated with small, positive increments in young child linear stature. Agricultural diversification may contribute to diversified diets through both subsistence- and income-generating pathways and may be an important strategy for improving diets and nutrition outcomes in low- and middle-income countries. Six research priorities for future studies of the influence of agricultural biodiversity on nutrition outcomes are identified based on gaps in the research literature. PMID:29028270

  19. Systematic review: handwashing behaviour in low- to middle-income countries: outcome measures and behaviour maintenance.

    PubMed

    Vindigni, Stephen M; Riley, Patricia L; Jhung, Michael

    2011-04-01

    To describe global approaches to handwashing research in low- and middle-income communities, schools and health care settings using behavioural outcome measurement and temporal study design. Peer-reviewed and grey literature was screened for handwashing studies that evaluated behaviour change. Relevant articles were assessed by their research approach, including the investigator's selected outcome measure and time frame of various study components (e.g., formative research, intervention and evaluation). The initial search yielded 527 relevant articles. After application of exclusion criteria, we identified 27 unique studies (30 total articles). Of the 27 articles, most were focused in the community setting. Fifteen (56%) documented observed handwashing behaviour, while 18 (67%) used proxy measures (e.g., soap presence, diarrhoea) and 14 (52%) used self-reported behaviour. Several studies used multiple outcome measures. While all studies had an evaluation of behaviour change, there was a dearth of studies that evaluated long-term maintenance of behaviour change after the intervention's conclusion. While the literature is replete with a variety of handwashing studies in community, school and health care settings, none have been able to definitively document long-term behaviour change, thereby challenging the sustainability of various interventions. Additionally, there is a need to better understand which research approach is most effective in promoting long-term behaviour compliance in global low- and middle-income settings. © 2011 Blackwell Publishing Ltd.

  20. Chronic Pain Without Clear Etiology in Low- and Middle-Income Countries: A Narrative Review.

    PubMed

    Jackson, Tracy; Thomas, Sarah; Stabile, Victoria; Han, Xue; Shotwell, Matthew; McQueen, K A Kelly

    2016-06-01

    Globally, 8 of the top 12 disabling conditions are related either to chronic pain or to the psychological conditions strongly associated with persistent pain. In this narrative review, we explore the demographic and psychosocial associations with chronic pain exclusively from low- and middle-income countries (LMICs) and compare them with current global data. One hundred nineteen publications in 28 LMICs were identified for review; associations with depression, anxiety, posttraumatic stress, insomnia, disability, gender, age, rural/urban location, education level, income, and additional sites of pain were analyzed for each type of chronic pain without clear etiology. Of the 119 publications reviewed, pain was described in association with disability in 50 publications, female gender in 40 publications, older age in 34 publications, depression in 36 publications, anxiety in 19 publications, and multiple somatic complaints in 13 publications. Women, elderly patients, and workers, especially in low-income and low-education subgroups, were more likely to have pain in multiple sites, mood disorders, and disabilities. In high-income countries, multisite pain without etiology, female gender, and association with mood disturbance and disability may be suggestive of a central sensitization syndrome (CSS). Because each type of prevalent chronic pain without known etiology reviewed had similar associations in LMICs, strategies for assessment and treatment of chronic pain worldwide should consider the possibility of prevalent CSS. Recognition is especially critical in resource-poor areas, because treatment of CSS is vastly different than localized chronic pain.

  1. International Migration of Doctors, and Its Impact on Availability of Psychiatrists in Low and Middle Income Countries

    PubMed Central

    Jenkins, Rachel; Kydd, Robert; Mullen, Paul; Thomson, Kenneth; Sculley, James; Kuper, Susan; Carroll, Joanna; Gureje, Oye; Hatcher, Simon; Brownie, Sharon; Carroll, Christopher; Hollins, Sheila; Wong, Mai Luen

    2010-01-01

    Background Migration of health professionals from low and middle income countries to rich countries is a large scale and long-standing phenomenon, which is detrimental to the health systems in the donor countries. We sought to explore the extent of psychiatric migration. Methods In our study, we use the respective professional databases in each country to establish the numbers of psychiatrists currently registered in the UK, US, New Zealand, and Australia who originate from other countries. We also estimate the impact of this migration on the psychiatrist population ratios in the donor countries. Findings We document large numbers of psychiatrists currently registered in the UK, US, New Zealand and Australia originating from India (4687 psychiatrists), Pakistan (1158), Bangladesh (149) , Nigeria (384) , Egypt (484), Sri Lanka (142), Philippines (1593). For some countries of origin, the numbers of psychiatrists currently registered within high-income countries' professional databases are very small (e.g., 5 psychiatrists of Tanzanian origin registered in the 4 high-income countries we studied), but this number is very significant compared to the 15 psychiatrists currently registered in Tanzania). Without such emigration, many countries would have more than double the number of psychiatrists per 100, 000 population (e.g. Bangladesh, Myanmar, Afghanistan, Egypt, Syria, Lebanon); and some countries would have had five to eight times more psychiatrists per 100,000 (e.g. Philippines, Pakistan, Sri Lanka, Liberia, Nigeria and Zambia). Conclusions Large numbers of psychiatrists originating from key low and middle income countries are currently registered in the UK, US, New Zealand and Australia, with concomitant impact on the psychiatrist/population ratio n the originating countries. We suggest that creative international policy approaches are needed to ensure the individual migration rights of health professionals do not compromise societal population rights to health

  2. A realist synthesis of cross-border patient movement from low and middle income countries to similar or higher income countries.

    PubMed

    Durham, Jo; Blondell, Sarah J

    2017-08-29

    Patient travel across borders to access healthcare is becoming increasingly common and widespread. Patients moving from high income to middle income countries for healthcare is well documented, with patients seeking treatments that are cheaper or more readily available than at home. Less well understood is when patients move from one low income country to another or from a low income country to a higher income country. In this paper, a realist review was undertaken to explore why, in what contexts and how patients from lower income countries travel to countries with the same, or more advanced, economies for planned healthcare. Based on an initial scoping of the literature and discussions with key informants, we generated an initial theory and set of propositions about why, how, who and in what contexts people cross international borders for planned healthcare. We then systematically located and synthesized (1) peer-reviewed studies from the Scopus, Embase, Web of Science and Econlit databases; (2) non-indexed reports using key informants and Google; and (3) papers from the reference lists of included documents, to glean supportive or contradictory evidence for our initial propositions. As we reviewed the literature and extracted our data, we drew on the work of Pierre Bourdieu to understand the interplay between material and non-material capital and cognitive processes in decisions to cross borders for healthcare. Patient travel was largely undertaken due to a lack of services in the home country and/or unacceptability of local services, with decisions on when, and where, to travel, usually made within the patient's social networks. They were able to travel via use of multiple resources, including social networks, economic and cultural capital, and habitus. Those patients with greater volumes of the aforementioned factors had greater healthcare options; however, even those with limited resources engaged in patient travel. Patient movement challenges traditional

  3. Alcohol taxation policy in Thailand: implications for other low- to middle-income countries.

    PubMed

    Sornpaisarn, Bundit; Shield, Kevin D; Rehm, Jürgen

    2012-08-01

      Prevention of drinking initiation is a significant challenge in low- and middle-income countries that have a high prevalence of abstainers, including life-time abstainers. This paper aims to encourage a debate on an alternative alcohol taxation approach used currently in Thailand, which aims specifically to prevent drinking initiation in addition to reduce alcohol-attributable harms.   Theoretical evaluation, simulation and empirical analysis.   The taxation method of Thailand, 'Two-Chosen-One' (2C1) combines specific taxation (as a function of the alcohol content) and ad valorem taxation (as a function of the price), resulting in an effective tax rate that puts a higher tax both on beverages which are preferred by heavy drinkers and on beverages which are preferred by potential alcohol consumption neophytes, compared to either taxation system alone. As a result of these unique properties of the 2C1 taxation system, our simulations indicate that 2C1 taxation leads to a lower overall consumption than ad valorem or specific taxation alone. In addition, it puts a relatively high tax on beverages attractive to young people, the majority of whom are currently abstaining. Currently, the abstention rates in Thailand are higher than expected based on its economic wealth, which could be taken as an indication that the taxation strategy is successful.   'Two-chosen-one' (2C1) taxation has the potential to simultaneously reduce alcohol consumption and prevent drinking initiation among youth; however, additional empirical evidence is needed to assess its effectiveness in terms of the public health impact in low- and middle-income countries. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

  4. Contribution of Maternal Immunity to Decreased Rotavirus Vaccine Performance in Low- and Middle-Income Countries

    PubMed Central

    Mwila, Katayi; Simuyandi, Michelo; Permar, Sallie R.

    2016-01-01

    ABSTRACT The role of maternal immunity, received by infants either transplacentally or orally from breast milk, in rotavirus vaccine (RV) performance is evaluated here. Breastfeeding withholding has no effect on vaccine responses, but higher levels of transplacental rotavirus-specific IgG antibody contribute to reduced vaccine seroconversion. The gaps in knowledge on the factors associated with low RV efficacy in low- and middle-income countries (LMIC) remain, and further research is needed to shed more light on these issues. PMID:27847365

  5. Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries.

    PubMed

    2016-01-01

    Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally. Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression. This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed. Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas. NCT02179112; Pre-results.

  6. Food Prices and Consumer Demand: Differences across Income Levels and Ethnic Groups

    PubMed Central

    Ni Mhurchu, Cliona; Eyles, Helen; Schilling, Chris; Yang, Qing; Kaye-Blake, William; Genç, Murat; Blakely, Tony

    2013-01-01

    Background Targeted food pricing policies may improve population diets. To assess their effects on inequalities, it is important to determine responsiveness to price changes across income levels and ethnic groups. Objective Our goal was to estimate price elasticity (PE) values for major commonly consumed food groups in New Zealand, by income and ethnicity. PE values represent percentage change in demand associated with 1% change in price of that good (own-PE) or another good (cross-PE). Design We used food expenditure data from national household economic surveys in 2007/08 and 2009/10 and Food Price Index data from 2007 and 2010. Adopting an Almost Ideal Demand System approach, own-PE and cross-PE estimates were derived for 24 food categories, household income quintiles, and two ethnic groups (Māori and non-Māori). Results Own-PE estimates (with two exceptions) ranged from −0.44 to −1.78. Cross-PE estimates were generally small; only 31% of absolute values were greater than 0.10. Excluding the outlier ‘energy drinks’, nine of 23 food groups had significantly stronger own-PEs for the lowest versus highest income quintiles (average regression-based difference across food groups −0.30 (95% CI −0.62 to 0.02)). Six own-PEs were significantly stronger among Māori; the average difference for Māori: non-Māori across food groups was −0.26 (95% CI −0.52 to 0.00). Conclusions Food pricing policies have potential to improve population diets. The greater sensitivity of low-income households and Māori to price changes suggests the beneficial effects of such policies on health would be greatest for these groups. PMID:24098408

  7. Addressing gaps in international blood availability and transfusion safety in low- and middle-income countries: a NHLBI workshop.

    PubMed

    Custer, Brian; Zou, Shimian; Glynn, Simone A; Makani, Julie; Tayou Tagny, Claude; El Ekiaby, Magdy; Sabino, Ester C; Choudhury, Nabajyoti; Teo, Diana; Nelson, Kenrad; Peprah, Emmanuel; Price, LeShawndra; Engelgau, Michael M

    2018-05-01

    In April 2017, a workshop sponsored by the National Heart, Lung, and Blood Institute, Division of Blood Diseases and Resources, and the Center for Translation Research and Implementation Science was held to discuss blood availability and transfusion safety in low- and middle-income countries (LMICs). The purpose of the workshop was to identify research opportunities for implementation science (IS) to improve the availability of safe blood and blood components and transfusion practices in LMICs. IS describes the late stages of the translational research spectrum and studies optimal and sustainable strategies to deliver proven-effective interventions. Regional working groups were formed to focus on opportunities and challenges in East Africa, Central/West Africa, Middle East and North Africa, Latin America and the Caribbean, Southeast Asia, Western Pacific Asia, Eastern Europe, and Central Asia. The need for an "adequate supply of safe blood" emerged as the major overriding theme. Among the regional working groups, common cross-cutting themes were evident. The majority of research questions, priorities, and strategies fell into the categories of blood availability, blood transfusion safety, appropriate use of blood, quality systems, health economics and budgeting, and training and education in IS. The workshop also brought into focus inadequate country-level data that can be used as the basis for IS initiatives. A mixed approach of needs assessment and targeted interventions with sufficient evidence base to move toward sustainment is an appropriate next step for blood availability and transfusion safety research in LMICs. © 2018 AABB.

  8. Food Safety in Low and Middle Income Countries

    PubMed Central

    Grace, Delia

    2015-01-01

    Evidence on foodborne disease (FBD) in low and middle income countries (LMICs) is still limited, but important studies in recent years have broadened our understanding. These suggest that developing country consumers are concerned about FBD; that most of the known burden of FBD disease comes from biological hazards; and, that most FBD is the result of consumption of fresh, perishable foods sold in informal markets. FBD is likely to increase in LMICs as the result of massive increases in the consumption of risky foods (livestock and fish products and produce) and lengthening and broadening value chains. Although intensification of agricultural production is a strong trend, so far agro-industrial production and modern retail have not demonstrated clear advantages in food safety and disease control. There is limited evidence on effective, sustainable and scalable interventions to improve food safety in domestic markets. Training farmers on input use and good practices often benefits those farmers trained, but has not been scalable or sustainable, except where good practices are linked to eligibility for export. Training informal value chain actors who receive business benefits from being trained has been more successful. New technologies, growing public concern and increased emphasis on food system governance can also improve food safety. PMID:26343693

  9. Food Safety in Low and Middle Income Countries.

    PubMed

    Grace, Delia

    2015-08-27

    Evidence on foodborne disease (FBD) in low and middle income countries (LMICs) is still limited, but important studies in recent years have broadened our understanding. These suggest that developing country consumers are concerned about FBD; that most of the known burden of FBD disease comes from biological hazards; and, that most FBD is the result of consumption of fresh, perishable foods sold in informal markets. FBD is likely to increase in LMICs as the result of massive increases in the consumption of risky foods (livestock and fish products and produce) and lengthening and broadening value chains. Although intensification of agricultural production is a strong trend, so far agro-industrial production and modern retail have not demonstrated clear advantages in food safety and disease control. There is limited evidence on effective, sustainable and scalable interventions to improve food safety in domestic markets. Training farmers on input use and good practices often benefits those farmers trained, but has not been scalable or sustainable, except where good practices are linked to eligibility for export. Training informal value chain actors who receive business benefits from being trained has been more successful. New technologies, growing public concern and increased emphasis on food system governance can also improve food safety.

  10. Perceptions and impact of plain packaging of tobacco products in low and middle income countries, middle to upper income countries and low-income settings in high-income countries: a systematic review of the literature

    PubMed Central

    Hughes, Nicole; Arora, Monika; Grills, Nathan

    2016-01-01

    Objective To review the current literature around the potential impact, effectiveness and perceptions of plain packaging in low income settings. Method A systematic review of the literature. Data sources 9 databases (PubMed, Global Health, Social Policy and Practice, Applied Social Sciences Index and Abstracts (ASSIA), CINAHL, PsycINFO, British Library for Development Studies (BLDS), Global Health Library and Scopus) were searched. The terms used for searching combined terms for smoking and tobacco use with terms for plain packaging. Study selection Studies investigating the impact of plain packaging on the determinants of tobacco use, such as smoking behaviour, appeal, prominence, effectiveness of health warnings, response to plain packs, attitudes towards quitting or likelihood of smoking in low-income settings, were identified. Studies must have been published in English and be original research of any level of rigour. Data extraction Two independent reviewers assessed studies for inclusion and extracted data. Data synthesis The results were synthesised qualitatively, with themes grouped under four key headings: appeal and attractiveness; salience of health warnings and perceptions of harm; enjoyment and perceived taste ratings; and perceptions of the impact on tobacco usage behaviour. Results This review has identified four articles that met the inclusion criteria. Studies identified that tobacco products in plain packaging had less appeal than in branded packaging in low-income settings. Conclusions This review indicates that plain packaging appears to be successful in reducing appeal of smoking and packets, and supports the call for plain packaging to be widely implemented in conjunction with other tobacco control policies. However, there are considerable gaps in the amount of research conducted outside high-income countries. PMID:27000787

  11. Patterns of authorship on community health workers in low-and-middle-income countries: an analysis of publications (2012–2016)

    PubMed Central

    Maleka, Nelisiwe

    2018-01-01

    Introduction Studies of authorship provide a barometer of local research capacity and ownership of research, considered key to defining appropriate research priorities, developing contextualised responses to health problems and ensuring that research informs policy and practice. This paper reports on an analysis of patterns of research authorship of the now substantial literature on community health workers (CHWs) in low-and-middle-income countries (LMICs) for the 5-year period: 2012–2016. Methods A search of five databases identified a total of 649 indexed publications reporting on CHWs in LMICs and meeting the inclusion criteria. The country, region and income classification of studies, affiliations (country, organisation) of lead (first) and last authors, proportions of all authors locally affiliated, programme area (eg, maternal child health) and funding source were extracted. Results The 649 papers reported experiences from 51 countries, 55% from middle-income countries (MICs) and 32% from low-income countries (LICs), with the remaining 13% multicountry studies. Overall, 47% and 54% of all the papers had a high-income country (HIC) lead and last author, respectively. Authorship followed three patterns: (1) a concentrated HIC pattern, with US-based authors numerically dominating LIC-based and multicountry studies; (2) an MIC pattern of autonomy, with a handful of countries—India, South Africa and Brazil, in particular—leading >70% of their CHW publications and (3) a pattern of unevenness among LICs in their lead authorship of publications varying from 14% (Malawi) to 54% (Uganda). Region, programme area and funding source were all associated with the distribution of authorship across country income categories. Conclusion The findings in this analysis mirror closely that of other authorship studies in global health. Collectively these provide a common message—that investments in global health programmes in the Millennium Development Goal era may have

  12. Mobile Health (mHealth) Approaches and Lessons for Increased Performance and Retention of Community Health Workers in Low- and Middle-Income Countries: A Review

    PubMed Central

    2013-01-01

    Background Mobile health (mHealth) describes the use of portable electronic devices with software applications to provide health services and manage patient information. With approximately 5 billion mobile phone users globally, opportunities for mobile technologies to play a formal role in health services, particularly in low- and middle-income countries, are increasingly being recognized. mHealth can also support the performance of health care workers by the dissemination of clinical updates, learning materials, and reminders, particularly in underserved rural locations in low- and middle-income countries where community health workers deliver integrated community case management to children sick with diarrhea, pneumonia, and malaria. Objective Our aim was to conduct a thematic review of how mHealth projects have approached the intersection of cellular technology and public health in low- and middle-income countries and identify the promising practices and experiences learned, as well as novel and innovative approaches of how mHealth can support community health workers. Methods In this review, 6 themes of mHealth initiatives were examined using information from peer-reviewed journals, websites, and key reports. Primary mHealth technologies reviewed included mobile phones, personal digital assistants (PDAs) and smartphones, patient monitoring devices, and mobile telemedicine devices. We examined how these tools could be used for education and awareness, data access, and for strengthening health information systems. We also considered how mHealth may support patient monitoring, clinical decision making, and tracking of drugs and supplies. Lessons from mHealth trials and studies were summarized, focusing on low- and middle-income countries and community health workers. Results The review revealed that there are very few formal outcome evaluations of mHealth in low-income countries. Although there is vast documentation of project process evaluations, there are few

  13. Mobile health (mHealth) approaches and lessons for increased performance and retention of community health workers in low- and middle-income countries: a review.

    PubMed

    Källander, Karin; Tibenderana, James K; Akpogheneta, Onome J; Strachan, Daniel L; Hill, Zelee; ten Asbroek, Augustinus H A; Conteh, Lesong; Kirkwood, Betty R; Meek, Sylvia R

    2013-01-25

    Mobile health (mHealth) describes the use of portable electronic devices with software applications to provide health services and manage patient information. With approximately 5 billion mobile phone users globally, opportunities for mobile technologies to play a formal role in health services, particularly in low- and middle-income countries, are increasingly being recognized. mHealth can also support the performance of health care workers by the dissemination of clinical updates, learning materials, and reminders, particularly in underserved rural locations in low- and middle-income countries where community health workers deliver integrated community case management to children sick with diarrhea, pneumonia, and malaria. Our aim was to conduct a thematic review of how mHealth projects have approached the intersection of cellular technology and public health in low- and middle-income countries and identify the promising practices and experiences learned, as well as novel and innovative approaches of how mHealth can support community health workers. In this review, 6 themes of mHealth initiatives were examined using information from peer-reviewed journals, websites, and key reports. Primary mHealth technologies reviewed included mobile phones, personal digital assistants (PDAs) and smartphones, patient monitoring devices, and mobile telemedicine devices. We examined how these tools could be used for education and awareness, data access, and for strengthening health information systems. We also considered how mHealth may support patient monitoring, clinical decision making, and tracking of drugs and supplies. Lessons from mHealth trials and studies were summarized, focusing on low- and middle-income countries and community health workers. The review revealed that there are very few formal outcome evaluations of mHealth in low-income countries. Although there is vast documentation of project process evaluations, there are few studies demonstrating an impact on

  14. Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review.

    PubMed

    Basu, Sanjay; Andrews, Jason; Kishore, Sandeep; Panjabi, Rajesh; Stuckler, David

    2012-01-01

    Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. Peer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of "private sector" included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. "Competitive dynamics" for funding appeared between the two sectors, such

  15. Prices paid for adult and paediatric antiretroviral treatment by low- and middle-income countries in 2012: high, low or just right?

    PubMed

    Perriëns, Joseph H; Habiyambere, Vincent; Dongmo-Nguimfack, Boniface; Hirnschall, Gottfried

    2014-01-01

    A viable market for antiretroviral drugs in low- and middle-income countries is key to the continued scale-up of antiretroviral treatment. We describe the price paid by low- and middle-income countries for 10 first- and 7 second-line adult and paediatric treatment regimens from 2003 to 2012, and compare the price of their finished formulations with the price of their active pharmaceutical ingredients in 2005, 2007, 2010 and 2012. Between 2003 and 2012 the median price of adult first-line treatment regimens per treatment-year decreased from USD499 to USD122, and that of second-line regimens from USD2,934 to USD497. In 2005 adult formulations were sold for a price 170% higher than the cost of their active pharmaceutical ingredients. This margin had decreased to 28% in 2012. Between 2004 and 2013, the price of paediatric treatment per treatment-year decreased from USD585 to USD147 for first-line and from USD763 to USD288 for second-line treatment. In 2005, paediatric treatment regimens were sold at a price 231% higher than the cost of their active pharmaceutical ingredients. This margin remained high and was 195% in 2012. The prices paid for antiretroviral drugs by low- and middle-income countries decreased between 2003 and 2012. Although the margins on their sale decreased, there is likely still space for price reduction, especially for the more recent World Health Organization recommended adult first-line regimens and for paediatric treatment.

  16. Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries: Systematic Review of Comparative Studies

    PubMed Central

    Berendes, Sima; Heywood, Peter; Oliver, Sandy; Garner, Paul

    2011-01-01

    Background In developing countries, the private sector provides a substantial proportion of primary health care to low income groups for communicable and non-communicable diseases. These providers are therefore central to improving health outcomes. We need to know how their services compare to those of the public sector to inform policy options. Methods and Findings We summarised reliable research comparing the quality of formal private versus public ambulatory health care in low and middle income countries. We selected studies against inclusion criteria following a comprehensive search, yielding 80 studies. We compared quality under standard categories, converted values to a linear 100% scale, calculated differences between providers within studies, and summarised median values of the differences across studies. As the results for for-profit and not-for-profit providers were similar, we combined them. Overall, median values indicated that many services, irrespective of whether public or private, scored low on infrastructure, clinical competence, and practice. Overall, the private sector performed better in relation to drug supply, responsiveness, and effort. No difference between provider groups was detected for patient satisfaction or competence. Synthesis of qualitative components indicates the private sector is more client centred. Conclusions Although data are limited, quality in both provider groups seems poor, with the private sector performing better in drug availability and aspects of delivery of care, including responsiveness and effort, and possibly being more client orientated. Strategies seeking to influence quality in both groups are needed to improve care delivery and outcomes for the poor, including managing the increasing burden of non-communicable diseases. Please see later in the article for the Editors' Summary PMID:21532746

  17. Priorities for research into human resources for health in low- and middle-income countries

    PubMed Central

    Chopra, Mickey; Atkins, Salla; Dal Poz, Mario Roberto; Bennett, Sara

    2010-01-01

    Abstract Objective To identify the human resources for health (HRH) policy concerns and research priorities of key stakeholders in low- and middle-income countries; to assess the extent to which existing HRH research addresses these concerns and priorities; and to develop a prioritized list of core research questions requiring immediate attention to facilitate policy development and implementation. Methods The study involved interviews with key informants, including health policy-makers, researchers and community and civil society representatives, in 24 low- and middle-income countries in four regions, a literature search for relevant reviews of research completed to date, and the assessment of interview and literature search findings at a consultative multinational workshop, during which research questions were prioritized. Findings Twenty-one research questions emerged from the key informant interviews, many of which had received little or no attention in the reviewed literature. The questions ranked as most important at the consultative workshop were: (i) To what extent do incentives work in attracting and retaining qualified health workers in underserviced areas? (ii) What is the impact of dual practice and multiple employment? and (iii) How can incentives be used to optimize efficiency and the quality of health care? Conclusion There was a clear consensus about the type of HRH policy problems faced by different countries and the nature of evidence needed to tackle them. Coordinated action to support and implement research into the highest priority questions identified here could have a major impact on health worker policies and, ultimately, on the health of the poor. PMID:20539857

  18. Impact of Socio-Health Factors on Life Expectancy in the Low and Lower Middle Income Countries

    PubMed Central

    MONDAL, Md. Nazrul Islam; SHITAN, Mahendran

    2013-01-01

    Abstract Background This study is concerned with understanding the impact of demographic changes, socioeconomic inequalities, and the availability of health factors on life expectancy (LE) in the low and lower middle income countries. Methods The cross-country data were collected from 91 countries from the United Nations agencies in 2012. LE is the response variable with demographics (total fertility rate, and adolescent fertility rate), socioeconomic status (mean year of schooling, and gross national income per capita), and health factors (physician density, and HIV prevalence rate) are as the three main predictors. Stepwise multiple regression analysis is used to extract the main factors. Results The necessity of more healthcare resources and higher levels of socioeconomic advantages are more likely to increase LE. On the other hand, demographic changes and health factors are more likely to increase LE by way of de-cease fertility rates and disease prevalence. Conclusion These findings suggest that international efforts should aim at increasing LE, especially in the low income countries through the elimination of HIV prevalence, adolescent fertility, and illiteracy. PMID:26060637

  19. Enhancing Neurosurgical Education in Low- and Middle-income Countries: Current Methods and New Advances

    PubMed Central

    LIANG, Kevin E; BERNSTEIN, Ilia; KATO, Yoko; KAWASE, Takeshi; HODAIE, Mojgan

    2016-01-01

    Low- and middle-income countries (LMICs) face a critical shortage of basic surgical services. Adequate neurosurgical services can have a far-reaching positive impact on society’s health care and, consequently, the economic development in LMICs. Yet surgery, and specifically neurosurgery has been a long neglected sector of global health. This article reviews the current efforts to enhance neurosurgery education in LMICs and outlines ongoing approaches for improvement. In addition, we introduce the concept of a sustainable and cost-effective model to enhance neurosurgical resources in LMICs and describe the process and methods of online curriculum development. PMID:27616319

  20. EMS Systems in Lower-Middle Income Countries: A Literature Review.

    PubMed

    Suryanto; Plummer, Virginia; Boyle, Malcolm

    2017-02-01

    Introduction Prehospital care is one of the many issues that require addressing by lower-middle income countries (LMICs) where approximately 90% of global injuries occur. This may arise from more traffic in LMICs, poor road conditions, lack of public awareness of the importance of road safety, and the lack of ability to provide first aid to the victims. However, prehospital care in LMICs remains underdeveloped. Problem There is insufficient evidence regarding the development of prehospital care among LMICs. Thus, the objective of this study was to investigate the status of Emergency Medical Services (EMS) systems in these countries. A review of medical-related electronic databases was designed to identify the development of EMS systems in LMICs. A search of the literature was undertaken using three electronic databases, CINAHL, Ovid Medline, and EMBASE via Ovid, from their commencement date until the end of July 2015. The grey literature was searched using Google Scholar. Articles were included if they reported on the establishment and current status of an EMS system and were excluded if they were letters to the editor, articles focusing on disaster management, a combination of more than one country if the other country was not a LMIC, written in a language other than English or Bahasa Indonesia, and/or focusing only on in-hospital care. There were 337 articles identified in CINAHL, 731 in Ovid Medline, 891 in EMBASE via Ovid, and 41 in Google Scholar. Based on the title and abstract, 31 articles from CINAHL, 40 from Ovid Medline, 43 from EMBASE, and 11 from Google Scholar were retrieved for further review. There were 92 articles that met the inclusion criteria with 35 articles removed, as they were duplicated, leaving 57 articles to be reviewed. From those 48 countries categorized as LMICs, there were 16 (33.3%) countries that had information about an EMS system, including injury types, patient demographic, prehospital transport, and the obstacles in implementing

  1. Human Health and Economic Impacts of Ozone Reductions by Income Group.

    PubMed

    Saari, Rebecca K; Thompson, Tammy M; Selin, Noelle E

    2017-02-21

    Low-income households may be disproportionately affected by ozone pollution and ozone policy. We quantify how three factors affect the relative benefits of ozone policies with household income: (1) unequal ozone reductions; (2) policy delay; and (3) economic valuation methods. We model ozone concentrations under baseline and policy conditions across the full continental United States to estimate the distribution of ozone-related health impacts across nine income groups. We enhance an economic model to include these impacts across household income categories, and present its first application to evaluate the benefits of ozone reductions for low-income households. We find that mortality incidence rates decrease with increasing income. Modeled ozone levels yield a median of 11 deaths per 100 000 people in 2005. Proposed policy reduces these rates by 13%. Ozone reductions are highest among low-income households, which increases their relative welfare gains by up to 4% and decreases them for the rich by up to 8%. The median value of reductions in 2015 is either $30 billion (in 2006 U.S. dollars) or $1 billion if reduced mortality risks are valued with willingness-to-pay or as income from increased life expectancy. Ozone reductions were relatively twice as beneficial for the lowest- compared to the highest-income households. The valuation approach affected benefits more than a policy delay or differential ozone reductions with income.

  2. Effects of changes in lunch-time competitive foods, nutrition practices, and nutrition policies on low-income middle-school children's diets.

    PubMed

    Alaimo, Katherine; Oleksyk, Shannon C; Drzal, Nick B; Golzynski, Diane L; Lucarelli, Jennifer F; Wen, Yalu; Velie, Ellen M

    2013-12-01

    The School Nutrition Advances Kids project tested the effectiveness of school-initiated and state-recommended school nutrition practice and policy changes on student dietary intake in low-income middle schools. Schools recruited by an application for grant funding were randomly assigned to (1) complete an assessment of nutrition education, policies, and environments using the Healthy School Action Tools (HSAT) and implement an action plan, (2) complete the HSAT, implement an action plan, and convene a student nutrition action team, (3) complete the HSAT and implement an action plan and a Michigan State Board of Education nutrition policy in their cafeteria à la carte, or (4) a control group. All intervention schools were provided with funding and assistance to make self-selected nutrition practice, policy, or education changes. Block Youth Food Frequency Questionnaires were completed by 1176 seventh-grade students from 55 schools at baseline and during eighth-grade follow-up. Nutrient density and food group changes for the intervention groups were compared to the control group, controlling for baseline dietary intake values, gender, race/ethnicity, school kitchen type, urbanization, and percent of students eligible for free or reduced-price meals. Analyses were conducted by randomization and based on changes the schools self-selected. Improvements in students' nutrient density and food group intake were found when schools implemented at least three new nutrition practice changes and established at least three new nutrition policies. Students in schools that introduced mostly healthful foods in competitive venues at lunch demonstrated the most dietary improvements. New USDA nutrition standards for à la carte and vending will likely increase the healthfulness of middle school children's diets.

  3. Critical review of the emerging research evidence on agricultural biodiversity, diet diversity, and nutritional status in low- and middle-income countries.

    PubMed

    Jones, Andrew D

    2017-10-01

    The declining diversity of agricultural production and food supplies worldwide may have important implications for global diets. The primary objective of this review is to assess the nature and magnitude of the associations of agricultural biodiversity with diet quality and anthropometric outcomes in low- and middle-income countries. A comprehensive review of 5 databases using a priori exclusion criteria and application of a systematic, qualitative analysis to the findings of identified studies revealed that agricultural biodiversity has a small but consistent association with more diverse household- and individual-level diets, although the magnitude of this association varies with the extent of existing diversification of farms. Greater on-farm crop species richness is also associated with small, positive increments in young child linear stature. Agricultural diversification may contribute to diversified diets through both subsistence- and income-generating pathways and may be an important strategy for improving diets and nutrition outcomes in low- and middle-income countries. Six research priorities for future studies of the influence of agricultural biodiversity on nutrition outcomes are identified based on gaps in the research literature. © The Author(s) 2017. Published by Oxford University Press on behalf of the International Life Sciences Institute.

  4. Will China Be Caught in the Middle-Income Trap? The Economic Path of South Korea and Malaysia May Help Provide the Answer

    DTIC Science & Technology

    2014-12-01

    outcomes. Child mortality, education of children , and income distribution has been show to be positively affected by strong education policy. 31 In a...and science, but are less rigid and more diversified, create a paradigm that fosters innovation and entrepreneurship .35 Research show that innovation...Ratio of children and old people to people of working age. 42 Aiyar et al., Growth Slowdowns and the Middle-Income Trap, 19. 17 B. CASE EXAMPLES The

  5. Population health in an era of rising income inequality: USA, 1980-2015.

    PubMed

    Bor, Jacob; Cohen, Gregory H; Galea, Sandro

    2017-04-08

    Income inequality in the USA has increased over the past four decades. Socioeconomic gaps in survival have also increased. Life expectancy has risen among middle-income and high-income Americans whereas it has stagnated among poor Americans and even declined in some demographic groups. Although the increase in income inequality since 1980 has been driven largely by soaring top incomes, the widening of survival inequalities has occurred lower in the distribution-ie, between the poor and upper-middle class. Growing survival gaps across income percentiles since 2001 reflect falling real incomes among poor Americans as well as an increasingly strong association between low income and poor health. Changes in individual risk factors such as smoking, obesity, and substance abuse play a part but do not fully explain the steeper gradient. Distal factors correlated with rising inequality including unequal access to technological innovations, increased geographical segregation by income, reduced economic mobility, mass incarceration, and increased exposure to the costs of medical care might have reduced access to salutary determinants of health among low-income Americans. Having missed out on decades of income growth and longevity gains, low-income Americans are increasingly left behind. Without interventions to decouple income and health, or to reduce inequalities in income, we might see the emergence of a 21st century health-poverty trap and the further widening and hardening of socioeconomic inequalities in health. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries

    PubMed Central

    Ademuyiwa, Adesoji O

    2016-01-01

    Background Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally. Methods Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression. Results This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed. Conclusions Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas. Trial registration number NCT02179112; Pre-results. PMID:28588977

  7. The association between ownership of common household devices and obesity and diabetes in high, middle and low income countries

    PubMed Central

    Lear, Scott A.; Teo, Koon; Gasevic, Danijela; Zhang, Xiaohe; Poirier, Paul P.; Rangarajan, Sumathy; Seron, Pamela; Kelishadi, Roya; Tamil, Azmi Mohd; Kruger, Annamarie; Iqbal, Romaina; Swidan, Hani; Gómez-Arbeláez, Diego; Yusuf, Rita; Chifamba, Jephat; Kutty, V. Raman; Karsidag, Kubilay; Kumar, Rajesh; Li, Wei; Szuba, Andrzej; Avezum, Alvaro; Diaz, Rafael; Anand, Sonia S.; Rosengren, Annika; Yusuf, Salim

    2014-01-01

    Background: Household devices (e.g., television, car, computer) are common in high income countries, and their use has been linked to obesity and type 2 diabetes mellitus. We hypothesized that device ownership is associated with obesity and diabetes and that these effects are explained through reduced physical activity, increased sitting time and increased energy intake. Methods: We performed a cross-sectional analysis using data from the Prospective Urban Rural Epidemiology study involving 153 996 adults from high, upper-middle, lower-middle and low income countries. We used multilevel regression models to account for clustering at the community and country levels. Results: Ownership of a household device increased from low to high income countries (4% to 83% for all 3 devices) and was associated with decreased physical activity and increased sitting, dietary energy intake, body mass index and waist circumference. There was an increased odds of obesity and diabetes with the ownership of any 1 household device compared to no device ownership (obesity: odds ratio [OR] 1.43, 95% confidence interval [CI] 1.32–1.55; diabetes: OR 1.38, 95% CI 1.28–1.50). Ownership of a second device increased the odds further but ownership of a third device did not. Subsequent adjustment for lifestyle factors modestly attenuated these associations. Of the 3 devices, ownership of a television had the strongest association with obesity (OR 1.39, 95% CI 1.29–1.49) and diabetes (OR 1.33, 95% CI 1.23–1.44). When stratified by country income level, the odds of obesity and diabetes when owning all 3 devices was greatest in low income countries (obesity: OR 3.15, 95% CI 2.33–4.25; diabetes: OR 1.97, 95% CI 1.53–2.53) and decreased through country income levels such that we did not detect an association in high income countries. Interpretation: The ownership of household devices increased the likelihood of obesity and diabetes, and this was mediated in part by effects on physical

  8. Exploring the Self/Group Initiated and On-the-Job Learning Activities of Low Income Women.

    ERIC Educational Resources Information Center

    Butterwick, Shauna

    The self- and group-initiated and on-the-job learning activities of low-income women were explored in a study of a small group of low-income mothers living in the greater Vancouver area of British Columbia, Canada. During the study, the low-income women attended meetings during which a participating researcher documented the women's experiences.…

  9. Costs of vaccine programs across 94 low- and middle-income countries.

    PubMed

    Portnoy, Allison; Ozawa, Sachiko; Grewal, Simrun; Norman, Bryan A; Rajgopal, Jayant; Gorham, Katrin M; Haidari, Leila A; Brown, Shawn T; Lee, Bruce Y

    2015-05-07

    While new mechanisms such as advance market commitments and co-financing policies of the GAVI Alliance are allowing low- and middle-income countries to gain access to vaccines faster than ever, understanding the full scope of vaccine program costs is essential to ensure adequate resource mobilization. This costing analysis examines the vaccine costs, supply chain costs, and service delivery costs of immunization programs for routine immunization and for supplemental immunization activities (SIAs) for vaccines related to 18 antigens in 94 countries across the decade, 2011-2020. Vaccine costs were calculated using GAVI price forecasts for GAVI-eligible countries, and assumptions from the PAHO Revolving Fund and UNICEF for middle-income countries not supported by the GAVI Alliance. Vaccine introductions and coverage levels were projected primarily based on GAVI's Adjusted Demand Forecast. Supply chain costs including costs of transportation, storage, and labor were estimated by developing a mechanistic model using data generated by the HERMES discrete event simulation models. Service delivery costs were abstracted from comprehensive multi-year plans for the majority of GAVI-eligible countries and regression analysis was conducted to extrapolate costs to additional countries. The analysis shows that the delivery of the full vaccination program across 94 countries would cost a total of $62 billion (95% uncertainty range: $43-$87 billion) over the decade, including $51 billion ($34-$73 billion) for routine immunization and $11 billion ($7-$17 billion) for SIAs. More than half of these costs stem from service delivery at $34 billion ($21-$51 billion)-with an additional $24 billion ($13-$41 billion) in vaccine costs and $4 billion ($3-$5 billion) in supply chain costs. The findings present the global costs to attain the goals envisioned during the Decade of Vaccines to prevent millions of deaths by 2020 through more equitable access to existing vaccines for people in all

  10. Supporting Unemployed, Middle-Aged Men: A Psychoeducational Group Approach

    ERIC Educational Resources Information Center

    Murphey, Charlotte M.; Shillingford, M. Ann

    2012-01-01

    This article presents a comprehensive group counseling approach to support unemployed, middle-aged men. An inclusive group curriculum designed to provide support and address potential mental health issues related to unemployment is introduced. The focus of the group is divided into 6 major areas that research has shown to have a significant impact…

  11. Learning Disabilities Screening and Evaluation Guide for Low- and Middle-Income Countries. Occasional Paper. RTI Press Publication OP-0052-1804

    ERIC Educational Resources Information Center

    Hayes, Anne M.; Dombrowski, Eileen; Shefcyk, Allison H.; Bulat, Jennae

    2018-01-01

    Learning disabilities are among the most common disabilities experienced in childhood and adulthood. Although identifying learning disabilities in a school setting is a complex process, it is particularly challenging in low- and middle-income countries that lack the appropriate resources, tools, and supports. This guide provides an introduction to…

  12. Promoting safe motherhood through the private sector in low- and middle-income countries.

    PubMed Central

    Brugha, Ruair; Pritze-Aliassime, Susanne

    2003-01-01

    The formal private sector could play a significant role in determining whether success or failure is achieved in working towards goals for safe motherhood in many low- and middle-income settings. Established private providers, especially nurses/midwives, have the potential to contribute to safe motherhood practices if they are involved in the care continuum. However, they have largely been overlooked by policy-makers in low-income settings. The private sector (mainly doctors) contributes to overprovision and high Caesarean section rates in settings where it provides care to wealthier segments of the population; such care is often funded through third-party payment schemes. In poorer settings, especially rural areas, private nurses/midwives and the women who choose to use them are likely to experience similar constraints to those encountered in the public sector - for example, poor or unaffordable access to higher level facilities for the management of obstetrical emergencies. Policy-makers at the country-level need to map the health system and understand the nature and distribution of the private sector, and what influences it. This potential resource could then be mobilized to work towards the achievement of safe motherhood goals. PMID:14576894

  13. Characteristics associated with self-rated health in the CARDIA study: Contextualising health determinants by income group.

    PubMed

    Nayak, Shilpa; Hubbard, Alan; Sidney, Stephen; Syme, S Leonard

    2016-12-01

    An understanding of factors influencing health in socioeconomic groups is required to reduce health inequalities. This study investigated combinations of health determinants associated with self-rated health (SRH), and their relative importance, in income-based groups. Cross-sectional data from year 15 (2000 - 2001) of the CARDIA study (Coronary Artery Risk Development in Young Adults, USA) - 3648 men and women (mean 40 years) - were split into 5 income-based groups. SRH responses were categorized as 'higher'/'lower'. Health determinants (medical, lifestyle, and social factors, living conditions) associated with SRH in each group were analyzed using classification tree analysis (CTA). Income and SRH were positively associated (p < 0.05). Data suggested an income-based gradient for lifestyle/medical/social factors/living conditions. Profiles, and relative importance ranking, of multi-domain health determinants, in relation to SRH, differed by income group. The highest ranking variable for each income group was chronic burden-personal health problem (<$25,000); physical activity ($25-50,000; $50-75,000; $100,000 +); and cigarettes/day ($75-100,000). In lower income groups, more risk factors and chronic burden indicators were associated with SRH. Social support, control over life, optimism, and resources for paying for basics/medical care/health insurance were greater (%) with higher income. SRH is a multidimensional measure; CTA is useful for contextualizing risk factors in relation to health status. Findings suggest that for lower income groups, addressing contributors to chronic burden is important alongside lifestyle/medical factors. In a proportionate universalism context, in addition to differences in intensity of public health action across the socioeconomic gradient, differences in the type of interventions to improve SRH may also be important.

  14. The impact of conditional cash transfers on child health in low- and middle-income countries: a systematic review.

    PubMed

    Owusu-Addo, Ebenezer; Cross, Ruth

    2014-08-01

    The review aimed to assess the effectiveness of conditional cash transfers (CCTs) in improving child health in low- and middle-income countries. Seven electronic databases were searched for papers: MEDLINE, EMBASE, PubMed, PsychINFO, BIOSIS Previews, Academic Search Complete, and CSA Sociological Abstracts. The included studies comprised of randomised controlled trials and controlled before-and-after studies evaluating the impact of CCTs on child health. Due to the substantial heterogeneity of the studies, a narrative synthesis was conducted on the extracted data. Sixteen studies predominantly from Latin American countries met the inclusion criteria. The outcomes reported by the studies in relation to CCTs' effectiveness in improving child health were reduction in morbidity risk, improvement in nutritional outcomes, health services utilisation, and immunisation coverage. The review suggests that to a large extent, CCTs are effective in improving child health by addressing child health determinants such as access to health care, child and maternal nutrition, morbidity risk, immunisation coverage, and household poverty in developing countries particularly middle-income countries. Of importance to both policy and practice, it appears that CCTs require effective functioning of health care systems to effectively promote child health.

  15. Nationwide survey of nutritional management in an Asian upper-middle income developing country government hospitals: Combination of quantitative survey and focus group discussion.

    PubMed

    Chittawatanarat, K; Tosanguan, K; Chaikledkaew, U; Tejavanija, S; Teerawattananon, Y

    2016-08-01

    The objective of this study was to identify the differences in pattern, process, and management of nutrition care in government hospitals in Thailand (an Asian upper-middle income developing country). This is a combination of a quantitative nationwide questionnaire survey and focus group discussions. A total of 2300 questionnaires were sent to government hospitals across Thailand. The responders were divided by routine-nutrition screening/assessment unit vs. non-routine-nutrition screening/assessment unit (RSA vs. NRSA). The comparison between the groups was reported as percentage and cross-sectional odds ratio (CS-OR) with 95% confidence interval (CI). The significant difference was defined as p < 0.05. A total of 814 questionnaires (35.4%) were returned. The three most common tools of RSA were 42% Bhumibol Nutrition Triage (BNT), 21.2% Subjective Global Assessment (SGA) and 20.2% Nutrition Alert Form (NAF). The RSA was significantly higher in proportion for the role of the nurses (RSA vs. NRSA; CS-OR [95% CI]: 68.3% vs. 11.9%; 15.8 [11.1 to 22.7]; p < 0.01), the multidisciplinary team (90.1% vs. 0.4%; 2266 [558 to 1909]; p < 0.01), the nutrition management guidelines (60.6% vs. 2.8%; 53.6 [29.6 to 102.8]; p < 0.01), the nurse-driven enteral feeding protocols (31.7% vs. 17.5%; 2.2 [1.5 to 3.1]; p < 0.01) and preference for hospital formula enteral nutrition (91.4% vs.69.7%; 4.6 [2.9 to 7.4]; p < 0.01). For focus group discussions, the main barrier of RSA implementation was that there was no national recommendation of a screening/assessment tool, inconsistency of policy and reimbursement, and professional and acceptable workload. Nutrition screening/assessment tools were found to be varied in Thailand. RSA affected the nutrition management working process and the types of nutrition support. The main barriers of RSA implementation were inconsistency of policy and reimbursement, acceptable workload, and national guidance as regards - screening

  16. Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries.

    PubMed

    Stenberg, Karin; Hanssen, Odd; Edejer, Tessa Tan-Torres; Bertram, Melanie; Brindley, Callum; Meshreky, Andreia; Rosen, James E; Stover, John; Verboom, Paul; Sanders, Rachel; Soucat, Agnès

    2017-09-01

    The ambitious development agenda of the Sustainable Development Goals (SDGs) requires substantial investments across several sectors, including for SDG 3 (healthy lives and wellbeing). No estimates of the additional resources needed to strengthen comprehensive health service delivery towards the attainment of SDG 3 and universal health coverage in low-income and middle-income countries have been published. We developed a framework for health systems strengthening, within which population-level and individual-level health service coverage is gradually scaled up over time. We developed projections for 67 low-income and middle-income countries from 2016 to 2030, representing 95% of the total population in low-income and middle-income countries. We considered four service delivery platforms, and modelled two scenarios with differing levels of ambition: a progress scenario, in which countries' advancement towards global targets is constrained by their health system's assumed absorptive capacity, and an ambitious scenario, in which most countries attain the global targets. We estimated the associated costs and health effects, including reduced prevalence of illness, lives saved, and increases in life expectancy. We projected available funding by country and year, taking into account economic growth and anticipated allocation towards the health sector, to allow for an analysis of affordability and financial sustainability. We estimate that an additional $274 billion spending on health is needed per year by 2030 to make progress towards the SDG 3 targets (progress scenario), whereas US$371 billion would be needed to reach health system targets in the ambitious scenario-the equivalent of an additional $41 (range 15-102) or $58 (22-167) per person, respectively, by the final years of scale-up. In the ambitious scenario, total health-care spending would increase to a population-weighted mean of $271 per person (range 74-984) across country contexts, and the share of gross

  17. Burden of road traffic injuries related to delays in implementing safety belt laws in low- and lower-middle-income countries.

    PubMed

    Martin, Aurélie; Lagarde, Emmanuel; Salmi, L Rachid

    2018-02-28

    Delayed implementation of effective road safety policies must be considered when quantifying the avoidable part of the fatal and nonfatal injuries burden. We sought to assess the avoidable part of disability-adjusted life years (DALYs) lost due to road traffic injuries related to delays in implementing road safety laws in low- and lower-middle-income countries. We chose one country for each of the regions of the World Health Organization (WHO) and World Bank (WB) country income levels. We used freely available data sets (WHO, International Traffic Safety Data and Analysis Group, the WB). Delays in implementation were calculated until 2013, from the year mandatory use of safety belts by motor vehicle front seat occupants was first introduced worldwide. We used life expectancy tables and age groups as social values in the DALY calculation model. From the estimated total burden, avoidable DALYs were calculated using estimates of the effectiveness of seat belt laws on fatal and nonfatal injuries combined, as extracted from published international reviews of evidence. From the reference year 1972, implementation delays varied from 27 years (Uzbekistan) to 41 years in Bolivia (no seat belt law as of 2013). During delays, total absolute numbers of DALYs lost due to road traffic injuries reached 8,462,099 in Nigeria, 7,203,570 in Morocco, 4,695,500 in Uzbekistan, 3,866,391 in Cambodia, 3,253,359 in Bolivia, and 3,128,721 in Sri Lanka. Using effectiveness estimates ranging from 3 to 20% reduction, the avoidable burden of road traffic injuries for car occupants was highest in Uzbekistan (avoidable part from 1.2 to 10.4%) and in Morocco (avoidable part from 1.5 to 12.3%). In countries where users of public transport and pedestrians were the most affected by the burden, the avoidable parts ranged from 0.5 to 4.4% (Nigeria) and from 0.5 to 3.4% (Bolivia). Burden of road traffic injuries mostly affected motorcyclists in Sri Lanka and Cambodia where the avoidable parts were

  18. Doing away with Debt: Using Existing Resources to Ensure College Affordability for Low and Middle-Income Families. [Executive Summary

    ERIC Educational Resources Information Center

    Education Trust, 2013

    2013-01-01

    America's financial-aid system has become almost impossible to navigate and burdensome for those who need it most. Tuition and fees are skyrocketing, forcing almost half of college-going students to borrow. Low and middle-income students are taking on frightening levels of debt. Bachelor's degree recipients leave school with an average of $26,600…

  19. Evidence summaries tailored to health policy-makers in low- and middle-income countries

    PubMed Central

    Glenton, Claire; Wiysonge, Charles Shey; Abalos, Edgardo; Mignini, Luciano; Young, Taryn; Althabe, Fernando; Ciapponi, Agustín; Marti, Sebastian Garcia; Meng, Qingyue; Wang, Jian; la Hoz Bradford, Ana Maria De; Kiwanuka, Suzanne N; Rutebemberwa, Elizeus; Pariyo, George W; Flottorp, Signe; Oxman, Andrew D

    2011-01-01

    Abstract Objective To describe how the SUPPORT collaboration developed a short summary format for presenting the results of systematic reviews to policy-makers in low- and middle-income countries (LMICs). Methods We carried out 21 user tests in six countries to explore users’ experiences with the summary format. We modified the summaries based on the results and checked our conclusions through 13 follow-up interviews. To solve the problems uncovered by the user testing, we also obtained advisory group feedback and conducted working group workshops. Findings Policy-makers liked a graded entry format (i.e. short summary with key messages up front). They particularly valued the section on the relevance of the summaries for LMICs, which compensated for the lack of locally-relevant detail in the original review. Some struggled to understand the text and numbers. Three issues made redesigning the summaries particularly challenging: (i) participants had a poor understanding of what a systematic review was; (ii) they expected information not found in the systematic reviews and (iii) they wanted shorter, clearer summaries. Solutions included adding information to help understand the nature of a systematic review, adding more references and making the content clearer and the document quicker to scan. Conclusion Presenting evidence from systematic reviews to policy-makers in LMICs in the form of short summaries can render the information easier to assimilate and more useful, but summaries must be clear and easy to read or scan quickly. They should also explain the nature of the information provided by systematic reviews and its relevance for policy decisions. PMID:21346891

  20. Mental health in low- and middle-income countries.

    PubMed

    Patel, Vikram

    2007-01-01

    Mental disorders in low- and middle-income countries (LAMIC) do not attract global health policy attention. This article is based on a selective review of research on mental disorders in adults in LAMIC since 2001 and recent analyses of disease burden in developing countries. Mental disorders account for 11.1% of the total burden of disease in LAMIC. Unipolar depressive disorder is the single leading neuropsychiatric cause of disease burden. Alcohol use disorders account for nearly 4% of the attributable disease burden in LAMIC. Mental disorders are closely associated with other public health concerns such as maternal and child health and HIV/AIDS. Poverty, low education, social exclusion, gender disadvantage, conflict and disasters are the major social determinants of mental disorders. Clinical trials demonstrate that locally available, affordable interventions in community and primary care settings are effective for the management of mental disorders. Mental health resources are very scarce and investment in mental health is < 1% of the health budget in many countries. The majority of people with mental disorders do not receive evidence-based care, leading to chronicity, suffering and increased costs of care. Strengthening care and services for people with mental disorders is a priority; this will need additional investment in human resources and piggy backing on existing public health programmes. Campaigns to increase mental health literacy are needed at all levels of the health system.

  1. The Burden of Cardiovascular Disease in Low- and Middle-Income Countries: Epidemiology and Management.

    PubMed

    Bowry, Ashna D K; Lewey, Jennifer; Dugani, Sagar B; Choudhry, Niteesh K

    2015-09-01

    Cardiovascular disease (CVD) is the second leading cause of mortality worldwide, accounting for 17 million deaths in 2013. More than 80% of these cases were in low- and middle-income countries (LMICs). Although the risk factors for the development of CVD are similar throughout the world, the evolving change in lifestyle and health behaviours in LMICs-including tobacco use, decreased physical activity, and obesity-are contributing to the escalating presence of CVD and mortality. Although CVD mortality is falling in high-income settings because of more effective preventive and management programs, access to evidence-based interventions for combating CVD in resource-limited settings is variable. The existing pressures on both human and financial resources impact the efforts of controlling CVD. The implementation of emerging innovative interventions to improve medication adherence, introducing m-health programs, and decentralizing the management of chronic diseases are promising methods to reduce the burden of chronic disease management on such fragile health care systems. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  2. Performance-based financing in low-income and middle-income countries: isn’t it time for a rethink?

    PubMed Central

    Albert, Lucien; Bisala, Badibanga N’Sambuka; Bodson, Oriane; Bonnet, Emmanuel; Bossyns, Paul; Colombo, Sandro; De Brouwere, Vincent; Dumont, Alexandre; Eclou, Dieudonné Sèdjro; Gyselinck, Karel; Hane, Fatoumata; Marchal, Bruno; Meloni, Remo; Noirhomme, Mathieu; Noterman, Jean-Pierre; Samb, Oumar Mallé; Ssengooba, Freddie; Touré, Laurence; Turcotte-Tremblay, Anne-Marie; Van Belle, Sara; Vinard, Philippe

    2018-01-01

    This paper questions the view that performance-based financing (PBF) in the health sector is an effective, efficient and equitable approach to improving the performance of health systems in low-income and middle-income countries (LMICs). PBF was conceived as an open approach adapted to specific country needs, having the potential to foster system-wide reforms. However, as with many strategies and tools, there is a gap between what was planned and what is actually implemented. This paper argues that PBF as it is currently implemented in many contexts does not satisfy the promises. First, since the start of PBF implementation in LMICs, concerns have been raised on the basis of empirical evidence from different settings and disciplines that indicated the risks, cost and perverse effects. However, PBF implementation was rushed despite insufficient evidence of its effectiveness. Second, there is a lack of domestic ownership of PBF. Considering the amounts of time and money it now absorbs, and the lack of evidence of effectiveness and efficiency, PBF can be characterised as a donor fad. Third, by presenting itself as a comprehensive approach that makes it possible to address all aspects of the health system in any context, PBF monopolises attention and focuses policy dialogue on the short-term results of PBF programmes while diverting attention and resources from broader processes of change and necessary reforms. Too little care is given to system-wide and long-term effects, so that PBF can actually damage health services and systems. This paper ends by proposing entry points for alternative approaches. PMID:29564163

  3. Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature.

    PubMed

    Naslund, John A; Aschbrenner, Kelly A; Araya, Ricardo; Marsch, Lisa A; Unützer, Jürgen; Patel, Vikram; Bartels, Stephen J

    2017-06-01

    Few individuals living with mental disorders around the globe have access to mental health care, yet most have access to a mobile phone. Digital technology holds promise for improving access to, and quality of, mental health care. We reviewed evidence on the use of mobile, online, and other remote technologies for treatment and prevention of mental disorders in low-income and middle-income countries. Of the 49 studies identified, most were preliminary evaluations of feasibility and acceptability. The findings were promising, showing the potential effectiveness of online, text-messaging, and telephone support interventions. We summarised the evaluations as: technology for supporting clinical care and educating health workers, mobile tools for facilitating diagnosis and detection of mental disorders, technologies for promoting treatment adherence and supporting recovery, online self-help programmes for individuals with mental disorders, and programmes for substance misuse prevention and treatment. Continued research is needed to rigorously evaluate effectiveness, assess costs, and carefully consider potential risks of digital technology interventions for mental disorders, while determining how emerging technologies might support the scale-up of mental health treatment and prevention efforts across low-resource settings. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature

    PubMed Central

    Naslund, John A; Aschbrenner, Kelly A; Araya, Ricardo; Marsch, Lisa A; Unützer, Jürgen; Patel, Vikram; Bartels, Stephen J

    2017-01-01

    Few individuals living with mental disorders around the globe have access to mental health care, yet most have access to a mobile phone. Digital technology holds promise for improving access to, and quality of, mental health care. We reviewed evidence on the use of mobile, online, and other remote technologies for treatment and prevention of mental disorders in low-income and middle-income countries. Of the 49 studies identified, most were preliminary evaluations of feasibility and acceptability. The findings were promising, showing the potential effectiveness of online, text-messaging, and telephone support interventions. We summarised the evaluations as: technology for supporting clinical care and educating health workers, mobile tools for facilitating diagnosis and detection of mental disorders, technologies for promoting treatment adherence and supporting recovery, online self-help programmes for individuals with mental disorders, and programmes for substance misuse prevention and treatment. Continued research is needed to rigorously evaluate effectiveness, assess costs, and carefully consider potential risks of digital technology interventions for mental disorders, while determining how emerging technologies might support the scale-up of mental health treatment and prevention efforts across low-resource settings. PMID:28433615

  5. Interventions to improve antiretroviral therapy adherence among adolescents in low- and middle-income countries: A systematic review of the literature

    PubMed Central

    Dulli, Lisa S.; Murray, Kate R.; Silverstein, Hannah; Dal Santo, Leila; Olsen, Patrick; Darrow de Mora, Danielle; McCarraher, Donna R.

    2018-01-01

    Introduction Globally, an estimated 30% of new HIV infections occur among adolescents (15–24 years), most of whom reside in sub-Saharan Africa. Moreover, HIV-related mortality increased by 50% between 2005 and 2012 for adolescents 10–19 years while it decreased by 30% for all other age groups. Efforts to achieve and maintain optimal adherence to antiretroviral therapy are essential to ensuring viral suppression, good long-term health outcomes, and survival for young people. Evidence-based strategies to improve adherence among adolescents living with HIV are therefore a critical part of the response to the epidemic. Methods We conducted a systematic review of the peer-reviewed and grey literature published between 2010 and 2015 to identify interventions designed to improve antiretroviral adherence among adults and adolescents in low- and middle-income countries. We systematically searched PubMed, Web of Science, Popline, the AIDSFree Resource Library, and the USAID Development Experience Clearinghouse to identify relevant publications and used the NIH NHLBI Quality Assessment Tools to assess the quality and risk of bias of each study. Results and discussion We identified 52 peer-reviewed journal articles describing 51 distinct interventions out of a total of 13,429 potentially relevant publications. Forty-three interventions were conducted among adults, six included adults and adolescents, and two were conducted among adolescents only. All studies were conducted in low- and middle-income countries, most of these (n = 32) in sub-Saharan Africa. Individual or group adherence counseling (n = 12), mobile health (mHealth) interventions (n = 13), and community- and home-based care (n = 12) were the most common types of interventions reported. Methodological challenges plagued many studies, limiting the strength of the available evidence. However, task shifting, community-based adherence support, mHealth platforms, and group adherence counseling emerged as strategies

  6. The IASSID Academy on Education, Teaching and Research and the Links with Low- and Middle-Income Countries: An International Partnership

    ERIC Educational Resources Information Center

    Hassiotis, Angela; Brown, Ivan; Brown, Roy I.; Favila, Gare; McConkey, Roy; Jokinen, Nancy; Lucchino, Ronald

    2011-01-01

    The Academy, an arm of the International Association for the Scientific Study of Intellectual Disabilities, was formed in 2006 in order to promote clinical and academic skills in low- and middle-income countries (LAMICs) and to carry out educational activities within international events. This article describes the global context of knowledge…

  7. Use of the ‘Accountability for Reasonableness’ Approach to Improve Fairness in Accessing Dialysis in a Middle-Income Country

    PubMed Central

    Maree, Jonathan David; Chirehwa, Maxwell T.; Benatar, Solomon R.

    2016-01-01

    Universal access to renal replacement therapy is beyond the economic capability of most low and middle-income countries due to large patient numbers and the high recurrent cost of treating end stage kidney disease. In countries where limited access is available, no systems exist that allow for optimal use of the scarce dialysis facilities. We previously reported that using national guidelines to select patients for renal replacement therapy resulted in biased allocation. We reengineered selection guidelines using the ‘Accountability for Reasonableness’ (procedural fairness) framework in collaboration with relevant stakeholders, applying these in a novel way to categorize and prioritize patients in a unique hierarchical fashion. The guidelines were primarily premised on patients being transplantable. We examined whether the revised guidelines enhanced fairness of dialysis resource allocation. This is a descriptive study of 1101 end stage kidney failure patients presenting to a tertiary renal unit in a middle-income country, evaluated for dialysis treatment over a seven-year period. The Assessment Committee used the accountability for reasonableness-based guidelines to allocate patients to one of three assessment groups. Category 1 patients were guaranteed renal replacement therapy, Category 3 patients were palliated, and Category 2 were offered treatment if resources allowed. Only 25.2% of all end stage kidney disease patients assessed were accepted for renal replacement treatment. The majority of patients (48%) were allocated to Category 2. Of 134 Category 1 patients, 98% were accepted for treatment while 438 (99.5%) Category 3 patients were excluded. Compared with those palliated, patients accepted for dialysis treatment were almost 10 years younger, employed, married with children and not diabetic. Compared with our previous selection process our current method of priority setting based on procedural fairness arguably resulted in more equitable allocation of

  8. Research Priorities for Eight Areas of Adolescent Health in Low- and Middle-Income Countries.

    PubMed

    Nagata, Jason M; Ferguson, B Jane; Ross, David A

    2016-07-01

    To conduct an expert-led process for identifying research priorities for eight areas of adolescent health in low- and middle-income countries. Specific adolescent health areas included communicable diseases prevention and management, injuries and violence, mental health, noncommunicable diseases management, nutrition, physical activity, substance use, and health policy. We used a modified version of the Child Health and Nutrition Research Initiative methodology for reaching consensus on research priorities. In a three phase process, we (1) identified research and program experts with wide-ranging backgrounds and experiences from all geographic regions through systematic searches and key informants; (2) invited these experts to propose research questions related to descriptive epidemiology, interventions (discovery, development/testing, and delivery/implementation), and health policy/systems; and (3) asked the experts to prioritize the research questions based on five criteria: clarity, answerability, importance or impact, implementation, and equity. A total of 142 experts submitted 512 questions which were edited and reduced to 303 for scoring. Overall, the types of the top 10 research questions in each of the eight health areas included descriptive epidemiology (26%), interventions: discovery (11%), development/testing (25%), delivery (33%), and policy, health and social systems (5%). Across health areas, the top questions highlighted integration of health services, vulnerable populations, and different health platforms (such as primary care, schools, families/parents, and interactive media). Priority questions have been identified for research in eight key areas of adolescent health in low- and middle-income countries. These expert-generated questions may be used by donors, program managers, and researchers to prioritize and stimulate research in adolescent health. Copyright © 2016. Published by Elsevier Inc.

  9. Identifying barriers for out of hospital emergency care in low and low-middle income countries: a systematic review.

    PubMed

    Kironji, Antony Gatebe; Hodkinson, Peter; de Ramirez, Sarah Stewart; Anest, Trisha; Wallis, Lee; Razzak, Junaid; Jenson, Alexander; Hansoti, Bhakti

    2018-04-19

    Out-of-hospital emergency care (OHEC), also known as prehospital care, has been shown to reduce morbidity and mortality from serious illness. We sought to summarize literature for low and low-middle income countries to identify barriers to and key interventions for OHEC delivery. We performed a systematic review of the peer reviewed literature from January 2005 to March 2015 in PubMed, Embase, Cochrane, and Web of Science. All articles referencing research from low and low-middle income countries addressing OHEC, emergency medical services, or transport/transfer of patients were included. We identified themes in the literature to form six categories of OHEC barriers. Data were collected using an electronic form and results were aggregated to produce a descriptive summary. A total 1927 titles were identified, 31 of which met inclusion criteria. Barriers to OHEC were divided into six categories that included: culture/community, infrastructure, communication/coordination, transport, equipment and personnel. Lack of transportation was a common problem, with 55% (17/31) of articles reporting this as a hindrance to OHEC. Ambulances were the most commonly mentioned (71%, 22/31) mode of transporting patients. However, many patients still relied on alternative means of transportation such as hired cars, and animal drawn carts. Sixty-one percent (19/31) of articles identified a lack of skilled personnel as a key barrier, with 32% (10/31) of OHEC being delivered by laypersons without formal training. Forty percent (12/31) of the systems identified in the review described a uniform access phone number for emergency medical service activation. Policy makers and researchers seeking to improve OHEC in low and low-middle income countries should focus on increasing the availability of transport and trained providers while improving patient access to the OHEC system. The review yielded articles with a primary focus in Africa, highlighting a need for future research in diverse

  10. Effect of Vocabulary Test Preparation on Low-Income Black Middle School Students' Reading Scores

    ERIC Educational Resources Information Center

    Mitchell, Ingrid; Nistor, Nicolae; Baltes, Beate; Brown, Michelle

    2016-01-01

    Black middle school students in the United States continue to perform poorly on standardized reading achievement tests in comparison to other racial and ethnic groups. The purpose of this research study was to examine the effectiveness of a vocabulary-focused test preparation program for Black middle school students. The theoretical framework…

  11. Association of Income Inequality With Pediatric Hospitalizations for Ambulatory Care-Sensitive Conditions.

    PubMed

    Bettenhausen, Jessica L; Colvin, Jeffrey D; Berry, Jay G; Puls, Henry T; Markham, Jessica L; Plencner, Laura M; Krager, Molly K; Johnson, Matthew B; Queen, Mary Ann; Walker, Jacqueline M; Latta, Grant M; Riss, Robert R; Hall, Matt

    2017-06-05

    The level of income inequality (ie, the variation in median household income among households within a geographic area), in addition to family-level income, is associated with worsened health outcomes in children. To determine the influence of income inequality on pediatric hospitalization rates for ambulatory care-sensitive conditions (ACSCs) and whether income inequality affects use of resources per hospitalization for ACSCs. This retrospective, cross-sectional analysis used the 2014 State Inpatient Databases of the Healthcare Cost and Utilization Project of 14 states to evaluate all hospital discharges for patients aged 0 to 17 years (hereafter referred to as children) from January 1 through December 31, 2014. Using the 2014 American Community Survey (US Census), income inequality (Gini index; range, 0 [perfect equality] to 1.00 [perfect inequality]), median household income, and total population of children aged 0 to 17 years for each zip code in the 14 states were measured. The Gini index for zip codes was divided into quartiles for low, low-middle, high-middle, and high income inequality. Rate, length of stay, and charges for pediatric hospitalizations for ACSCs. A total of 79 275 hospitalizations for ACSCs occurred among the 21 737 661 children living in the 8375 zip codes in the 14 included states. After adjustment for median household income and state of residence, ACSC hospitalization rates per 10 000 children increased significantly as income inequality increased from low (27.2; 95% CI, 26.5-27.9) to low-middle (27.9; 95% CI, 27.4-28.5), high-middle (29.2; 95% CI, 28.6-29.7), and high (31.8; 95% CI, 31.2-32.3) categories (P < .001). A significant, clinically unimportant longer length of stay was found for high inequality (2.5 days; 95% CI, 2.4-2.5 days) compared with low inequality (2.4 days; 95% CI, 2.4-2.5 days; P < .001) zip codes and between charges ($765 difference among groups; P < .001). Children living in areas of high income

  12. The Role of Breakfast in the American Family Diet by Income Group.

    ERIC Educational Resources Information Center

    Bowman, Shanthy A.

    1998-01-01

    Examined data from Continuing Survey of Food Intakes by Individuals (USDA) concerning breakfast consumption in families and the kinds of food chosen. Found that 85% of families reported having breakfast; most of those reporting no breakfast came from lowest income group. Consumption of cereals, fruits and juices increased with income; consumption…

  13. Combating Global Antibiotic Resistance: Emerging One Health Concerns in Lower- and Middle-Income Countries.

    PubMed

    Nadimpalli, Maya; Delarocque-Astagneau, Elisabeth; Love, David C; Price, Lance B; Huynh, Bich-Tram; Collard, Jean-Marc; Lay, Kruy Sun; Borand, Laurence; Ndir, Awa; Walsh, Timothy R; Guillemot, Didier

    2018-03-05

    Antibiotic misuse in lower- and middle-income countries (LMICs) contributes to the development of antibiotic resistance that can disseminate globally. Strategies specific to LMICs that seek to reduce antibiotic misuse by humans, but simultaneously improve antibiotic access, have been proposed. However, most approaches to date have not considered the growing impact of animal and environmental reservoirs of antibiotic resistance, which threaten to exacerbate the antibiotic resistance crisis in LMICs. In particular, current strategies do not prioritize the impacts of increased antibiotic use for terrestrial food-animal and aquaculture production, inadequate food safety, and widespread environmental pollution. Here, we propose new approaches that address emerging, One Health challenges.

  14. What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries.

    PubMed

    Mackintosh, Maureen; Channon, Amos; Karan, Anup; Selvaraj, Sakthivel; Cavagnero, Eleonora; Zhao, Hongwen

    2016-08-06

    Private health care in low-income and middle-income countries is very extensive and very heterogeneous, ranging from itinerant medicine sellers, through millions of independent practitioners-both unlicensed and licensed-to corporate hospital chains and large private insurers. Policies for universal health coverage (UHC) must address this complex private sector. However, no agreed measures exist to assess the scale and scope of the private health sector in these countries, and policy makers tasked with managing and regulating mixed health systems struggle to identify the key features of their private sectors. In this report, we propose a set of metrics, drawn from existing data that can form a starting point for policy makers to identify the structure and dynamics of private provision in their particular mixed health systems; that is, to identify the consequences of specific structures, the drivers of change, and levers available to improve efficiency and outcomes. The central message is that private sectors cannot be understood except within their context of mixed health systems since private and public sectors interact. We develop an illustrative and partial country typology, using the metrics and other country information, to illustrate how the scale and operation of the public sector can shape the private sector's structure and behaviour, and vice versa. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Methods for conducting systematic reviews of risk factors in low- and middle-income countries.

    PubMed

    Shenderovich, Yulia; Eisner, Manuel; Mikton, Christopher; Gardner, Frances; Liu, Jianghong; Murray, Joseph

    2016-03-15

    Rates of youth violence are disproportionately high in many low- and middle-income countries [LMICs] but existing reviews of risk factors focus almost exclusively on high-income countries. Different search strategies, including non-English language searches, might be required to identify relevant evidence in LMICs. This paper discusses methodological issues in systematic reviews aiming to include evidence from LMICs, using the example of a recent review of risk factors for child conduct problems and youth violence in LMICs. We searched the main international databases, such as PsycINFO, Medline and EMBASE in English, as well as 12 regional databases in Arabic, Chinese, English, French, Spanish, Portuguese and Russian. In addition, we used internet search engines and Google Scholar, and contacted over 200 researchers and organizations to identify potentially eligible studies in LMICs. The majority of relevant studies were identified in the mainstream databases, but additional studies were also found through regional databases, such as CNKI, Wangfang, LILACS and SciELO. Overall, 85% of eligible studies were in English, and 15% were reported in Chinese, Spanish, Portuguese, Russian or French. Among eligible studies in languages other than English, two-thirds were identified only by regional databases and one-third was also indexed in the main international databases. There are many studies on child conduct problems and youth violence in LMICs which have not been included in prior reviews. Most research on these subjects in LMICs has been produced in the last two-three decades and mostly in middle-income countries, such as China, Brazil, Turkey, South Africa and Russia. Based on our findings, it appears that many studies of child conduct problems and youth violence in LMICs are reported in English, Chinese, Spanish and Portuguese, but few such studies are published in French, Arabic or Russian. If non-English language searches and screening had not been conducted in

  16. Alcohol taxes' contribution to prices in high and middle-income countries: Data from the International Alcohol Control Study.

    PubMed

    Wall, Martin; Casswell, Sally; Callinan, Sarah; Chaiyasong, Surasak; Viet Cuong, Pham; Gray-Phillip, Gaile; Parry, Charles

    2017-11-22

    Taxation is increasingly being used as an effective means of influencing behaviour in relation to harmful products. In this paper we use data from six participating countries of the International Alcohol Control Study to examine and evaluate their comparative prices and tax regimes. We calculate taxes and prices for three high-income and three middle-income countries. The data are drawn from the International Alcohol Control survey and from the Alcohol Environment Protocol. Tax systems are described and then the rates of tax on key products presented. Comparisons are made using the Purchasing Power Parity rates. The price and purchase data from each country's International Alcohol Control survey is then used to calculate the mean percentage of retail price paid in tax weighted by actual consumption. Both ad valorem and specific per unit of alcohol taxation systems are represented among the six countries. The prices differ widely between countries even though presented in terms of Purchasing Power Parity. The percentage of tax in the final price also varies widely but is much lower than the 75% set by the World Health Organization as a goal for tobacco tax. There is considerable variation in tax systems and prices across countries. There is scope to increase taxation and this analysis provides comparable data, including the percentage of tax in final price, from some middle and high-income countries for consideration in policy discussion. © 2017 The Authors Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.

  17. Brucellosis in low-income and middle-income countries

    PubMed Central

    Rubach, Matthew P.; Halliday, Jo E.B.; Cleaveland, Sarah; Crump, John A.

    2014-01-01

    Purpose of review Human brucellosis is a neglected, underrecognized infection of widespread geographic distribution. It causes acute febrile illness and a potentially debilitating chronic infection in humans, and livestock infection has substantial socioeconomic impact. This review describes new information regarding the epidemiology of brucellosis in the developing world and advances in diagnosis and treatment. Recent findings The highest recorded incidence of human brucellosis occurs in the Middle East and Central Asia. Fever etiology studies demonstrate brucellosis as a cause of undifferentiated febrile illness in the developing world. Brucellosis is a rare cause of fever among returning travelers, but is more common among travelers returning from the Middle East and North Africa. Sensitive and specific rapid diagnostic tests appropriate for resource-limited settings have been validated. Randomized controlled trials demonstrate that optimal treatment for human brucellosis consists of doxycycline and an aminoglycoside. Decreasing the burden of human brucellosis requires control of animal brucellosis, but evidence to inform the design of control programs in the developing world is needed. Summary Brucellosis causes substantial morbidity in human and animal populations. While improvements in diagnostic options for resource-limited settings and stronger evidence for optimal therapy should enhance identification and treatment of human brucellosis, prevention of human disease through control in animals remains paramount. PMID:23963260

  18. Income analysis of goat farmers on the farmers group in district of Serdang Bedagai

    NASA Astrophysics Data System (ADS)

    Manurung, J. N.; Hasnudi; Supriana, T.

    2018-02-01

    The farmers group are expected to reduce the production cost of goat breeding and improve the income of farmers which impact on the welfare of goat farmers. This research aim to analyze the factors that influence the income of farmers group, in sub-district Dolok Masihul Pegajahan, and Dolok Merawan, Serdang Bedagai. The method used is survey method with 90 respondents. Data was analysed by multiple linear regression. The result showed, simultaneously goat cost, sale price of goat, fixed cost and variable cost had significant effect on income of goat farmers. Partially, goat cost, variable cost and sale price of goat had significant effect on income of goat farmers, while fixed cost had no significant effect.

  19. Technology transfer of hearing aids to low and middle income countries: policy and market factors.

    PubMed

    Seelman, Katherine D; Werner, Roye

    2014-09-01

    The competitive market advantages of industry and the balancing force of international governmental organizations (IGOs) are examined to identify market and policy in support of sustainable technology transfer of hearing aids to low and middle income countries. A second purpose is to examine the usefulness of findings for other assistive technologies (AT). Searches of electronic databases, IGO documents, industry reports and journals were supplemented by informal discussions with industry and IGO staff and audiologists. The value chain is used to examine the competitive advantage of industry and the balancing tools of certain IGOs. Both industry and IGOs engage in intellectual property (IP) and competition activities and are active in each segment of the hearing aid value chain. Their market and policy objectives and strategies are different. IGOs serve as balancing forces for the competitive advantages of industry. The hearing aid market configuration and hearing aid fitting process are not representative of other AT products but IP, trade and competition policy tools used by IGOs and governments are relevant to other AT. The value chain is a useful tool to identify the location of price mark-ups and the influence of actors. Market factors and reimbursement and subsidization policies drive hearing aid innovation. UN-related international government organization activities are responsive to the needs of disability populations who cannot afford assistive technology. Policy tools used by international governmental organizations are applicable across assistive technology. A partnership model is important to distribution of hearing aids to low and middle income countries.

  20. Early-life conditions and older adult health in low- and middle-income countries: a review

    PubMed Central

    McEniry, M.

    2012-01-01

    Population aging and subsequent projected large increases in chronic conditions will be important health concerns in low- and middle-income countries. Although evidence is accumulating, little is known regarding the impact of poor early-life conditions on older adult (50 years and older) health in these settings. A systematic review of 1141 empirical studies was conducted to identify population-based and community studies in low- and middle-income countries, which examined associations between early-life conditions and older adult health. The resulting review of 20 studies revealed strong associations between (1) in utero/early infancy exposures (independent of other early life and adult conditions) and adult heart disease and diabetes; (2) poor nutrition during childhood and difficulties in adult cognition and diabetes; (3) specific childhood illnesses such as rheumatic fever and malaria and adult heart disease and mortality; (4) poor childhood health and adult functionality/disability and chronic diseases; (5) poor childhood socioeconomic status (SES) and adult mortality, functionality/disability and cognition; and (6) parental survival during childhood and adult functionality/disability and cognition. In several instances, associations remained strong even after controlling for adult SES and lifestyle. Although exact mechanisms cannot be identified, these studies reinforce to some extent the importance of early-life environment on health at older ages. Given the paucity of cohort data from the developing world to examine hypotheses of early-life conditions and older adult health, population-based studies are relevant in providing a broad perspective on the origins of adult health. PMID:23316272

  1. Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review

    PubMed Central

    Basu, Sanjay; Andrews, Jason; Kishore, Sandeep; Panjabi, Rajesh; Stuckler, David

    2012-01-01

    Introduction Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. Methods and Findings Peer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of “private sector” included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. “Competitive dynamics” for

  2. Emergency medical systems in low- and middle-income countries: recommendations for action.

    PubMed Central

    Kobusingye, Olive C.; Hyder, Adnan A.; Bishai, David; Hicks, Eduardo Romero; Mock, Charles; Joshipura, Manjul

    2005-01-01

    Emergency medical care is not a luxury for rich countries or rich individuals in poor countries. This paper makes the point that emergency care can make an important contribution to reducing avoidable death and disability in low- and middle-income countries. But emergency care needs to be planned well and supported at all levels--at the national, provincial and community levels--and take into account the entire spectrum of care, from the occurrence of an acute medical event in the community to the provision of appropriate care at the hospital. The mix of personnel, materials, and health-system infrastructure can be tailored to optimize the provision of emergency care in settings with different levels of resource availability. The misconception that emergency care cannot be cost effective in low-income settings is demonstrably inaccurate. Emergencies occur everywhere, and each day they consume resources regardless of whether there are systems capable of achieving good outcomes. With better planning, the ongoing costs of emergency care can result in better outcomes and better cost-effectiveness. Every country and community can and should provide emergency care regardless of their place in the ratings of developmental indices. We make the case for universal access to emergency care and lay out a research agenda to fill the gaps in knowledge in emergency care. PMID:16184282

  3. Progress in HPV vaccination in low- and lower-middle-income countries.

    PubMed

    LaMontagne, D Scott; Bloem, Paul J N; Brotherton, Julia M L; Gallagher, Katherine E; Badiane, Ousseynou; Ndiaye, Cathy

    2017-07-01

    The past 10 years have seen remarkable progress in the global scale-up of human papillomavirus (HPV) vaccinations. Forty-three low- and lower-middle-income countries (LLMICs) have gained experience in delivering this vaccine to young adolescent girls through pilot programs, demonstration programs, and national introductions and most of these have occurred in the last 4 years. The experience of Senegal is summarized as an illustrative country case study. Publication of numerous delivery experiences and lessons learned has demonstrated the acceptability and feasibility of HPV vaccinations in LLMICs. Four areas require dedicated action to overcome remaining challenges to national scaling-up: maintaining momentum politically, planning successfully, securing financing, and fostering sustainability. Advances in policy, programming, and science may help accelerate reaching 30 million girls in LLMICs with HPV vaccine by 2020. © 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

  4. Barriers associated with frequency of leisure-time physical activity among Brazilian adults of different income strata.

    PubMed

    Silva, K S; Del Duca, G F; Garcia, L M T; da Silva, J A; Bertuol, C; de Oliveira, E S A; de Barros, M V G; Nahas, M V

    2016-02-01

    This study aimed to estimate the prevalence of the main perceived barriers to leisure-time physical activity (LTPA) and their associations with the frequency of LTPA in a representative sample of industrial workers from Brazil (n = 47,477), according to their income strata (low income: ≤$US280, middle income: $US281-$US1400, and high income: ≥$US1401). Data were collected between 2006 and 2008 via questionnaires about the main perceived barrier to LTPA and the frequency of LTPA. Multinomial logistic regression was performed to evaluate differences among groups. There was a lower prevalence of regular practice of LTPA in the low- (15.8%) and middle-income strata (18.2%) than among the individuals of the high-income stratum (27.6%). A large proportion of workers who regularly participated in LTPA reported no barriers (low: 43.1%; middle: 46.8%; high: 51.6%). Additional obligations and fatigue were the two most common perceived barriers in all family income strata among participants who engaged in different frequencies of LTPA. The odds for all perceived barriers showed a positive trend related to frequency of LTPA (from regular to no LTPA), with higher values according to income. In summary, the ordering of the main perceived barriers to LTPA differed according to workers' income stratum and frequency of engaging in LTPA. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review.

    PubMed

    Fisher, Jane; Cabral de Mello, Meena; Patel, Vikram; Rahman, Atif; Tran, Thach; Holton, Sara; Holmes, Wendy

    2012-02-01

    To review the evidence about the prevalence and determinants of non-psychotic common perinatal mental disorders (CPMDs) in World Bank categorized low- and lower-middle-income countries. Major databases were searched systematically for English-language publications on the prevalence of non-psychotic CPMDs and on their risk factors and determinants. All study designs were included. Thirteen papers covering 17 low- and lower-middle-income countries provided findings for pregnant women, and 34, for women who had just given birth. Data on disorders in the antenatal period were available for 9 (8%) countries, and on disorders in the postnatal period, for 17 (15%). Weighted mean prevalence was 15.6% (95% confidence interval, CI: 15.4-15.9) antenatally and 19.8% (19.5-20.0) postnatally. Risk factors were: socioeconomic disadvantage (odds ratio [OR] range: 2.1-13.2); unintended pregnancy (1.6-8.8); being younger (2.1-5.4); being unmarried (3.4-5.8); lacking intimate partner empathy and support (2.0-9.4); having hostile in-laws (2.1-4.4); experiencing intimate partner violence (2.11-6.75); having insufficient emotional and practical support (2.8-6.1); in some settings, giving birth to a female (1.8-2.6), and having a history of mental health problems (5.1-5.6). Protective factors were: having more education (relative risk: 0.5; P = 0.03); having a permanent job (OR: 0.64; 95% CI: 0.4-1.0); being of the ethnic majority (OR: 0.2; 95% CI: 0.1-0.8) and having a kind, trustworthy intimate partner (OR: 0.52; 95% CI: 0.3-0.9). CPMDs are more prevalent in low- and lower-middle-income countries, particularly among poorer women with gender-based risks or a psychiatric history.

  6. Workplace wellness programming in low-and middle-income countries: a qualitative study of corporate key informants in Mexico and India.

    PubMed

    Wipfli, Heather; Zacharias, Kristin Dessie; Nivvy Hundal, Nuvjote; Shigematsu, Luz Myriam Reynales; Bahl, Deepika; Arora, Monika; Bassi, Shalini; Kumar, Shubha

    2018-05-09

    A qualitative study of key informant semi-structured interviews were conducted between March and July 2016 in Mexico and India to achieve the following aims: to explore corporations' and stakeholders' views, attitudes and expectations in relation to health, wellness and cancer prevention in two middle-income countries, and to determine options for health professions to advance their approach to workplace wellness programming globally, including identifying return-on-investment incentives for corporations to implement wellness programming. There is an unmet demand for workplace wellness resources that can be used by corporations in an international context. Corporations in India and Mexico are already implementing a range of health-related wellness programs, most often focused on disease prevention and management. A number of companies indicated interest is collecting return on investment data but lacked the knowledge and tools to carry out return-on-investment analyses. There was widespread interest in partnership with international non-governmental organizations (public health organizations) and a strong desire for follow-up among corporations interviewed, particularly in Mexico. As low-and middle-income countries continue to undergo economic transitions, the workforce and disease burden continue to evolve as well. Evidence suggests a there is a growing need for workplace wellness initiatives in low-and middle-income countries. Results from this study suggest that while corporations in India and Mexico are implementing wellness programming in some capacity, there are three areas where corporations could greatly benefit from assistance in improving wellness programming in the workplace: 1) innovative toolkits for workplace wellness initiatives and technical support for adaptation, 2) assistance with building partnerships to help implement wellness initiatives and build capacity, and 3) tools and training to collect data for surveillance as well as monitoring and

  7. Slow progress in diarrhea case management in low and middle income countries: evidence from cross-sectional national surveys, 1985-2012.

    PubMed

    Sreeramareddy, Chandrashekhar T; Low, Yue-Peng; Forsberg, Birger Carl

    2017-03-21

    Diarrhea remains to be a main cause of childhood mortality. Diarrhea case management indicators reflect the effectiveness of child survival interventions. We aimed to assess time trends and country-wise changes in diarrhea case management indicators among under-5 children in low-and-middle-income countries. We analyzed aggregate data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys done from 1986 to 2012 in low-and-middle-income countries. Two-week prevalence rates of diarrhea, caregiver's care seeking behavior and three case management indicators were analyzed. We assessed overall time trends across the countries using panel data analyses and country-level changes between two sequential surveys. Overall, yearly increase in case management indicators ranged from 1 · 3 to 2 · 5%. In the year 2012, <50% of the children were given correct treatment (received oral rehydration and increased fluids) for diarrhea. Annually, an estimated 300 to 350 million children were not given oral rehydration solutions, or recommended home fluids or 'increased fluids' and 304 million children not taken to a healthcare provider during an episode of diarrhea. Overall, care seeking for diarrhea, increased from pre-2000 to post-2000, i.e. from 35 to 45%; oral rehydration rates increased by about 7% but the rate of 'increased fluids' decreased by 14%. Country-level trends showed that care seeking had decreased in 15 countries but increased in 33 countries. Care seeking from a healthcare provider increased by ≥10% in about 23 countries. Oral rehydration rates had increased by ≥10% in 15 countries and in 30 countries oral rehydration rates increased by <10%. Very limited progress has been made in the case management of childhood diarrhea. A better understanding of caregiver's care seeking behavior and health care provider's case management practices is needed to improve diarrhea case management in low- and-middle-income countries.

  8. The general movement assessment in non-European low- and middle-income countries.

    PubMed

    Tomantschger, Iris; Herrero, Dafne; Einspieler, Christa; Hamamura, Cristina; Voos, Mariana Calil; Marschik, Peter B

    2018-02-05

    Abnormal general movements are among the most reliable markers for cerebral palsy. General movements are part of the spontaneous motor repertoire and are present from early fetal life until the end of the first half year after term. In addition to its high sensitivity (98%) and specificity (91%), the assessment of general movements is non-invasive and time- and cost-efficient. It is therefore ideal for assessing the integrity of the young nervous system, most notably in lowresource settings. Studies on the general movements assessment in low- and middle-income countries such as China, India, Iran, or South Africa are still rare but increasing. In Brazil, too, researchers have demonstrated that the evaluation of general movements adds to the functional assessment of the young nervous system. Applying general movements assessment in vulnerable populations in Brazil is therefore highly recommended.

  9. Eating Dinner Away from Home: Perspectives of Middle- to High-Income Parents

    PubMed Central

    Robson, Shannon M.; Crosby, Lori E.; Stark, Lori J.

    2015-01-01

    This study sought to understand barriers and facilitators for preparing and eating dinner at home in families who report eating dinner away from home ≥3 per week. Cross-sectional, mixed methods (focus groups, questionnaires) study. Twenty-seven parents with a child 3–10 years-old who reported eating dinner away from home ≥3 times per week from a pediatric medical center in the Midwest participated. The key concepts analytic framework guided focus group analysis. Descriptive statistics were used to characterize parent demographics, anthropometrics, attitudes and confidence toward cooking, perceptions of dinner costs and portions, and parent and child dinners. Parents reported confidence in cooking a home prepared meal, but that eating away from home was reinforcing because it provided quality family time and diminished barriers such as picky eating and perceived costs. Home cooking was also hindered by early school lunch and after-school sports as children were not hungry or home at the typical dinner hour and parents did not want to cook after 8pm. Parents estimated preparing and eating a meal at home took significantly more time than driving and eating out (80.7 minutes vs. 30.3 minutes, p<0.001). Parents significantly (F (3, 104) = 8.80, p<0.001) overestimated the cost of home-prepared meals compared to take-out and frozen meals. Portion size was also overestimated for a protein serving. Findings are limited to predominantly married, female parents whom are highly educated and working. To reduce eating out, interventions should address family factors (e.g., time management, quality time) and child behavior (e.g., picky eating). Innovative interventions that include experiential cooking opportunities that incorporate time management, address picky eating and enthusiasm for cooking with education on decreasing costs may be particularly beneficial for middle- to high-income families. PMID:26386299

  10. E-health in low- and middle-income countries: findings from the Center for Health Market Innovations.

    PubMed

    Lewis, Trevor; Synowiec, Christina; Lagomarsino, Gina; Schweitzer, Julian

    2012-05-01

    To describe how information communication technology (ICT) is being used by programmes that seek to improve private sector health financing and delivery in low- and middle-income countries, including the main uses of the technology and the types of technologies being used. In-country partners in 16 countries directly searched systematically for innovative health programmes and compiled profiles in the Center for Health Market Innovations' database. These data were supplemented through literature reviews and with self-reported data supplied by the programmes themselves. In many low- and middle-income countries, ICT is being increasingly employed for different purposes in various health-related areas. Of ICT-enabled health programmes, 42% use it to extend geographic access to health care, 38% to improve data management and 31% to facilitate communication between patients and physicians outside the physician's office. Other purposes include improving diagnosis and treatment (17%), mitigating fraud and abuse (8%) and streamlining financial transactions (4%). The most common devices used in technology-enabled programmes are phones and computers; 71% and 39% of programmes use them, respectively, and the most common applications are voice (34%), software (32%) and text messages (31%). Donors are the primary funders of 47% of ICT-based health programmes. Various types of ICT are being employed by private organizations to address key health system challenges. For successful implementation, however, more sustainable sources of funding, greater support for the adoption of new technologies and better ways of evaluating impact are required.

  11. Opposites Detract: Middle School Peer Group Antipathies

    PubMed Central

    Laursen, Brett; Bukowski, William M.; Nurmi, Jari-Eri; Marion, Donna; Salmela-Aro, Katariina; Kiuru, Noona

    2010-01-01

    This study examines variability in patterns of peer group antipathy. Same-grade adolescent peer groups were identified from sociometric nominations of preferred affiliates in a community sample of 600 Finnish 9th grade middle school students (M = 15.0 years-old). Hierarchical linear modeling determined characteristics of youth in actor groups (nominators) that predicted antipathy for youth in target groups (nominatees) on the basis of target group characteristics. Most antipathies were based on dissimilarity between groups representing the mainstream culture and groups opposed to it. The higher a peer group's school burnout, the more its members disliked students in peer groups with higher school grades and students in peer groups with higher sports participation. Conversely, the higher a peer group's school grades, the more its members disliked students in peer groups with higher school burnout. Students in peer groups with less problem behavior disliked students in peer groups with more problem behavior. There was some evidence of rivalry within the mainstream culture: The higher a group's school grades, the more its members disliked those in groups whose members participated in sports. PMID:20378125

  12. State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European Region.

    PubMed

    Mathauer, Inke; Theisling, Mareike; Mathivet, Benoit; Vilcu, Ileana

    2016-04-02

    Many low-and middle-income countries (LMIC) of the World Health Organization (WHO) European Region have introduced social health insurance payroll taxes after the political transition in the late 1980s, combined with budget transfers to allow for exempting specific population groups from paying contributions, such as those outside formal sector work and in particular vulnerable groups. This paper assesses the institutional design aspects of such financing arrangements and their performance with respect to universal health coverage progress in LMIC of the European region. The study is based on a literature review and review of secondary databases for the performance assessment. Such financing arrangements currently exist in 13 LMIC of that region, with strong commonalities in institutional design: This includes a wide range of different eligible population groups, mostly mandatory membership, integrated pools for both the exempted and contributors, and relatively comprehensive benefit packages. Performance is more varied. Enrolment rates range from about 65 % to above 95 %, and access to care and financial protection has improved in several countries. Yet, inequities between income quintiles persist. Budget transfers to health insurance arrangements have helped to deepen UHC or maintain achievements with respect to UHC in these European LMICs by covering those outside formal sector work, and in particular vulnerable population groups. However, challenges remain: a comprehensive benefit package on paper is not enough as long as supply side constraints and quality gaps as well as informal payments prevail. A key policy question is how to reach those so far uncovered.

  13. Policy options for pharmaceutical pricing and purchasing: issues for low- and middle-income countries.

    PubMed

    Nguyen, Tuan Anh; Knight, Rosemary; Roughead, Elizabeth Ellen; Brooks, Geoffrey; Mant, Andrea

    2015-03-01

    Pharmaceutical expenditure is rising globally. Most high-income countries have exercised pricing or purchasing strategies to address this pressure. Low- and middle-income countries (LMICs), however, usually have less regulated pharmaceutical markets and often lack feasible pricing or purchasing strategies, notwithstanding their wish to effectively manage medicine budgets. In high-income countries, most medicines payments are made by the state or health insurance institutions. In LMICs, most pharmaceutical expenditure is out-of-pocket which creates a different dynamic for policy enforcement. The paucity of rigorous studies on the effectiveness of pharmaceutical pricing and purchasing strategies makes it especially difficult for policy makers in LMICs to decide on a course of action. This article reviews published articles on pharmaceutical pricing and purchasing policies. Many policy options for medicine pricing and purchasing have been found to work but they also have attendant risks. No one option is decisively preferred; rather a mix of options may be required based on country-specific context. Empirical studies in LMICs are lacking. However, risks from any one policy option can reasonably be argued to be greater in LMICs which often lack strong legal systems, purchasing and state institutions to underpin the healthcare system. Key factors are identified to assist LMICs improve their medicine pricing and purchasing systems. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

  14. Understanding caregivers' attitudes towards physical punishment of children: evidence from 34 low- and middle-income countries.

    PubMed

    Cappa, Claudia; Khan, Shane M

    2011-12-01

    This article presents findings on caregivers' attitudes towards physical punishment of children from 34 household surveys conducted in low- and middle-income countries in 2005 and 2006. The article analyzes the variability in attitudes by background characteristics of the respondents to examine whether various factors at the individual and family levels correlate with the caregivers' beliefs in the need for violent discipline. The article also examines to what extent attitudes influence behaviors and compares groups of respondents to see how attitudes relate to disciplinary practices across caregivers of different socio-economic backgrounds. The analysis is based on nationally representative data from 33 MICS and 1 DHS surveys. Questions on child discipline were addressed to the mother (or primary caregiver) of one randomly selected child aged 2-14 years in each household. The questionnaire asked whether any member of the household had used various violent and non-violent disciplinary practices with that child during the past month. Additionally, the interviewers asked the respondent if she believed that, in order to bring up that child properly, physical punishment was necessary. The sample included 166,635 mothers/primary caregivers. The analysis shows that, in most countries, the majority of mothers/primary caregivers did not think there was a need for physical punishment. Overall, characteristics such as household wealth and size, educational level and age, as well as place of residence were significantly associated with caregivers' attitudes. The analysis confirms that beliefs influence disciplinary practices to a large degree: in all the countries but two, children were significantly more likely to experience physical punishment if their mothers/primary caregivers thought such punishment was needed. However, large proportions of children were found to be subject to physical punishment even if their mothers/primary caregivers did not consider this method

  15. Influence of organisational culture on the implementation of health sector reforms in low- and middle-income countries: a qualitative interpretive review.

    PubMed

    Mbau, Rahab; Gilson, Lucy

    2018-01-01

    Health systems, particularly in low- and middle-income countries, are commonly plagued by poor access, poor performance, inefficient use and inequitable distribution of resources. To improve health system efficiency, equity and effectiveness, the World Development Report of 1993 proposed a first wave of health sector reforms, which has been followed by further waves. Various authors, however, suggest that the early reforms did not lead to the anticipated improvements. They offer, as one plausible explanation for this gap, the limited consideration given to the influence over implementation of the software aspects of the health system, such as organisational culture - which has not previously been fully investigated. To identify, interpret and synthesise existing literature for evidence on organisational culture and how it influences implementation of health sector reforms in low- and middle-income countries. We conducted a systematic search of eight databases: PubMed; Africa-Wide Information, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Econlit, PsycINFO, SocINDEX with full text, Emerald and Scopus. Eight papers were identified. We analysed and synthesised these papers using thematic synthesis. This review indicates the potential influence of dimensions of organisational culture such as power distance, uncertainty avoidance, and in-group and institutional collectivism over the implementation of health sector reforms. This influence is mediated through organisational practices such as communication and feedback, management styles, commitment and participation in decision-making. This interpretive review highlights the dearth of empirical literature around organisational culture and therefore its findings can only be tentative. There is a need for health policymakers and health system researchers to conduct further analysis of organisational culture and change within the health system.

  16. How food insecurity could lead to obesity in LMICs:  When not enough is too much: a realist review of how food insecurity could lead to obesity in low- and middle-income countries.

    PubMed

    Farrell, Penny; Thow, Anne Marie; Abimbola, Seye; Faruqui, Neha; Negin, Joel

    2017-05-24

    While food insecurity is a well-known cause of under-nutrition and stunting, in recent decades it has also been linked with obesity. Understanding and thus minimising the risk factors for obesity in low- and middle-income country contexts, which often lack the health system capacity to treat the consequent obesity-related illnesses, is crucial. This study adopted realist review methodology because it enabled us to analyse and organise the evidence from low- and middle-income countries into a coherent scheme. By comparing this evidence to existing theory on food security and nutrition, we aimed to provide a richer understanding of the nuances and the socio-demographic nature of the food insecurity-obesity relationship. The review generated 13 peer-reviewed articles which studied the relationship between food insecurity and overweight/obesity in low- and middle-income countries. Affordability of high-energy, processed foods was identified as a main mechanism, which determined whether or not food insecurity leads to obesity in low- and middle-income countries. Other mechanisms identified were: quantity and diversity of food consumed; spatial-temporal access to nutritious food; inter-personal food choice and distribution; and non-dietary behaviours. Despite the limited empirical evidence available, our review presents meaningful and policy-relevant insights into the food insecurity-obesity relationship in from low- and middle-income countries. Interventions to address the food insecurity-obesity link need to address diet quality, and demand a broad understanding across a variety of experiences. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. Achieving Universal General Secondary Education in Ethiopia in Line with the Middle-Income Country Vision: A Reality or a Dream?

    ERIC Educational Resources Information Center

    Gbre-eyesus, Mulugeta Tsegai

    2017-01-01

    This article analyses the challenges facing secondary education in the context of Ethiopia's Growth and transformation Plan (GtP) for 2010/11-2014/15 and its stated goal of becoming a middle-income country by 2025. It does not aim to provide a definitive set of recommendations for universalising general secondary education to meet the demands of a…

  18. Using the Theory of Normative Social Behavior to Understand Compliance with a Smoke-Free Law in a Middle-Income Country

    ERIC Educational Resources Information Center

    Byron, M. J.; Cohen, J. E.; Frattaroli, S.; Gittelsohn, J.; Jernigan, D. H.

    2016-01-01

    Smoke-free laws, which ban smoking in public venues, can be effective in protecting public health, but it has been difficult to achieve compliance with these laws in low- and middle-income countries. This study was conducted to understand the social norms around public smoking and learn how to improve compliance in Bogor, the first Indonesian city…

  19. Closing the global cancer divide- performance of breast cancer care services in a middle income developing country

    PubMed Central

    2014-01-01

    Background Cancer is the leading cause of deaths in the world. A widening disparity in cancer burden has emerged between high income and low-middle income countries. Closing this cancer divide is an ethical imperative but there is a dearth of data on cancer services from developing countries. Methods This was a multi-center, retrospective observational cohort study which enrolled women with breast cancer (BC) attending 8 participating cancer centers in Malaysia in 2011. All patients were followed up for 12 months from diagnosis to determine their access to therapies. We assess care performance using measures developed by Quality Oncology Practice Initiative, American Society of Clinical Oncology/National Comprehensive Cancer Network, American College of Surgeons’ National Accreditation Program for Breast Centers as well as our local guideline. Results Seven hundred and fifty seven patients were included in the study; they represent about 20% of incident BC in Malaysia. Performance results were mixed. Late presentation was 40%. Access to diagnostic and breast surgery services were timely; the interval from presentation to tissue diagnosis was short (median = 9 days), and all who needed surgery could receive it with only a short wait (median = 11 days). Performance of radiation, chemo and hormonal therapy services showed that about 75 to 80% of patients could access these treatments timely, and those who could not were because they sought alternative treatment or they refused treatment. Access to Trastuzumab was limited to only 19% of eligible patients. Conclusions These performance results are probably acceptable for a middle income country though far below the 95% or higher adherence rates routinely reported by centres in developed countries. High cost trastuzumab was inaccessible to this population without public funding support. PMID:24650245

  20. Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

    PubMed

    2016-10-31

    As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. ISRCTN51817007 © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.

  1. Interventions for the prevention of cardiovascular diseases: a protocol for a systematic review of economic evaluations in low-income and middle-income countries.

    PubMed

    Aminde, Leopold Ndemnge; Veerman, Lennert

    2016-12-21

    Low-income and middle-income countries (LMICs) are experiencing a growing disease burden due to cardiovascular and other chronic non-communicable diseases. Interventions for the control of these diseases are paramount; however, these countries are faced with competing health and financial needs. There is an urgent need for quality evidence on cost-effective strategies to address these chronic diseases. We aim to synthesise the current literature on economic evaluations of interventions for primary and secondary cardiovascular disease prevention in LMICs. A systematic review of studies (published and unpublished) in LMICs up to 30 October 2016 will be conducted. The following databases will be searched: PubMed/MEDLINE, EMBASE, SCOPUS, CINAHL, Web of Science, EconLit, NHS Economic Evaluations Database (NHS EED). Data sources specific to African literature, such as the WHO AFROLIB, Africa Index Medicus and African Journals online (AJOL) as well as grey literature, will also be searched. 2 reviewers shall independently screen potential articles for inclusion and disagreements shall be resolved by consensus. Quality appraisal of studies shall be done using Drummond's checklist for economic evaluation of studies. A descriptive synthesis of the evidence obtained is planned. The primary outcomes will be costs per life years gained or unit of clinical outcome, cost per quality-adjusted life years or disability-adjusted life years. This systematic review protocol has been prepared according to the Preferred Reporting Items for Systematic reviews and Meta-analyses for Protocols (PRISMA-P) 2015 statement. Ethics approval is not required considering that this is a protocol for a systematic review of published studies. Results from this review will be disseminated via conference presentations and peer-reviewed journal publications. CRD42016043510. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  2. Attitudes towards Intimate Partner Violence against Women among Women and Men in 39 Low- and Middle-Income Countries

    PubMed Central

    Tran, Thach Duc; Nguyen, Hau; Fisher, Jane

    2016-01-01

    Background Violence against women perpetrated by an intimate partner (IPV) is prevalent in low- and middle-income countries (LAMIC). The aim was to describe the attitudes of women and men towards perpetration of physical violence to women by an intimate partner, in a large group of low- and middle-income countries. Methods and Findings We used data from Round Four of the UNICEF Multiple Indicator Cluster Surveys. Attitudes towards IPV against women were assessed by a study-specific scale asking if ‘wife beating’ is justified in any of five circumstances. Overall, data from 39 countries (all had data from women and 13 countries also had data from men) were included in the analyses. The proportions of women who held attitudes that ‘wife-beating’ was justified in any of the five circumstances varied widely among countries from 2.0% (95% CI 1.7;2.3) in Argentina to 90.2% (95% CI 88.9;91.5) in Afghanistan. Similarly, among men it varied from 5.0% (95% CI 4.0;6.0) in Belarus to 74.5% (95% CI 72.5;76.4) in the Central African Republic. The belief that ‘wife-beating’ is acceptable was most common in Africa and South Asia, and least common in Central and Eastern Europe and Latin America and the Caribbean. In general this belief was more common among people in disadvantaged circumstances, including being a member of a family in the lowest household wealth quintile, living in a rural area and having limited formal education. Young adults were more likely to accept physical abuse by a man of his intimate partner than those who were older, but people who had never partnered were less likely to have these attitudes. Conclusions Violence against women is an international priority and requires a multicomponent response. These data provide evidence that strategies should include major public education programs to change attitudes about the acceptability of IPV against women, and that these should be addressed to women and girls as well as to boys and men. PMID:27893861

  3. Continuous positive airway pressure (CPAP) to treat respiratory distress in newborns in low- and middle-income countries.

    PubMed

    Dewez, Juan Emmanuel; van den Broek, Nynke

    2017-01-01

    Severe respiratory distress is a serious complication common to the three major causes of neonatal mortality and morbidity (prematurity, intra-partum-related hypoxia and infections). In low- and middle-income countries (LMICs), 20% of babies presenting with severe respiratory distress die.Continuous positive airway pressure (CPAP), is an effective intervention for respiratory distress in newborns and widely used in high-income countries. Following the development of simple, safe and relatively inexpensive CPAP devices, there is potential for large-scale implementation in the developing world.In this article, we describe existing CPAP systems and present a review of the current literature examining the effectiveness of CPAP compared to standard care (oxygen) in newborns with respiratory distress. We also discuss the evidence gap which needs to be addressed prior to its integration into health systems in LMICs. © The Author(s) 2016.

  4. Continuous positive airway pressure (CPAP) to treat respiratory distress in newborns in low- and middle-income countries

    PubMed Central

    van den Broek, Nynke

    2016-01-01

    Severe respiratory distress is a serious complication common to the three major causes of neonatal mortality and morbidity (prematurity, intra-partum-related hypoxia and infections). In low- and middle-income countries (LMICs), 20% of babies presenting with severe respiratory distress die. Continuous positive airway pressure (CPAP), is an effective intervention for respiratory distress in newborns and widely used in high-income countries. Following the development of simple, safe and relatively inexpensive CPAP devices, there is potential for large-scale implementation in the developing world. In this article, we describe existing CPAP systems and present a review of the current literature examining the effectiveness of CPAP compared to standard care (oxygen) in newborns with respiratory distress. We also discuss the evidence gap which needs to be addressed prior to its integration into health systems in LMICs. PMID:26864235

  5. Strategic Reading Groups: Guiding Readers in the Middle Grades

    ERIC Educational Resources Information Center

    Berne, Jennifer; Degener, Sophie C.

    2012-01-01

    Strategic grouping can transform reading instruction in the middle grades from a hit-or-miss learning experience to a targeted, responsive one. This book features a practical and field-tested model for small-group differentiated reading instruction in Grades 4-8. Jennifer Berne and Sophie C. Degener offer a clear, detailed discussion of how to…

  6. The effect of balanced protein energy supplementation in undernourished pregnant women and child physical growth in low- and middle-income countries: a systematic review and meta-analysis.

    PubMed

    Stevens, Briony; Buettner, Petra; Watt, Kerrianne; Clough, Alan; Brimblecombe, Julie; Judd, Jenni

    2015-10-01

    The beneficial effect of balanced protein energy supplementation during pregnancy on subsequent child growth is unclear and may depend upon the mother entering pregnancy adequately nourished or undernourished. Systematic reviews to-date have included studies from high-, middle- and low-income countries. However, the effect of balanced protein energy supplementation should not be generalised. This review assesses the effect of balanced protein energy supplementation in undernourished pregnant women from low- and middle-income countries on child growth. A systematic review of articles published in English (1970-2015) was conducted via MEDLINE, Scopus, the Cochrane Register and hand searching. Only peer-reviewed experimental studies analysing the effects of balanced protein energy supplementation in undernourished pregnant women from low- and middle-income countries with measures of physical growth as the primary outcome were included. Two reviewers independently assessed full-text articles against inclusion criteria. Validity of eligible studies was ascertained using the Quality Assessment Tool for Quantitative Studies (EPHPP QAT). In total, seven studies met the inclusion criteria. All studies reported on birthweight, five on birth length, three on birth head circumference, and one on longer-term growth. Standardised mean differences were calculated using a random-effects meta-analysis. Balanced protein energy supplementation significantly improved birthweight (seven randomised controlled trials, n = 2367; d = 0.20, 95% confidence interval, 0.03-0.38, P = 0.02). No significant benefit was observed on birth length or birth head circumference. Impact of intervention could not be determined for longer-term physical growth due to limited evidence. Additional research is required in low- and middle-income countries to identify impacts on longer-term infant growth. © 2015 John Wiley & Sons Ltd.

  7. Human-experienced temperature changes exceed global average climate changes for all income groups

    NASA Astrophysics Data System (ADS)

    Hsiang, S. M.; Parshall, L.

    2009-12-01

    Global climate change alters local climates everywhere. Many climate change impacts, such as those affecting health, agriculture and labor productivity, depend on these local climatic changes, not global mean change. Traditional, spatially averaged climate change estimates are strongly influenced by the response of icecaps and oceans, providing limited information on human-experienced climatic changes. If used improperly by decision-makers, these estimates distort estimated costs of climate change. We overlay the IPCC’s 20 GCM simulations on the global population distribution to estimate local climatic changes experienced by the world population in the 21st century. The A1B scenario leads to a well-known rise in global average surface temperature of +2.0°C between the periods 2011-2030 and 2080-2099. Projected on the global population distribution in 2000, the median human will experience an annual average rise of +2.3°C (4.1°F) and the average human will experience a rise of +2.4°C (4.3°F). Less than 1% of the population will experience changes smaller than +1.0°C (1.8°F), while 25% and 10% of the population will experience changes greater than +2.9°C (5.2°F) and +3.5°C (6.2°F) respectively. 67% of the world population experiences temperature changes greater than the area-weighted average change of +2.0°C (3.6°F). Using two approaches to characterize the spatial distribution of income, we show that the wealthiest, middle and poorest thirds of the global population experience similar changes, with no group dominating the global average. Calculations for precipitation indicate that there is little change in average precipitation, but redistributions of precipitation occur in all income groups. These results suggest that economists and policy-makers using spatially averaged estimates of climate change to approximate local changes will systematically and significantly underestimate the impacts of climate change on the 21st century population. Top: The

  8. Type and extent of trans-disciplinary co-operation to improve food security, health and household environment in low and middle income countries: systematic review.

    PubMed

    Gaihre, Santosh; Kyle, Janet; Semple, Sean; Smith, Jo; Subedi, Madhu; Marais, Debbi

    2016-10-18

    Although linkages have been found between agricultural interventions and nutritional health, and the development of clean fuels and improved solid fuel stoves in reducing household air pollution and adverse health effects, the extent of the potential of combined household interventions to improve health, nutrition and the environment has not been investigated. A systematic review was conducted to identify the extent and type of community-based agricultural and household interventions aimed at improving food security, health and the household environment in low and middle income countries. A systematic search of Ovid MEDLINE, PUBMED, EMBASE and SCOPUS databases was performed. Key search words were generated reflecting the "participants, interventions, comparators, outcomes and study design" approach and a comprehensive search strategy was developed following "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" recommendations. Any community-based agricultural and/or household interventions were eligible for inclusion if the focus was to improve at least one of the outcome measures of interest. All relevant study designs employing any of these interventions (alone/in combination) were included if conducted in Low and middle income countries. Review articles, and clinical and occupational studies were excluded. A total of 123 studies were included and grouped into four intervention domains; agricultural (n = 27), air quality (n = 34), water quality (n = 32), and nutritional (n = 30). Most studies were conducted in Asia (39.2 %) or Africa (34.6 %) with the remaining 26.1 % in Latin America. Very few studies (n = 11) combined interventions across more than one domain. The majority of agricultural and nutritional studies were conducted in Africa and Asia, whereas the majority of interventions to improve household air quality were conducted in Latin America. It is clear that very little trans-disciplinary research has been done with

  9. Effectiveness of community health worker training programmes for cardiovascular disease management in low-income and middle-income countries: a systematic review.

    PubMed

    Abdel-All, Marwa; Putica, Barbara; Praveen, Deversetty; Abimbola, Seye; Joshi, Rohina

    2017-11-03

    Community health workers (CHWs) are increasingly being tasked to prevent and manage cardiovascular disease (CVD) and its risk factors in underserved populations in low-income and middle-income countries (LMICs); however, little is known about the required training necessary for them to accomplish their role. This review aimed to evaluate the training of CHWs for the prevention and management of CVD and its risk factors in LMICs. A search strategy was developed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and five electronic databases (Medline, Global Health, ERIC, EMBASE and CINAHL) were searched to identify peer-reviewed studies published until December 2016 on the training of CHWs for prevention or control of CVD and its risk factors in LMICs. Study characteristics were extracted using a Microsoft Excel spreadsheet and quality assessed using Effective Public Health Practice Project's Quality Assessment Tool. The search, data extraction and quality assessment were performed independently by two researchers. The search generated 928 articles of which 8 were included in the review. One study was a randomised controlled trial, while the remaining were before-after intervention studies. The training methods included classroom lectures, interactive lessons, e-learning and online support and group discussions or a mix of two or more. All the studies showed improved knowledge level post-training, and two studies demonstrated knowledge retention 6 months after the intervention. The results of the eight included studies suggest that CHWs can be trained effectively for CVD prevention and management. However, the effectiveness of CHW trainings would likely vary depending on context given the differences between studies (eg, CHW demographics, settings and training programmes) and the weak quality of six of the eight studies. Well-conducted mixed-methods studies are needed to provide reliable evidence about the effectiveness and

  10. Effectiveness of community health worker training programmes for cardiovascular disease management in low-income and middle-income countries: a systematic review

    PubMed Central

    Putica, Barbara; Praveen, Deversetty; Abimbola, Seye; Joshi, Rohina

    2017-01-01

    Introduction Community health workers (CHWs) are increasingly being tasked to prevent and manage cardiovascular disease (CVD) and its risk factors in underserved populations in low-income and middle-income countries (LMICs); however, little is known about the required training necessary for them to accomplish their role. This review aimed to evaluate the training of CHWs for the prevention and management of CVD and its risk factors in LMICs. Methods A search strategy was developed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and five electronic databases (Medline, Global Health, ERIC, EMBASE and CINAHL) were searched to identify peer-reviewed studies published until December 2016 on the training of CHWs for prevention or control of CVD and its risk factors in LMICs. Study characteristics were extracted using a Microsoft Excel spreadsheet and quality assessed using Effective Public Health Practice Project’s Quality Assessment Tool. The search, data extraction and quality assessment were performed independently by two researchers. Results The search generated 928 articles of which 8 were included in the review. One study was a randomised controlled trial, while the remaining were before–after intervention studies. The training methods included classroom lectures, interactive lessons, e-learning and online support and group discussions or a mix of two or more. All the studies showed improved knowledge level post-training, and two studies demonstrated knowledge retention 6 months after the intervention. Conclusion The results of the eight included studies suggest that CHWs can be trained effectively for CVD prevention and management. However, the effectiveness of CHW trainings would likely vary depending on context given the differences between studies (eg, CHW demographics, settings and training programmes) and the weak quality of six of the eight studies. Well-conducted mixed-methods studies are needed to provide

  11. Impact of measles supplementary immunisation activities on utilisation of maternal and child health services in low-income and middle-income countries.

    PubMed

    Postolovska, Iryna; Helleringer, Stéphane; Kruk, Margaret E; Verguet, Stéphane

    2018-01-01

    Measles supplementary immunisation activities (SIAs) are an integral component of measles elimination in low-income and middle-income countries (LMICs). Despite their success in increasing vaccination coverage, there are concerns about their negative consequences on routine services. Few studies have conducted quantitative assessments of SIA impact on utilisation of health services. We analysed the impact of SIAs on utilisation of selected maternal and child health services using Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 28 LMICs, where at least one SIA occurred over 2000-2014. Logistic regressions were conducted to investigate the association between SIAs and utilisation of the following services: facility delivery, postnatal care and outpatient sick child care (for fever, diarrhoea, cough). SIAs do not appear to significantly impact utilisation of maternal and child services. We find a reduction in care-seeking for treatment of child cough (OR 0.67; 95% CI 0.48 to 0.95); and a few significant effects at the country level, suggesting the need for further investigation of the idiosyncratic effects of SIAs in each country. The paper contributes to the debate on vertical versus horizontal programmes to ensure universal access to vaccination. Measles SIAs do not seem to affect care-seeking for critical conditions.

  12. Impact of measles supplementary immunisation activities on utilisation of maternal and child health services in low-income and middle-income countries

    PubMed Central

    Postolovska, Iryna; Helleringer, Stéphane; Kruk, Margaret E; Verguet, Stéphane

    2018-01-01

    Background Measles supplementary immunisation activities (SIAs) are an integral component of measles elimination in low-income and middle-income countries (LMICs). Despite their success in increasing vaccination coverage, there are concerns about their negative consequences on routine services. Few studies have conducted quantitative assessments of SIA impact on utilisation of health services. Methods We analysed the impact of SIAs on utilisation of selected maternal and child health services using Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 28 LMICs, where at least one SIA occurred over 2000–2014. Logistic regressions were conducted to investigate the association between SIAs and utilisation of the following services: facility delivery, postnatal care and outpatient sick child care (for fever, diarrhoea, cough). Results SIAs do not appear to significantly impact utilisation of maternal and child services. We find a reduction in care-seeking for treatment of child cough (OR 0.67; 95% CI 0.48 to 0.95); and a few significant effects at the country level, suggesting the need for further investigation of the idiosyncratic effects of SIAs in each country. Conclusion The paper contributes to the debate on vertical versus horizontal programmes to ensure universal access to vaccination. Measles SIAs do not seem to affect care-seeking for critical conditions. PMID:29755760

  13. Nurses' contribution to short-term humanitarian care in low- to middle-income countries: An integrative review of the literature.

    PubMed

    Dawson, Sonja; Elliott, Doug; Jackson, Debra

    2017-12-01

    To appraise the literature related to voluntary humanitarian work provided by international nurses in low- to middle-income countries. Nurses and other health professionals are engaged with both governmental and nongovernmental organisations to provide care within international humanitarian relief and development contexts. Current literature describes accounts of charitable health professional activity within short-term health-focused humanitarian trips; however, there is minimal research describing the care that nurses provide and the professional roles and tasks they fulfil whilst participating in international volunteer healthcare service. Integrative review. A search of articles published between 1995-2015 was conducted using seven bibliographic databases. Inclusion criteria incorporated nurses and allied health professionals' involvement in a volunteer short-term medical team capacity. Papers describing military and/or disaster response with a service-learning focus were excluded. Nineteen papers were selected for review, description and discussion of findings. Findings revealed limited data describing the care nurses provide and the professional roles and tasks they fulfil within the context of international humanitarian short-term medical trips. Issues raised included a description of demographic data regarding participants and sending agencies, motivation for volunteer participation, perceptions of effectiveness of particular programmes and sustainability issues related to cultural, ethical or moral obligations of foreign health professionals working in a low- to middle-income countries. Study findings highlighted that although nurses are recruited and participate in health-focused humanitarian activities in low- to middle-income countries, there is extremely limited documented research about the amount and type of care that nurses specifically provide in this context. Furthermore, when identified, it is most often hidden within studies outlining services

  14. Linking agriculture and health in low- and middle-income countries: an interdisciplinary research agenda.

    PubMed

    Dangour, Alan D; Green, Rosemary; Häsler, Barbara; Rushton, Jonathan; Shankar, Bhavani; Waage, Jeff

    2012-05-01

    Recent global fluctuations in food prices and continuing environmental degradation highlight the future challenge of feeding a growing world population. However, current dialogues rarely address the relationship between agricultural changes and health. This relationship is traditionally associated with the role of food in nutrition and with food safety, and while these are key interactions, we show in this paper that the relationship is far more complex and interesting. Besides the direct effects of agriculture on population nutrition, agriculture also influences health through its impact on household incomes, economies and the environment. These effects are felt particularly in low- and middle-income countries, where dramatic changes are affecting the agriculture-health relationship, in particular the growth of nutrition-related chronic disease and the associated double burden of under- and over-nutrition. Greater understanding of the negative effects of agriculture on health is also needed. While lengthening food value chains make the chain of influence between agricultural policy, food consumption, nutrition and health more complex, there remain opportunities to improve health by changing agricultural systems. The first challenge in doing this, we suggest, is to improve our capacity to measure the impact of agricultural interventions on health outcomes, and vice versa.

  15. Cervical Cancer Prevention Through HPV Vaccination in Low- and Middle-Income Countries in Asia

    PubMed Central

    Toh, Zheng Quan; Licciardi, Paul V; Russell, Fiona M; Garland, Suzanne M; Batmunkh, Tsetsegsaikhan; Mulholland, Edward K

    2017-01-01

    Cervical cancer is ranked the first or second most common cancer in women of low- and middle-income countries (LMICs) in Asia. Cervical cancer is almost exclusively caused by human papillomavirus (HPV), and majority of the cases can be prevented with the use of HPV vaccines. The HPV vaccines have demonstrated high vaccine efficacies against HPV infection and cervical cancer precursors in clinical and post-marketing studies, and are in use in most high-income countries. However, their use in LMICs are limited mainly due to the high costs and logistics in delivering multiple doses of the vaccine. Other issues such as the safety of the vaccines, social and cultural factors, as well as poor knowledge and awareness of the virus have also contributed to the low uptake of the vaccine. This mini-review focuses on the need for HPV vaccine implementation in Asia given the substantial disease burden and underuse of HPV vaccines in LMICs in this region. In addition, the progress towards HPV vaccine introduction, and barriers preventing further rollout of these essential, life-saving vaccines are also discussed in this article. PMID:28950675

  16. Socioeconomic Inequalities in Secondhand Smoke Exposure at Home and at Work in 15 Low- and Middle-Income Countries

    PubMed Central

    Lee, John Tayu; Arora, Monika; Millett, Christopher

    2016-01-01

    Introduction: In high-income countries, secondhand smoke (SHS) exposure is higher among disadvantaged groups. We examine socioeconomic inequalities in SHS exposure at home and at workplace in 15 low- and middle-income countries (LMICs). Methods: Secondary analyses of cross-sectional data from 15 LMICs participating in Global Adult Tobacco Survey (participants ≥ 15 years; 2008–2011) were used. Country-specific analyses using regression-based methods were used to estimate the magnitude of socioeconomic inequalities in SHS exposure: (1) Relative Index of Inequality and (2) Slope Index of Inequality. Results: SHS exposure at home ranged from 17.4% in Mexico to 73.1% in Vietnam; exposure at workplace ranged from 16.9% in Uruguay to 65.8% in Bangladesh. In India, Bangladesh, Thailand, Malaysia, Philippines, Vietnam, Uruguay, Poland, Turkey, Ukraine, and Egypt, SHS exposure at home reduced with increasing wealth (Relative Index of Inequality range: 1.13 [95% confidence interval [CI] 1.04–1.22] in Turkey to 3.31 [95% CI 2.91–3.77] in Thailand; Slope Index of Inequality range: 0.06 [95% CI 0.02–0.11] in Turkey to 0.43 [95% CI 0.38–0.48] in Philippines). In these 11 countries, and in China, SHS exposure at home reduced with increasing education. In India, Bangladesh, Thailand, and Philippines, SHS exposure at workplace reduced with increasing wealth. In India, Bangladesh, Thailand, Philippines, Vietnam, Poland, Russian Federation, Turkey, Ukraine, and Egypt, SHS exposure at workplace reduced with increasing education. Conclusion: SHS exposure at homes is higher among the socioeconomically disadvantaged in the majority of LMICs studied; at workplaces, exposure is higher among the less educated. Pro-equity tobacco control interventions alongside targeted efforts in these groups are recommended to reduce inequalities in SHS exposure. Implications: SHS exposure is higher among the socioeconomically disadvantaged groups in high-income countries. Comprehensive smoke

  17. Socioeconomic Inequalities in Secondhand Smoke Exposure at Home and at Work in 15 Low- and Middle-Income Countries.

    PubMed

    Nazar, Gaurang P; Lee, John Tayu; Arora, Monika; Millett, Christopher

    2016-05-01

    In high-income countries, secondhand smoke (SHS) exposure is higher among disadvantaged groups. We examine socioeconomic inequalities in SHS exposure at home and at workplace in 15 low- and middle-income countries (LMICs). Secondary analyses of cross-sectional data from 15 LMICs participating in Global Adult Tobacco Survey (participants ≥ 15 years; 2008-2011) were used. Country-specific analyses using regression-based methods were used to estimate the magnitude of socioeconomic inequalities in SHS exposure: (1) Relative Index of Inequality and (2) Slope Index of Inequality. SHS exposure at home ranged from 17.4% in Mexico to 73.1% in Vietnam; exposure at workplace ranged from 16.9% in Uruguay to 65.8% in Bangladesh. In India, Bangladesh, Thailand, Malaysia, Philippines, Vietnam, Uruguay, Poland, Turkey, Ukraine, and Egypt, SHS exposure at home reduced with increasing wealth (Relative Index of Inequality range: 1.13 [95% confidence interval [CI] 1.04-1.22] in Turkey to 3.31 [95% CI 2.91-3.77] in Thailand; Slope Index of Inequality range: 0.06 [95% CI 0.02-0.11] in Turkey to 0.43 [95% CI 0.38-0.48] in Philippines). In these 11 countries, and in China, SHS exposure at home reduced with increasing education. In India, Bangladesh, Thailand, and Philippines, SHS exposure at workplace reduced with increasing wealth. In India, Bangladesh, Thailand, Philippines, Vietnam, Poland, Russian Federation, Turkey, Ukraine, and Egypt, SHS exposure at workplace reduced with increasing education. SHS exposure at homes is higher among the socioeconomically disadvantaged in the majority of LMICs studied; at workplaces, exposure is higher among the less educated. Pro-equity tobacco control interventions alongside targeted efforts in these groups are recommended to reduce inequalities in SHS exposure. SHS exposure is higher among the socioeconomically disadvantaged groups in high-income countries. Comprehensive smoke-free policies are pro-equity for certain health outcomes that are

  18. Gender, Socioeconomic Status, and Self-Rated Health in a Transitional Middle-Income Setting: Evidence From Thailand

    PubMed Central

    Seubsman, Sam-ang; Kelly, Matthew James; Yiengprugsawan, Vasoontara; Sleigh, Adrian C.

    2011-01-01

    Poor self-rated health (SRH) correlates strongly with mortality. In developed countries, women generally report worse SRH than males. Few studies have reported on SRH in developing countries. The authors report on SRH in Thailand, a middle-income developing country. The data were derived from a large nationwide cohort of 87 134 adult Open University students (54% female, median age 29 years). The authors included questions on socioeconomic and demographic factors that could influence SRH. The Thai cohort in this study mirrors patterns found in developed countries, with females reporting more frequent “poor” or “very poor” SRH (odds ratio = 1.35; 95% confidence interval = 1.26-1.44). Cohort males had better SRH than females, but levels were more sensitive to socioeconomic status. Income and education had little influence on SRH for females. Among educated Thai adults, females rate their health to be worse than males, and unlike males, this perception is relatively unaffected by socioeconomic status. PMID:20460290

  19. Gender, socioeconomic status, and self-rated health in a transitional middle-income setting: evidence from Thailand.

    PubMed

    Seubsman, Sam-Ang; Kelly, Matthew James; Yiengprugsawan, Vasoontara; Sleigh, Adrian C

    2011-09-01

    Poor self-rated health (SRH) correlates strongly with mortality. In developed countries, women generally report worse SRH than males. Few studies have reported on SRH in developing countries. The authors report on SRH in Thailand, a middle-income developing country.The data were derived from a large nationwide cohort of 87 134 adult Open University students (54% female, median age 29 years). The authors included questions on socioeconomic and demographic factors that could influence SRH. The Thai cohort in this study mirrors patterns found in developed countries, with females reporting more frequent "poor" or "very poor" SRH (odds ratio = 1.35; 95% confidence interval = 1.26-1.44). Cohort males had better SRH than females, but levels were more sensitive to socioeconomic status. Income and education had little influence on SRH for females. Among educated Thai adults, females rate their health to be worse than males, and unlike males, this perception is relatively unaffected by socioeconomic status.

  20. Tobacco control environment: cross-sectional survey of policy implementation, social unacceptability, knowledge of tobacco health harms and relationship to quit ratio in 17 low-income, middle-income and high-income countries.

    PubMed

    Chow, Clara K; Corsi, Daniel J; Gilmore, Anna B; Kruger, Annamarie; Igumbor, Ehimario; Chifamba, Jephat; Yang, Wang; Wei, Li; Iqbal, Romaina; Mony, Prem; Gupta, Rajeev; Vijayakumar, Krishnapillai; Mohan, V; Kumar, Rajesh; Rahman, Omar; Yusoff, Khalid; Ismail, Noorhassim; Zatonska, Katarzyna; Altuntas, Yuksel; Rosengren, Annika; Bahonar, Ahmad; Yusufali, AfzalHussein; Dagenais, Gilles; Lear, Scott; Diaz, Rafael; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Lanas, Fernando; Rangarajan, Sumathy; Teo, Koon; McKee, Martin; Yusuf, Salim

    2017-03-31

    This study examines in a cross-sectional study 'the tobacco control environment' including tobacco policy implementation and its association with quit ratio. 545 communities from 17 high-income, upper-middle, low-middle and low-income countries (HIC, UMIC, LMIC, LIC) involved in the Environmental Profile of a Community's Health (EPOCH) study from 2009 to 2014. Community audits and surveys of adults (35-70 years, n=12 953). Summary scores of tobacco policy implementation (cost and availability of cigarettes, tobacco advertising, antismoking signage), social unacceptability and knowledge were associated with quit ratios (former vs ever smokers) using multilevel logistic regression models. Average tobacco control policy score was greater in communities from HIC. Overall 56.1% (306/545) of communities had >2 outlets selling cigarettes and in 28.6% (154/539) there was access to cheap cigarettes (<5cents/cigarette) (3.2% (3/93) in HIC, 0% UMIC, 52.6% (90/171) LMIC and 40.4% (61/151) in LIC). Effective bans (no tobacco advertisements) were in 63.0% (341/541) of communities (81.7% HIC, 52.8% UMIC, 65.1% LMIC and 57.6% LIC). In 70.4% (379/538) of communities, >80% of participants disapproved youth smoking (95.7% HIC, 57.6% UMIC, 76.3% LMIC and 58.9% LIC). The average knowledge score was >80% in 48.4% of communities (94.6% HIC, 53.6% UMIC, 31.8% LMIC and 35.1% LIC). Summary scores of policy implementation, social unacceptability and knowledge were positively and significantly associated with quit ratio and the associations varied by gender, for example, communities in the highest quintile of the combined scores had 5.0 times the quit ratio in men (Odds ratio (OR) 5·0, 95% CI 3.4 to 7.4) and 4.1 times the quit ratio in women (OR 4.1, 95% CI 2.4 to 7.1). This study suggests that more focus is needed on ensuring the tobacco control policy is actually implemented, particularly in LMICs. The gender-related differences in associations of policy, social unacceptability and

  1. A narrative synthesis of illustrative evidence on effects of capitation payment for primary care: lessons for Ghana and other low/middle-income countries.

    PubMed

    Andoh-Adjei, Francis-Xavier; Spaan, Ernst; Asante, Felix A; Mensah, Sylvester A; van der Velden, Koos

    2016-12-01

    To analyse and synthesize available international experiences and information on the motivation for, and effects of using capitation as provider payment method in country health systems and lessons and implications for low/middle-income countries. We did narrative review and synthesis of the literature on the effects of capitation payment on primary care. Eleven articles were reviewed. Capitation payment encourages efficiency: drives down cost, serves as critical source of income for providers, promotes adherence to guidelines and policies, encourages providers to work better and give health education to patients. It, however, induces reduction in the quantity and quality of care provided and encourages skimming on inputs, underserving of patients in bad state of health, "dumping" of high risk patients and negatively affect patient-provider relationship. The illustrative evidence adduced from the review demonstrates that capitation payment in primary care can create positive incentives but could also elicit un-intended effects. However, due to differences in country context, policy makers in Ghana and other low/middle-income countries may only be guided by the illustrative evidence in their design of a context-specific capitation payment for primary care. Netherlands Fellowship Programme (NFP), Fellowship number: NFP-PhD.12/352.

  2. Hierarchical cluster analysis of labour market regulations and population health: a taxonomy of low- and middle-income countries

    PubMed Central

    2012-01-01

    Background An important contribution of the social determinants of health perspective has been to inquire about non-medical determinants of population health. Among these, labour market regulations are of vital significance. In this study, we investigate the labour market regulations among low- and middle-income countries (LMICs) and propose a labour market taxonomy to further understand population health in a global context. Methods Using Gross National Product per capita, we classify 113 countries into either low-income (n = 71) or middle-income (n = 42) strata. Principal component analysis of three standardized indicators of labour market inequality and poverty is used to construct 2 factor scores. Factor score reliability is evaluated with Cronbach's alpha. Using these scores, we conduct a hierarchical cluster analysis to produce a labour market taxonomy, conduct zero-order correlations, and create box plots to test their associations with adult mortality, healthy life expectancy, infant mortality, maternal mortality, neonatal mortality, under-5 mortality, and years of life lost to communicable and non-communicable diseases. Labour market and health data are retrieved from the International Labour Organization's Key Indicators of Labour Markets and World Health Organization's Statistical Information System. Results Six labour market clusters emerged: Residual (n = 16), Emerging (n = 16), Informal (n = 10), Post-Communist (n = 18), Less Successful Informal (n = 22), and Insecure (n = 31). Primary findings indicate: (i) labour market poverty and population health is correlated in both LMICs; (ii) association between labour market inequality and health indicators is significant only in low-income countries; (iii) Emerging (e.g., East Asian and Eastern European countries) and Insecure (e.g., sub-Saharan African nations) clusters are the most advantaged and disadvantaged, respectively, with the remaining clusters experiencing levels of population health consistent

  3. Hierarchical cluster analysis of labour market regulations and population health: a taxonomy of low- and middle-income countries.

    PubMed

    Muntaner, Carles; Chung, Haejoo; Benach, Joan; Ng, Edwin

    2012-04-18

    An important contribution of the social determinants of health perspective has been to inquire about non-medical determinants of population health. Among these, labour market regulations are of vital significance. In this study, we investigate the labour market regulations among low- and middle-income countries (LMICs) and propose a labour market taxonomy to further understand population health in a global context. Using Gross National Product per capita, we classify 113 countries into either low-income (n = 71) or middle-income (n = 42) strata. Principal component analysis of three standardized indicators of labour market inequality and poverty is used to construct 2 factor scores. Factor score reliability is evaluated with Cronbach's alpha. Using these scores, we conduct a hierarchical cluster analysis to produce a labour market taxonomy, conduct zero-order correlations, and create box plots to test their associations with adult mortality, healthy life expectancy, infant mortality, maternal mortality, neonatal mortality, under-5 mortality, and years of life lost to communicable and non-communicable diseases. Labour market and health data are retrieved from the International Labour Organization's Key Indicators of Labour Markets and World Health Organization's Statistical Information System. Six labour market clusters emerged: Residual (n = 16), Emerging (n = 16), Informal (n = 10), Post-Communist (n = 18), Less Successful Informal (n = 22), and Insecure (n = 31). Primary findings indicate: (i) labour market poverty and population health is correlated in both LMICs; (ii) association between labour market inequality and health indicators is significant only in low-income countries; (iii) Emerging (e.g., East Asian and Eastern European countries) and Insecure (e.g., sub-Saharan African nations) clusters are the most advantaged and disadvantaged, respectively, with the remaining clusters experiencing levels of population health consistent with their labour market

  4. A systematic review of innovative diabetes care models in low-and middle-income countries (LMICs).

    PubMed

    Esterson, Yonah B; Carey, Michelle; Piette, John D; Thomas, Nihal; Hawkins, Meredith

    2014-02-01

    Over 70% of the world's patients with diabetes reside in low-and middle-income countries (LMICs), where adequate infrastructure and resources for diabetes care are often lacking. Therefore, academic institutions, health care organizations, and governments from Western nations and LMICs have worked together to develop a variety of effective diabetes care models for resource-poor settings. A focused search of PubMed was conducted with the goal of identifying reports that addressed the implementation of diabetes care models or initiatives to improve clinical and/or biochemical outcomes in patients with diabetes mellitus. A total of 15 published manuscripts comprising nine diabetes care models in 16 locations in sub-Saharan Africa, Latin America, and Asia identified by the above approach were systematically reviewed. The reviewed models shared a number of principles including collaboration, education, standardization, resource optimization, and technological innovation. The most comprehensive models used a number of these principles, which contributed to their success. Reviewing the principles shared by these successful programs may help guide the development of effective future models for diabetes care in low-income settings.

  5. Diabetes Awareness of Low-Income Middle School Students Participating in the Help a Friend, Help Yourself Youth Diabetes Awareness Education Program

    ERIC Educational Resources Information Center

    Wroten, Kathryn; Reames, Elizabeth S.; Tuuri, Georgianna

    2012-01-01

    The study reported here investigated the effectiveness of the LSU AgCenter Help a Friend, Help Yourself youth diabetes education curriculum to increase knowledge and awareness of diabetes and its symptoms in low-income middle school students participating in the Boys and Girls Club after-school program. The curriculum includes four lessons with…

  6. A systematic review of factors that affect uptake of community-based health insurance in low-income and middle-income countries.

    PubMed

    Adebayo, Esther F; Uthman, Olalekan A; Wiysonge, Charles S; Stern, Erin A; Lamont, Kim T; Ataguba, John E

    2015-12-08

    Low-income and middle-income countries (LMICs) have difficulties achieving universal financial protection, which is primordial for universal health coverage. A promising avenue to provide universal financial protection for the informal sector and the rural populace is community-based health insurance (CBHI). We systematically assessed and synthesised factors associated with CBHI enrolment in LMICs. We searched PubMed, Scopus, ERIC, PsychInfo, Africa-Wide Information, Academic Search Premier, Business Source Premier, WHOLIS, CINAHL, Cochrane Library, conference proceedings, and reference lists for eligible studies available by 31 October 2013; regardless of publication status. We included both quantitative and qualitative studies in the review. Both quantitative and qualitative studies demonstrated low levels of income and lack of financial resources as major factors affecting enrolment. Also, poor healthcare quality (including stock-outs of drugs and medical supplies, poor healthcare worker attitudes, and long waiting times) was found to be associated with low CBHI coverage. Trust in both the CBHI scheme and healthcare providers were also found to affect enrolment. Educational attainment (less educated are willing to pay less than highly educated), sex (men are willing to pay more than women), age (younger are willing to pay more than older individuals), and household size (larger households are willing to pay more than households with fewer members) also influenced CBHI enrolment. In LMICs, while CBHI schemes may be helpful in the short term to address the issue of improving the rural population and informal workers' access to health services, they still face challenges. Lack of funds, poor quality of care, and lack of trust are major reasons for low CBHI coverage in LMICs. If CBHI schemes are to serve as a means to providing access to health services, at least in the short term, then attention should be paid to the issues that militate against their success.

  7. Research and the health of indigenous populations in low- and middle-income countries.

    PubMed

    Mohindra, K S

    2017-06-01

    In low- and middle-income countries (LMICs)-when there are available data-a 'health divide' exists between indigenous and non-indigenous populations living in the same society. Despite the limited available evidence suggesting that indigenous populations have high levels of health needs, there is scant research on indigenous health, especially in Africa, China and South Asia. Pursuing research, however, is clouded by the prior negative experiences that indigenous populations have had with researchers. In this paper, we describe the current evidence base on indigenous health in LMICs, propose practical strategies for undertaking future research, and conclude by describing how global health researchers can contribute to improving the health of indigenous populations. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  8. Perceptions of the health system and public trust in government in low- and middle-income countries: evidence from the World Health Surveys.

    PubMed

    Rockers, Peter C; Kruk, Margaret E; Laugesen, Miriam J

    2012-06-01

    In low- and middle-income countries, health care systems are an important means by which individuals interact with their government. As such, aspects of health systems in these countries may be associated with public trust in government. Greater trust in government may in turn improve governance and government effectiveness. We identify health system and non-health system factors hypothesized to be associated with trust in government and fit several multilevel regression models to cross-national data from 51,300 respondents in thirty-eight low- and middle-income countries participating in the World Health Surveys. We find that health system performance factors are associated with trust in government while controlling for a range of non-health system covariates. Taken together, higher technical quality of health services, more responsive service delivery, fair treatment, better health outcomes, and financial risk protection accounted for a 13 percentage point increase in the probability of having trust in government. Health system performance and good governance may be more inter-related than previously thought. This finding is particularly important for low-income and fragile states, where health systems and governments tend to be weakest. Future research efforts should focus on determining the causal mechanisms that underlie the observed associations between health system performance and trust in government.

  9. A Multiple Case Study of Mental Health Interventions in Middle Income Countries: Considering the Science of Delivery.

    PubMed

    Kidd, Sean A; Madan, Athena; Rallabandi, Susmitha; Cole, Donald C; Muskat, Elisha; Raja, Shoba; Wiljer, David; Aylward, David; McKenzie, Kwame

    2016-01-01

    In the debate in global mental health about the most effective models for developing and scaling interventions, there have been calls for the development of a more robust literature regarding the "non-specific", science of delivery aspects of interventions that are locally, contextually, and culturally relevant. This study describes a rigorous, exploratory, qualitative examination of the key, non-specific intervention strategies of a diverse group of five internationally-recognized organizations addressing mental illness in middle income countries (MICs). A triangulated approach to inquiry was used with semi-structured interviews conducted with service recipients, service providers and leaders, and key community partners (N = 159). The interview focus was upon processes of implementation and operation. A grounded theory-informed analysis revealed cross cutting themes of: a holistic conceptualization of mental health problems, an intensive application of principles of leverage and creating the social, cultural, and policy "space" within which interventions could be applied and resourced. These findings aligned with key aspects of systems dynamic theory suggesting that it might be a helpful framework in future studies of mental health service implementation in MICs.

  10. The efficacy of interventions to reduce adolescent childbearing in low- and middle-income countries: a systematic review.

    PubMed

    McQueston, Kate; Silverman, Rachel; Glassman, Amanda

    2013-12-01

    This study reviews the scope and quality of existing literature regarding the interventions to reduce adolescent childbearing in low- and middle-income countries and compiles findings concerning their effectiveness. A total of 737 studies published between 2000 and 2011 were reviewed; 19 were identified as meeting eligibility criteria. Studies were included that: evaluated program effects on adolescents and young people, either as the primary target population or as a subset of a broader target group; evaluated an intervention intended to reduce adolescent fertility or generate improvements on a related outcome; and reported childbearing-related outcomes. Evidence indicates that a variety of interventions may be successful at reducing fertility, including school-based programs, health counseling, and cash transfers. An overview of evaluation efforts to date is provided, and potential best practices are highlighted. Conclusions are that funding for adolescent fertility initiatives should be directed toward programs for which a sound evidence base exists, such as cash transfers or other interventions that encourage school enrollment, and that programs of unknown effectiveness should be conducted in tandem with rigorous evaluation. © 2013 The Population Council, Inc.

  11. Neonatal vitamin A supplementation for the prevention of mortality and morbidity in term neonates in low and middle income countries.

    PubMed

    Haider, Batool A; Sharma, Renee; Bhutta, Zulfiqar A

    2017-02-24

    Vitamin A deficiency is a major public health problem in low and middle income countries. Vitamin A supplementation in children six months of age and older has been found to be beneficial, but no effect of supplementation has been noted for children between one and five months of age. Supplementation during the neonatal period has been suggested to have an impact by increasing body stores in early infancy. To evaluate the role of vitamin A supplementation for term neonates in low and middle income countries with respect to prevention of mortality and morbidity. We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2), MEDLINE via PubMed (1966 to 13 March 2016), Embase (1980 to 13 March 2016) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 13 March 2016). We also searched clinical trials databases, conference proceedings and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. Randomised and quasi-randomised controlled trials. Also trials with a factorial design. Two review authors independently assessed trial quality and extracted study data. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence. We included 12 trials (168,460 neonates) in this review, with only a few trials reporting disaggregated data for term infants. Therefore, we analysed data and presented estimates for term infants (when specified) and for all infants.Data for term neonates from three studies did not show a statistically significant effect on the risk of infant mortality at six months in the vitamin A group compared with the control group (typical risk ratio (RR) 0.80; 95% confidence interval (CI) 0.54 to 1.18; I 2 = 63%). Analysis of data for all infants from 11 studies revealed no evidence of a significant reduction in the risk of

  12. Barriers in the mind: promoting an economic case for mental health in low- and middle-income countries

    PubMed Central

    MCDAID, DAVID; KNAPP, MARTIN; RAJA, SHOBA

    2008-01-01

    In recent years, policy makers in high-income countries have placed an increasing emphasis on the value of maintaining good mental health, recognizing the contribution that this makes to quality of life, whilst ever more mindful of the socio-economic consequences of poor mental health. The picture in many other parts of the world is much less encouraging; policy attention and resources are still directed largely at communicable diseases. We reflect on some of the challenges faced in these countries and outline the role that economic evidence could play in strengthening the policy case for investment in mental health. Clearly this should include assessment of the economic impact of strategies implemented outside, as well as within the health sector. The ways in which mental health services are delivered is also of critical importance. Non-governmental organizations (NGOs) have long been shown to be key stakeholders in the funding, coordination and delivery of these services in high-income countries. Their role in low- and middle-income countries, where infrastructure and policy focus on mental health are more limited, can be even more vital in overcoming some of the barriers to the development of mental health policy and practice. PMID:18560485

  13. Cost-effectiveness of ritodrine and fenoterol for treatment of preterm labor in a low-middle-income country: a case study.

    PubMed

    Jakovljevic, Mihajlo; Varjacic, Mirjana; Jankovic, Slobodan M

    2008-01-01

    In countries with high income, tocolytic therapy with beta-mimetic agents is a cost-effective strategy compared to placebo. In our study, the cost-effectiveness of two beta-mimetic agents, ritodrine and fenoterol, used in the management of preterm labor was compared in the setting of a low-middle-income transitional country, Serbia & Montenegro. This case study was conducted at the Gynecology-Obstetrics Clinic, Clinical Center "Kragujevac," in Kragujevac, Serbia & Montenegro, between October 2004 and January 2006. In total, 235 pregnant patients with threatened preterm labor were enrolled, but 35 were lost to follow-up. Of the remaining 200 patients, 85 were given ritodrine, and 115 fenoterol. The perspective of Republic Institute for Health Insurance in Serbia was taken into account. Only direct costs were calculated; primary outcomes of the study were length of pregnancy (in weeks), time passed from the onset of uterine contractions to delivery (in weeks), and score on modified Flanagan's quality-of-life scale for chronic diseases, measured after discharge from hospital. Prolongation of pregnancy was significantly longer in the fenoterol group (12.7 +/- 8.4 weeks) than in the ritodrine group (11.6 +/- 7.1 weeks). The mean duration of hospitalization was shorter in the fenoterol group (11.9 +/- 8.8 days) than in the ritodrine group (14.9 +/- 11.3 days). The treatment with fenoterol was less costly and more cost-effective than the treatment with ritodrine, but the difference in cost-effectiveness was not statistically significant. The cost of treatment per gained week of pregnancy prolongation was 3345.51 +/- 7668.04 CSD in the fenoterol group, and 4181.96 +/- 12,069.83 CSD in the ritodrine group. The observed differences in treatment costs and duration of hospitalization per patient did not translate into significant differences in cost-effectiveness ratios, because of low costs of hospitalization and human labor in Serbian health system. Nevertheless, fenoterol

  14. Preeclampsia in low and middle income countries-health services lessons learned from the PRE-EMPT (PRE-Eclampsia-Eclampsia Monitoring, Prevention and Treatment) project.

    PubMed

    von Dadelszen, Peter; Firoz, Tabassum; Donnay, France; Gordon, Rebecca; Justus Hofmeyr, G; Lalani, Shifana; Payne, Beth A; Roberts, James M; Teela, Katherine C; Vidler, Marianne; Sawchuck, Diane; Magee, Laura A

    2012-10-01

    The hypertensive disorders of pregnancy, in particular preeclampsia, matter because adverse events occur in women with preeclampsia and, to a lesser extent, in women with the other hypertensive disorders. These adverse events are maternal, perinatal, and neonatal and can alter the life trajectory of each individual, should that life not be ended by complications. In this review we discuss a number of priorities and dilemmas that we perceive to be facing health services in low and middle income countries as they try to prioritize interventions to reduce the health burden related to preeclampsia. These priorities and dilemmas relate to calcium for preeclampsia prevention, risk stratification, antihypertensive and magnesium sulphate therapy, and mobile health. Significant progress has been and is being made to reduce the impact of preeclampsia in low and middle income countries, but it remains a priority focus as we attempt to achieve Millennium Development Goal 5.

  15. Cancer genetics education in a low- to middle-income country: evaluation of an interactive workshop for clinicians in Kenya.

    PubMed

    Hill, Jessica A; Lee, Su Yeon; Njambi, Lucy; Corson, Timothy W; Dimaras, Helen

    2015-01-01

    Clinical genetic testing is becoming an integral part of medical care for inherited disorders. While genetic testing and counseling are readily available in high-income countries, in low- and middle-income countries like Kenya genetic testing is limited and genetic counseling is virtually non-existent. Genetic testing is likely to become widespread in Kenya within the next decade, yet there has not been a concomitant increase in genetic counseling resources. To address this gap, we designed an interactive workshop for clinicians in Kenya focused on the genetics of the childhood eye cancer retinoblastoma. The objectives were to increase retinoblastoma genetics knowledge, build genetic counseling skills and increase confidence in those skills. The workshop was conducted at the 2013 Kenyan National Retinoblastoma Strategy meeting. It included a retinoblastoma genetics presentation, small group discussion of case studies and genetic counseling role-play. Knowledge was assessed by standardized test, and genetic counseling skills and confidence by questionnaire. Knowledge increased significantly post-workshop, driven by increased knowledge of retinoblastoma causative genetics. One-year post-workshop, participant knowledge had returned to baseline, indicating that knowledge retention requires more frequent reinforcement. Participants reported feeling more confident discussing genetics with patients, and had integrated more genetic counseling into patient interactions. A comprehensive retinoblastoma genetics workshop can increase the knowledge and skills necessary for effective retinoblastoma genetic counseling.

  16. Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries.

    PubMed

    Nosratnejad, Shirin; Rashidian, Arash; Dror, David Mark

    2016-01-01

    Access to healthcare is mostly contingent on out-of-pocket spending (OOPS) by health seekers, particularly in low- and middle-income countries (LMICs). This would require many LMICs to raise enough funds to achieve universal health insurance coverage. But, are individuals or households willing to pay for health insurance, and how much? What factors positively affect WTP for health insurance? We wanted to examine the evidence for this, through a review of the literature. We systematically searched databases up to February 2016 and included studies of individual or household WTP for health insurance. Two authors appraised the identified studies. We estimated the WTP as a percentage of GDP per capita, and adjusted net national income per capita of each country. We used meta-analysis to calculate WTP means and confidence intervals, and vote-counting to identify the variables that more often affected WTP. 16 studies (21 articles) from ten countries met the inclusion criteria. The mean WTP of individuals was 1.18% of GDP per capita and 1.39% of adjusted net national income per capita. The corresponding figures for households were 1.82% and 2.16%, respectively. Increases in family size, education level and income were consistently correlated with higher WTP for insurance, and increases in age were correlated with reduced WTP. The WTP for healthcare insurance among rural households in LMICs was just below 2% of the GPD per capita. The findings demonstrate that in moving towards universal health coverage in LMICs, governments should not rely on households' premiums as a major financing source and should increase their fiscal capacity for an equitable health care system using other sources.

  17. Systematic Review of Willingness to Pay for Health Insurance in Low and Middle Income Countries

    PubMed Central

    Nosratnejad, Shirin; Rashidian, Arash; Dror, David Mark

    2016-01-01

    Objective Access to healthcare is mostly contingent on out-of-pocket spending (OOPS) by health seekers, particularly in low- and middle-income countries (LMICs). This would require many LMICs to raise enough funds to achieve universal health insurance coverage. But, are individuals or households willing to pay for health insurance, and how much? What factors positively affect WTP for health insurance? We wanted to examine the evidence for this, through a review of the literature. Methods We systematically searched databases up to February 2016 and included studies of individual or household WTP for health insurance. Two authors appraised the identified studies. We estimated the WTP as a percentage of GDP per capita, and adjusted net national income per capita of each country. We used meta-analysis to calculate WTP means and confidence intervals, and vote-counting to identify the variables that more often affected WTP. Result 16 studies (21 articles) from ten countries met the inclusion criteria. The mean WTP of individuals was 1.18% of GDP per capita and 1.39% of adjusted net national income per capita. The corresponding figures for households were 1.82% and 2.16%, respectively. Increases in family size, education level and income were consistently correlated with higher WTP for insurance, and increases in age were correlated with reduced WTP. Conclusions The WTP for healthcare insurance among rural households in LMICs was just below 2% of the GPD per capita. The findings demonstrate that in moving towards universal health coverage in LMICs, governments should not rely on households' premiums as a major financing source and should increase their fiscal capacity for an equitable health care system using other sources. PMID:27362356

  18. Potential effectiveness of anti-smoking advertisement types in ten low and middle income countries: do demographics, smoking characteristics and cultural differences matter?

    PubMed

    Durkin, Sarah; Bayly, Megan; Cotter, Trish; Mullin, Sandra; Wakefield, Melanie

    2013-12-01

    Unlike high income countries, there is limited research to guide selection of anti-tobacco mass media campaigns in low and middle income countries, although some work suggests that messages emphasizing serious health harms perform better than other message types. This study aimed to determine whether certain types of anti-smoking advertisements are more likely to be accepted and perceived as effective across smokers in 10 low to middle income countries. 2399 18-34 year old smokers were recruited in Bangladesh, China, Egypt, India, Indonesia, Mexico, Philippines, Russia, Turkey and Vietnam to view and rate 10 anti-tobacco ads. Five ads were shown in all countries and five ads were chosen by country representatives, providing a total of 37 anti-smoking ads across all countries (10 graphic health effects ads, 6 simulated health effects, 8 emotional stories of health effects, 7 other health effects and 6 non-health effects). Smokers rated ads on a series of 5-point scales containing aggregated measures of Message Acceptance and Perceived Effectiveness. All ads and materials were translated into the local language of the testing regions. In multivariate analysis, graphic health effects ads were most likely to be accepted and perceived as effective, followed by simulated health effects ads, health effects stories, other health effects ads, and then non-health effects ads. Interaction analyses indicated that graphic health effects ads were less likely to differ in acceptance or perceived effectiveness across countries, gender, age, education, parental status and amount smoked, and were less likely to be affected by cultural differences between characters and contexts in ads and those within each country. Ads that did not emphasize the health effects of smoking were most prone to inconsistent impact across countries and population subgroups. Graphic ads about the negative health effects of smoking may be most suitable for wide population broadcast in low and middle income

  19. Strain and its correlates among carers of people with dementia in low-income and middle-income countries. A 10/66 Dementia Research Group population-based survey

    PubMed Central

    Prince, Martin; Brodaty, Henry; Uwakwe, Richard; Acosta, Daisy; Ferri, Cleusa P; Guerra, Mariella; Huang, Yueqin; Jacob, KS; Llibre Rodriguez, Juan J; Salas, Aquiles; Sosa, Ana Luisa; Williams, Joseph D; Jotheeswaran, AT; Liu, Zhaorui

    2012-01-01

    Objectives In a multi-site population-based study in several middle-income countries, we aimed to investigate relative contributions of care arrangements and characteristics of carers and care recipients to strain among carers of people with dementia. Based on previous research, hypotheses focused on carer sex, care inputs, behavioural and psychological symptoms (BPSD) and socioeconomic status, together with potential buffering effects of informal support and employing paid carers. Methods In population-based catchment area surveys in 11 sites in Latin America, India and China, we analysed data collected from people with dementia and care needs, and their carers. Carer strain was assessed with the Zarit Burden Interview. Results With 673 care recipient/carer dyads interviewed (99% of those eligible), mean Zarit Burden Interview scores ranged between 17.1 and 27.9 by site. Women carers reported more strain than men. The most substantial correlates of carer strain were primary stressors BPSD, dementia severity, needs for care and time spent caring. Socioeconomic status was not associated with carer strain. Those cutting back on work experienced higher strain. There was tentative evidence for a protective effect of having additional informal or paid support. Conclusions Our findings underline the global impact of caring for a person with dementia and support the need for scaling up carer support, education and training. That giving up work to care was prevalent and associated with substantial increased strain emphasizes the economic impact of caring on the household. Carer benefits, disability benefits for people with dementia and respite care should all be considered. Copyright © 2012 John Wiley & Sons, Ltd. PMID:22460403

  20. Growth in adolescent delinquency and alcohol use in relation to young adult crime, alcohol use disorders, and risky sex: a comparison of youth from low- versus middle-income backgrounds.

    PubMed

    Mason, W Alex; Hitch, Julia E; Kosterman, Rick; McCarty, Carolyn A; Herrenkohl, Todd I; Hawkins, J David

    2010-12-01

    This study examined adolescent delinquency and alcohol use in relation to young adult crime, alcohol use disorders (AUDs), and risky sex. Analyses further examined the influences of late childhood involvement in these problem behavior outcomes, with mediation through teen delinquency and alcohol use, and examined differences in the pathways for youth from low- compared to middle-income backgrounds. Multiple-group latent growth curve modeling was conducted using data collected from a sample of 808 youth followed from age 10 to age 24. Self-report assessments included delinquent involvement, alcohol use, and sexual activity in late childhood; delinquency and alcohol use in adolescence; and crime, AUDs, and risky sex in early adulthood. Late childhood delinquent involvement was associated with young adult crime, AUDs, and risky sex indirectly through adolescent delinquency, and had a persistent direct effect on crime. Adolescent delinquency also mediated the relation between early sex onset and crime. Early alcohol use predicted a higher level of, and a faster rate of increase in, adolescent drinking, which predicted, in turn, young adult AUDs and risky sex. Significant group differences indicated stronger associations between adolescent delinquency and each young adult outcome for youth from low- compared to those from middle-income backgrounds. Early intervention may help prevent the development of crime, AUDs, and risky sex behaviors, especially among disadvantaged youth. © 2010 The Authors. Journal of Child Psychology and Psychiatry. © 2010 Association for Child and Adolescent Mental Health.